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Knee

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Knee

injuries
- meniscus
  - patella femoral pain syndrome
    - Gastroc muscle strain
      - ACL
        MCL
  - ITB friction syndrome
PFPS
- biomechanics
  - muscle tightness/weakness
    - pain/steps, hills, uneven surfaces
      - knee valgus
        femoral internal rotation
        if neglected - patellofemoral osteoarthritis
        increased loads to PFJ
- treatment
  - relative rest, stop aggrevating activities
    - keep CV work, swimming, pain free
      - ice for pan
        quad strength for pattella tracking
        look at hips and ankles
        glute med
        footwear, pronate
        quads, hams, hip abd/add, gastroc stretching
        soft tissue reduce pattella friction
        non flexible
ITB Friction syndrome
- occurs knee flexion
  - ITB passes over Lateral epicondyle
    - some think inflammation of itb as result of friction
      - some results in bursitis
        seen athletes run down hill
        change knee angle, foot strike reduced
- features
  - pain lateral side aggrev. knee running
    - downhill/stairs
      - tenderness over lateral epicondyle of femur 1-2 cm above joint line
        repeated flexion/extension may reproduce symptoms
        obers
        hug opposite knee
  - treatments
    - rest aggrevating activitys
      - reduce inflammation - ice, nsaids, electro
        increase fexibility: massage - stretch
        increase lateral hip stabilizers
        correct predisposing factors
        heat before exercise
·
- meniscal tears
  - mechanism
    - foot anchored to ground
      - weight bearing
        twisting action
    - more common in acl deficient knees
  - features
    - small tear no immediate symptoms
      - over 24 hours pain and swelling appear
      - larger tears
        pain on joint line
        immediate reduced ROM
        intermittent locking
        pain on squatting
        clicking
        feels a tearing sensation
        joint effusion
        pain hyperflexion
        90% healling rates in peripheral meniscus
    - treatment
      - gradual rehab, control pain, swelling, ice, compression, electro
        NWB until effusion has decreased and flexion 100
        bucket handle require surgery - mri
        increase full rom and strength
        gentle rom
        increase surrounding muscle strength
        re- ed gait
        rehab on ipad
        knee brace up to 6 weeks
- ACL
  - contact/non contact
    - sudden change direction
      - twisting /cutting
        landing
        knee slight flexion, valgus, IR/ER of tibia
        contact - impact with varus force
  - features
    - often hears pop
      - sudden pain
        repetitive giving way
        swelling
        in first few hours
        haemarthrosis
        best asses time of injury prior to swelling
        painful and decreased extension
        lachmans
        anterior draw test
        feels poppin out then in
        instability
        widespread tenderness
        restricted ROM
        joint line tenderness
        if medial possible meniscus also
    - restore hyperextension
      - reduce swelling and pain
        restore flexion
        strengtheing
        quads, hams, hip ext, hip abd, calves
        NWB - CKC - PWB - FWB
        sport specific
        return to sport
      - conservative + pre opp
      - before surgery
        knee has hyperextension
        minimal/no swelling
        almost full flexion
        good control of quads
        inflammation resolved (4 weeks)
        post surgery
        restore hyperextension
        reduce swelling and pain
        restore flexion
        same as
        <
        return 6-9 months post surgery
- - MCL
    - force applied to lateral side of knee
      - valgus
      - high manouvvre, foot on floor with valgus stress
        falling valgus force
        grade 1
        localised tenderness on femoral condyle
        no swelling
        grade 2
        marked tenderness - local swelling
        valgus test produces pain
        laxity with definate end point
        grade 3
        complete tear
        feeling of instability
        present pain but not much
        ligament tenderness
        no distinct endpoint
    - features
      - feeling loose/ giving way
        instant pain medially
        knee ext/flex painful and limited
        walk impaired
        swelling of joint
        tender over insertion on medial femoral condyle/joint line
      - grade 1
        protect ligament - brace
        decrease pain/inflammation
        isometrics not done between 0-20 of flexion
        avoid stress healing
        hamstring, hip abd/add after 48 hours
        after 1 week progress to full extension and functional exercise
        grade 2
        brace in 20-60 degrees
        4-6 weeks
        ligament heal
        treat same grade one with brace
        after brace incr. ROM - heat, massage, mobes
        jogging after 6 weeks if quads strong
        Grade 3
        brace for 6 weeks
        2 weeks - 30-60
        2 weeks - 10 - 90
        2 weeks - 0 - 130
        strengthen quads, abd, hams same grade 1-2
        full quad strength must be returned before back to sport
        usually 12 weeks
  - early rehab
    - unilateral isometric control
      - after iso control able - static quads
        chopping
        flex/ext
        add/abd
        on side/ on back
      - compare billaterally, alternate
    - intermediate
      - 25/50/75 - squat, stand
        2 hand, 1 hand, no hands
        2 foot calf raise
        ""^
        squat against wall
        can add calf raises
        on bench
        stand and sit
        holding onto bench
        weight on hands
        wall squat
        25, 50, full squat
        can progress onto balance board
      - late
        knee extension with theraband
        chair sits
        can add weight
        walk on spot
        high knees
        step ups - down bench
        step ups, down, bench lateral
        progress to chair
        forward lunge
        progress to bench
        dumbells
        reverse lunge
        increase lunge distances
        multidrectional lunges
        plyometrics
        proprio
        progress with dumbells
        entire foot on bench
        step down toes first

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Description: Mind Map on Knee, created by Glen Chesterton on 09/05/2017.
Created by: Glen Chesterton
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Knee

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