Chapter 21
Chapter 21
Chapter 21
The Knee
Anterior Posterior
Rectus femoris Biceps femoris
Vastus lateralis Semitendinosus
Vastus intermedius Semimembranosus
Vastus medialis
Medially Laterally
Gracilis TFL/ITB (affected by
Adductor longus, brevis, gluteus maximus, etc.)
magnus
Genu Valgum
– Femur descends obliquely in a medial direction (normal 5–10
degrees).
– Greater load on lateral compartment.
– Associated with coxa varum at hip.
Genu Varum
– Angulation of femur and tibia is 0 or laterally orientated.
– Increases load on medial compartment.
– Associated with coxa valgum.
Treatment
Postural retraining of lower extremity and
lumbopelvic region
Co-contraction of lower extremities (high reps-low
resistance)
Neurologic Causes:
Lumbar spine injury or disease
MS
Parkinson’s disease
Treatment:
Bleeding control followed by progressive
mobility and strengthening.
Plyometrics if within patient’s functional
abilities and goals.
Occurs primarily at
quadriceps.
Treatment:
Strengthening activities for
the quadriceps.
Focus on primary cause of
disuse.
Treatment:
Avoid resisted open chain (OC) exercises.
Closed chain (CC) exercises including deceleration, cutting
maneuvers, lateral movements, resisted rotational movements,
and activities on unstable surfaces.
Treatment:
Avoid open chain exercises.
Closed chain exercises are used.
LCL
Much less common than MCL injuries.
Commonly results from hyperextension varus stress.
Treatment:
Loading must occur in frontal and transverse planes.
Acute
Aquatics is excellent
for:
Mobility, gait, initiating
balance, walking,
physiologic stretching, leg
kicks, toe raises, single
leg balance, and squats.
Continuation training
and progressing to
non-device-assisted
exercises.
Land-based CC
exercises.
Resisted OC
exercises.
Functional specific
drills.
1. Patellar fracture
2. Distal femur fracture
3. Tibial plateau fracture
4. Treatment
Surgically fixated – AROM/PROM exercises for flexion
and extension.
Quadriceps and hamstring setting exercises.
Weight-bearing CC exercises – Based on healing and
NM control.
Treatment:
Weight-bearing through large ROM should be
avoided.
Partial weight-bearing as tolerated is permitted.
Progression is dictated by procedure.
Treatment:
Postural education
Exercises for underlying impairments
(e.g., hip rotator weakness)
Stretching of hip and knee
musculature
Overuse.
Poor tracking of patella (shape of osseus
surfaces or muscle imbalance).
Q-angle greater in those with PFPS (excessive
pronation of foot?)
Greater degree of lateral patellar tilt.
Muscle imbalance (VMO:VL).