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Knee Injuries
mvpboxing |  May 04, 2017, 12:05PM
IT band friction syndrome
  1. Definition and Occurrence
    1. The IT Band is a fibrotendinous band that extends off the tensor fascia latae muscle along the outside of the leg and inserts on the outside of the distal knee joint. It functions as both a knee flexor and extensor. As it nears its insertion on the tibia, it crosses over a bony prominence on the femur. During activities that require repetitive flexing and extending of the knee, especially those that extend the knee towards end range, the band is subject to significant frictional forces. This can lead to inflammation and pain of the band and its surrounding structures.
    2. One of the most common running and cycling injuries
  2. Signs and Symptoms
    1. Pain during flexion and extension of the knee, especially between 0 and 30 degrees and during stairs
    2. Pain can sometimes be accompanied by popping or snapping with range of motion
    3. Swelling around where the band inserts onto the first part of the tibia bone
    4. Tightness when palpating the band. The band can often be displaced anteriorly, impeding its optimal function
  3. Treatment
    1. Rest, Ice, and NSAIDS for inflammation control
    2. IT Band and quadriceps stretching
    3. Hip abductor and extensor strengthening
    4. Balance and proprioceptive training to keep hips, knees, and feet in proper alignment
    5. Training re-organization
      1. Ease back into running on a gradual incline to avoid friction on the IT band
      2. Start gradual and work up to full mileage
    6. Footwear analysis to avoid over-pronation, which can increase frictional forces up the kinetic chain to the IT band
  4. Prehab (Prevention)
    1. Hip strengthening
    2. Appropriate training progression
    3. Avoid running on slanted surfaces and excessive downhill running
    4. Adjust seat on bicycle so excessive knee extension isn’t present
ACL Injury
  1. Definition and Occurrence
    1. The Anterior Cruciate Ligament gives a vital component of stability to the knee joint, helping to prevent anterior motion of the tibia on the femur during dynamic activities. It is most commonly torn while landing from a jump or performing a cutting maneuver. It is the most commonly torn ligament of those located within the knee joint.
  2. Signs and Symptoms
    1. Giving way of the knee joint during activity
    2. A subjective feeling of instability of the knee
    3. Increased forward movement of the tibia bone when the femur is stabilized
    4. Pain and swelling around the knee joint
  3. Treatment
    1. Surgical treatment is indicated, especially in the athletic population, to restore proper joint motion and stability.
      1. A patellar tendon or hamstring graft is often used to replace the torn ligament.
      2. Sometimes, strengthening is indicated prior to surgery to help improve and
    2. Post-surgically, physical therapy is initiated to restore range of motion and strength
      1. Joint will be protected in dynamic brace
      2. ROM restored first
      3. Vital to restore hamstrings strength since this group of muscles must become an important stabilizer of anterior tibial motion.
      4. Proprioceptive muscle re-education for dynamic stability: Balance training activities
      5. Sport specific training
  4. Prehab (prevention)
    1. Prehab is especially important in the female athletic population, as they been shown to have a four to eight times higher incidence of ACL rupture.
      1. Plyometrics: Very important to practice good landing mechanics and lower extremity alignment during drills
      2. Hamstring and quadriceps strengthening
      3. Balance exercises
MCL injury
  1. Definition and Occurrence
    1. The medial collateral ligament runs along the inside part of the knee joint towards the middle of the body. It assists in providing stability to the knee joint by preventing the knee from buckling inwards. It is most commonly injured during contact sports with a blow to the outside of the knee. Since it is attached to the medial meniscus, this and the ACL can often be injured simultaneously. These three injuries comprise the “unhappy triad”.
  2. Signs and Symptoms
    1. Pain, Stiffness, Swelling, and tenderness to the touch along the inside of the knee joint
    2. Instability of the knee joint, especially with force applied to the outer aspect of the joint. This sign is usually not present with less severe MCL injuries
  3. Treatment
    1. Rest, Ice, Elevation initially
    2. Physician may recommend a brace that limits knee motion in our out but encourages bending and straightening
    3. The time required before initiating knee rehabilitation will depend on the size and severity of the initial tear of the MCL
    4. Rehabilitation will focus on restoring dynamic stability to the knee joint
      1. Strengthening
      2. Balance exercises
      3. Plyometrics
      4. Sport Specific training
  4. Prehab (prevention)
    1. Balance and proprioceptive exercises
    2. Plyometrics
Patellofemoral Pain Syndrome
  1. Definition and Occurrence
    1. The patellofemoral joint is subject to a lot of stress during repetitive activities that involved knee motion such as running and cycling. As the knee bends and straightens, the patellofemoral joint glides up and down along the femur bone. In the presence of muscle imbalances or altered joint mechanics, the patella can track abnormally, causing pain and premature joint wear.
    2. There can be many causes of the improper patellar tracking. Muscle imbalances in the hip and knee muscles are the most common, but altered joint motion at the ankle joint with landing can contribute to patellofemoral pain.
  2. Signs and Symptoms
    1. Aching or pain under the kneecap, especially with going up and down stairs or after sitting for long periods of time
    2. Audible creaking sensation when bending and straightening knee
    3. Should the tracking problem become worse, the kneecap can dislocate from its groove in the femur
  3. Treatment
    1. Treatment will vary based on the primary causes of the condition
    2. Rest, Ice, and possible taping or bracing
    3. Stretching of lateral knee structures that may be pulling on knee cap
    4. Selective strengthening of quadriceps and hip muscles
    5. Neuromuscular re-education of quadriceps muscle
    6. Correction of any improper foot biomechanics
    7. Hamstring stretching and strengthening
    8. Balance and Prioprioceptive exercises
  4. Prehab (prevention)
    1. Proper training progression
    2. Avoid running on uneven surfaces
    3. Hamstring stretching and quadriceps strengthening
    4. Proper squat form
Meniscus injury
  1. Definition and Occurrence
    1. There are two menisci in each knee that help serve as shock absorbers to impact between the shin and the thigh bone. Without them, the articular cartilage would easily wear out due to the large compressive forces taken at the joint. The menisci are most often injured in the younger population during forceful twisting maneuvers with outside force applied at the knee joint. In the older population, the menisci can easily become injured duing less forceful movements. The medial or inside meniscus is most often injured because of its attachment to the medial collateral ligament.
  2. Signs and Symptoms
    1. Pain, either localized or diffuse
    2. Swelling
    3. Locking or popping with bending/straightening of the knee joint
  3. Treatment
    1. Depending on the severity of the injury and the functional needs of the athlete, the tear can be non-operatively rehabilitated or surgically repaired
    2. Non- surgical treatment will consist of:
      1. Rest, Ice, and Pain management
      2. Regaining knee strength and stability to promote normal knee alignment with exercise and sports
    3. Post surgical rehab
      1. This will depend of if the damaged meniscus is reparired or if it is removed. If it is repaired, strict weight bearing restrictions must be observed to obtain proper healing. With removal, weight bearing exercises can begin much sooner.
  4. Prehab (prevention)
    1. Knee strengthening and stability training
    2. Prioprioceptive exercises
    3. Balance training

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