knee rehab

[Doc.Sust]

Knee Rehabilitation


A successful, appropriate exercise program for the knee does not require expensive, joint-specific equipment, additional personnel, more office space or extra time. While isokinetic machines are valuable for research, current rehab concepts do not consider such equipment necessary. The low-tech approach can be quite effective for the treatment of most knee conditions. With an understanding of normal knee function, knowledge of the involved muscles, and simple, at-home exercise equipment, doctors of chiropractic can readily help their patients with knee complaints. What follows are the important rehab components, along with specific recommendations for several common knee problems.

Effective Programs for Specific Conditions



Stretching and passive motion. Muscle imbalance inhibits normal joint function and limits functional range of motion. In some knee conditions, improving the flexibility of shortened and tight muscles is necessary. Slow, sustained stretching, performed regularly and frequently, is effective, and can usually be started immediately, even in the early stages following an injury. Gentle, passive movement of the joint also should be initiated soon after an injury to prevent the formation of adhesions, which make future rehab more difficult. If an injury is unusually acute (with joint effusion), an initial period of relative rest with cryotherapy is appropriate.



During this period, however, exercise of the opposite leg should be encouraged. Vigorous exercise of the uninvolved contralateral leg muscles produces a neurological stimulus in the injured muscles (called the "crossover effect"), and helps prevent atrophy.

Three knee conditions, in particular, benefit from specific stretching. Iliotibial band syndrome is an overuse condition that causes pain along the lateral aspect of the knee. Ober's test is positive for a shortened iliotibial band and indicates the need for lengthening of this long segment of connective tissue. Jumper's knee (or patellar tendinitis) and Osgood-Schlatter's disease are caused by repetitive excessive tension on the patellar tendon below the kneecap. When the tendon is attached to the still-open growth center at the tibial tuberosity, adolescents develop the characteristic swelling and bony disruption. Both conditions benefit from gentle, progressive stretching of the quadriceps muscle group and temporary avoidance of jumping and sprinting activities.

Isotonic resistance (open and closed chain). Weak or injured muscles can be strengthened rapidly with the use of isotonic resistance exercises. The resistance can come from a machine; weights; surgical-grade rubber tubing; or using the weight of the body. More important than the equipment used is whether the knee joint is exercised in an open- or closed-chain position. The knee is part of a closed kinetic chain when the foot is fixed (usually on the ground). The knee and leg are utilized in this fashion during most daily and sports activities, and require the co-contraction of accessory and stabilizing muscles. An open-chain exercise is done with the foot and lower leg moving freely. Both approaches to resistance exercise are useful, but one may be more appropriate for a certain knee problem than the other.



Open-chain exercising can be initiated early with a symptomatic knee, as it doesn't require the musculoskeletal structures to bear the weight of the body. Initial exercising should be done with a limited amount of movement - from 30°( to full extension (called "terminal extension" exercises). These exercises are particularly useful for patients who have patellofemoral tracking problems, with symptoms traditionally described as chondromalacia patellae. Meniscal tears also are more safely exercised when the damaged cartilage is not bearing weight directly. As the patient progresses, additional resistance can be supplied safely with at-home equipment incorporating surgical-grade rubber tubing.(these bands can be purchased at gill athletics vis the internet)



Closed-chain strengthening, with the foot on the floor, is considered a functional form of exercise. However, when ligaments have been damaged and there is joint translation and slipping, much caution must be taken initially. Injuries to the anterior cruciate or medial collateral ligaments respond well to resistance exercises that control knee joint alignment, by fixing the foot to the floor. Examples include partial squats ,lunges and step-ups, or stairclimbing. Resistance can be increased progressively and gradually with the use of hand weights or a weight bar. The leg-press machine is another closed-chain exercise device available at many gyms; however, this machine does not retrain the co-contraction of accessory support muscles as fully as do weight-bearing exercises.

Eccentric exercise. When the injured tissue is a tendon, the eccentric portion of resistance exercising has been found to be particularly useful. This entails focusing on the lengthening or "negative" part of a strength exercise (the "letting down" of the weight or tubing). For the knee, this is performed most easily by descending a stair or stepping off a box. The contraction of the quadriceps muscles as they lengthen is particularly useful in strengthening the tendons involved in knee-extensor disorders, such as patellar tendinitis and patellar tracking problems. This movement also contracts other muscles, which must assist in the complex movements required of the knee. Specifically, the patient steps down onto the uninvolved leg, while controlling the movement with the quadriceps of the problem knee. The patient then returns by pushing back up with the uninvolved leg. Three sets of 10 step-downs are helpful when performed at least once a day.



Proprioception and coordination. For many athletes (recreational or competitive), it is important to regain the fine neurological control necessary for accurate knee and lower-extremity movements. Approximately five to 10 minutes each day should be spent standing on one leg on a mini-trampoline, or using a specialized rocker board, with the eyes closed. The advantage of these balance exercises is seen when a patient returns to sports activities and can perform at high levels without consciously having to protect the knee. Rocker-board exercises are particularly necessary after ligament, meniscus, and muscle injuries, but also can help patients with chronic knee problems regain full function. Research has shown that custom-made orthotic support also can help improve balance and proprioception.

Plyometric exercise. To re-establish the rapid responses necessary for ideal performance in many sports, advanced exercises designed to develop explosive power are necessary. Plyometric exercises include jumping with rapid returns, "bounding" style of running, or dropping off a box and quickly jumping up as high as possible. These types of exercises are useful during the final phase of rehab for all athletes who hope to return to full function after any type of knee problem. Sedentary patients, and those who do not need to develop this level of specialized contractions, generally do not need to progress to this specialized type of knee rehab.

Functional alignment. Many chronic and overuse knee problems develop secondary to imbalances in weight-bearing alignment of the lower extremities. These imbalances need to be addressed to resolve the patient's current symptoms and prevent future knee problems. In fact, measuring the Q-angle often demonstrates that patients with patellofemoral problems have underlying lower-extremity misalignments. Leg-length discrepancies and pronation problems frequently are associated with iliotibial band syndrome, patellar tracking problems, and chronic, degenerative knee complaints. Even anterior cruciate ligament ruptures have been found to be more common in athletes who have excessive pronation. The use of custom-made orthotics or heel lifts is often a necessary part of a comprehensive knee rehab program.



Shock absorption. For patients who already show evidence of degenerative changes to the joint surfaces, providing additional dispersion of ground reaction forces is necessary. Even healthy young athletes who expose their knees to frequent pounding (runners, basketball players, etc.) should be supplied with shock-absorbing insoles to decrease the stress transmitted from their feet to their knee joints. Many recreational athletes can avoid developing knee problems if they are fitted with custom-made orthotics that support the feet and ankles, and limit the forces on the knee joints. Shock-absorbing orthotics provide almost immediate symptom relief for patients with chronic, degenerative knee symptoms.8

Early Detection and Care

Instituting an appropriate and progressive rehab program is key to managing patients with knee complaints.9 Several rehab techniques are available, none of which require expensive equipment or excessive time commitments. Selecting the best exercise approach for each patient's knee problem is important. A closely monitored home exercise program allows the doctor of chiropractic or physical therapist to provide cost-efficient, effective rehabilitative care.

Perhaps most critical in the long term is addressing any biomechanical alignment problems associated with knee complaints. This entails screening the patient for excessive pronation and leg-length discrepancies. Failure to recognize these complicating factors can result in a patient with recurring knee complaints, or possibly symptoms that vary in location. In other words, once an area is treated and strengthened, another will begin to show the effects of the underlying biomechanical stress. Once the lower extremities are aligned properly, the muscles strengthened and lengthened, and the two joints of the knee work smoothly, patients can enjoy the benefits of functional knee joints well into their elder years.

thank you to fellow chiro Dr. K Christenesen for her valubale info and help

[S431M7]

interesting info.

Knee Rehabilitation


Early Detection and Care

Instituting an appropriate and progressive rehab program is key to managing patients with knee complaints.9 Several rehab techniques are available, none of which require expensive equipment or excessive time commitments. Selecting the best exercise approach for each patient's knee problem is important. A closely monitored home exercise program allows the doctor of chiropractic or physical therapist to provide cost-efficient, effective rehabilitative care.

Perhaps most critical in the long term is addressing any biomechanical alignment problems associated with knee complaints. This entails screening the patient for excessive pronation and leg-length discrepancies. Failure to recognize these complicating factors can result in a patient with recurring knee complaints, or possibly symptoms that vary in location. In other words, once an area is treated and strengthened, another will begin to show the effects of the underlying biomechanical stress. Once the lower extremities are aligned properly, the muscles strengthened and lengthened, and the two joints of the knee work smoothly, patients can enjoy the benefits of functional knee joints well into their elder years.

thank you to fellow chiro Dr. K Christenesen for her valubale info and help

[Doc.Sust]

interesting info.

glad it could help you

[green22]

great info!!!!!!thanks

[Doc.Sust]

^^no problem

[Oucheeeeee]

Wow Doc, I just read more in that post than I have had questions answered with visits with probably 10 different orthopeadic surgeons over the past 34 years (my knees went rogue at 16 - I'm near 50 now).

I've had over 20 knee ops and, after a failed Autologous condrocyte implant eight years ago, no-one told me to excercise my right leg when my left was imobile for 8 weeks.

Anyhow, here's the question, and I appreciate anything comes without warrenty and actual mileage may vary........

I had bi lateral scope of both knees 4 weeks ago and have been told I have grade 4 arthritis on weightbearing section of both femurs. Surgeon won't consider replacement joints as the rest of my knees are in really good shape. He mentioned building up the vastus medialis as that would help stability and aid weight bearing.

As I can't do the heavy weights I used to do 20 years ago, would a course of aas do me any favours if I concentrated on my Quads only? I'm struggling to do enough (on my left leg) to feel a burn. The joint screams way before the muscle does. On my right leg, I can lift more, hold it for longer and get a burn.

I really need some help getting this muscle firing again, but am scared that if I do aas, it would add muscle and hence weight to all my body EXCEPT where I need it. Is there any way (legal or no) to actually target a specific muscle or muscle group. (My very ill-thought out plan was to get some testosterone , jab for 6 weeks, and during that time, work ONLY that muscle ;-) - I know - basic at best and possibly dangerous. I had just purchased some Test Enan and was about to take my first ever jab and head straight down the gym until I found this website and, after a couple of basic posts/pointers, found my way here. After reading much of the info, I'm putting the test in the top drawer whilst I work out exactly whether it will help or not.

What would you do with a game knee that has to have quads rebuilt?

Thx,

Oucheeeeee

[stevey_6t9]

Have you ever contemplated on seeing a sports doc. that might prescribe you some low dose test or deca to help with your injury?

[weak_link]

^^no problem

Nice article...I have a question..I had left knee pain for a year and took 12 advils a day to ignore it...obviously it became worse and untolerable...I went to PT for a couple of months but nothing seemed to work...I got a MRI and it showed no arthritus but some fluid in the knee and some very mild degenerative scarring which the doctor said was normal for a guy of my age. It should'nt of caused all this pain...anyway, I had a debrement around the back of my knee cap and my quad tendon...nothing major...its been six months and its almost worse than before surgery...my left leg has atrophied a ton...suppossedly I have developed a bad case of patellor tendonitiscaused by the imbalance of strength between my IT band and my VMO...the problem is I cannot train my Quad properly to gain strength because it irritates the tendonitis massively...but the only "cure" is to strengthen my quad so my knee cap won't grind into my PT...my question is ..has anyone here gone through this and made it out with completet pain free knee use again? Secondly, would it help if I did some VAR to speed up the strengthening of my quad muscles?

[bbminded]

You story sounds close to mine. Because of my job i beat the crap out of my kness esp the left one because i had to use it more because of the nature of my work(truck/delivery driver). I already had pain in my back but it was just bareable enough to get through my workouts.
Well one day i went in the gym(leg day actually)and i started on leg extensions first to get warmed up. Well i think i probably did more then warm them up considering i was doing the whole stack of weights for three sets.
So then i go over to get ready to squat. I started light and things seemed fine. Added little more weight(think225lbs) and as soon as my thighs hit parallel my left knee just gave out. It wasnt a type of pain you could work through like my back or some thing.
It just completely gave out. And it continued after that outside the gym as well. Getting up from the couch or trying to sit and get up from the bathroom again my knee just gave out.they did an mri and didnt see anything serious other then some water build up!
it didnt hurt real bad when i was just relaxing or when i was walking sometimes it throbbed a little but nothing even close to what happens when my left thigh reached parellel to the ground no matter what i was doing.
Everything went downhill after that. I got on hard meds, stopped working out because it depressed me that much, plus i was still doing the same job and just reinjuring it everyday!
Ive been outta work now since feb and back in school. no job yet. But starting back to the gym this coming monday. I havent had any recent episodes in a while with the knee doing day to day stuff. I got that supp from usp labs called cissus because of all the good ive heard about it. i guess ill find out this next week where im at. Hopefully its gotten better with the rest and i now know better to NOT warm up with heavy heavy leg extensions!!!

Nice article...I have a question..I had left knee pain for a year and took 12 advils a day to ignore it...obviously it became worse and untolerable...I went to PT for a couple of months but nothing seemed to work...I got a MRI and it showed no arthritus but some fluid in the knee and some very mild degenerative scarring which the doctor said was normal for a guy of my age. It should'nt of caused all this pain...anyway, I had a debrement around the back of my knee cap and my quad tendon...nothing major...its been six months and its almost worse than before surgery...my left leg has atrophied a ton...suppossedly I have developed a bad case of patellor tendonitiscaused by the imbalance of strength between my IT band and my VMO...the problem is I cannot train my Quad properly to gain strength because it irritates the tendonitis massively...but the only "cure" is to strengthen my quad so my knee cap won't grind into my PT...my question is ..has anyone here gone through this and made it out with completet pain free knee use again? Secondly, would it help if I did some VAR to speed up the strengthening of my quad muscles?

[RobbieC]

I have knee problems and Ive been to seven different doctors so far. First it took 3 just to find out where the problem was located. Now I know, but still havent got a clear diagnosis. Ok, anyway. I have had physio and also useless. Seriously, if you wanna improve things you have to be pro-active, exercise daily and adjust them depending to your condition. You dont need all the crazy stuff around it. And dont trust doctors, if it doesnt feel right, they probably dont kno wwhat they are talking about. At least that was my experience.

[dj erk15]

Great thread and great info.

[KennyBoy]

Great info! However I have mild CP. I am 41 and have never known a day without some pain in any of my joints. I have osteoarthritis and waiting for an MRI to confirm or rule out torn ACL and MCL in my right knee do to a recent accident. I had the knee repaired in high school after dislocating it. One of the problems I have is underdeveloped VMO's in both legs and am prone to dislocating my kneecaps almost at will. What can I do to strengthen my knees altogether esp my VMOs. I've begun to really investigate GH and its benefits for those with CP, but I also know that I need to train correctly in order to stave off any further injuries. Any advice would be greatly appreciated. thank you.

[KennyBoy]

Is there another forum that might offer the advice I'm looking for??

[KennyBoy]

Thanks for taking the time to read, much success!

[poweranger]

Thanks for taking the time to read, much success!

Did you find any info in regards to this topic? I am currently scheduled to get a scope done next week and wanted to know the same info?

[Times Roman]

I had my right knee scoped last march. should have had it done years ago. now I want my left one done.

then there is also....

HA Knee injections
MSM

[KennyBoy]

No, not yet.

[KennyBoy]

[QUOTE=poweranger;6389701]Did you find any info in regards to this topic? I am currently scheduled to get a scope done next week and wanted to know the same info?[/QUOTE

[KennyBoy]

[QUOTE=poweranger;6389701]Did you find any info in regards to this topic? I am currently scheduled to get a scope done next week and wanted to know the same info?[/

[TeresaDavis]

really informative piece of article i will definitely try it on my mother whos been suffering from sheer pain after a knee injury..

[tigerspawn]

Thanks for the informative thread DOC. Over year ago I had 400+ pt. that was being assisted by 2 CNAs fall on my right leg. My ACL, MCL, and LCL were all torn. My cartilage was sheared with a 55% loss. I had surgery and 4 months of physical therapy. Even after therapy my range of motion was at around 55 degrees. My knee would give out on me just walking through Wal-Mart. Workers comp doctor said I was as good as I was ever going to get. They said that I was permanently disabled and should be considered the same as someone who lost their leg from knee down. Thanks to my own research and lots of hard work my knee is stable; it doesn’t give out any more. My range of motion is around 110 degrees. This has allowed me to do squats and dead lifts as long as I use wraps. My ability to run is still impaired. However, I am able to do most other cardio. I won’t allow myself to be stopped.

[brianfantana]

Still recovering from a ruptured tendon in my knee, cross trainer all the way... ROM good but feels like it's going to go all the time. Good post.

[Perkfit]

Great read and thank you. I think the most important and most commonly ignored part if this post is early detection and care. It's easy to try and push trough the pain rather than rest and or have it looked at and fix, but from experience if you jump on it early it can save a lot of headaches later.

[Wallstreetbully]

4 knee surgeries myself. All on the same knee at that. Take this shit seriously!

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