Download Corrective Strategies for Foot and Ankle Impairments

Chapter 13
Corrective Strategies for Knee
Impairments
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Purpose
To provide the health and fitness professional with the knowledge
and skills to effectively develop and implement corrective exercise
strategies for knee impairments.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objectives
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Understand the basic functional anatomy of the knee complex.
Understand the mechanisms for common knee injuries.
Determine the common risk factors that can lead to knee injuries.
Incorporate a systematic assessment and corrective exercise
strategy for knee impairments.
Functional
Anatomy
Knee
Injuries
Risk
Factors
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Systematic
Assessment &
Corrective
Exercise Strategy
Introduction
The knee is a region that is greatly
affected and influenced by joints above
and below it.
The structures that help form the ankle,
and hip joints also make up the knee
joint.
Over time, this will increase stress and
injury risk, ultimately leading to knee
impairments.
It is important to understand the:
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anatomy
causes
exercise strategies for prevention and
management
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Functional Anatomy: Bones and Joints
The tibia and femur make up the tibiofemoral joint, and the patella
and femur make up the patellofemoral joint.
The fibula is also noted as it is the attachment site of the biceps
femoris which crosses and affects the knee.
Femur
Tibiofemoral Joint
Fibula
Patellofemoral
Joint
Tibia
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Biceps Femoris
Functional Anatomy: Bones and Joints
(cont.)
Pelvis (Ilium)
Sacroiliac
Joint
Iliofemoral
Joint
Sacrum
Collectively, these structures
anchor the proximal myofascial
tissues.
Femur
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Functional Anatomy: Bones and Joints
(cont.)
Fibula
Collectively, these structures anchor
the distal myofascial tissues of the
knee.
Tibia
Talocrural
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Functional Anatomy: Muscles
Gastrocnemius
Soleus
Adductor Complex
Hamstrings
It is important to restore and maintain normal range of motion and strength, and eliminate
any muscle inhibition, to ensure joints are operating optimally.
TFL/IT-Band
Quadriceps
Gluteus Medius
Gluteus Maximus
Muscle imbalances may result in altered force-couple relationships which will lead to altered
joint arthrokinematics, increased stresses to the knee, and potential injury.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Knee Injuries and Associated Movement
Deficiencies
Iliotibial Band (IT-Band)
Patellar Tendinopathy
(Jumper’s Knee)
Patellofemoral Syndrome
Syndrome (Runner’s Knee)
Anterior Cruciate Ligament
(ACL) Injury
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Systematic Process to Determine Knee
Impairments
Identifying faulty movement patterns allows the health and fitness professional to
predict possible range of motion restrictions and muscle weakness.
Assessment
Static Posture
Overhead Squat
Observation
Pronation distortion syndrome (tibial and
femoral adduction and internal rotation)
Knees move inward (adduct and internally
rotate)
Knees move outward (abduct and
externally rotate)
Single-Leg Squat
Tuck Jump Assessment
Knee moves inward (adduct and internally
rotate)
Knee and thigh deficits (i.e. excessive
knee valgus on landing)
Foot placement deficits and poor landing
technique
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Varus
Valgus
Corrective Exercise Strategies for Knee
Impairments
Inhibit
Lengthen
Activate
Integrate
Inhibitory
Techniques
Lengthening
Techniques
Activation
Techniques
Integration
Techniques
Self-Myofascial
Release
Static
Stretching
Isolated
Strengthening
Integrated
Dynamic
Movement
Once muscle weakness and range of motion deficiencies have been identified,
the corrective exercise strategy can be developed utilizing NASM’s Corrective
Exercise Continuum.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Step 1. Inhibit (Knees Move Inward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move Inward
Inhibit
Self-Myofascial Release
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Hold on tender area
for 30 sec.
Lateral
Gastrocnemius
Lateral Gastrocnemius
Adductors
TFL/IT Band
Biceps Femoris (short
head)
Adductors
Biceps Femoris
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TFL/IT Band
Step 2. Lengthen (Knees Move Inward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move Inward
Lengthen
Static Stretching
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Hold stretch for 30 sec.
Lateral
Gastrocnemius
Adductors
Lateral Gastrocnemius
Adductors
TFL
Biceps Femoris (short
head)
TFL
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Biceps Femoris
Step 3. Activate (Knees Move Inward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move
Inward
Activate
Isolated Strengthening
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10-15 repetitions with 2sec. isometric hold and 4sec. eccentric contraction
Anterior
Tibialis
Posterior
Tibialis
Anterior Tibialis
Posterior Tibialis
Gluteus Medius
Gluteus Maximus
Gluteus
Medius
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Gluteus
Maximus
Step 4. Integrate (Knees Move Inward)
Phase
Modality
Exercise
Acute Variables
Integrate
Integrated Dynamic Movement
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10-15 repetitions under
control
Wall Jumps
180○ Jumps
Wall Jumps
Tuck Jumps
Long Jumps (Two Feet)
180○ Jumps
Single-Leg Hops
Cutting Maneuvers
Tuck Jumps
Single-Leg Hops
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Long Jumps
Cutting
Maneuvers
Step 1. Inhibit (Knees Move Outward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move Outward
Inhibit
Self-Myofascial Release
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Hold on tender area
for 30 sec.
Piriformis
Piriformis
TFL
Biceps Femoris
TFL
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Biceps
Femoris
Step 2. Lengthen (Knees Move Outward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move
Outward
Lengthen
Static Stretching
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Hold on tender area for 30 sec.
Piriformis
TFL
Piriformis
TFL
Biceps Femoris
Biceps Femoris
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Step 3. Activate (Knees Move Outward)
Compensation
Phase
Modality
Muscle(s) Exercise
Acute Variables
Knees Move
Outward
Activate
Isolated Strengthening
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10-15 repetitions with 2sec. isometric hold and 4sec. eccentric contraction
Adductors
Adductors
Medial Hamstrings
Gluteus Maximus
Medial
Hamstrings
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Gluteus
Maximus
Integrate (Knees Move Outward)
Phase
Modality
Exercise
Acute Variables
Integrate
Integrated Dynamic Movement
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10-15 repetitions under
control
Ball Squats with
Overhead Press
Jumping Progression
Functional Movement Progression
Ball Squats with Overhead Press
Step-Ups with Overhead Press
Lunges with Overhead Press
Single-Leg Squat with Overhead Press
Step-Ups with
Overhead Press
Lunges with
Overhead Press
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Single-Leg Squats with
Overhead Press
Summary
It is important for health and fitness
professionals to utilize an integrated
assessment process in order to gather the
appropriate information needed to develop a
specific and systematic corrective exercise
strategy.
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