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Knee Rehabilitation
Anatomy Review
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Bony Anatomy
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Lower Leg
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Upper Leg
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Tibia
Fibula
Femur
Patella
Anatomy Review
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Lower Leg Musculature
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Anterior
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Tibialis Anterior
Medial
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Tom, Dick and Harry
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Lateral
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Tibialis Posterior
Extensor Digitorum
Longus
Extensor Hallicus Longus
Peroneals
Posterior
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Gastrocnemius
Soleus
Tibialis Anterior
Anatomy Review
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Thigh Musculature
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Anterior
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Quadriceps Femoris
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Vastus Lateralis
Vastus Medialis
Vastus Intermedius
Rectus Femoris
Posterior
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Biceps Femoris
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Long Head
Short Head
Semi-tendonosis
Semi-membranosis
Gracilis
Anatomy Review
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Ligaments
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Medial Collateral
Lateral Collateral
Anterior Cruciate
Posterior Cruciate
Anatomy Review
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Cartilage
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Medial Meniscus
Lateral Meniscus
Articular Cartilage
Anatomy Review
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Joint Capsule
Anatomy Review
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Bursae
Knee Evaluation (History)
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Determining the mechanism of injury is critical
 History- Current Injury
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Past history
Mechanism- what position was your body in?
Did the knee collapse?
Did you hear or feel anything?
Could you move your knee immediately after injury or was it locked?
Did swelling occur?
Where was the pain
History - Recurrent or Chronic Injury
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What is your major complaint?
When did you first notice the condition?
Is there recurrent swelling?
Does the knee lock or catch?
Is there severe pain?
Grinding or grating?
Does it ever feel like giving way?
What does it feel like when ascending and descending stairs?
What past treatment have you undergone?
Knee Evaluation (Observation)
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Observation
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Walking, half squatting, going up and down stairs
Swelling, ecchymosis,
Leg alignment
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Genu valgum and genu varum
Hyperextension and hyperflexion
Patella alta and baja
Patella rotated inward or outward
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May cause a combination of problems
Knee Evaluation (Observation)
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Knee Symmetry or
Asymmetry
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Do the knees look
symmetrical? Is there
obvious swelling?
Atrophy?
Leg Length Discrepancy
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Anatomical or functional
Anatomical differences
can potentially cause
problems in all weight
bearing joints
Functional differences
can be caused by pelvic
rotations or malalignment of the spine
Knee Evaluation (Palpation)
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Palpation – Bony
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Medial tibial plateau
Medial femoral condyle
Adductor tubercle
Gerdy’s tubercle
Lateral tibial plateau
Lateral femoral condyle
Lateral epicondyle
Head of fibula
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Tibial tuberosity
Superior and inferior patella
borders (base and apex)
Around the periphery of the
knee relaxed, in full flexion
and extension
Knee Evaluation (Palpation)
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Palpation - Soft
Tissue
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Vastus medialis
Vastus lateralis
Vastus intermedius
Rectus femoris
Quadriceps and patellar
tendon
Sartorius
Medial patellar plica
Anterior joint capsule
Iliotibial Band
Arcuate complex
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Medial and lateral collateral
ligaments
Pes anserine
Medial/lateral joint capsule
Semitendinosus
Semimembranosus
Gastrocnemius
Popliteus
Biceps Femoris
Knee Evaluation (Special Tests)
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Active / Passive Range of Motion
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Flexion – 0o to 135o
Extension – 130o to 0o
Manual Muscle Testing
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Five Point grading system
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5 = Complete ROM against gravity, with full resistance
4 = Complete ROM against gravity, with some resistance
3 = Complete ROM against gravity, with no resistance
2 = Complete ROM, with gravity omitted
1 = Some muscle contractility with no joint motion
0 = No muscle contractility
Knee Flexion / Extension
Hip Flexion / Extension / Internal Rotation / External Rotation
Dorsiflexion / Plantar Flexion
Knee Evaluation (Special Tests)
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Joint Instability
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Medial Collateral Ligament Instability
Knee Evaluation (Special Tests)
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Joint Instability
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Lateral Collateral Ligament Instability
Knee Evaluation (Special Tests)
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Joint Instability
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Anterior Cruciate Ligament (Lachman’s Test)
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Will not force knee into painful flexion immediately after injury
Reduces hamstring involvement
At 30 degrees of flexion an attempt is made to translate the tibia anteriorly on the
femur
A positive test indicates damage to the ACL
Knee Evaluation (Special Tests)
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Joint Instability
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Anterior Cruciate Ligament (Ant. Drawer)
 Drawer test at 90 degrees of flexion
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Tibia sliding forward from under the femur is considered a positive
sign (ACL)
Should be performed w/ knee internally and externally to test
integrity of joint capsule
Knee Evaluation (Special Test)
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Other ACL Stability Tests
 Pivot Shift Test
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Used to determine anterolateral rotary instability
Position starts w/ knee extended and leg internally rotated
The thigh and knee are then flexed w/ a valgus stress applied to the
knee
Reduction of the tibial plateau (producing a clunk) is a positive sign
Jerk Test
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Reverses direction of the pivot shift
Moves from position of flexion to extension
W/out and ACL the tibia will sublux at 20 degrees of flexion
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Joint Stability Tests
 Posterior Cruciate Ligament Stability
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Posterior Sag Test (Godfrey’s test)
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Athlete is supine w/ both knees flexed to 90 degrees
Lateral observation is required to determine extent of posterior sag while
comparing bilaterally
Knee Evaluation (Special Tests)
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Other Posterior Cruciate Ligament Tests
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Posterior Drawer Test
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Knee is flexed at 90 degrees and a posterior force is
applied to determine translation posteriorly
Positive sign indicates a PCL deficient knee
Knee Evaluation (Special Tests)
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Meniscal Pathology
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McMurray’s Meniscal Test
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Used to determine displaceable meniscal tear
Leg is moved into flexion and extension while knee is internally and
externally rotated in conjunction w/ valgus and varus stressing
A positive test is found w/ clicking and popping response
Medial Meniscus Testing
Knee Evaluation (Special Tests)
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McMurray Test Continued
Lateral Meniscus Test
Knee Evaluation (Special Tests)
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Meniscal Pathology
 Apley’s Compression Test
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Hard downward pressure
is applied w/ rotation
Pain indicates a
meniscal injury
Apley’s Distraction Test
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Traction is applied w/
rotation
Pain will occur if there is
damage to the capsule
or ligaments
No pain will occur if it is
meniscal
Knee Evaluation
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Palpation of the Patella
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Must palpate around and under patella to determine points of pain
Patella Grinding, Compression and Apprehension Tests
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A series of glides and compressions are performed w/ the patella to
determine integrity of patellar cartilage
Knee Rehabilitation
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Bag of Tricks
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Range of Motion
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Neuromuscular Control
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Core Stability training
Muscular Strength, Endurance, and
Power
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Proprioceptive Neuromuscular
Facilitation
Postural Stability
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Joint Mobilization, Soft-Tissue
Mobilization
Plyometrics, Open KC, Closed KC,
Isokinetics, Aquatics
Cardiovascular Endurance
Knee Rehabilitation
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Three simple keys
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Range of Motion
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Strength
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Needed to increase motion and return to
function as quickly as prudent and possible
Needed to deter further problems or protect
the area of injury from further injury
Functionality
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Needed to return the student-athlete or
patient to normal daily activities within reason.
Knee Rehabilitation
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Range of Motion Theory’s
Passive ROM is the key to early ROM
 Active ROM starts and progresses as
treatments continue
 “Normal” Knee ROM
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Knee Flexion = 0o to 130o+
 Knee Extension = 130o+ to 0o+
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Knee Rehabilitation
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Passive Range of Motion Exercises
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Flexion Exercises
Wall Hangs (assisting device is gravity)
 Towel Slides (assisting device is arms)
 Stationary Bike (assisting device is other leg)
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Extension Exercises
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Table Hangs
Knee Rehabilitation
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Strengthening
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Closed Kinetic Chain
Used early in rehabilitation
 More stable for the knee joint
 Exercise include:
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Mini-Squats (or with Swiss ball)
Wall Slides
Lunges (as ROM permits)
Leg Press Machine
Lateral Step-ups
T.K.E (Terminal Knee Extension) with T-Band
Knee Rehabilitation
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Strengthening
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Open Kinetic Chain
Also used early in rehabilitation
 Exercise include:
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Quad Sets
Hamstring Sets
Straight Leg Raises in four directions
Hamstring Curl Machine
Leg Extension Machine
Knee Rehabilitation
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Functionality
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Agility Drills / Training
Ladder
 Dot Drills
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Plyometric Drills / Training