Introduction to Athletic Training
Fall 2013
• The knee is a hinge joint
• What motions occur at the knee?
• Flexion
• Extension
• What do you already know about the knee?
• Femur
• Tibia
• Fibula
• Patella
• Lateral epicondyle
• Medial epicondyle
• Patellofemoral groove
• Tibial tuberosity
• What attaches here?
• Patella tendon
• Tibial plateau
• What rests here?
• Medial & lateral menisci
• Fibular head
• Anterior Cruciate Ligament
• Posterior Cruciate Ligament
• Medial Collateral Ligament
• Lateral Collateral Ligament
• ACL
• Prevent anterior translation (forward movement of tibia on femur)
• PCL
• Prevent posterior translation (backwards movement of tibia on femur)
• LCL
• Provide lateral stability
• MCL
• Provide medial stability
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Medial femoral epicondyle
Lateral femoral epicondyle
Patella
Tibial tuberosity
Tibial plateau
Tibia
Fibula
Fibular Head
Lateral Collateral Ligament
Medial Collateral Ligament
• Quadriceps
• Rectus femoris
• Vastus medialis
• Vastus lateralis
• Vastus intermedius
• Cause what action?
• Extension
• Hamstrings
• Biceps femorus
• Semimembranosis
• Semitendinosis
• Cause what action?
• Knee flexion
• Calf Muscles = Gastroc-soleus Complex
• Gastrocnemius
• Soleus
• Cause what action?
• Gastroc. helps with
knee flexion
• Patella tendon
• Quadriceps tendon
• Quadriceps
• Rectus femoris
• Vastus medialis
• Vastus lateralis
• Hamstrings
• Biceps femoris & tendon
• Semimembranosus
• Semitendinosus
• Gastrocnemius tendons
• Gastrocnemius
• Knee flexion
• ~135 degrees
• Knee extension
• 0-10 degrees
• Measuring ROM
• Fulcrum – lateral epicondyle of femur
• Stationary arm – midline of fibula
• Moving arm – midline of femur
• Leandro Barbosa (basketball)
http://www.youtube.com/watch?v=klZwj_EJVN4
• Victoria Azarenka
http://www.youtube.com/watch?v=dsIj73UTfK8
• Sara Tucholsky
http://www.youtube.com/watch?v=jocw-oD2pgo
• Jamaal Charles
http://www.youtube.com/watch?v=QrvHzaDxBug
• What stabilizes the knee?
• Menisci, ligaments, tendons, muscles
• What can we do to make the knee more stable?
• Strengthen surrounding musculature (hamstrings, quads)
• Excess weight
• “For every pound of weight lost, there is a four pound reduction in knee joint
stress.”
• Biomechanical problems
• Leg length discrepancy, patellar tracking, angle of hips/knees
• Lack (or imbalance!!) of muscular strength or flexibility
• Certain sports
• Example: female soccer and basketball players predisposed to ACL injury
• Previous injury
• PEP Program
• Designed by the Santa Monica Sports Medicine Research Foundation
• 5 Sections
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Warm Up
Strengthening
Plyometrics
Agilities
Stretching
• Patellofemoral Syndrome (Chondromalacia)
• S/S
• Achiness around patella
• Increases with prolonged sitting
• Grinding with flexion and extension
• Treatment/prevention
• Strengthen quadriceps (especially vastus medialis)
• Quad./hamstring flexibility
• Patellar Dislocation
• of Injury
• Patella is forced laterally
• Occurs when knee is bent and forced into internal rotation.
Soccer patella dislocation:
http://www.youtube.com/watch?v=6-JNFiXkXfc
• Signs/symptoms
• Deformity
• Pain
• Should AT’s reduce a patellar dislocation?
• NO!!!
• Refer to physician
• Rehabilitation
• Brace for support
• Restore ROM
• Improve strength
• Patellar Tendinitis
• Chronic
• Predisposing factors
• Running
• Jumping
• Signs/symptoms?
• 3 Stages
• 1: Pain after activity
• 2: Pain during & after activity
• 3: Pain during & after for a
prolonged amount of time.
• Rehab/Prevention?
• Rest/Avoid aggravating activities
• Chopat strap
• Strengthening leg muscles
• Stretching leg muscles
• If untreated, can lead to?
• Patella tendon rupture (tear)
• Osgood – Schlatter Disorder
• Repeated avulsion fractures at the tibial tuberosity.
• More common in young athletes
• Peaks around 16 – 17 years old
• Predisposing factors?
• Running
• Jumping
• Treatment?
• Anterior Cruciate Ligament
• ACL prevents what?
• Anterior translation of tibia against femur
• Mechanism of Injury
• Quick change of direction
• Twisting motion at the lower leg
• Hyperextension
• Signs and Symptoms of ACL Tear
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A small pop can be heard or felt
Limited ROM due to swelling, pain
Swelling
Instability
Pain in back of knee
• Immediate Treatment?
• PRICES
• Long Term Treatment?
• Surgery (3 Graft types – patella tendon, hamstring, cadaver)
• Post – Op rehabilitation for ~6 months
• Posterior Cruciate Ligament
• Prevents?
• Posterior translation of tibia against femur
• Mechanism of Injury
• Falls and lands on bent knee
• Forced hyperflexion
• Blow to front of tibia
• PCL
• Signs/symptoms
• Pop may or may not be heard
• Mild swelling
• Initial Treatment?
• PRICES
• Long term treatment?
• Surgery not required depending on individual
• Rehabilitation
• Strengthening of quadriceps
• How does a PCL tear differ from an ACL tear?
• Medial Collateral Ligament
• Mechanism of Injury
• Valgus stress
• S/S
• Grades
• 1 – 3 (mild  severe)
• Treatment/Rehab
• PRICES
• Mild – elastic wrap for compression/support
• Moderate/Severe – immobilizer
• Strengthen which muscles?
• Hip adductor muscles
• Lateral Collateral Ligament
• Mechanism of Injury
• Varus force
• Blow from the medial side
• S/S
• Grades 1 – 3 (mild  severe)
• Treatment/Rehab
• Surgery required to repair
• Similar to MCL injury
• EXCEPT…
• Strengthen the hip abductors instead
• Function of menisci
• Shock absorption
• Stability
• M.O.I.
• Twisting movement
• Hyperflexion/hyperextension
• S/S
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Pain the joint line
Weight bearing
Catching and locking
Loss of motion (both flexion & extension)
• Treatment/Rehabilitation
• Need for surgery depends on what?
• Severity of tear
• Rehabilitation depends on type of surgery…
• Menisectomy (removal of tear)
• 4 – 6 weeks until athlete may return to play
• Meniscus repair (stitch the tear and anchor to joint capsule)
• 3 – 6 months until athlete may return to play
You are covering a girls’ soccer game. During a transition in
game play one of the players goes down and does not get back
up. When you get over to her, she is in considerable pain. She
says she felt a pop “inside” her knee when she changed directions.
She has some loss of motion and swelling on either side of her
patella. After you help her up to move off the field she is hesitant
to put weight on it because it’s painful and feels like it’s going to
give out again.
ACL Tear
• A middle school basketball player enters the athletic training
room complaining of pain in the anterior part of his right knee
along his patellar tendon. He used to just have pain after he
finished practices and games, but is starting to have pain during
AND after activity. It has been bothering him for about a
month. There is some thickening of the patellar tendon and it is
painful to palpate.
Patellar tendinitis
• A tennis player enters the athletic training room with knee pain.
She says that during a match yesterday she planted her foot
and pivoted, trying to make a play. She doesn’t remember
feeling or hearing any pops, but has been having a significant
amount of pain in her knee that hasn’t gotten any better. She
says that her pain increases when she goes up or down the
stairs. She’s also starting to notice that her knee feels like it’s
catching or locking when she flexes and extends it. Upon
palpation you notice that most of her pain is located along the
tibial plateau (or joint line).
Meniscus tear