Techniques to Rehabilitate and Protect the Knees

By Brian Richey

Corrective Exercises V/s Medical Exercises

Responsible for Stability of Knee

  • ACL – 82-88%
  • Miniscus – 2-4%
  • MCL – 4-8%
  • LCL – 1-2%

Goals for ACL

  • Recruit the Vastus Medialis Obliquus (VMO)
  • Strengthen Hamstrings
  • No open chain Terminal Knee Extension (TKE) – Exercise for ACL is leg extension machine but don’t go the last 30%

Goals for Miniscus Tear

  • No/Limit Impact
  • Recruit VMO
  • Be Careful with hamstring strengthening

*Knee replacement can be done only twice and each lasts about 10-20 years (10yrs if active)

Patello-Femoral Syndrome

  • Always lurking after knee injury
  • AKA Chondromalacia
  • “Noisy Knee” (No its not OK) – Find a noise free range of motion
  • Often see swelling, pain, VMO shut down
  • Tight IT Bank (To roll or not to roll?) – IT MUST be tight, roll it but not too much

What is Quad Dominance?

  • Quadriceps dominance relates to an imbalance between knee extensor and flexor strength, recruitment and coordination
  • Need proper “co-contraction” – quads & hamstrings contraction keeps the Tibia in HAPPY balance

Weakness of the Gluteus Medius

  • Internal rotation of femur
  • Knee tracking and alignment is altered
  • Primary knee “stabilizer”

*While doing a single leg squat if the knee or femur rotates inward there is an issue, whereas if it stays straight you are fine.
*Joints want to be stable, Muscles want to be mobile

Before you start

  • Control swelling (MD or PT)
  • Activate VMO

Goals for Knee Rehab

  • Assess the Situation (Medical Condition or Imbalances)
  • Activate / Recruit the VMO
  • Activate / Recruit Glute Maximus/Hamstring
  • Activate / Recruit Glute Medius

Types of exercises used to activate muscles: Isometrics; Concentric and Eccentric; Dynamic; Physiology overload

  1. Contraindications
  2. Rehab Goals
  3. Assessment Techniques
  4. Exercises

Assessment

  • Thomas Test: Supine position on the edge of table, hold one knee to the chest, leave the other leg suspended, if the other knee does not go back to the level of the table, TIGHT HIP FLEXOR; if suspended knee is not at bent 90% then TIGHT QUADRICEP, if the knee rotated outwards TIGHT IT BAND.
  • Squat Test: While going into a squat if your knees are internally rotated
  • Trendelenburg Test: When you stand on one feet with the other knee bent, if the entire body weight shift on the standing leg you are fully reliant on the IT band

Contraindications (what not to do)

  • ACL – NO Open Chain Terminal Knee Extensions
  • Meniscus – Avoid High Impact (No Plyometrics)
  • Patello Femoral Syndrome – Stay away from painful ROM

Exercises:

  1. VMO Activation: Place one leg on table with knees locked, feel the VMO, press your fingers hard on that curvature, try to push back using your VMO muscles, it is fired up, do it 2-3 times a day for a week
  2. Quad Sets: place foam roller below your knee, heels on the surface, knees locked & activate your quads it actually fires up your quads, hamstring & glutes
  3. Straight Leg Raise: Supine position with one knee bent, lock the other knee, pull the toe up toward your shin, slowly raise the leg, activates & fires your quad, try doing without the toes pulled up
  4. Open Chain TKE/ Short Arc Quads: (NOT for ACL) Supine position, roller below the knees , pull toes up of one leg & raise your heel, tap on your VMO, its all fired up
  5. Side SLR (side lying leg raise): For Glute medius activation, lie down sideways with back against the wall, raise one knee to your chest. If you roll your hip against the wall and lift the heel with knees locked & toes pulled up, you are using the hip flexor or the TFL (tensor fascia latae). If you roll your hip inwards and lift the heel with knees locked & toes pulled up, you’ll fire up the Glutes Medius & Maximus.
  6. Closed Chain TKE: Use a resistance band, have someone to pull the band placing at the back of your knee. Now bend the knee very slightly and back to locked position. Do it for 2 minutes to fire up VMO
  7. Ball Glute Recruitment
  8. 1 arm 1 leg abduct
  9. Gluteal Pivot (w/Tube)
  10. Foam Roll Bridge: Supine poistion, knees bent, foot on roller, Curl your foot arc on the roller and then lift your glutes, fires up the hamstring incredibly.
  11. Ball bridge / Leg Raise
  12. Side Lying Clamshell:
  13. Hip external crossovers:
  14. Retro walking: Reverse walking with resistance band around your waist, fires up the hamstring & glutes and it is closed chain TKE
  15. Single Leg Step-up
  16. Skaters: Body weight on the inner arc while doing this, activates your glute medius
    *Higher reps with low resistance cause muscle hypertrophy than high resistance/ wt low reps
    *Everything works for a certain clients and for a certain length of time, but not everything works for everybody

brian@fit4lifedc.com
http://www.fit4lifedc.com

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