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THE KNEE COMPLEX The knee complex consists of 3 joints a)tibio- femoral joint b)patello-femoral joint c)tibio- fibular joint the knee joint has a number of structures within which when affected give different scenarios.sports such as jogging, tennis, cricket, football etc can cause direct or indirect injury to the knee. Injuries to the knee complex may involve- 1) patella tracking problems 2) muscle injuries 3) ligament injuries 4) meniscal injuries 5) cartilage problems leading to arthritis 6) bony injuries 7) bursitis and tendonitis it is important to distinguish which structure is involved to be able to decide the line of treatment in the acute, subacute and chronic stages. It is also important to note that a person may present with knee pain but not have a problem at the knee. The pain may come from the spine, hip or ankle which would misguide us to believe that a person has a knee pathology. PATELLA TRACKING Normally the patella is aligned medial to the tibial tuberosity . While extending the knee , the patella moves superiorly and laterally due to the pull of the quadriceps Dysfunctions of the patella may involve- malalignment, stiffness, problems with tracking, hypermobility. Treatment approaches involve- taping, mobilising, bracing and strengthening of the muscles around the knee joint. MUSCLE DYSFUNCTIONS These involve – 1) muscle tightness or contractures 2) muscle weakness 3) muscular imbalance 4) muscle strains 5) contusions treatment approaches involve- RICE, stretching and strengthening techniques , muscular control , taping and rehabilitating the person to resume athletic activity. LIGAMENT INJURIES There are 4 main ligaments in the knee complex 1) Medial collateral ligament 2) Lateral collateral ligament 3) Anterior cruciate ligament 4) Posterior cruciate ligament SPRAIN I II III SYMPTOMS Mild Moderate Severe SIGNS Tenderness, moderate loss Moderate loss of No abnormal of function function Motion Abnormal motion Marked Abnormal Motion COMPLIC- Tendency to Tendency to be Persistant ATIONS recur. Unstable. Instability. Prone to Traumatic Arthritis. Arthritis. TEARS OF Minor Partial Complete. FIBRES IMMOBILITY 2wks. 6wks. 10wks. Treatment approaches involve rest, icing, strengthening, co-contractions, stabilization excersises, bracing, operative measures. These ligaments are very important in stabilizing the joint in translatory and rotatory movements and therefore are very prone to injury in any kind of sport. The muscles are unable to act well if the ligament does not perform its function and therefore efficiency of the ligament plays an important role in performing any kind of sport . if the ligament is injured , the muscles have to be so well strengthened that they not only perform their own function but also do that of the ligament. Therefore the muscles have to stabilize the joint and move it too. This requires not only strength but also a lot of control in both groups of muscles- flexors and extensors. MENISCAL INJURIES Menisci are like cushions in the knee joint that are important for shock absorption and stability of the joints. There are 2 menisci- medial and lateral. Due to injuries the menisci can be torn leading to problems in shock absorption and proper mobility of the joint. Treatment approaches involve conservative treatment with immobilization and rest followed by strengthening of the muscles and their balance, and operative treatment after which the muscles have to be strengthened really well to ensure good mobility and stability of the knee joint. PREVENTION OF KNEE INJURIES 1) good warm ups and stretches before exs 2) proper shoes 3) diet control 4) gradual strengthening 5) training balance REHABILITATION ACUTE--- RICE POST – INJURY GRADUAL REHABILITATION--- strengthening protocols like progressive resisted exs, use of thera bands and swiss ball REHAB WITH SPECIFICITY--- exs to achieve what the person could do before the injury. Exs in different positions , getting good muscular control, strength , flexibility and endurance. |
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