Rehabilitation for a sports Knee Injury
As with the human shoulder, a selection of injuries and surgical measures exist for the knee joint. Here we discuss three collective disorders of the knee: anterior knee pain, anterior cruciate ligament injury, and total knee arthroplasty. In addition to this, exercise considerations (indications and contraindications) after release from rehabilitation services will be outlined.
Anterior Knee Pain
The term ‘anterior knee pain’ is on occasion used interchangeably with “runner’s knee”, but it is mentioned clinically as patellofemoral pain syndrome (PFPS) and is a common finding in young adults, linked with general anterior or retro patellar knee soreness in the absence of other apparent pathology. PFPS is a multifactorial ailment with suggested causes associated with inherent factors such as misalignment of the lower extremity, quadriceps feebleness, or neuromuscular inadequacies of the thigh musculature (or some mixture of these). Collectively, these factors alter the tracing of the patella, resultant from tightness of nearby tissues, unevenness in the forces acting on the patella (commonly the relationship between the vastus lateralis and the vastus medialis obliquus, or VMO), and conceivably a change in foot biomechanics. The general belief is that the vastus lateralis overrides the VMO and yanks excessively on the patella, causing the patella to move sideways when the quadriceps muscles are energetic. Because the quadriceps muscles help individuals walk up stairs and assist braking of the body during walking on flat surfaces and down steps, overall quadriceps strengthening does mend function and reduce discomfort. However, weakness in the proximal muscles will cut an individual’s ability to stabilise the lower extremity, particularly throughout dynamic movements. Consequently, specific exercises emphasising unilateral equilibrium actions and targeting hip strength are accepted as an essential constituent of treatment and prevention of anterior knee pain. Although generally, there are no contraindications for this condition, one must be cautious with exercises exceeding a ninety degree angle (i.e., deep squatting and deep lunges).
Anterior Cruciate Ligament Reconstruction
The anterior cruciate ligament (ACL) is a key stabilising structure of the knee. Damage to the ACL can lead to joint instability during landing and rotating tasks. Because of its important function, reconstruction is a common management choice for joint slackness and potential functional instability, especially with active, competitive people and those with high-demand professions. During rehabilitation, both open (straight-leg raise, leg curl; and hip flexion, extension, abduction, and adduction) and closed (leg press, squat, multidirectional lunges, step-ups, and unilateral stance activities) kinetic chain exercises are significant parts of the overall programme. Specific contraindications for exercise subsequent to ACL reconstruction include full range of motion open kinetic chain leg extension exercise, as well as closed kinetic chain exercise using greater than ninety degrees of knee flexion.
Total Knee Arthroplasty
Years of frequent loading on the human knee can end in degeneration and degradation of the joint faces of the distal femur and proximal tibia. Often the deterioration is specifically situated on either the medial or the lateral side of the knee joint, based on specifically the individual’s lower extremity configuration. People who are excessively bow-legged, or knock-kneed, or who have had severe injury to the knee (for instance widespread fractures through the joint, meniscal pathology, or shakiness of the knee due to unrepaired or unsuccessful repair of ligamentous assemblies), are habitually candidates for a total knee replacement. Rehabilitation begins instantaneously with a range of motion focus. Individuals execute open and closed kinetic chain exercises at first in the hospital and at home prior to official rehabilitation. Following discharge, individuals often have 100 – 120 degrees of knee flexion and practically complete extension. Indications for exercise incorporate cycling, swimming, and endurance-based activities that decrease joint impact loading and develop muscular and cardiovascular function and fitness levels. Particular exercises, such as leg press, calf raises, and knee flexion and extension exercises by means of small resistance and high repetition organisation are recommended. Again, closed kinetic chain exercises that place the knee in greater than 100 degrees of flexion are hazardous and enact added stresses on the knee. As this is a lot of information to process, a guideline table is included below:
Table 1: Knee Movement and Exercise Guidelines
| Diagnosis | Movement Contraindications | Exercise Contraindications | Exercise Indications |
| Anterior knee pain | Closed chain knee movements with greater than 90 degrees of knee flexion.Open chain knee movements ranging from 0 to 30 degrees of knee flexion. | Full squat; full lunge. End range of leg extension. Stair stepper with large steps. | A quarter or half squat, and leg press. Partial lunge, leg curl. Stair stepper with short, choppy steps. |
| ACL Reconstruction | Open chain knee movements less than 45 degrees of knee flexion. | End range of leg extension. | ¾ squat and leg press, step-up, leg curl, stiff-legged deadlift, elliptical trainer. |
| Knee Arthroplasty | Closed chain knee movements with greater than 100 degrees of knee flexion. Kneeling. | Full squat, full lunge. | ¼ to ½ squat and leg press, partial lunge, leg extension and leg curl, stationary bicycle, aquatics, swimming. |
Each of the knee joint’s structures necessitates a precise type of exercise to return the individual to full function after injury or surgery; with anterior knee pain, for instance, the emphasis is on dropping inflammation and pain, whereas after total knee arthroplasty the stress is on range of motion. Quadriceps and hip strengthening is a shared goal in virtually all knee injury rehabilitation programmes and is a fundamental element to returning more normal functions after injury.
Bibliography
- 1. Baechle, Thomas R., and Roger W. Earle. "Rehabilitation and Reconditioning." NSCA Essentials of Strength Training and Conditioning. 2nd Edition. Champaign, Illinois: Human Kinetics, 2008. 474-478.
2. Dodds, J.A., and S.P. Arnoczky. 1994. Anatomy of the anterior cruciate ligament: A blueprint for repair and reconstruction. Arthroscopy 10 (2): 132-139.
3. Earl, J.E., and C.S. Vetter. 2007. Patellofemoral pain, Physical Medicine and Rehabilitation Clinics of North America 18: 439-458.
4. Earle, Roger W., and Thomas R. Baechle. "Clients With Orthopaedic, Injury, and Rehabilitation Concerns." NSCA's Essentials of Personal Training. 2nd ed. Champaign, IL: Human Kinetics, 2012. 554-556.
5. Prentice, W.E. 2006. Arnheim’s Principles of Athletic Training. 12th edition. New York: McGraw-Hill.
