Manual Therapy

11-2-09

Knee!

At first glance the knee may look like a very simplistic joint but in reality is the largers and most complex joints in the human body. Not only is it a very complicated joint but one that encounters the most injuries as well.

As we did last time with the hip joint, Julian will begin the lecture in trivia fashion. This is a great way to review our basic anatomy of the joint.

Bones of the Knee(4 main ones)
-femur(thigh bone)
-tibia(shin bone)
-fibula(outer shine bone)
-patella(knee cap)
All of these bones are covered with articular cartilage .

Ligaments of the Knee
-medial collateral ligament(MCL)
-lateral collateral ligament(LCL)
-anterior cruciate ligament(ACL)
-posterio cruciate ligament(PCL)
-capsule
-medial coronary ligament
-lateral coronary ligament
-transverse ligament
-oblique popliteal ligament
-arcuate popliteal ligament
-anterior meniscofemoral ligament
-posterior meniscofemoral ligament
-ligamentum patellae(tendon)
These ligaments allow for stability of the knee to occur.

Menisci(knee cartilage)
-medial menisci
-lateral menisci
These are crescent shaped cartilages that lie on the superior surface of the tibia and as the names describe, one medially and one laterally. They act as shock absorbers as well as allowing for weight distrubution throughout the tibia and femur.


Joints(3)
-knee joint
-patellofemoral joint
-superior tibiofibular joint

Muscles
-quadriceps
-sartorius
-biceps femoris
-semimembranosus
-semitendinosus
-gracilis
-popliteus
-gastrocnemiusss

Ok, now we got the basic anatomy of the knee down we can go forth with our treatments.

When treating for a capsular pattern we will use five different techniques: medial rotation mobilisation, AP of tibia mobilisation, flexion mobilisation, PA of the femur mobilisation and extension mobilisation. See below diagrams(in order as listed)




Photos taken from Musculoskeletal Education: Manual Therapy Lower Limb. J.Hatcher. 2005
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For non-capsular pattern treatments we may see loose body, meniscal tear, medial/lateral ligament sprain and contractile lesions to the quadriceps, hamstrings and gastrocnemius.

Loose Body
Key clinical features:

• twinges of pain
• sense of locking/giving way
• springy end feel in extension/flexion

Tx: loose body manoeuvre to knee joint

Warning:

• Always conduct full orthopaedic examination and history before applying any of these techniques.
• Ensure patient comfort & saftey at all times.

Directions:

1. Have patient lying on several pillows on flat bed first.
2. Using end of bed, flex hip and knee so the latter is resting over the edge of the bed (keep the bed up relatively high).
3. Place one hand directly over dorsum of foot, the other around back of ankle.
4. Apply traction to knee by squatting using your body weight (helps to have one leg up on bed frame).
5. Maintain traction with body weight and swing backwards and upwards taking leg through short range of extension, simultaneously rotating lower leg into3 flicks of motion. (Direction of rotation is into least painful direction).

Medial ligament sprain
Key clinical features:

• pain on valgus stress/lateral rotation of knee

Tx: RICE, deep transverse friction in max extension----->max flexion

Lateral ligament sprain
Key clinical features:

• pain on varus stress

Tx: deep transverse frictions

Meniscal tear
Key clinical features:

• similar to loose body
• pain with meniscus tests

Tx: refer to have surgery


Taken from Musculoskeletal Education: Manual Therapy Lower Limb. J.Hatcher. 2005
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Contractile lesions

REFER TO TREATMENTS AROUND THE HIP; SAME CONCEPT