Rehabilitation Of Knee Injuries Research Articles

Immediate effects of kinesiology tape on quadriceps muscle peak torque and knee joint repositioning error in healthy males: Effects of different tensions and directions

BackgroundKnee joint injuries may result from compromised quadriceps muscle strength or diminished knee joint proprioception. The application of Kinesio tape (KT) on the quadriceps muscle from origin to insertion (OTI-KT) or insertion to origin (ITO-KT) could impact knee joint proprioception and quadriceps muscle strength. This study aims to assess the effects of different tensions and directions of KT application on active and passive knee joint repositioning errors (AJRE and PJRE) and peak concentric and eccentric peak torque (CPT and EPT) of the quadriceps muscles in healthy males. MethodTwenty-one healthy males participated in this repeated-measures study design. CPT, EPT, AJRE, and PJRE of the dominant limb were measured by a Biodex dynamometer before and after applying OTI-KT with 0%, 15%, and 40% extra tensions and ITO-KT with 0% tension. ResultsITO-KT demonstrated a significant reduction in AJRE (p < 0.05). Meanwhile, for OTI-KT, a statistically significant difference was observed in both AJRE and PJRE concerning time (F1,126 = 19.74, p < 0.05 for AJRE; F1,126 = 9.96, p < 0.05 for PJRE) and tension (F2,126 = 22.14, p < 0.05 for AJRE; F2,126 = 20.67, p < 0.05 for PJRE). ConclusionApplying KT, especially OTI KT with 40% and 15% extra tension, shows potential in enhancing knee proprioception without immediate impacts on quadriceps muscle torque. This suggests applications in sports performance and knee injury rehabilitation.

Who's Afraid of Electrical Stimulation? Let's Revisit the Application of NMES at the Knee.

BACKGROUND: Restoring quadriceps strength is essential for successful rehabilitation of knee injuries, but many athletes return to their previous activity with persisting muscle weakness. Strong evidence supports using neuromuscular electrical stimulation (NMES) to improve quadriceps strength; however, there is a lack of widespread clinical implementation. We believe there is a critical need to provide clinical approaches that promote using NMES to improve patients' quadriceps strength and ensuring clinicians provide high-value rehabilitation care. CLINICAL QUESTION: What is best practice when using NMES to facilitate strength after injury, what are barriers to its use, and how can they be addressed? KEY RESULTS: We discuss the low clinical implementation of NMES, perceived barriers to using NMES, and provide recommendations for setup and dosage parameters for effective use of NMES. CLINICAL APPLICATION: We aim for this commentary, with accompanying videos, to serve as a resource for clinicians who are using commercially available NMES units in clinical practice. J Orthop Sports Phys Ther 2024;54(2):1-6. Epub 31 October 2023. doi:10.2519/jospt.2023.12028.

Tri-axial loading response to anti-gravity running highlights movement strategy compensations during knee injury rehabilitation of a professional soccer player

ABSTRACT Anti-gravity treadmills have been used in rehabilitation to manipulate exposure to loading and to prescribe return to outside running. Analysis is typically restricted to the vertical plane, but tri-axial accelerometry facilitates multi-planar analysis with relevance to injury mechanism. In this case a professional male soccer player, 4 weeks post-operative surgery to repair a medial meniscectomy, 8 months after Anterior Cruciate Ligament reconstruction to the same knee, completed anti-gravity treadmill running at 70–95% bodyweight (BW) at 5% increments. Tri-axial accelerometers were placed proximal to the Achilles tendon of the injured and healthy leg, and at C7. The planar acceleration at touchdown highlighted an increase at 85% BW, identifying 70% and 85% BW as discrete loading progressions. C7 (3.21 ± 0.68 m·s−2) elicited lower (P < 0.001) vertical acceleration than the lower limb (9.31 ± 1.82 m·s−2), with no difference between limbs suggesting bilateral symmetry. However, in the medio-lateral plane the affected limb (−0.15 ± 1.82 m·s−2) was exposed to lower (P = 0.001) medio-lateral acceleration than the non-affected limb (2.92 ± 1.35 m·s−2) at touchdown, indicative of bilateral asymmetry. PlayerLoad during foot contact was sensitive to accelerometer location, with the affected limb exposed to greater loading in all planes (P ≤ 0.082), exacerbated at 90–95% BW. Tri-axial accelerometry provides a means of assessing multi-planar loading during rehabilitation, enhancing objective progression.

Lived experiences of patients undergoing treatment for traumatic knee injury using integrated psychological training (MOTIFS) in the context of care-as-usual training: a phenomenological interview study

The objective was to increase understanding of how knee-injured people make sense of using the Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training intervention. This model integrates structured psychological skills...

Using Motion Analysis in the Evaluation, Treatment &amp; Rehabilitation of Pediatric &amp; Adolescent Knee Injuries: A Review of the Literature

Three-dimensional motion capture systems may improve evaluation, treatment, and rehabilitation of knee injuries, because quantitative assessment of the knee improves understanding of biomechanical mechanisms. The benefit of using motion analysis in pediatric sports medicine is that it allows closer and more focused evaluation of sports injuries using kinematics, kinetics, and electromyogram with physical and imaging to determine what is happening dynamically during sports. Future research investigating knee injuries should focus on identifying risk factors, assessing the effectiveness of surgical and nonsurgical interventions, and developing return to sport/rehabilitation protocols. The literature is focused on motion capture in adults with knee injuries.

Rehabilitation After Pediatric and Adolescent Knee Injuries.

According to epidemiology studies, the majority of youth sports injuries presenting to primary care, athletic trainers, and emergency departments impact the musculoskeletal system. Both acute and overuse knee injuries can contribute to sports attrition before high school. Effective rehabilitation of knee injuries ensures a timely return to sports participation and minimizes the negative physical, psychological, and social consequences of becoming injured. The following article provides rehabilitation and returns to play strategies for postsurgical and nonsurgical injuries of the young athlete's knee.

Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction.

Background:A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies.Purpose:To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport–related ACLR and uninjured peers of a similar age, sex, and sport.Study Design:Cross-sectional study. Level of evidence III.Methods:Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects.Results:Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = –0.04 deg/% [95% CI, –0.07 to –0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = –0.2° [95% CI, –0.3° to –0.0°]; P = .014) and hip flexion (β = –0.1° [95% CI, –0.2° to –0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = –0.34 BW [95% CI, –0.61 to –0.07 BW]; P = .014) (pushoff: β = –0.20 BW [95% CI, –0.32 to –0.08 BW]; P = .001).Conclusion:Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges.Clinical Relevance:It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport–related ACLR.

Balancing return to sport and a functional knee. exploring the perceptions of exercise therapy and physical activity of youth 1-2 years after a sport-related anterior cruciate ligament injury

Purpose: Young athletes who experience an anterior cruciate ligament (ACL) tear have an increased risk for future inactivity, obesity, and early-onset osteoarthritis (OA). Despite this, rehabilitation primarily focuses on return to sport with limited effort made to prevent OA. Exercise therapy and physical activity are essential components of knee injury rehabilitation and mitigate known risk factors for post-traumatic OA (i.e., adiposity and muscle weakness). However, deleterious psychological and social responses (e.g., re-injury anxiety, loss of athletic identity or social networks) to sport-related injuries may impact an individual’s inclination to participate in exercise-based activities.

Ability of Isokinetic Dynamometer to Predict Isotonic Knee Extension 1-Repetition Maximum

Resistance training exercise prescription is often based on exercises performed at a percentage of a 1-repetition maximum (1RM). Following knee injury, there is no consensus when a patient can safely perform 1RM testing. Resistance training programs require the use of higher loads, and loads used in knee injury rehabilitation may be too low to elicit gains in strength and power. A maximum isometric contraction can safely be performed during early stages of knee rehabilitation and has potential to predict an isotonic knee extension 1RM. To determine whether a 1RM on an isotonic knee extension machine can be predicted from isometric peak torque measurements. Descriptive laboratory study. University research laboratory. A total of 20 (12 males and 8 females) healthy, physically active adults. An isokinetic dynamometer was used to determine isometric peak torque (in N·m). 1RM testing was performed on a knee extension machine. Linear regression was used to develop a prediction equation, and Bland-Altman plots with limits of agreement calculations were used to validate the equation. There was a significant correlation (P < .001, r = .926) between peak torque (283.0 [22.6]N·m) and the knee extension 1RM (69.1 [22.6]kg). The prediction equation overestimated the loads (2.3 [9.1]kg; 95% confidence interval, -15.6 to 20.1kg). The results show that isometric peak torque values obtained on an isokinetic dynamometer can be used to estimate 1RM values for isotonic knee extension. Although the prediction equation tends to overestimate loads, the relatively wide confidence intervals indicate that results should be viewed with caution.

Revisión de la literatura científica sobre los avances en rehabilitación de lesiones de rodilla en patinaje (desde la fisioterapia)

IntroducciónEl patinaje ha experimentado un gran auge en los últimos años, siendo cada vez mayor el número de personas que se inician en esta actividad tanto a nivel recreativo como competitivo, en especial en nuestro país que se ha convertido en potencia mundial en éste deporte (en 2017 Colombia obtuvo el título Mundial número 15 y el octavo de manera consecutiva). A medida que la popularidad del deporte ha aumentado, también las lesiones asociadas con él, algunas de ellas graves, cuya recuperación puede tardar y extenderse más allá de un año, entre éstas las de la rodilla.&#x0D; La experiencia de lesión tiene repercusiones e impactos en la vida del deportista a nivel emocional, cognitivo y de expectativas y tras una lesión, la fisioterapia se constituye en uno de los ejes fundamentales de la rehabilitación y de la reincorporación a la competencia, sin embargo, revisiones previas no permiten identificar la existencia de avances concretos en la rehabilitación de este tipo de lesion. En esta revisión se analiza la literatura científica acerca de los avances en rehabilitación de lesiones de rodilla (patinaje artístico, de carrera y de velocidad), publicada desde el año 200 a 2017. Materiales y Métodos: estudio de enfoque cuantitativo, método documental Tipo: Revisión integradora, sobre los avances (conceptuales, metodológicos y tecnológicos), de la rehabilitación en lesiones de rodilla en el patinaje (artístico, de carrera y de velocidad), en publicaciones entre el 2000 al 2017. Resultados: Se encontraron 32 registros bibliográficos, pero solo 20 cumplieron con criterios de inclusión. Las estrategias y técnicas se han mantenido en el tiempo como base de rehabilitación deportiva: entrenamiento propioceptivo, alienación y balance muscular, programas de rehabilitación neuromuscular y patinaje terapéutico. Conclusiones: Es reducida la producción científica en rehabilitación de lesiones de rodilla en el patinaje, desde la fisioterapia; el abordabe fisioterapeutico reporta programas propioceptivos, de entrenamiento neuromuscular, ejercicios de flexibioidad, coordinación y fuerza, sin evidentes avances científicos tecnológicos.

Sports Physical Therapy Section Poster Presentations (Abstracts SPO1-SPO166).

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, SPO designates a Sports Physical Therapy Section poster presentation. J Orthop Sports Phys Ther 2018;48(1):A203-A276. doi:10.2519/jospt.2018.48.1.A203.

Rehabilitation of posterolateral corner injuries of knee

Injuries to the posterolateral corner (PLC) of the knee pose a significant challenge in sports rehabilitation due to their complex nature. Identifying PLC injuries are paramount in preventing chronic pain, instability, and/or surgical failure. To educate health professionals and athlete about posterior lateral corner injuries of the knee. Mr. X, 28-year-old badminton coach have been assessed with PLC injury with lateral collateral ligament (LCL) injury have been, clinically evaluated and rehabilitated efficiently. Mr. X was diagnosed with LCL injury and PLC injury, the treatment program provided for him on aspects of pain management, strengthening dynamic posterolateral structures, and increasing flexibility so he could continue his services pain-free. Cryotherapy was done before strengthening and stretching exercises. Very often PLC is forgotten during the assessment and rehabilitation of knee injuries. This study throws light into posterolateral aspect of the knee in preventing future complication of the instability of knee which may lead to disability.

Benefits of using transcranial magnetic stimulation as a tool to facilitate the chronic knee injury rehabilitation.

[Purpose] While primary motor cortex activation has been implicated as a key factor in the arthrogenic muscle inhibition after knee joint injury, no viable rehabilitation protocol has been developed to accommodate this factor. In this study, transcranial magnetic stimulation was applied as a means of dissipating arthrogenic muscle inhibition by introducing temporary motor cortex excitation prior to the rehabilitation. [Subjects and Methods] Twenty-four subjects who have underwent the surgery due to knee injury were recruited, and randomly assigned to the control or the simulation groups. The levels of electromyography signals during the maximum voluntary contraction of the quadriceps muscle before, during, and after training designed for the quadriceps strength rehabilitation were measured. [Results] When compared to controls, subjects who received the transcranial magnetic stimulations showed significantly increased levels of voluntary muscle contraction after the training. Moreover, the beneficial effect of the stimulation increased as the rehabilitation progressed. [Conclusion] Transcranial magnetic stimulation itself does not directly improve the symptoms related to knee injuries. However, the use of this technique can provide a time window for effective intervention by dissipating the unwanted effect of the arthrogenic muscle inhibition during rehabilitation.

The Squat: An Excellent Final-Phase Knee Rehabilitative Assessment Tool

During the last 30 years, physiotherapy therapy and biokinetic rehabilitation have moved away from traditional isolated assessments to integrative functional screenings, viewing joint stability from a dynamic multi-planar perspective. An integrative functional final-phase knee rehabilitative assessment is needed to determine the quality of the rehabilitative progress; hence the authors’ proposed the squat as this assessment tool. The squat is a popular closed kinetic chain exercise that has been judiciously applied in the double stance closedkinetic-chain rehabilitation of knee injuries. However, it is postulated that the squat can extend as a final-phase-rehabilitative tool to assess whether the patient is ready to commence with open-kinetic chain-exercises.

46th Mary McMillan Lecture: Not Eureka.

Lynn Snyder-Mackler, PT, PhD, ScD, ATC, SCS, FAPTA, for more than 25 years, has been a leader in developing evidence-based approaches for the rehabilitation of knee injuries, educating new physical therapy professionals and mentoring future rehabilitation scientists. She has received almost all of APTA's distinguished awards and is an international leader in physical therapy. Holding several positions and appointments at the University of Delaware, Dr Snyder-Mackler is Alumni Distinguished Professor of Physical Therapy, Academic Director of the Delaware Physical Therapy Clinic, Faculty Athletics Representative, and Adjunct Professor of Biomedical Engineering. She is also a visiting researcher for the Norwegian Research Center for Active Rehabilitation. Dr Snyder-Mackler earned a bachelor of arts from Johns Hopkins University, a certificate in physical therapy and a master of science in organizational behavior from the University of Pennsylvania, and an ScD in applied anatomy and physiology from Boston University. Named a Catherine Worthingham Fellow in 2003, Dr Snyder-Mackler has earned many other APTA honors, including the Eugene Michels New Investigator Award, Golden Pen Award, Chattanooga Research Award, Marian Williams Award, Helen J. Hislop Award, Orthopaedic Section Steven J. Rose Award, and Section on Research John H.P. Maley Award. I thank President Rockar and the Board of Directors for honoring me (Fig. 1). While I may be in doubt that I deserve this honor over others, there is no question of my happiness in receiving it. We in Delaware have had a tough couple of weeks. Steve Cope, who used his innovative harness systems to give mobility to those with disabilities, whose test kitchen was our new University of Delaware physical therapy home at STAR Campus, died after a very brief illness on May 20. Our colleague and friend, Seema Sonnad, a world-renowned health services researcher who codirected the Value Institute at Christiana Care in Delaware, …

REHABILITATION AFTER KNEE INJURIES IN BASKETBALL ATHLETES IN THEIR OPINION

REHABILITATION AFTER KNEE INJURIES IN BASKETBALL ATHLETES IN THEIR OPINION

A reliable low-cost wireless and wearable gait monitoring system based on a plastic optical fibre sensor

A wearable and wireless system designed to evaluate quantitatively the human gait is presented. It allows knee sagittal motion monitoring over long distances and periods with a portable and low-cost package. It is based on the measurement of transmittance changes when a side-polished plastic optical fibre is bent. Four voluntary healthy subjects, on five different days, were tested in order to assess inter-day and inter-subject reliability. Results have shown that this technique is reliable, allows a one-time calibration and is suitable in the diagnosis and rehabilitation of knee injuries or for monitoring the performance of competitive athletes. Environmental testing was accomplished in order to study the influence of different temperatures and humidity conditions.

The Role of Yoga Therapy in Knee Rehabilitation

Therapeutic Yoga can be especially well-suited to aiding in the rehabilitation of knee injuries. This article discusses some common types of knee injuries and how Yoga can help rehabilitate some knee injuries. Specific âsanas for the knees are discussed, as well as how to work with the wellness of the whole person through âsana, prânâyâma, and meditation. Consideration is given to how Yoga therapists can work with other healthcare providers to improve the safety and efficacy of Yoga therapy. Two case studies of knee rehabilitation through Yoga therapy (one in a group class setting, and one in private Yoga therapy) are described, including details of the Yoga interventions that helped both individuals avoid surgical intervention.

Biomechanical Comparison of Two Lower Extremity Exercise Machines Used for Knee Injury Rehabilitation

2004 The goals of rehabilitation after an ACL reconstruction include improving cardiovascular and muscular fitness. Although stationary bicycles are commonly used to accomplish this task, recumbent stepping ergometers have been shown to achieve the same goals. Few data exist regarding the use of recumbent steppers by individuals who have ACL surgery. PURPOSE: To evaluate the knee joint reaction forces and lower extremity muscle activity during stepping and cycling. METHODS: Fourteen healthy individuals with no history of lower extremity injury (age: 22.9 ± 1.9 y, 173.6 ± 11.3 cm, 76.7 ± 13.2kg) and 10 individuals who had undergone ACL reconstruction in their right knees (age: 22.2 ± 4.1 y, 175.3 ± 7.6 cm, 73.0 ± 12.9 kg, 43 ± 32 months post-op) participated. Subjects were videotaped with two cameras as they performed moderate (RPE = 3) exercise on a stepper and a cycle. Four seat positions were utilized resulting in minimum knee flexion angles of 0° (full extension), 15°, 30°, and 45°. The right pedals of the stepper and bike were fitted with a load cell. Video (60Hz) and force data (900Hz) were synchronized and used to perform an inverse dynamics analysis. To assess the myoelectric activity of selected lower extremity muscles, six pairs of surface electrodes were attached to the right side of the body over the following muscles: vastus lateralis (VL), vastus medialis (VM), rectus femoris, biceps femoris, medial gastrocnemius, and soleus. RESULTS: Statistical analyses (ANOVA) revealed that proximal/distal forces were significantly decreased for the stepper compared to the cycle (p = .029) while medial/lateral forces increased (p<.001). When compared to the cycle, significantly reduced muscle activity was detected for the VL (p = .005) and VM (p = .001) for the stepper. Significant main effects (increased muscle activity with increasing knee angle) were found in the VM (p = .012) and VL (p = .058). CONCLUSION: Our results indicate that lower extremity biomechanics on the two machines tested are not affected by knee surgery status. The reduced compressive knee force, equal anterior shear force, and the similar muscle activity for 4 of the 6 lower extremity muscles tested, indicate that a recumbent stepper is a viable rehabilitation modality after ACL surgery. Supported by NuStep, Inc. (UPN#01061905)

Biomechanical Comparison of Two Lower Extremity Exercise Machines Used for Knee Injury Rehabilitation

2004 The goals of rehabilitation after an ACL reconstruction include improving cardiovascular and muscular fitness. Although stationary bicycles are commonly used to accomplish this task, recumbent stepping ergometers have been shown to achieve the same goals. Few data exist regarding the use of recumbent steppers by individuals who have ACL surgery. PURPOSE: To evaluate the knee joint reaction forces and lower extremity muscle activity during stepping and cycling. METHODS: Fourteen healthy individuals with no history of lower extremity injury (age: 22.9 ± 1.9 y, 173.6 ± 11.3 cm, 76.7 ± 13.2kg) and 10 individuals who had undergone ACL reconstruction in their right knees (age: 22.2 ± 4.1 y, 175.3 ± 7.6 cm, 73.0 ± 12.9 kg, 43 ± 32 months post-op) participated. Subjects were videotaped with two cameras as they performed moderate (RPE = 3) exercise on a stepper and a cycle. Four seat positions were utilized resulting in minimum knee flexion angles of 0° (full extension), 15°, 30°, and 45°. The right pedals of the stepper and bike were fitted with a load cell. Video (60Hz) and force data (900Hz) were synchronized and used to perform an inverse dynamics analysis. To assess the myoelectric activity of selected lower extremity muscles, six pairs of surface electrodes were attached to the right side of the body over the following muscles: vastus lateralis (VL), vastus medialis (VM), rectus femoris, biceps femoris, medial gastrocnemius, and soleus. RESULTS: Statistical analyses (ANOVA) revealed that proximal/distal forces were significantly decreased for the stepper compared to the cycle (p = .029) while medial/lateral forces increased (p<.001). When compared to the cycle, significantly reduced muscle activity was detected for the VL (p = .005) and VM (p = .001) for the stepper. Significant main effects (increased muscle activity with increasing knee angle) were found in the VM (p = .012) and VL (p = .058). CONCLUSION: Our results indicate that lower extremity biomechanics on the two machines tested are not affected by knee surgery status. The reduced compressive knee force, equal anterior shear force, and the similar muscle activity for 4 of the 6 lower extremity muscles tested, indicate that a recumbent stepper is a viable rehabilitation modality after ACL surgery. Supported by NuStep, Inc. (UPN#01061905)