Corrective Strategies for Foot and Ankle Impairments

Transcript Corrective Strategies for Foot and Ankle Impairments

Chapter 13 Corrective Strategies for Knee Impairments

Purpose

To provide the health and fitness professional with the knowledge and skills to effectively develop and implement corrective exercise strategies for knee impairments.

Objectives

• • • • Understand the basic functional anatomy of the knee complex.

Understand the mechanisms for common knee injuries.

Determine the common risk factors that can lead to knee injuries.

Incorporate a systematic assessment and corrective exercise strategy for knee impairments.

Functional Anatomy Knee Injuries Risk Factors Systematic Assessment & Corrective Exercise Strategy

Introduction

The knee is a region that is greatly affected and influenced by joints above and below it.

The structures that help form the ankle, and hip joints also make up the knee joint.

Over time, this will increase stress and injury risk, ultimately leading to knee impairments.

Functional Anatomy: Bones and Joints

The tibia and femur make up the tibiofemoral joint, and the patella and femur make up the patellofemoral joint. The fibula is also noted as it is the attachment site of the biceps femoris which crosses and affects the knee.

Tibiofemoral Joint Femur Patellofemoral Joint

Biceps Femoris

Functional Anatomy: Bones and Joints (cont.)

Pelvis (Ilium) Iliofemoral Joint Sacroiliac Joint Sacrum Collectively, these structures anchor the proximal myofascial tissues.

Functional Anatomy: Bones and Joints (cont.)

Fibula Tibia Collectively, these structures anchor the distal myofascial tissues of the knee.

Functional Anatomy: Muscles

Gastrocnemius Soleus Adductor Complex Hamstrings

It is important to restore and maintain normal range of motion and strength, and eliminate any muscle inhibition, to ensure joints are operating optimally.

TFL/IT-Band Quadriceps Gluteus Medius Gluteus Maximus

Muscle imbalances may result in altered force-couple relationships which will lead to altered joint arthrokinematics, increased stresses to the knee, and potential injury. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Knee Injuries and Associated Movement Deficiencies

Iliotibial Band (IT-Band) Syndrome (Runner’s Knee) Patellar Tendinopathy (Jumper’s Knee) Anterior Cruciate Ligament (ACL) Injury Patellofemoral Syndrome

Systematic Process to Determine Knee Impairments

Identifying faulty movement patterns allows the health and fitness professional to predict possible range of motion restrictions and muscle weakness.

Assessment Static Posture Overhead Squat Single-Leg Squat Tuck Jump Assessment Observation

Pronation distortion syndrome (tibial and femoral adduction and internal rotation) Knees move inward (adduct and internally rotate) Knees move outward (abduct and externally rotate) Knee moves inward (adduct and internally rotate) Knee and thigh deficits (i.e. excessive knee valgus on landing) Foot placement deficits and poor landing technique Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Varus Valgus

Corrective Exercise Strategies for Knee Impairments

Inhibit Inhibitory Techniques Lengthen Lengthening Techniques Activate Activation Techniques Integrate Integration Techniques

Self-Myofascial Release Static Stretching Isolated Strengthening Integrated Dynamic Movement Once muscle weakness and range of motion deficiencies have been identified, the corrective exercise strategy can be developed utilizing NASM’s Corrective Exercise Continuum. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Step 1. Inhibit (Knees Move Inward)

Compensation

Knees Move Inward

Phase

Inhibit

Modality

Self-Myofascial Release • • • •

Muscle(s) Exercise

Lateral Gastrocnemius Adductors TFL/IT Band Biceps Femoris (short head)

Acute Variables

Hold on tender area for 30 sec.

Lateral Gastrocnemius Adductors TFL/IT Band Biceps Femoris

Step 2. Lengthen (Knees Move Inward)

Compensation Phase Modality

Knees Move Inward Lengthen Static Stretching

Muscle(s) Exercise Acute Variables

• • • • Lateral Gastrocnemius Adductors TFL Biceps Femoris (short head) Hold stretch for 30 sec.

Lateral Gastrocnemius Adductors TFL Biceps Femoris

Step 3. Activate (Knees Move Inward)

Compensation

Knees Move Inward

Phase

Activate

Modality

Isolated Strengthening • • • •

Muscle(s) Exercise

Anterior Tibialis Posterior Tibialis Gluteus Medius Gluteus Maximus

Acute Variables

10-15 repetitions with 2 sec. isometric hold and 4 sec. eccentric contraction

Anterior Tibialis Posterior Tibialis Gluteus Medius Gluteus Maximus

Step 4. Integrate (Knees Move Inward)

Phase

Integrate

Modality

Integrated Dynamic Movement • • • • • •

Exercise

Wall Jumps Tuck Jumps Long Jumps (Two Feet) 180 ○ Jumps Single-Leg Hops Cutting Maneuvers

Acute Variables

10-15 repetitions under control

Wall Jumps Tuck Jumps Long Jumps 180

○

Jumps Single-Leg Hops

Cutting Maneuvers

Step 1. Inhibit (Knees Move Outward)

Compensation Phase

Knees Move Outward Inhibit

Modality

Self-Myofascial Release

Muscle(s) Exercise

• • • Piriformis TFL Biceps Femoris

Acute Variables

Hold on tender area for 30 sec.

Piriformis TFL Biceps Femoris

Step 2. Lengthen (Knees Move Outward)

Compensation

Knees Move Outward

Phase Modality Muscle(s) Exercise

Lengthen Static Stretching • • • Piriformis TFL Biceps Femoris

Acute Variables

Hold on tender area for 30 sec.

Piriformis TFL Biceps Femoris

Step 3. Activate (Knees Move Outward)

Compensation Phase Modality Muscle(s) Exercise Acute Variables

Knees Move Outward Activate Isolated Strengthening • • • Adductors Medial Hamstrings Gluteus Maximus 10-15 repetitions with 2 sec. isometric hold and 4 sec. eccentric contraction

Adductors Medial Hamstrings Gluteus Maximus

Integrate (Knees Move Outward)

Phase

Integrate

Modality

Integrated Dynamic Movement • • • • • •

Exercise

Jumping Progression Functional Movement Progression Ball Squats with Overhead Press Step-Ups with Overhead Press Lunges with Overhead Press Single-Leg Squat with Overhead Press

Acute Variables

10-15 repetitions under control

Ball Squats with Overhead Press Step-Ups with Overhead Press Lunges with Overhead Press Single-Leg Squats with Overhead Press

Summary

It is important for health and fitness professionals to utilize an integrated assessment process in order to gather the appropriate information needed to develop a specific and systematic corrective exercise strategy.

Corrective Strategies for Foot and Ankle Impairments

Transcript Corrective Strategies for Foot and Ankle Impairments

Chapter 13 Corrective Strategies for Knee Impairments

Purpose

Objectives

Introduction

Functional Anatomy: Bones and Joints

Functional Anatomy: Bones and Joints (cont.)

Functional Anatomy: Bones and Joints (cont.)

Functional Anatomy: Muscles

Common Knee Injuries and Associated Movement Deficiencies

Systematic Process to Determine Knee Impairments

Corrective Exercise Strategies for Knee Impairments

Step 1. Inhibit (Knees Move Inward)

Step 2. Lengthen (Knees Move Inward)

Step 3. Activate (Knees Move Inward)

Step 4. Integrate (Knees Move Inward)

Step 1. Inhibit (Knees Move Outward)

Step 2. Lengthen (Knees Move Outward)

Step 3. Activate (Knees Move Outward)

Integrate (Knees Move Outward)

Summary

Directory