Corrective Strategies for Foot and Ankle Impairments

Chapter 13 Corrective Strategies for Knee Impairments Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Purpose To provide the health and fitness professional with the knowledge and skills to effectively develop and implement corrective exercise strategies for knee impairments. Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. It is important to understand the: anatomy causes

exercise strategies for prevention and management Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Femur Tibiofemoral Joint Fibula Patellofemoral Joint Tibia Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Biceps Femoris Functional Anatomy: Bones and Joints (cont.) Pelvis (Ilium) Sacroiliac

Joint Iliofemoral Joint Sacrum Collectively, these structures anchor the proximal myofascial tissues. Femur Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Functional Anatomy: Bones and Joints (cont.) Fibula Collectively, these structures anchor the distal myofascial tissues of the knee. Tibia Talocrural Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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) Patellar Tendinopathy

(Jumpers Knee) Patellofemoral Syndrome Syndrome (Runners Knee) Anterior Cruciate Ligament (ACL) Injury Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 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) Single-Leg Squat

Tuck Jump Assessment 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 Lengthen Activate Integrate Inhibitory Techniques Lengthening

Techniques Activation Techniques 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 NASMs Corrective Exercise Continuum. Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Step 1. Inhibit (Knees Move Inward) Compensation

Phase Modality Muscle(s) Exercise Acute Variables Knees Move Inward Inhibit Self-Myofascial Release Hold on tender area for 30 sec. Lateral Gastrocnemius Lateral Gastrocnemius Adductors TFL/IT Band Biceps Femoris (short

head) Adductors Biceps Femoris Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins TFL/IT Band Step 2. Lengthen (Knees Move Inward) Compensation Phase Modality Muscle(s) Exercise Acute Variables Knees Move Inward Lengthen Static Stretching

Hold stretch for 30 sec. Lateral Gastrocnemius Adductors Lateral Gastrocnemius Adductors TFL Biceps Femoris (short head) TFL Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Biceps Femoris Step 3. Activate (Knees Move Inward) Compensation Phase Modality

Muscle(s) Exercise Acute Variables Knees Move Inward Activate Isolated Strengthening 10-15 repetitions with 2sec. isometric hold and 4sec. eccentric contraction Anterior Tibialis Posterior Tibialis Anterior Tibialis Posterior Tibialis Gluteus Medius Gluteus Maximus

Gluteus Medius Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Gluteus Maximus Step 4. Integrate (Knees Move Inward) Phase Modality Exercise Acute Variables Integrate Integrated Dynamic Movement

10-15 repetitions under control Wall Jumps 180 Jumps Wall Jumps Tuck Jumps Long Jumps (Two Feet) 180 Jumps Single-Leg Hops Cutting Maneuvers Tuck Jumps Single-Leg Hops Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Long Jumps Cutting Maneuvers Step 1. Inhibit (Knees Move Outward) Compensation Phase

Modality Muscle(s) Exercise Acute Variables Knees Move Outward Inhibit Self-Myofascial Release Hold on tender area for 30 sec. Piriformis Piriformis TFL Biceps Femoris TFL Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Biceps Femoris Step 2. Lengthen (Knees Move Outward) Compensation Phase Modality Muscle(s) Exercise Acute Variables Knees Move Outward Lengthen Static Stretching Hold on tender area for 30 sec. Piriformis

TFL Piriformis TFL Biceps Femoris Biceps Femoris Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Step 3. Activate (Knees Move Outward) Compensation Phase Modality Muscle(s) Exercise Acute Variables Knees Move Outward Activate Isolated Strengthening

10-15 repetitions with 2sec. isometric hold and 4sec. eccentric contraction Adductors Adductors Medial Hamstrings Gluteus Maximus Medial Hamstrings Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Gluteus Maximus Integrate (Knees Move Outward) Phase Modality Exercise Acute Variables

Integrate Integrated Dynamic Movement 10-15 repetitions under control Ball Squats with Overhead Press 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 Step-Ups with Overhead Press Lunges with Overhead Press

Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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