Basic Athletic Training Chapter 7 Knee and Thigh

Chapter Objectives Name the anatomy of the knee and thigh Identify the steps in an evaluation format Compare the common injuries to the knee and thigh Demonstrate the principles of rehabilitation to the knee and thigh Describe the preventive/supportive techniques and protective devices for the lower extremity

Anatomy The knee is the largest joint in the body, but structurally weak The instability of the knee is supported by four strong ligaments and 12 muscles The femur (thighbone) is the longest and strongest bone in the body

Knee, Quadriceps, and Hamstring Anatomy Bones Ligaments Cartilage Muscles and tendons and their functions Dermatomes Myotomes Range of motion

Evaluation Format (H)istory Mechanism of injury (How did it happen?) Location of pain (Where does it hurt?) Sensations experienced (Did you hear a pop or snap?) Previous injury (Have you injured this anatomical structure before?) (O)bservation—compare the uninjured to the injured lower extremity and look for bleeding, deformity, swelling, discoloration, scars, and other signs of trauma

Evaluation Format (P)alpation—the physical inspection of an injury. Palpate the anatomical structures/joints above and below the injured site, then palpate affected area. Using bilateral comparison, these items should be palpated: Neurological (motor and sensory) Circulation (pulse and capillary refill) Anatomical structures (palpate) Fracture test (palpation, compression, and distraction)

Evaluation Format (S)pecial Tests—look for joint instability, disability, and pain. Assess disability in the following areas: Joint stability Muscle/tendon Accessory anatomical structures Inflammatory conditions Range of motion (active, assistive, passive, and resistive) Pain or weakness in the affected area

Conditions that Indicate an Athlete Should be Referred for Physician Evaluation Gross deformity Significant pain Increased swelling Circulation or neurological impairment Joint instability Suspected fracture or dislocation Abnormal sensations such as clicking, popping, grating, or weakness Locked knee or excessive limited motion Any doubt regarding the severity or nature of the injury

Common Injuries Contusions Ligament sprains Meniscus tears Patellar tendinitis Chondromalacia patellae The female athlete’s knee Osgood-Schlatter condition Muscular strains

Preventive/Supportive Techniques Wrapping techniques for compression Knee compression wrap Wrapping techniques for support Knee joint, hamstrings, quadriceps, hip flexor, and hip adductor wraps Taping techniques for the knee, thigh and hip Collateral knee Hyperextended knee Anterior cruciate Patella tendon Hip pointer

Rehabilitation Included in any rehabilitation protocol is: Range of motion exercises Resistive exercises Cardiovascular/fitness activities Sport specific activities Return to competition guidelines Full range of motion Strength, power, and endurance are proportional to the athlete’s size and sport No pain during running, jumping, or agility movements No loss of function

Preventing ACL Injuries in Females Women 4-6 times more likely to tear ACL Common mechanism of injury: non-contact torsion Women—tend to land more straight-legged (ligament dominant) Men—tend to land more with bent knee (muscular dominant) Prevention program—shown to give significant reduction in ACL injuries. Includes: Hamstring strengthening Plyometric/agility drills Proper biomechanics during landing Knee over toes; avoid valgus position

Protective Devices Closed/open patella neoprene sleeve Hinged knee brace Knee brace Lateral patella subluxation braces Patella stabilizing strap Patella tendon tendinitis braces Patella tendon strap Pre-patella bursitis protectors Prophylactics knee brace: rehabilitative and functional Sport-specific pads

Musculoskeletal Disorders Bursitis Dislocation Fracture Iliotibial band friction syndrome Meniscal tear Myositis ossificans Osteochondritis dissecans Popliteal cyst

Questions ?