Knee

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Quadriceps Muscle Strains

Injuries to the quadriceps muscle group occur frequently in sports and athletic activities. A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle, often at the same time as a forceful contraction or repetitive functional overloading. Pain may be associated with localized swelling and loss of motion.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

Meniscal Tears

The medial and lateral menisci are c-shaped pieces of cartilage which function to cushion the compressive loads in the knee. Tears to this cartilage can occur with activity that involves forcefully twisting/rotating the knee, especially with full weight on it. Signs and symptoms include joint line pain, locking, difficulty extending the knee, and swelling/stiffness of the knee.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonics
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Isometric Exercise
  • Plyometrics
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Anterior Cruciate Ligament (ACL) Tear

The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonics
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Isometric Exercise
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Posterior Cruciate Ligament (PCL) Tear

The posterior cruciate ligament (PCL) is stronger and less commonly injured. Motor vehicle accident, when the knee(s) forcefully impact the car dashboard, is a common mechanism of injury. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. Surgery is not typically required.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Low Back Active Range of Motion
  • Isometric Exercise
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Medial Collateral Ligament (MCL) Tear

MCL tears are common injuries. A forceful stress on the outside of the knee can cause a stretching and injury of the MCL. Signs and symptoms include knee pain at the inner aspect and swelling. Medial meniscal tears and ACL injury may occur with severe trauma (commonly occurs during football and soccer). Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Severe tears may require surgery.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Isometric Exercise
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Lateral Collateral Ligament (LCL) Tears

Lateral collateral ligament tears (LCL) are less common. Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Surgery is uncommon.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Isometric Exercise
  • Proprioception Exercises
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Anterior Knee Pain

Anterior knee pain is pain that occurs in the front and center of the knee and can be caused by a number of conditions. The patella (kneecap) sits over the front of the knee joint and should glide smoothly as you bend or straighten your knee. Pain often begins when the patella is no longer moving properly due to imbalances caused by tightness or weakness in the muscles surrounding the knee. Overuse or excessive activity may also put too much stress on the kneecap and cause increased pain. Chondromalacia (softening of the cartilage), quadriceps tendinitis/tendinosis, and patellar tendinitis/tendinosis are three common causes of anterior knee pain.

Physical therapy can improve these conditions by addressing strength and flexibility deficits in order to correct muscle imbalances and promote improved functional mobility.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Isometric Exercise
  • Proprioception Exercises
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Patello-femoral Pain (Commonly Called Chondromalacia Patella)

Patellofemoral pain (PFP) is diffuse pain in the front of the knee, under, or around the kneecap. It is a prevalent orthopedic condition affecting physically active adolescents, athletes, and people who perform physical labor. Females are at a greater risk of developing PFP. PFP is exacerbated by activities that load the patellofemoral joint such as running, jumping, squatting, and prolonged sitting with flexed knees.

Physical therapists commonly evaluate and provide treatment for patients with PFP, managing pain and restoring patellofemoral function.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Proprioception Exercises
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Plyometrics
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Fitness
  • Improve Muscle Strength and Power
  • Optimize Joint Alignment
  • Improve Proprioception
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Patellar Tendinitis (Jumper’s Knee)

Patellar tendinitis is an overuse injury caused by repeated stress to the patellar tendon. The patellar tendon connects the patella (kneecap) to the shinbone. It is most common in athletes whose sports involve frequent jumping, such as basketball and volleyball. Pain is the most common symptom.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Iontophoresis
  • Gait or Walking Training
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Proprioception Exercises
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Plyometrics
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Knee Osteoarthritis

Osteoarthritis of the knee occurs when the protective cartilage covering the ends of the femur and tibia wears away over time. There are also two wedge-shaped pieces of cartilage (medial and lateral menisci) which act as “shock absorbers” in the knee. As the cartilage wears away, it becomes rough and frayed, and the space between the two bones decreases. Bone spurs may form causing pain, inflammation, and decreased mobility in the joint.

Osteoarthritis can effectively be managed and it is important to stay active. Physical therapy can help manage pain, increase range of motion, and increase strength in order to promote improved walking, stair climbing, and ability to get in/out of chairs. A good course of Physical Therapy can prevent having surgery as well.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Gait or Walking Training
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Proprioception Exercises
  • Proprioceptive Neuromuscular Facilitation (PNF)
  • Plyometrics
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Relaxation
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Iliotibial Band Friction Syndrome (ITBS)

The iliotibial band (ITB) is a thick band of fascia that runs along the outside of the thigh. It consists of dense fibrous connective tissue from both the Tensor Fascia Latae and Gluteus Maximus muscle. It inserts into the outer region of the shin bone just below the knee joint.

Iliotibial band friction syndrome (ITBS) is considered a non-traumatic overuse injury that is often seen in runners or cyclists. Repetitive flexion and extension of the knee causes friction of the ITB over the lateral epicondyle of the femur (a region of the outer thigh bone just above the knee joint). This repetitive friction can cause pain and inflammation on the outside of the knee. There can also be an audible snapping sensation as the band slips over the bony tubercle.

Other factors contributing to ITBS can be weakness of the hip muscles, poor flexibility, abnormal body mechanics, improper footwear, or improper bike fit for cyclists. Physical therapy can abolish symptoms of ITBS by addressing strength/flexibility deficits, assessing footwear and body mechanics, and exploring effective pain management techniques.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Gait or Walking Training
  • Hip Resistive Range of Motion
  • Knee Resistive Range of Motion
  • Ice Massage
  • Proprioception Exercises
  • Plyometrics
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Improve Range of Motion
  • Improve Tolerance for Prolonged Activities

About Total Knee Replacement

The knee is the most commonly replaced joint in the body. A total knee arthroplasty (knee replacement) is generally indicated when a patient can no longer tolerate the pain of osteoarthritis. In the procedure, arthritic parts of the knee joint are replaced with artificial parts.

Physical therapists help patients with TKA regain movement and function, improve activity, and return to daily activities. Physical therapists can also help the patient prepare for and recover from surgery and will develop an individualized plan for each patient to move again after surgery.

If you have knee pain, you may be able to delay the need for surgery by working with a physical therapist to improve the flexibility and strength of the muscles that support the knee. Physical activity and weight control through proper diet may help reduce the risk of osteoarthritis of the knee from worsening.

Physical Therapy Pre and Post Surgery

There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

  • Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist directed program could help you delay or avoid knee replacement.
  • Seeing a physical therapist before surgery and going through a “prehab” program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.
  • Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.

Give us a call to learn more about how we can help you.

  • Quadriceps Muscle Strains

    Injuries to the quadriceps muscle group occur frequently in sports and athletic activities. A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle, often at the same time as a forceful contraction or repetitive functional overloading. Pain may be associated with localized swelling and loss of motion.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Hip Active Range of Motion
    Hip Joint Mobilization
    Hip Passive Range of Motion
    Hip Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Meniscal Tears

    The medial and lateral menisci are c-shaped pieces of cartilage which function to cushion the compressive loads in the knee. Tears to this cartilage can occur with activity that involves forcefully twisting/rotating the knee, especially with full weight on it. Signs and symptoms include joint line pain, locking, difficulty extending the knee, and swelling/stiffness of the knee.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isotonics
    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Plyometrics
    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Anterior Cruciate Ligament (ACL) Tear

    The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

    ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isotonics
    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Posterior Cruciate Ligament (PCL) Tear

    The posterior cruciate ligament (PCL) is stronger and less commonly injured. Motor vehicle accident, when the knee(s) forcefully impact the car dashboard, is a common mechanism of injury. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. Surgery is not typically required.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Low Back Active Range of Motion

    The movement of the low back, by the patient, through a range of motion against gravity. AROM is usually prescribed for arthritis, initial recovery of joint motion gentle strengthening without trauma to joints.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Medial Collateral Ligament (MCL) Tear

    MCL tears are common injuries. A forceful stress on the outside of the knee can cause a stretching and injury of the MCL. Signs and symptoms include knee pain at the inner aspect and swelling. Medial meniscal tears and ACL injury may occur with severe trauma (commonly occurs during football and soccer). Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Severe tears may require surgery.

    Treatments

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Lateral Collateral Ligament (LCL) Tears

    Lateral collateral ligament tears (LCL) are less common. Initially, rest, ice, elevation and compression is necessary followed by bracing and rehabilitation. Surgery is uncommon.

    Treatments

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Anterior Knee Pain

    Anterior knee pain is pain that occurs in the front and center of the knee and can be caused by a number of conditions. The patella (kneecap) sits over the front of the knee joint and should glide smoothly as you bend or straighten your knee. Pain often begins when the patella is no longer moving properly due to imbalances caused by tightness or weakness in the muscles surrounding the knee. Overuse or excessive activity may also put too much stress on the kneecap and cause increased pain. Chondromalacia (softening of the cartilage), quadriceps tendinitis/tendinosis, and patellar tendinitis/tendinosis are three common causes of anterior knee pain.

    Physical therapy can improve these conditions by addressing strength and flexibility deficits in order to correct muscle imbalances and promote improved functional mobility.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Patello-femoral Pain (Commonly Called Chondromalacia Patella)

    Patellofemoral pain (PFP) is diffuse pain in the front of the knee, under, or around the kneecap. It is a prevalent orthopedic condition affecting physically active adolescents, athletes, and people who perform physical labor. Females are at a greater risk of developing PFP. PFP is exacerbated by activities that load the patellofemoral joint such as running, jumping, squatting, and prolonged sitting with flexed knees.

    Physical therapists commonly evaluate and provide treatment for patients with PFP, managing pain and restoring patellofemoral function.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Plyometrics
    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Fitness
    • Improve Muscle Strength and Power
    • Optimize Joint Alignment
    • Improve Proprioception
    • Increase Oxygen to Tissues
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Patellar Tendinitis (Jumper’s Knee)

    Patellar tendinitis is an overuse injury caused by repeated stress to the patellar tendon. The patellar tendon connects the patella (kneecap) to the shinbone. It is most common in athletes whose sports involve frequent jumping, such as basketball and volleyball. Pain is the most common symptom.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Iontophoresis

    Medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Plyometrics
    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Tolerance for Prolonged Activities

    Resources

  • Knee Osteoarthritis

    Osteoarthritis of the knee occurs when the protective cartilage covering the ends of the femur and tibia wears away over time. There are also two wedge-shaped pieces of cartilage (medial and lateral menisci) which act as “shock absorbers” in the knee. As the cartilage wears away, it becomes rough and frayed, and the space between the two bones decreases. Bone spurs may form causing pain, inflammation, and decreased mobility in the joint.

    Osteoarthritis can effectively be managed and it is important to stay active. Physical therapy can help manage pain, increase range of motion, and increase strength in order to promote improved walking, stair climbing, and ability to get in/out of chairs. A good course of Physical Therapy can prevent having surgery as well.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Knee Active Range of Motion
    Knee Joint Mobilization
    Knee Passive Range of Motion
    Knee Resistive Range of Motion
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Proprioceptive Neuromuscular Facilitation (PNF)

    Performed in diagonal patterns that mimic functional movements. Initially this technique was used in developmentally and neurologically impaired patients. Today, PNF (or a variation of it)is commonly used for almost every aspect of neuromuscular retraining. It can be used on the professional athlete or someone in a nursing home.

    Plyometrics
    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Relaxation
    • Improve Tolerance for Prolonged Activities
    • Improve Wound Healing

    Resources

  • Iliotibial Band Friction Syndrome (ITBS)

    The iliotibial band (ITB) is a thick band of fascia that runs along the outside of the thigh. It consists of dense fibrous connective tissue from both the Tensor Fascia Latae and Gluteus Maximus muscle. It inserts into the outer region of the shin bone just below the knee joint.

    Iliotibial band friction syndrome (ITBS) is considered a non-traumatic overuse injury that is often seen in runners or cyclists. Repetitive flexion and extension of the knee causes friction of the ITB over the lateral epicondyle of the femur (a region of the outer thigh bone just above the knee joint). This repetitive friction can cause pain and inflammation on the outside of the knee. There can also be an audible snapping sensation as the band slips over the bony tubercle.

    Other factors contributing to ITBS can be weakness of the hip muscles, poor flexibility, abnormal body mechanics, improper footwear, or improper bike fit for cyclists. Physical therapy can abolish symptoms of ITBS by addressing strength/flexibility deficits, assessing footwear and body mechanics, and exploring effective pain management techniques.

    Treatments

    Active Assistive Range of Motion

    Patient or therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Core Strengthening

    The trunk and its associated muscles make up the core. The extremities are the arms, forearms, hands, thighs, legs, ankles/feet. Strong core muscles provide a foundation for the extremities to attach to and work more efficiently. It is hypothesized that a weak core can cause excessive stress on the extremity muscles, tendons, ligaments and joints. Core strengthening is a multi-joint exercise, involving larger muscle groups such as the chest, back, abdominals, back, hip/thigh, and shoulder blade muscles. Core strengthening is often incorporated as part of a low back or neck rehabilitation program. Because recovery or enhancement of core strength provides a stable base for the extremities, it is also commonly part of an arm, forearm, thigh, leg or ankle program.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Hip Resistive Range of Motion
    Knee Resistive Range of Motion
    Ice Massage
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Plyometrics
    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Improve Range of Motion
    • Improve Tolerance for Prolonged Activities

    Resources

  • About Total Knee Replacement

    The knee is the most commonly replaced joint in the body. A total knee arthroplasty (knee replacement) is generally indicated when a patient can no longer tolerate the pain of osteoarthritis. In the procedure, arthritic parts of the knee joint are replaced with artificial parts.

    Physical therapists help patients with TKA regain movement and function, improve activity, and return to daily activities. Physical therapists can also help the patient prepare for and recover from surgery and will develop an individualized plan for each patient to move again after surgery.

    If you have knee pain, you may be able to delay the need for surgery by working with a physical therapist to improve the flexibility and strength of the muscles that support the knee. Physical activity and weight control through proper diet may help reduce the risk of osteoarthritis of the knee from worsening.

    Physical Therapy Pre and Post Surgery

    There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

    • Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist directed program could help you delay or avoid knee replacement.
    • Seeing a physical therapist before surgery and going through a “prehab” program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.
    • Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.

    Give us a call to learn more about how we can help you.