Thursday, July 7, 2011

Special knee traction/distraction/rehab article!

   So as someone with quite a bit of experience w/ knee injuries, I have put together an article (short and sweet, just like Josh Kim) on a veriety of treatments. These are not all used effectively together, but in some cases they can work all together. With that said, identifying the issues that caused the knee issue/injury is paramount of importance. The knee is a hinge joint and SHOULD only operate in one plane. Take a car door and twist the top away and the bottom of the door toward you and see if the car door closes well after (NOTE: dont really try this; if you actually do this the damage, and the responsibility, is up to you. This is just for mental imagery). That would be an example of forcing a single-plane joint to move in a dual-plane manner (through shear forces) and will certainly result in the destruction of the joint.
   Since the body works in kinetic chains, observe the mobility (or lack of) of the ankle and hips. Do the ankles dorsiflex beyond 90 degrees? do they evert (tilt outward-facing at the bottom of the foot) or invert (opposite of evert) at or near end-ROM for plantarflexion or dorsiflexion? What about the hips? Are the hip flexors chronically shortened and overtight (if this subject is American, then the answer is a resounding yes 99.99% of the time), and are the glute /hip complexes able to effectively rotate the femur inward and outward at all points of hip flexion/extension? Check all these points to observe what issues the kinetic chain is placing on the knee. An example is the lack of femur rotation outward near the bottom of a squat (almost end-ROM for most ppl) causing varus stress on the knee and possible overtension of the MCL.
Band Traction
Band traction for the knee is iffy business. If the ligamentous tissue is damaged this could result in serious pain and/or injury. Even meniscal damage can cause some pain due to the vacuum suction-like effect when pulling apart the joint space. With that said, however, feel free to give it a try. If it helps, use it. If not, avoid it.
Knee Traction #1
Wrap the knee before traction and distraction
Knee traction on swiss ball
Alternate view of traction on knee
 With this first setup you should ensure plenty of time is spent in traction before moving anything. A friend can push down on the band about midway between the anchor point and the attachment to the body to generate more tension for additional traction. Also, gradually rolling the swiss ball back underneath the knee, inches at a time, will eventually get the knee joint open and lengthened.

Knee Traction #2
This alternate setup is more aggressive and should be approached mildly at first to evaluate the appropriateness for the individual and their particular issues.
Tension on the ankle and above the knee

Additional tension by looping around the elbow and pulling upward
Be sure to use lighter bands (minis work well) to start with. This can generate serious torque forces on the knee joint if not careful. Allow to move through a range of motion for the knee before considering this done.

Band Distraction
Band distraction is very similar to traction, except the tension is less than with traction, and this is dynamic traction through a ROM essentially, where traction by itself is simply static. Move the joint around through a ROM, and use additional help moving the body/joint complex against resistance if needed. An example is Knee Traction #2, the band looped above the knee joint, that setup can be used if you arent strong enough (ie your hip flexors) to move the knee through a decent ROM against the band.
Extended in distraction

Partial flexion in distraction
   Remember, band distraction is all about movement + traction. Ensure that while in distraction, the knee can move in flexion/extension with the femur in inward/outward rotation positions as well. If you find a weakness, that is your new enemy. Kill it. If the knee is not able to flex at such a large ROM with the femur in external rotation, it looks like a 10 min squat test to free up those tissues would be a good start. Problem solving all the redundant combinations of problems for all the issues in the body is NOT something I plan on doing here for free, not could I do it accurately over the internet. So if you have a basic question, ask away. If you want me to problem solve for you (for free), you would be better off slamming your head in a door.

Knee Rehab
Knee rehab is a snake oil business at best unless you can identify what/where weaknessess are coming from.
Foam rolling and SMR should be your friend and you should identify which tissues are sensitive to the SMR and correct this sensitivity (usually due to a trigger point).
This video shows the Terminal Knee Extension (TKE) which is the basis for most knee rehab.
This video is part one of several (I think 8) and Buddy Morris is VERY knowledgeable about fixing knee issues, being a former NFL head/strength coach. He gives a good progression/regression for TKE's somewhere in one of the parts of this interview: ie watch all of them.
If this video has information you need be sure to seek out the other parts to this interview.

This video below has several good ideas for knee rehab, however, I would personally use them as a method of evaluating for problems, not necessarily the method of correcting them.

Lastly, for more information on traction/distraction, check out this:
http://www.t-nation.com/readArticle.do?id=1105903

1 comment:

  1. Very informative and impressive post you have written, this is quite interesting and i have went through it completely, an upgraded information is shared, keep sharing such valuable information. Physiotherapy Treatment

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