I’ve got a few video clips for you.
One of the clips is from last month’s Injury of the Month on meniscus tears.
The second one is from Assessment & Exercise.
Meniscus Tears and Squatting
In the above video, I go through the importance of a vertical shin if you or your client has a meniscus tear.
It is a very important clip from the video presentation from Meniscus Tear Solution.
If you are unable to watch or listen to the video above, check out the transcription below.
Now, this is a really important part when it comes to the do’s and don’ts for a meniscus tear. The importance of keeping the vertical shin. So if we look at a vertical shin, so the foot’s flat on the floor, the shin is perpendicular to the floor. Keeping that vertical shin, it decreases the flexion, range of motion that ends up occurring in the knee. So if I have the knee come forward what ends up happening is I get an increase in knee flexion. And as I end up having more knee flexion, I end up having more stress on that meniscus. If I keep that vertical shin, I’m going to put less stress on that meniscus. If I also keep that vertical shin, I’m also going to put less stress on the patella femoral joint so that patella coming up against the femur and that ends up being an issue when it comes to something like the runner’s knee, patella femoral pain syndrome. I can end up having a small negative slope, that’s okay. A negative slope would mean the knee being back and the shin being at an angle like this as opposed to a positive slope which would be like this.
Another thing is, if I look at this paper, if my center of gravity ends up being neutral when I’m doing like a squatting movement, so relatively over my feet, I end up having a balance between the activation of hamstrings and quadriceps. If I shift my center of gravity more anterior, I end up having an increase in the hamstrings, which ends up putting more stress within that knee joint. Also, if I move in that anterior center of gravity shift that ends up creating more of a positive slope in the shin. What I end up having is more of a weight shift occurring in that femur, creating more compressive forces occurring in that knee joint because my weight is wanting to slide forward. Now, if I end up moving my center of gravity more posterior like I am in this picture: vertical shin, center of gravity’s more posterior, I get less hamstring activation. So I’m getting less shear occurring in that knee joint. I really do enjoy this exercise when it comes to the knee, specifically meniscus tear or a meniscus injury. And I’ll end up going through this in detail more in the exercise part of the Meniscus Tear Solution Program.
Other important thing is, the meniscus is a secondary stabilizer for the ACL. With the hamstrings being activated, it ends up pulling on the knee and creating more compressive forces happening within that knee. And then also that hamstring ends up assisting that ACL when it comes to preventing any anterior translation of that shin.
So summarizing things, we want to do exercises that involve a vertical shin because it ends up decreasing the flexion range of motion that is happening in that knee, which is good. The more flexion we have, the more stress that it ends up putting in that knee joint, puts less stress on the patella femoral joint which is good. And then we’re looking at having like a weight shift more posterior to decrease hamstring activation. And then also to prevent any type of that weight shift forward, positive vertical shin, leading to more shear occurring in that knee joint.
So I hope that makes sense and I hope I kind of highlighted the importance of that vertical shin, especially when it relates to meniscus tear injury, when it relates to the exercise side of things.
If you or your client has a meniscus tear, you can check out my Meniscus Tear Solution:
Now onto the second clip.
Screw Home Mechanism of the Knee
In the above clip, I highlight why it is important to work on terminal knee extension.
If you are unable to watch or listen to the interview above, check out the transcription below.
Okay, going to this lack of extension. Why the lack of extension is really an issue? If we lack that extension we are missing the “Screw Home Mechanism” of the knee. So this ends up being the last little bit of the knee or you end up having rotation going on in the knee and gliding in the knee going on in order to reduce the stress on the quadriceps during standing and put load on the cartilage, menisci and bones. So if we look at it here, when we reach that last little bit of extension, the load is moved off of the muscles and it’s moved on to the passive structures. So it ends up being loaded up on the femur, the tibia, the articular cartilage, the menisci. They end up taking a load and decreasing the stress and demand on the muscles and secondarily onto the ligaments.
An example would be if you look at the flamingo. When the flamingo stands on one leg, the leg is perfectly loaded and all the load is being put on the passive structures. Now, some people may think, “Oh, that’s bad. You’re not supposed to load up a joint”. You’re bringing the joint to straight or to neutral, you’re sticking within normal ranges of motion. Everyone should be able to control their body weight or at least hold their body weight on one leg. If they’re not able to do that statically, it’s going to be difficult for them to even walk if they can’t hold up their weight on one leg.
And then that over activation of the quadriceps and other muscles in the leg, it ends up leading to you know fatigue, more susceptibility to injury and leads to more muscle imbalances. So it’s important to consider that end range extension and looking at that end range extension when we’re talking about unloaded, partially loaded and fully loaded.
Now, I suggest you try this. Try to stand on your leg with the knee bent in like 5, 10,15 degrees of flexion and see how it feels for a long period of time. Try for 30 seconds, 1 minute, 2 minutes, 3 minutes. See how it is when those active structures are loaded up for a long period of time. And then try with the leg fully straight or maybe a little bit of hyperextension and see how it is and see how those muscular structures are when it comes to, are they relaxed? And they will be rather relaxed.
Just to give you an update, I have added CECs and CEUs to Assessment & Exercise:
If you would like to get Assessment & Exercise with CECs/CEUs, click here.
Have a great day.
Rick Kaselj, MS