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.
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 significant clip from the video presentation from Meniscus Tear Solution.
If you cannot watch or listen to the video above, check out the transcription below.
This is an essential part of the dos and don’ts for a meniscus tear—the importance of keeping the vertical shin. So if we look at a vertical shin, the foot’s flat on the floor and the shin is perpendicular to the floor. Keeping that vertical shin decreases the flexion and range of motion 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 have more stress on that meniscus. If I keep that vertical shin, I will put less pressure on that meniscus. If I also maintain that vertical shin, I’m also going to put less stress on the patella-femoral joint. The patella that comes up against the femur is an issue when it comes to something like the runner’s knee, patella-femoral pain syndrome. I can end up having a slight 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 like this.
Another thing is, if I look at this paper, if my center of gravity ends up being neutral when I’m doing 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 anteriorly, I have an increase in the hamstrings, which puts more stress on that knee joint. Also, if I move in that anterior center of gravity shift, that creates more of a positive slope in the shin. I have more weight shifts occurring in that femur, making more compressive forces occur in that knee joint because my weight wants to slide forward. If I end up moving my center of gravity more posterior like in this picture: vertical shin, the center of gravity’s more posterior, I get less hamstring activation. So I’m getting less shear occurring in that knee joint. I enjoy this exercise for the knee, specifically a 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.
Another important thing is that the meniscus is a secondary stabilizer for the ACL. With the hamstrings being activated, it pulls on the knee and creates more compressive forces 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 decreases the flexion range of motion that is happening in that knee, which is good. The more flexion we have, the more stress it puts on that knee joint, which puts less pressure on the patella-femoral joint, which is good. And then we’re looking at having a more posterior weight shift to decrease hamstring activation. And then to prevent any that weight shifts forward, positive vertical shin, leading to more shear occurring in that knee joint.
So I hope that makes sense, and I hope I highlighted the importance of that vertical shin, especially when it relates to meniscus tear injury and 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 working on terminal knee extension is essential.
If you cannot watch or listen to the interview above, check out the transcription below.
Okay, we are going to this lack of extension. Why is the lack of attachment an issue? If we lack that extension, we are missing the “Screw Home Mechanism.” So this ends up being the last little bit of the knee, or you end up having rotation in the knee and gliding in the knee going on to reduce the stress on the quadriceps during standing and put a load on the cartilage, menisci, and bones. So if we look at it here, when we reach that last little bit of extension, the bag is moved off of the muscles and moved on to the passive structures. So it ends up being loaded up on the femur, the tibia, the articular cartilage, and the menisci. They take a load and decrease the stress and demand on the muscles and secondarily onto the ligaments.
An example will 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. Some people may think, “Oh, that’s bad. You’re not supposed to load up a joint”. You’re bringing the joint 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 even to 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 leads to, you know, fatigue, more susceptibility to injury, and more muscle imbalances. So it’s essential to consider that end range extension and look 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 an extended period. Try 30 seconds, 1 minute, 2 minutes, and 3 minutes. See how it is when those active structures are loaded up for an extended period. And then try with the leg entirely 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 relatively simple.
To give you an update, I have added CECs and CEUs to Assessment & Exercise:
Click here if you would like to get Assessment & Exercise with CECs/CEUs.
Have a great day.
Rick Kaselj, MS