Best exercises for rotational laxity of the knee

[MWill002]

A patient with lax knees, in extension femur rotates internally and tibia externally. Ligaments are intact.

What are your best exercises for correcting that?

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[noyceguy]

This is an example of the normal screw-home mechanism of the knee, where there is IR of the femur on the tibia in closed chain in terminal extension.

 

[jesspt]

A patient with lax knees, in extension femur rotates internally and tibia externally. Ligaments are intact.

What are your best exercises for correcting that?

Uh, What?

 

[Fiveoboy11]

A patient with lax knees, in extension femur rotates internally and tibia externally. Ligaments are intact.

What are your best exercises for correcting that?

I'm not convinced there's anything wrong with that knee. If there was and the ligaments were lax I'd suggest avoining stretches of the knee and to stop rotating it like in that video. Then add balance exercises.

 

[Azimuthal]

Is there an impairment associated with the hypermobility?

 

[MWill002]

Yes, some hypermobility, few degrees hyperextension. Repetitive activity like walking causes pain, specially in this hyperextended position. Probably infrapatellar fat pad (Hoffa) and capsule pain. Probably stretching the capsule and irritating fat pad.

 

[Fiveoboy11]

When during the walking cycle do you feel pain? Talk about the circumstances surrounding the onset of your pain. I think you're assuming that hypermobility of your knee is causing your problem. That's not necessarily the case. How do you know for sure it's hypermobile? Do you have the same problem in the other knee?

 

[jesspt]

Yes, some hypermobility, few degrees hyperextension. Repetitive activity like walking causes pain, specially in this hyperextended position. Probably infrapatellar fat pad (Hoffa) and capsule pain. Probably stretching the capsule and irritating fat pad.

I don't think hyper mobility means what you think it means.

 

[jesspt]

Yes, some hypermobility, few degrees hyperextension. Repetitive activity like walking causes pain, specially in this hyperextended position. Probably infrapatellar fat pad (Hoffa) and capsule pain. Probably stretching the capsule and irritating fat pad.

So you percieve pain posteriorly? Anteriorly? Both?

It sounds like you just attended some CEU course where they discussed infra patellar fat pad syndrome.

 

[MWill002]

My bad, both knees are the same. Pain anteromedial, bit anterolateral. No trauma history. McMurray OK, ligaments ok, PFPS OK, X-ray OK, ROM 4-0-heel-almost-touches-posterior-thigh, genu varum, some overpronation from feet, very little pes valgus, pes anserina OK, muscle tests don't provoke pain.

Pain comes at terminal stance phase, specially in the end of it while the knee is mostly extended - then rotation is seeable. Less pain while avoiding full extention while walking.

 

[Fiveoboy11]

Maybe try : no stretching of calf/hamstring + strengthen calf/hamstring + ice + tape top (as in superior portion) of patella in extension + nsaid

 

[Azimuthal]

My bad, both knees are the same. Pain anteromedial, bit anterolateral. No trauma history. McMurray OK, ligaments ok, PFPS OK, X-ray OK, ROM 4-0-heel-almost-touches-posterior-thigh, genu varum, some overpronation from feet, very little pes valgus, pes anserina OK, muscle tests don't provoke pain.

Pain comes at terminal stance phase, specially in the end of it while the knee is mostly extended - then rotation is seeable. Less pain while avoiding full extention while walking.

What's his beighton score? You mean ligaments intact versus "ok"? If hypermobile, ratings?

I guess this is more confusing to me as I did not perform the physical exams. If IR of the femor occurs at that stage, I would expect to see a valgus moment and over pronation.

Or hips may be retroverted with compensation or adaptation? How do hips look?

Too many questions.

If it's notable that IR occurs during terminal stance, during decreasing glute max, increasing psoas activation, perhaps look into the developing glute max and other hip ER's, along with hamstrings and gastrocs. Stretch TFL if needed.

 

[jesspt]

Why is this something other than patellofemoral pain syndrome?

 

[Fiveoboy11]

Why is this something other than patellofemoral pain syndrome?

I wonder:
if the pain is on the sides of the patella (he said medial and lateral) or medial and lateral to the patellar tendon?
if there is pain in TKE with and without quad activation or one or the other?

Sounds like no pain with maximum pressure retropatellar as in with quad MMT or squat. Does kneeling hurt? Any popping or clicking of the patella? You'd think with patellofemoral pain syndrome he'd have a lot of pain with prone knee flexion end range.

Maybe give the guy the benefit of the doubt. PFPS doesn't make sense to me but maybe something from the feet or hips too.

 

[jesspt]

I wonder:
if the pain is on the sides of the patella (he said medial and lateral) or medial and lateral to the patellar tendon?
if there is pain in TKE with and without quad activation or one or the other?

Sounds like no pain with maximum pressure retropatellar as in with quad MMT or squat. Does kneeling hurt? Any popping or clicking of the patella? You'd think with patellofemoral pain syndrome he'd have a lot of pain with prone knee flexion end range.

Maybe give the guy the benefit of the doubt. PFPS doesn't make sense to me but maybe something from the feet or hips too.

PFPS is the most common pain condition affecting the knee. His pain is anterior.
When I hear hooves, my first thought is horses, not zebras. Knee capsular laxity seems like a zebra to me. Am I alone?

 

[truthseeker]

I'm with you man, mainly because you are a scientist

 

[Fiveoboy11]

PFPS is the most common pain condition affecting the knee. His pain is anterior.
When I hear hooves, my first thought is horses, not zebras. Knee capsular laxity seems like a zebra to me. Am I alone?

I don't know that you've scientifically proven it's pfps...

The OP said "PFPS ok"

Doesn't look like you're using the scientific method to me, lots of factors point away from what you're saying.

 

[truthseeker]

the point is , it is impossible to reliably evaluate a patient - via second hand info - from a source we don't know - on the internet.
I just told a student of mine that knee pain that comes on without obvious trauma is patella-femoral syndrome until proven otherwise.

 

[Fiveoboy11]

the point is , it is impossible to reliably evaluate a patient - via second hand info - from a source we don't know - on the internet.
I just told a student of mine that knee pain that comes on without obvious trauma is patella-femoral syndrome until proven otherwise.

It's not impossible but it's also not perfect. Everyone thinks the gold standard is in person but I think we'll begin to see more and more assessment and treatment in healthcare without face to face interaction. What percentage of people do you think actually see a PT that would benefit from at least an assessment? As it currently stands folks likely tend more to seek the opinion of family/friends and themselves more than anything. So, I'm all for telehealth or any variant of it. It's quicker and cheaper. Especially as a PT and a patient I could see how it could be nice. The APTA is on board with it, businesses are springing up, state laws are being changed. Let's also keep in mind that the reliability between PT's doing a traditional evaluation on the same patient is likely very poor. The POC's are likely therefore to vary widely as well. PT's can't even have good reliability in measuring a joints ROM. So I think your reliabilty argument is nonsense. I also disagree that a patient with knee pain has pfps until proven otherwise, regardless of how you assess them.

 

[jesspt]

I don't know that you've scientifically proven it's pfps...

The OP said "PFPS ok"

Doesn't look like you're using the scientific method to me, lots of factors point away from what you're saying.

I didn't say that I've scientifically proven that it is PFPS. I said that the patient in question has some anterior knee pain, which, much like Truth says below, is PFPS until it is proven otherwise.

PFPS ok - I don't know what that means. It could mean that he is using an outdated model of PFPS diagnosis and using an unreliable test, such as patellar tracking to determine his PF joint is clear. Perhaps not. Most of the OPs information is vague and most of the information they provide adds little value in determining a diagnosis and plan of care.

the point is , it is impossible to reliably evaluate a patient - via second hand info - from a source we don't know - on the internet.
I just told a student of mine that knee pain that comes on without obvious trauma is patella-femoral syndrome until proven otherwise.

Yes. This.

Does anyone on this board who treats patients think they have ever seen a patient who has the symptoms as described above and felt the primary impairments were knee capsular laxity?

 

[Fiveoboy11]

I didn't say that I've scientifically proven that it is PFPS. I said that the patient in question has some anterior knee pain, which, much like Truth says below, is PFPS until it is proven otherwise.

I could buy that given the opportunity to test hypotheses. That requires the person to return and provide info that you want and clarify. In other words, if he doesn't return by your line of reasoning he has pfps. That doesn't hold up. You haven't proven or disproven it have you? Do we ever even know for sure in most cases? Looks like it's definitely not pfps until proven otherwise. Nonspecified anterior knee pain until specified otherwise makes more sense to me.

PFPS ok - I don't know what that means. It could mean that he is using an outdated model of PFPS diagnosis and using an unreliable test, such as patellar tracking to determine his PF joint is clear. Perhaps not. Most of the OPs information is vague and most of the information they provide adds little value in determining a diagnosis and plan of care.

I don't either but I would certainly give some weight to it not being pfps if he writes "pfps ok" versus completely disregarding it like you have.


Yes. This.

Does anyone on this board who treats patients think they have ever seen a patient who has the symptoms as described above and felt the primary impairments were knee capsular laxity?

No. Do you see patients often with pfps who you feel have a primary impairment of knee capsular laxity?

 

[jesspt]

No. Do you see patients often with pfps who you feel have a primary impairment of knee capsular laxity?

Of course not. I don't see any patients with any knee pain who I feel have capsular laxity, especially if the symptoms are of non-traumatic onset, with intact ACL, CPL, MCL and LCL.

The OP hasn't seen a patient with knee capsular laxity either. The just think they have.