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How To Use Small Knee Bends To Help Your Return To Play

In part three of this knee joint series we discussed important tissues to focus on when using hands on treatment with your knee joint patient.

Now it’s time to take the next step and begin helping your patient to bend the knee and load in different directions.

Today I’ll explain how to take those crucial first steps and introduce small knee bends into your step-by-step treatment plan…

A Solid Foundation

Your lowel level rehab and knee bends are a step in your athletes journey toward your change of direction and back to sport. At this stage you are building a solid foundation which allows progression. You do not want to be jumping from 0 to 100. It’s just part of your patient’s graded exposure.

The Second Toe Rule

At university and in placements I was always told, the knee needs to stay over the second toe. Years later, working in professional sport I had an athlete with a complex long-term knee injury. He had always been told to keep the knee over the second toe rule and he was solely focussed on that. It wasn’t until I asked him to forget this rule that we really made a difference to his life.

These rules do not work in the real world. It is impossible to keep your knee above the second toe when twisting and changing direction. So, the very first thing to remember with your rehab programme is that the knee needs to move in three planes of motion.

Single Leg Squat

Using this exercise you want to identify the strategy the athlete is using. Look at where the knee is going naturally. If you feel you want to decrease the perceived threat you want to load that knee so the nervous system can have confidence when performing these motions in the real world.

Take an athlete with an MCL injury. When using this exercise you would be looking for it to load and adapt because it will have to tolerate a load in the real world. So, instead of reaching out with your patient’s leg to 12 o’clock try getting them to go out to 2 or 3. This will put a valgus force on the knee and ensure it is moving through all planes.

Now, if you were dealing with an LCL then you could reverse this, having your patient reach out to 10 o’clock. In doing this we want to convince the knee that it is safe to load in as many different directions as possible so that when your athlete gets back to the real world then there shouldn’t be any issues.

5 O’Clock

Before you really get back into the return to play and a real change of direction you want to make sure the knee is tolerating load correctly.

Just as we did with the other one legged squats you can have your patient plant one foot then take the other to 4 o’clock, back and then to 5 o’clock. This movement is giving us a frontal plane force, a transverse plane of force and a sagittal plane of force because the knee is flexing.

Most importantly you are setting up these tissues for success and giving your athlete confidence.

Exercise Without The Pain Experience

If your patient has medial knee pain, you want the knee, hip and ankle moving and working together in the first session. This isn’t always easy as your patient could still have a pain experience when attempting a one legged squat to 12 or 2 o’clock.

In this case there are still other options to get everything working and moving together. What you can do is to set the task of one legged squat, moving the foot to 10 o’clock. This way you are getting the knee to work but without the pain experience.

Give The Body Options

So just giving the knee, ankle, and the hip options, can have massive implications on the pain experience. My outlook on this is to give the system as many options as possible.

In the first session you can begin to restore specific movements and reassure parts of the system that may not be as good at generating torque. Then, by the second and third session, we may want to come use more extensive movements.
Remember, you’re not restricted to these movements. We might be using another exercise to get the knee, ankle and hip working together. These exercises will always be the next logical step after you have performed the objective assessment and considered the patient’s full story.

Click here for more information on taking the next steps with your athlete in their graded exposure.

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