Knee Joint Assessment
In this knee joint series we have covered everything from your hands-on treatment to changing direction. This is all well and good but if you can’t make sense of your assessments then the rest of the process is lost.
In the mentorship I teach just how key these initial assessments are. Today, I want to bring a few core elements of the knee assessment to your attention.
From my clinical experience the sweep test is incredibly powerful. Whenever I have sent athletes for an MRI, the sweep test has been a key indicator for detecting a knee effusion.
First and foremost you want to go down into where the VMO attached. From there you sweep up and come down the vastus lateralis. What you will see if a knee effusion is present, you’ll see a pocket of fluid emerge in the space where the VMO attaches.
This is an incredibly useful Key Performance Indicator (KPI) to progress your athlete. If the knee effusion is acute I tend to steer away from letting athletes train. Of course, there is some literature out there which says you should but for me it doesn’t sit comfortably. Is the risk really worth the reward?
I’d encourage you to use the sweep test on a session by session basis. Ideally if there is a knee effusion present then it really should be gone by the second or third session. If it continues to hang around then we need to think, why could the nervous system be causing the effusion?
In 10 years of work in professional sport have never had a positive McMurray’s or Apley’s. This is exactly what I meant in part one by saying these special tests aren’t really that special. It all depends on you to put the whole thing together, the mechanisms, injury history and the individual athletes story.
One thing I do find to be very valuable clinically is overpressure and you should not be afraid to use it. With overpressure we are stressing the anterior meniscus. You’re stressing the posterior compartments of the meniscus. If there is a knee joint effusion and joint line tenderness, they will have a pinch in the back of the knee then it can lead you to think that maybe the meniscus is irritated.
Another KPI I use to tell how stable or unstable this issue is, is how quickly the knee joint effusion and the pinch at the back of the knee takes to settle in the next session. Very often time can help take the effusion down.
I have seen so many students try to test the MCL and just go through the basic motions. What you need to do is find and gap the jointline on the inside. When you stress the MCL you want to have intent. As you push you need to gap the medial joint line and see if there is a pain response.
You can do this dynamically or in flexion. However, if the knee is in flexion there will be some rotation in the knee when you try to gap it. If you do it dynamically, that force applied will be going into the frontal plane if you flex it will be into the transverse plane.
If you do this test and the gap is large do not panic. If an athlete has had issues with their MCL in the past it will often stick around and give you a positive test.
There are a few differing ACL tests and everyone has their own favourite. For me the lachman test is very powerful in my knee assessment arsenal.
Many other people prefer anterior draw. If you are performing this test then you need to compress and take off the tendon. This will help the hamstring and gastrocs to relax so you can get a real end feel. Again you want to give it force. I would rather be aggressive than not be aggressive enough and miss something.
If you do this test straight after the athlete has come in from the field, do not panic if you do not get an end feel. The hamstrings are prone to going into protective tension, you can often find a false-positive.
In my experience these are the key areas you’ll want to test in your knee joint assessment. Of course, there are other special tests but these should be the fundamentals for any therapist.
As you move on and progress with your athlete you can start actively looking for and clinically reasoning toward the true cause of the issue. Perhaps other tests like considering the difference between the range in motion between prone and supine can begin to lead you toward the true stressor.
It is important to be clear from the start on how your assessment will work and how to make sense of any tests you perform.
Of course, it is your chance to treat the 20% and reduce the symptoms but it is really an opportunity to start working on the 80% and finding the true cause of the issue.
If you want more information on treating even the most complex of knee joint problems click here.