The tibiofemoral joint is comprised of the convex femur and concave tibia which move along a coronal axis during flexion and extension. Internal rotation occurs in a transverse plane and abduction and adduction occur in a coronal plane. Within the knee are four main stabilizing ligaments: MCL, ACL, LCL and PCL.
Below is a link to The Institute for Arthroscopy & Sports Medicine in San Francisco's ACL reconstruction protocol, where Dr. Jeffrey Halbrecht is the Medical Director.
Obtaining an accurate diagnosis of glenohumeral instability can be difficult, therefore several points must be considered when assessing the patient. A thorough history and clinical examination are necessary as radiographs typically do not provide additional information. Asymptomatic shoulder laxity must be differentiated from symptomatic instability. Other pathological conditions may be present, such as rotator cuff impingement. No single test may be used to diagnose glenohumeral instabilities.
A thorough subjective evaluation will assist the examiner in identifying the often vague symptoms associated with nontraumatic glenohumeral instability. Symptoms may include activity related global pain, aching, looseness and reports of slipping of the joint. Transient neurological symptoms may be reported and must be differentiated from cervical radiculopathy and thoracic outlet syndrome. Anterior instability may be present with pain with overhead activities or when the shoulder is in an abducted and externally rotated position.
between the asymptomatic and asymptomatic
Ligamentous hyperextensibility should be assessed using the Beighton scale. A score ≥ 4 out of 9 indicates generalized joint laxity.
Achilles Tendon Rupture
... Slowly increased training intensity
Since injuries to the Achilles tendon often occur when tr…
Slowly increased training intensity
Since injuries to the Achilles tendon often occur when training intensity is abruptly increased, intensity should be increased by no greater than 10% each week. Beckham tear/ repair Video:
Anderson, K., (2004). Achilles Tendon Rupture / Repair Protocol. William Beaumont Hospital.
... Chris, Gabriel. “Functional Testing and Return to Sport.” OrthoCarolina Sports Performance. We…
Chris, Gabriel. “Functional Testing and Return to Sport.” OrthoCarolina Sports Performance. Web 16 Apr. 2012 http://www.hickoryortho.com/uploads/file/Functional%20Testing%20and%20Return%20to%20Sport%20-%20Chris%20Gabriel.pdf.
Denney, Linda. (2012, February 28). The Knee [powerpoint]. Musculoskeletal III. Kansas City, KS.
Jarosz, Brett S., and Rick A. Ames. "Chiropractic Management of a Medial Meniscus Tear in a Patient with Tibiofemoral Degeneration: A Case Report." Journal of Chiropractic Medicine 9.4 (2010): 200-08. PubMed. Web. 16 Apr. 2012. <http:www.ncbi.nlm.nih.gov/pmc/articles/PMC3206581/>.
"Meniscal Tears - OrthoInfo - AAOS." American Academy of Orthopedic Surgeons. AAOS, Feb. 2009. Web. 16 Apr. 2012. <http://orthoinfo.aaos.org/topic.cfm?topic=a00358>.
-Take caution when initiating rapid deceleration with plyometric drills
-Addition of external resistance does not appear to increase ACL loading with WBing exercise
The most common reason for poor outcomes following ACL reconstruction is failing to regain full extension range of motion. Inability to gain full extension can cause an increase in patellofemoral contact pressure, increased scar adhesion in the anterior aspect of the knee and poor movement quality. There are several ways to increase extension motion, including PROM, supine heel props, and gastroc stretching. Two additional methods are pictured below: