precautions - ruptured post cruciate ligament

[neuromuscular]

If there is no cause of the problem other than the torn PCl, you may consider how the hip is impacting on the knee as Hoppenfeld and others infer.

You might see if there is a hip imbalance by landmarking the ASIS to ASIS and having the patient do hip abduction directly lateral in the coronal plane and note if there is a superior or inferior movement of either or both of the ASIS

Then do an ASIS to PSIS on each side with the patient doing a hip abduciton directly lateral in the coronal plane. If either or both are moving into anterior or posterior rotation, the hip may be affecting the knee by extra pressure to it. That is my area of research.

I find that many patients with a knee problem are having an effect on the knee from the hip

For more ideas on the PCL you might contact a sports injury practitioner.

Hope this is of help.

Best regards,

Neuromuscular.

[Fyzzio]

I find that many patients with a knee problem are having an effect on the knee from the hip

I might have not stated it clearly: my client DOES NOT have a knee problem.

And I am aware of your research project, as you comment on it in nearly every post.

But you are completely right, I will contact a sports injury Physio to ask for precautions or don'ts in regards to an unfunctional PCL.


Thanks for all. Cheers,
Andrea

[Hunter_PT]

hahaha...thank god someone told neuromuscular to shut up about his damned research project! NO....ONE....CARES!

[Fyzzio]

Hunter,
maybe you should think twice before you post replies ....
You are misinterpreting what I wrote, your comments are rude and your attitude is appalling.
Regrads,
Fyzzio

[msk101]

HI Fyzzio,

As far as precautions go for a PCL deficient knee they are similar to ACL. Avoid sharp or steep declines that require maximal eccentric quads loading and exert a shearing force on the knee, also a full squat is not ideal as you've already covered. I would also not recommend high velocity kicking (eg a ball or karate style) although it doesn't sound like something your client would be doing. The other thing to watch for is open chain full knee extension due to the shearing forces as well, similarly with high loading hamstring curls from a full knee extension position ... make sure the quads are active as well... start from a 10degree flexed position if you're going to do this as an exercise, however i'd suggest there are more functional closed chain exercises that would be better for you client.

People can quite happily live without a PCL but i would emphasise quads and hamstring co-contraction coordination and strength to increase muscular stability of the knee. I wouldn't encourage the patient to full lock weightbear on the knee because without a PCL that will exert considerably more force on the ACL and isn't ideal when it comes to unlocking.... locking a PCL deficient knee is actually more like hyper extension locking which i would avoid. Avoid pivoting or twisting on that leg as well. Go for muscular strength and cocontraction with quads and hams.

Hope that helps.

Cheers
Msk101

[Fyzzio]

Thanks, mate,
that was great advise!!!
Cheers,
Fyzzio

[neuromuscular]

I might have not stated it clearly: my client DOES NOT have a knee problem.

And I am aware of your research project, as you comment on it in nearly every post.

But you are completely right, I will contact a sports injury Physio to ask for precautions or don'ts in regards to an unfunctional PCL.


Thanks for all. Cheers,
Andrea

Dear fysio:

MSK101 makes some very good points. The joint is mechanical and your expertise is in nerurological. The mechanical aspects are compromised with the PCL restraint gone. The mechanical pressure and vectors of force will be to hyperextend the joint.

You might add to the obvious that your client will have muscle loading and recruitment problems in that the muscles will try to splint or brace the joint. You might consider not just strengthening exercises, but also keeping the proper tonus and balance in the muscles over the joint.

My reference to the hip is that knee problems, ie lack of support, create changes in gait that work themselves through the body in less obvious ways. ( see Hoppenfeld and others.) My reference to the hip assessment is that this should not be overlooked.

Sorry about the negative remarks about my research, but the research has gone beyond me as the OGI, or Ola Grimsby Institute is preparing a research paper on it. I am out of the picture on this as the research is being finished in the USA by another person. The relevance of it to your problem is that it will show if your client is having gait and postural adaptions to his weakened stuctural problem.

Hope this is helpful.

My best to you,

Neuromuscular.