REBRIEF

KNEE JOINT ASSESSMENT

This article follows on from ‘What’s Your Problem?’ published in January’s issue of sportEX dynamics. This article also fea- tured a series of assessment forms for massage practitioners to use in sporting competitions. The next issue will feature an article on ankle assessment.

By Joan Watt, MCSP, MSMA

INTRODUCTION There are always two parts to be considered in any assessment:

1. Subjective - ensure you have obtained all the relevant history and completed all required formalities (subjective assessment was covered in detail in the Jan ‘07 issue of sportEX dynamics and was accompanied by a range of range of assessment forms) 2. Objective assessment involves observation, measurement, specific testing and functional activities and then progresses to pal- pation and specific examination, not forgetting to check any equip- ment or footwear needed for activities.

OBSERVATION Looking at the knee joint observe the person walking, standing, getting up from the seated position, stair climbing and into functional activities such as car entry and exit, cycling, running or whatever activity pertains to the person being assessed.

Look at the knee joint specifically for: ■ Asymmetry

■ Popliteal swelling

■ Arthritic bony changes ■ Genu varum (bow legs) ■ Patellar alignment and position

■ General effusion ■ Any sign of injury

■ Genu valgum (knock knees) ■ Genu recurvatum (hyperextension)

Always make sure to check the feet as well. Check for pes planus (flat feet), pes cavus (high arch), valgus or varus of forefoot and hindfoot and any restrictions of movement.

MEASUREMENT Range of movement ■ Flexion 145o

-150o ■ Internal rotation 5o

Muscle strength tests Muscle strength testing can be extremely useful use your own resistance if no machines are available.

■ Quadriceps - sit the patient on the edge of couch, start with the knee at 90o

of

flexion and ask them to extend against your pressure applied onto the tibia

■ Hamstrings couch, knee flexed to 20o

the patient lies prone on to 30o

, ask to

flex against your resistance applied just above the ankle

■ Gastrocnemius - patient supine on couch, knee in extension, instruct to plantar flex against your resistance applied to the sole of the foot

■ Test hamstring flexibility - patient supine on couch with leg extended and raised. Extension indicated by the amount of stretch available

■ ITB stretch - patient in side lying with lower knee bent as high as possible. The practitioner stabalises the pelvis and extends the leg backwards and then drops the leg downwards. The extent of the extension and abduction indicates flexibility.

waddling forward. If the person is unable to get into squat at all, cannot waddle, or experiences pain while trying, the test is positive. Further testing is then required to give the reason for this result.

Always remember joint pain may also be caused by muscle problems affecting the muscles acting on that joint.

FURTHER READING ■ Physical Assessment Dr Nikita A. Vizniak by Professional Health Systems. ISBN 0973274255

■ Principles of Manual Sports Medicine by Steven J Karageanes, Lippincott Williams & Wilkins. ISBN 0781741890

■ Hands on Sports Therapy by Keith Ward. Thomson Learning. ISBN 1861529201

■ Extension 0o -5o ■ External rotation 5o

Patellar mobility Ideally the patella should lie laterally in full extension, move medi- ally during midrange flexion and then return to a lateral position when the knee is fully flexed.

A good start point for knee joint testing is to ask the patient to do the waddle walk – this involves assessing the person going into full squat, thigh and calf in contact if possible and then

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THE AUTHOR Joan Watt, MCSP, MSMA is a chartered physiotherapist and sports massage practitioner. She has worked at numerous Olympic and Commonwealth games, continues to travel widely as both a practi- tioner as well as a manager and is currently manager of the GB Shooting team.

■ What’s your Problem? – Article – assessment overview, poster and accompanying printable injury report forms ■ Record Taking – Article – Make sure your’re covered

INTERACTIVE sportEX dynamics 2007;12(Apr):14-15