PHYSICAL THERAPY

Passive knee flexion test Lift the knee slightly toward the chest and gently flex the knee by bringing the heel toward the buttock. If you reach the buttock without pain or limitation, give the foot a slight push toward the buttock. If the knee is swollen you will not be able to bring the heel to the buttock, so do not force it. If the motion is limit- ed, check the other knee to see that it is not just the person’s natural structure.

Figure 3: Passive knee flexion test

Passive knee extension test Place one hand under the Achilles tendon and the other hand above the knee. Now press down with the hand above the knee, while simultaneously pulling up with the hand under the Achilles. You are gently, passive- ly trying to straighten the knee. If the knee is swollen, movement will be slightly limited and/or painful.

the knee is taut, give it a slight extra push. If there is still no pain, slide the leg off the table laterally and repeat the test with the knee slightly bent (about one inch).

Figure 5: Valgus knee stress test Figure 4: Passive knee extension test

Valgus stressing of the medial knee Standing next to the knee facing the person’s head, place your outer hand on the lateral aspect of the knee with your fingers just under the knee. Then, place the palm of your inner hand on the medial ankle as shown in the photograph. Now apply a shearing force in opposing directions to stress the medial knee. In other words push laterally with the hand on the medial ankle and medi- ally with the hand on the lateral knee. If there is no pain when

Varus stressing of the lateral knee Facing the client’s head, place your outer hand on the lateral ankle. Then place your inner hand on the medial knee with your fingers just under the knee. Now apply a shearing force in oppos- ing directions to stress the lateral knee, that is, press laterally with the hand on the medial knee and push medially with the hand on the lateral ankle. If there is no pain when the knee is taut, give it a slight extra push. If there is still no pain, repeat the test with the knee bent only one inch by slipping the leg off the table. If the valgus test or the varus test causes pain, you have verified a strain of the medial collateral or lateral collateral ligament respectively. It should hurt where the person normally feels pain. If the injury is severe, you have to exert only a small amount of pressure during the test. If it is mild, you must exert more pressure. If passive flexion and/or passive extension are painful or limited in the ability to move through a full range of movement it means that there is some swelling accompanying the collateral ligament

injury.

Collateral ligament injuries are often accompanied by a tear of a ligament that attaches the meniscus to the tibia (the coro- nary ligament). These two liga- ments are often injured simulta- neously.

Figure 6: Varus knee stress test

PRINCIPLE: HEALING INJURED TISSUES Most of the body’s healing processes proceed without our con- scious direction. When musculo-skeletal structures are damaged or torn, the body’s wisdom ensures that the damage, whenever possi- ble, will be repaired. However, to a large extent the degree and quality of this repair depends upon our own participation. The nat- ural mechanisms of inflammation and wound healing are usually excessive for the job at hand. The body over-compensates when it responds to injury. More plasma, red and white cells, blood platelets and chemical mediators are released than are actually needed to allow full healing to occur. Therefore, addition- al scar tissue is likely to form. This scar tissue often binds togeth- er damaged and undamaged structures, resulting in adhesions that, as we have seen, can lead to re-injury and to chronic pain.

There are several methods by which we can help the body limit the formation of adhesive scar tissue and/or recover from adhesions that have already formed. The first of these methods is friction therapy. A therapist applies cross-fibre friction therapy in a con- trolled manner to break up specifically targeted areas of adhesive scar tissue. When friction therapy is accompanied by the second method, healing in the presence of a full range of motion, healthy tissue can grow without the re-formation of adhesions. This means that in order to heal properly, the body part must be regularly moved through its full range of movement during the healing process so that adhesions do not form. If the injured person is able to collaborate with the body’s healing processes by adequate

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