THE Knee is a semi-sellar synovial joint, semi- in that it allows primarily flexion and extension in one plane only. True sellar, or saddle joints allow some abduction/adduction. The human knee, though, only moves front to back, and rotates inward and outward SLIGHTLY WHEN BENT, or flexed. Problems arise when it is FORCED to rotate. There are four major ligaments that control the placement of the humerus, or thigh bone, onto the two condyles, or cups, of the tibia, the primary leg bone. The tibia condyle cups are topped with fibrous cartilage called meniscuses, or menisci. These ligaments limit the movement of the knee.

Looking at the ligaments, it is a simple but brilliant arrangement. There is one along inside, or medial, and another along the outside, or lateral. They run longwise, attaching above the knee at the side of the humerus, and below the knee at the tibia on the inside and fibula on the outside. There is also the patellar ligament that attaches to the kneecap and the tibia, but it does little to control the knee joint itself. The OTHER two ligaments are the key to the knee movement. The anterior cruciate ligament attaches from the upper inside end of the humerus and runs forward and down onto the tibia. The posterior cruciate ligament attaches from lower inside end of the tibia and runs back and up onto the femur. All things being equal, the side ligaments keep sideways movement to a minimum, and the cruciate ligaments keep the femur from slipping off the tibia.

INJURIES:
1.     Knee strain
2.     Collateral ligament sprain
3.     Cruciate ligament sprain
4.     Meniscus tears
5.     Patella strain



1.     Knee strain

As you can see in the picture , there are many other parts to the connective matrix of the knee. When the knee is forced into extreme bends, overloaded, or twisted while straight, the trauma falls on many of the parts. When no single ligament is torned or stretched, but many parts are traumatized, we call that a “strain.”

Treatment is conservative. Muscle-test the leg, using abduction and hip flexion against leveraged resistance. What did he just say? Remember, if the hip, knee, ankle, or the foot joints are misaligned, the pressure sensors of the joint will register the fact with the brain. The brain will then inhibit the muscles crossing that joint, weakening them. While the muscles are weakened, recovery of the injured joint will be slow, or not at all. That road leads to scar tissue and lingering problems.

MUSCLE TESTING THE LOWER EXTREMITY.      In order to ascertain whether the PROPRIOCEPTIVE NERVOUS SYSTEM is inhibiting/weakening the muscles, lie the patient on their back, knee locked, legs straight. Say the RIGHT KNEE is hurt. Standing at the foot of table, hold down the left ankle. Grasp the right ankle and ask the patient to push their right leg out to side against your restraint. This is “Abduction” of the leg. They should be able to push your hand to the side and lock the leg out. If not, the joints of the leg are proprioceptively weak, so are the muscles. Next, stand at the patient’s right side, left hand pushing down on the left front iliac crest. Ask the patient to lift the right-straightened-leg to a 45 degree angle. Put your right hand on the right knee and ask the patient to push up strong against your restraint. They should be able to hold your weight up, about two hundred pounds. If not, the proprioceptive system is inhibiting/weakening the hip flexors.

Back to treatment. First, get a doctor to position the thoracolumbar and lumbar spine joints to the correct place. The clinician should then adjust the hip, knee, ankle, and foot joints to the proper position. Re-test the muscles.

When they are strong, ultrasound the ligament and capsule attachments.

Now, ice the front, side, and back of the knee, 10 minutes with the cold pack on, 10 minutes with no cold pack. Repeat 3 times every 4-6 hours.

Exercise the knee with sitting leg extension; first, rotate the foot inward to 45 degrees and straighten the leg from the bent position using thera-bands, yellow for kids and small people, red for average, or green for stronger resistance. Twenty five repetitions 2-3 times a day.