PT on the Net Research

Dislocated Patella


Question:

I have a new client who recently dislocated his patella. His knees hyperextend and need corrective stabilization. Your thoughts please.

Answer:

As always, I will begin by making mention that referring out to a sports medicine professional is the first step. Rehabilitation may be necessary before any fitness training begins. That being said, let's look at your client's knee injury and instability from a kinetic chain standpoint.

Assessing your client's static (standing) and transitional (overhead squat) posture, as well as doing at least a basic muscular balance assessment (flexibility/ROM) will be vital to your success. Research has shown that certain common muscular imbalances can contribute to injuries such as those experienced by your client. If you're not familiar with these assessment techniques, I would recommend reading the "related articles" at right. These three articles will introduce you to a systematic method of discovering serial postural distortion patterns in your clients. After all, the "program" is only as good as the "assessment!"

Research has also shown a correlation between restrictions in function at the hip and ankle joints and knee injury such as in pronation distortion posture. During your static and transitional phase of the assessment, you may notice excessive knee adduction and internal rotation as well as excessive foot pronation and external rotation (flat feet). Likewise, during your muscular balance/flexibility phase of the assessment, you may notice decreased hip extension as well as decreased ankle dorsiflexion and inversion (supination). Here is a guide to understanding the muscles that commonly cause these patterns:

To learn more about progressing your client from stability based exercises to strength and finally to power, check out Mike Clark's series "Essentials of Integrated Training" (under "related articles" at right).