I just want to show you here a very nice and relaxing way to stretch the iliotibial band. It is a little more effective than some of the standing, weight-bearing positions that you often see. Although it does require that the person think ahead and not think that they are going to do it right before the hop on the track or head out in the neighborhood. Another good way to stretch hamstrings is just to lie up against a wall. We encourage people to maintain these positions for 15-30 seconds and practice some relaxation breathing. You can do the hamstring stretch bilaterally as well as unilaterally. Much better than having an assisted hamstring stretch.
What I want to show you here is really the rationale for why therapists choose to do the kind of knee exercises that they do. Here we are talking about open and closed kinetic chain. The leg press, which is the dark line here, is a closed kinetic chain. As you can see, what happens with patellofemoral joint compression, as you move from extension to more flexion – here, almost 90 degrees – you get a steady increase in patellar compressive forces. On the other hand, if you are talking about seated leg extension, which is an open kinetic chain exercise, what happens there is just the opposite and as you move from complete extension to flexion you actually get a decrease in patellar compressive forces. They meet here in the middle, somewhere between 40-50 degrees. So when we are choosing knee strengthening exercises for someone who is experiencing pain on up and down stairs, or up and down grades or in squatting and knee bending, the guidelines for clinical choices are to try to decrease pain that comes from patellar compression and to try to strengthen the quadriceps so it is not inhibited by pain. Some of the things that we do in that case are functional strengthening. You see we call it a wall-slide or a squat. In this case the person would do it only to about 45 degrees and many people will tell you that if they try to go lower than that, that’s when they start to have knee pain. So we try to strengthen functionally in this position. Once they are doing well with that we might go to one-legged activity, put them on a Bapp’s board. But still you don’t want to go past – as long as they are in pain – you don’t want to go past that point of knee flexion pain. Another example here. Bob and I keep trying to turn her the other way, however this really is correct. This is closed kinetic chain on a leg press and once again, you would try to encourage her not to do deep knee-bending but to stay at the other end of the range. We will follow her monthly for a period of months, trying to monitor her to make sure that she is making progress and check back in with us.
Probably what we are seeing here, and what our bottom line would be is that people with fairly good lower extremities very often start to have a problem when the increase in activity or demand outstrips the conditioning of the neuromusculature and they need time to back off a little bit and get in condition and get in shape for what they are doing.
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