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11/19/2010
1
Unraveling the Mystery of Cervical Pain #2:
Client History & The 23 Injuries
Common to the Knee
Unraveling the Mystery of Cervical Pain #2:
Client History & The 23 Injuries
Common to the Knee
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.
11/19/2010
2
Webinar GoalsWebinar Goals
• Understand the significance of each part of the client history and the 23 most common knee injuries
• Understand the significance of each part of the client history and the 23 most common knee injuries
LogisticsLogistics• Time: 60 minutes
• Schedule:
• Presentation 40-45 minutes
• Questions 15–20 minutes
• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.
• Get a pen and paper please
• Time: 60 minutes
• Schedule:
• Presentation 40-45 minutes
• Questions 15–20 minutes
• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.
• Get a pen and paper please
PretestPretest1. If there is swelling in the knee, it is most likely a ligament or
joint injury. True or False?
2. There is no referred pain in the knee. Generally, where it hurts is where it is injured. True or False?
3. When the knee gives way, it usually means there is an injury to the meniscus. True or False?
4. When there is a patella tendon injury, it hurts most when going down stairs. True or False?
5. When the knee locks in flexion, it means there is a loose piece of bone or cartilage in the joint. True or False?
6. If a deep knee bend causes a grating, grinding sound, it is very likely that the person has chondromalacia. True or False?
1. If there is swelling in the knee, it is most likely a ligament or joint injury. True or False?
2. There is no referred pain in the knee. Generally, where it hurts is where it is injured. True or False?
3. When the knee gives way, it usually means there is an injury to the meniscus. True or False?
4. When there is a patella tendon injury, it hurts most when going down stairs. True or False?
5. When the knee locks in flexion, it means there is a loose piece of bone or cartilage in the joint. True or False?
6. If a deep knee bend causes a grating, grinding sound, it is very likely that the person has chondromalacia. True or False?
11/19/2010
3
Knee History Knee History
Did you see a doctor/therapist?Did you see a doctor/therapist?
• If there was a diagnosis, you can test it against your assessment
• More subtle injuries may be present which were missed in the diagnosis
• If there was a diagnosis, you can test it against your assessment
• More subtle injuries may be present which were missed in the diagnosis
What was the diagnosis?What was the diagnosis?
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4
• Serious medical issues
• Advise the client to see a doctor
• Ask what worked for the client
• Serious medical issues
• Advise the client to see a doctor
• Ask what worked for the client
Did you get treatment? If so, did it help?
Did you get treatment? If so, did it help?
Did you have surgery?Did you have surgery?
When was the first time you had knee pain?
How long has the knee been in continuous pain?
When was the first time you had knee pain?
How long has the knee been in continuous pain?
• This may show a long-term or chronic pattern
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5
• Possible causes of pain• Possible causes of pain
Was the onset of pain gradual?Was the onset of pain gradual?
• Overuse
• Lack of strength activities
• Alignment issues
• Start/stop activities
• Overuse
• Lack of strength activities
• Alignment issues
• Start/stop activities
Do you think it was caused by a particular injury?
Do you think it was caused by a particular injury?
• May indicate the structures injured or the severity of the injury
• May indicate the structures injured or the severity of the injury
Was the onset of pain sudden or through an accident?
Was the onset of pain sudden or through an accident?
11/19/2010
6
• Only ligament injuries, a loose body in the knee joint or meniscus injuries cause swelling
• Only ligament injuries, a loose body in the knee joint or meniscus injuries cause swelling
Did the knee joint swell?Did the knee joint swell?
• Quick swelling indicates blood in the joint• Quick swelling indicates blood in the joint
Did this swelling occur quickly?Did this swelling occur quickly?
Locating and Identifying the Injury
Locating and Identifying the Injury
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Where does it hurt?Where does it hurt?
Medial PainMedial Pain
• Medial collateral ligament• Medial coronary ligament• Medial quadriceps
expansion• Medial Retinaculum• Medial hamstring
attachments
Lateral PainLateral Pain
• Lateral collateral ligament• Lateral coronary ligament• Lateral quadriceps
expansion• Lateral Retinaculum• Biceps femoris hamstring
attachment
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Anterior PainAnterior Pain
• Patellar tendon and entire quadriceps mechanism
• Quadriceps expansions• Patellar ligament• Lower attachment of
patellar ligament• Prepatellar bursa• Infrapatellar bursa• Suprapatellar bursa• Anterior cruciate ligament
Posterior PainPosterior Pain
• Posterior cruciate ligament• Hamstring injury• Gastrocnemius tear
Deep PainDeep Pain
• Cruciate ligaments• Torn meniscus• Traumatic arthritis in the
joint• Infrapatellar bursa• Loose body in the joint
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Swollen Knee PainSwollen Knee Pain
• Collateral ligament• Coronary ligament• Condromalacia• Cruciate ligament tear• Torn cartilage• Loose body in the joint
All Over PainAll Over Pain
• Multiple injuries
• Loose ligaments
Does the knee feel as though it will give way but it doesn’t?
Does the knee feel as though it will give way but it doesn’t?
• Early meniscal tears
• Coronary ligament sprains
• Early meniscal tears
• Coronary ligament sprains
11/19/2010
10
Do you have trouble climbing up or down stairs?
Do you have trouble climbing up or down stairs?
• Patella tendinitis (climbing up stairs)
• Chondromalacia (going down stairs)
• Patella tendinitis (climbing up stairs)
• Chondromalacia (going down stairs)
Does the knee hurt when you stand up after sitting?
Does the knee hurt when you stand up after sitting?
• Patella tendinitis• Patella tendinitis
• Indicates multiple injuries• Indicates multiple injuries
Does the pain change?Does the pain change?
11/19/2010
11
Pinpointing Injuries We Cannot Treat
Pinpointing Injuries We Cannot Treat
How old are you?How old are you?
• Chondromalacia
• Dislocating patella
• Osgood Schlatter’s Disease
• Chondromalacia
• Dislocating patella
• Osgood Schlatter’s Disease
Did the leg give way? Was it in flexion or extension?
Did the leg give way? Was it in flexion or extension?
• In flexion means torn meniscus or severe coronary ligament sprain
• In extension means there is a loose body in the joint
• In flexion means torn meniscus or severe coronary ligament sprain
• In extension means there is a loose body in the joint
11/19/2010
12
Did the leg lock? In what position?Did the leg lock? In what position?
• Flexion: Torn meniscus
• Extension: Loose body
• Flexion: Torn meniscus
• Extension: Loose body
Do you have sudden twinges?Do you have sudden twinges?
• Loose body
• Medial quadriceps expansion
• Loose body
• Medial quadriceps expansion
Did you or do you hear a click?In what position?
Did you or do you hear a click?In what position?
• Torn meniscus (at 30 degrees flexion)• Torn meniscus (at 30 degrees flexion)
11/19/2010
13
Does it grate or grind?Does it grate or grind?
• Chondromalacia• Chondromalacia
The 23 Common Injuries to the Knee
The 23 Common Injuries to the Knee
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
1. Infrapatella tendinitis
2. Suprapatellar tendinitis
3. Medial quadriceps expansion strain
4. Lateral quadriceps expansion strain
1. Infrapatella tendinitis
2. Suprapatellar tendinitis
3. Medial quadriceps expansion strain
4. Lateral quadriceps expansion strain
11/19/2010
14
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
5. Medial collateral ligament sprain
6. Lateral collateral ligament sprain
5. Medial collateral ligament sprain
6. Lateral collateral ligament sprain
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
7. Medial coronary ligament sprain
8. Lateral coronary ligament sprain
7. Medial coronary ligament sprain
8. Lateral coronary ligament sprain
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
9. Tensor fascia lata sprain9. Tensor fascia lata sprain
11/19/2010
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The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
10.Medial hamstring attachment strain
11.Lateral hamstring attachment strain
10.Medial hamstring attachment strain
11.Lateral hamstring attachment strain
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
12.Infrapatellar bursitis
13.Suprapatellar bursitis
14.Prepatellar bursitis
12.Infrapatellar bursitis
13.Suprapatellar bursitis
14.Prepatellar bursitis
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
15.Chondromalacia15.Chondromalacia
11/19/2010
16
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
16.Torn medial meniscus
17.Torn lateral meniscus
16.Torn medial meniscus
17.Torn lateral meniscus
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
18.Anterior cruciate ligament sprain
19.Posterior cruciate ligament sprain
18.Anterior cruciate ligament sprain
19.Posterior cruciate ligament sprain
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
20.Traumatic inflammation of the knee joint
20.Traumatic inflammation of the knee joint
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The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
21.Dislocating patella21.Dislocating patella
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
22.Osgood Schlatter’s Disease22.Osgood Schlatter’s Disease
The 23 Common Injuries to the KneeThe 23 Common Injuries to the Knee
23. Loose Body in the knee joint(Loose floating fragment ofcartilage or bone)
23. Loose Body in the knee joint(Loose floating fragment ofcartilage or bone)
11/19/2010
18
23 Knee Injuries Overview Video23 Knee Injuries Overview Video
The video will be available at the end of the Webinar
QuestionsQuestions
QuestionsQuestions
Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin
11/19/2010
19
Post-testPost-test1. If there is swelling in the knee, it is most likely a ligament or
joint injury. True or False?
2. There is no referred pain in the knee. Generally, where it hurts is where it is injured. True or False?
3. When the knee gives way, it usually means there is an injury to the meniscus. True or False?
4. When there is a patella tendon injury, it hurts most when going down stairs. True or False?
5. When the knee locks in flexion, it means there is a loose piece of bone or cartilage in the joint. True or False?
6. If a deep knee bend causes a grating, grinding sound, it is very likely that the person has chondromalacia. True or False?
1. If there is swelling in the knee, it is most likely a ligament or joint injury. True or False?
2. There is no referred pain in the knee. Generally, where it hurts is where it is injured. True or False?
3. When the knee gives way, it usually means there is an injury to the meniscus. True or False?
4. When there is a patella tendon injury, it hurts most when going down stairs. True or False?
5. When the knee locks in flexion, it means there is a loose piece of bone or cartilage in the joint. True or False?
6. If a deep knee bend causes a grating, grinding sound, it is very likely that the person has chondromalacia. True or False?
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11/19/2010
20
ReviewsReviews
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WEBINAR SERIES
Unraveling the Mystery of Low Back Pain
WEBINAR SERIES
Unraveling the Mystery of Low Back Pain
1. Sacroiliac Dysfunction
2. Client History and Treatment Options
3. Iliolumbar Ligament Sprains4. Sacrotuberous Ligament Sprains
5. Supraspinous Ligament Sprains6. Muscle Injuries
7. Clinical Reasoning
1. Sacroiliac Dysfunction
2. Client History and Treatment Options
3. Iliolumbar Ligament Sprains4. Sacrotuberous Ligament Sprains
5. Supraspinous Ligament Sprains6. Muscle Injuries
7. Clinical Reasoning
WEBINAR SERIES
Unraveling the Mystery of Shoulder Pain
WEBINAR SERIES
Unraveling the Mystery of Shoulder Pain
1. Subscapularis Muscle-Tendon Injury
2. Supraspinatus Muscle-Tendon Injury3. Infraspinatus Muscle-Tendon Injury
4. Adhesive Capsulitis/Frozen Shoulder5. Clinical Applications
1. Subscapularis Muscle-Tendon Injury
2. Supraspinatus Muscle-Tendon Injury3. Infraspinatus Muscle-Tendon Injury
4. Adhesive Capsulitis/Frozen Shoulder5. Clinical Applications
11/19/2010
21
WEBINAR SERIES
Unraveling the Mystery of Cervical Pain
WEBINAR SERIES
Unraveling the Mystery of Cervical Pain
1. Whiplash and Central Ligament Sprains
2. Client History and Treatment Options3. TP7 Ligament Sprains
4. Lateral Ligament Sprains5. Clinical Applications 1
6. Clinical Applications 2
1. Whiplash and Central Ligament Sprains
2. Client History and Treatment Options3. TP7 Ligament Sprains
4. Lateral Ligament Sprains5. Clinical Applications 1
6. Clinical Applications 2
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