DEVELOPMENT OF AN INSTRUMENT TO ASSESS 评估仪器的发展.pptVIP

Biomechanical Considerations for Rehabilitation of the Knee James J. Irrgang, MS, PT, ATC Department of Physical Therapy University of Pittsburgh and Centers for Rehab Services Pittsburgh PA Bony Architecture of the Knee Femur Tibia Patella Tibio-Femoral Joint Tibio-Femoral Joint Patello-Femoral Joint Restraints to Patellar Motion Bony architecture Passive restraints Active restraints Restraints to Patellar Motion Medial retinaculum Medial P-F ligament Medial menisco-patellar ligament Restraints to Patellar Motion ITB Lateral P-F ligament Lateral patello-tibial ligament Restraints to Patellar Motion Vastus lateralis Vastus medialis Vastus intermedius Rectus femoris Patellofemoral Motion Flexion - patella glides inferiorly Extension - patella glides superiorly Patello-Femoral Contact Patello-Femoral Contact Area Patellofemoral Joint Reaction Force Angle of knee flexion Quadriceps force Quadriceps Force Flexion moment arm of T-F joint Extension moment arm of P-F joint Open Chain Knee Extension Increased flexion moment arm Increased quadriceps force PFJR force peaks at 350 Decreased contact area results in increasing contact stress from 90 to 200 of flexion Closed Chain Knee Extension Increased flexion moment arm Increased quadriceps force Increased PFJR Increased contact area partially off-sets increasing PFJR to minimize increase in contact stress Open vs. Closed Chain Exercise PFJR contact stress greater with OKC from 0 to 450 PFJR contact stress greater with CKC from 45 to 900 Patellofemoral Joint Reaction Force Walking - .5 times body weight Stairs - 3 to 4 times body weight Squatting - 7 to 8 times body weight EMG Activity of Quadriceps EMG relatively low increases with increasing angle of knee flexion EMG Activity of Quadriceps EMG activity increases with decreasing angle of knee flexion Ligamentous Restraints of Knee Collateral ligaments Cruciate ligaments Capsular ligaments Ligamentous Restraints of Knee Ligamentous Restraints of Knee Ligamentous Rest