무릎관절(knee joint) 관절가동, 수기저항운동, 자가운동, 기능적 운동법 - 정리중

[문형철]

무릎 관절은 두가지

1. 슬개대퇴관절

2. 대퇴경골관절 

patella tracking이 올바르게

내외측 반월판에 균등한 부하가 주어지면서 움직이게 하는 방법은? 

panic bird...

Knee and Leg (Fig. 5.48)

Tibiofemoral Articulation

The concave tibial plateaus articulate on the convex femoral condyles. Biomechanics of the knee joint are described in Chapter 21. 

Resting Position

The resting position is 25 flexion.

Treatment Plane

The treatment plane is along the surface of the tibial plateaus; therefore, it moves with the tibia as the knee angle changes.

Stabilization

In most cases, the femur is stabilized with a belt or by the table. 

1. Tibiofemoral Distraction, Long-Axis Traction (Fig. 5.49)

Indications

Testing; initial treatment; pain control; general mobility.

Patient Position

Sitting, supine, or prone, beginning with the knee in the resting position.

Progress to positioning the knee at the limit of the range of flexion or extension.

Rotation of the tibia may be added prior to applying the traction force. Use internal rotation at endrange

flexion and external rotation at end-range extension.

Hand Placement

Grasp around the distal leg, proximal to the malleoli with both hands.

Mobilizing Force

Pull on the long axis of the tibia to separate the joint surfaces.

2. Tibiofemoral Posterior Glide (Fig. 5.50)

Indications

Testing; to increase flexion.

Patient Position

Supine, with the foot resting on the table. The position for the drawer test can be used to mobilize the tibia either

anteriorly or posteriorly, although no grade I distraction can be applied with the glides.

Therapist Position and Hand Placement

Sit on the table with your thigh fixating the patient’s foot. With both hands, grasp around the tibia, fingers pointing

posteriorly and thumbs anteriorly.

Mobilizing Force

Extend your elbows and lean your body weight forward; push the tibia posteriorly with your thumbs. 

3. Tibiofemoral Anterior Glide (Fig. 5.52)

Indication

To increase extension. 

Patient Position

Prone, beginning with the knee in resting position; progress to the end of the available range.

The tibia may also be positioned in lateral rotation.

Place a small pad under the distal femur to prevent patellar compression.

Hand Placement

Grasp the distal tibia with the hand that is closer to it and place the palm of the proximal hand on the posterior aspect

of the proximal tibia.

Mobilizing Force

Force with the hand on the proximal tibia in an anterior direction. The force may be directed to the lateral or medial

tibial plateau to isolate one side of the joint.

Alternate Position

If the patient cannot be positioned prone, position him or her supine with a fixation pad under the tibia.

The mobilizing force is placed against the femur in a posterior direction. 

4. Patellofemoral Joint, Distal Glide (Fig. 5.53)

Indication

To increase patellar mobility for knee flexion.

Patient Position

Supine, with knee extended; progress to positioning the knee at the end of the available range in flexion.

Hand Placement

Stand next to the patient’s thigh, facing the patient’s feet.

Place the web space of the hand that is closer to the thigh around the superior border of the patella. Use the other

hand for reinforcement.

Mobilizing Force

Glide the patella in a caudal direction, parallel to the femur.

5. Proximal Tibiofibular Articulation: Anterior (Ventral) Glide (Fig. 5.55)

Indications

To increase movement of the fibular head; to reposition a posteriorly positioned head.

Patient Position

Side-lying, with the trunk and hips rotated partially toward prone.

The top leg is flexed forward so the knee and lower leg are resting on the table or supported on a pillow.

Therapist Position and Hand Placement

Stand behind the patient, placing one of your hands under the tibia to stabilize it.

Place the base of your other hand posterior to the head of the fibula, wrapping your fingers anteriorly.

Mobilizing Force

The force comes from the heel of your hand against the posterior aspect of the fibular head, in an anterior-lateral

direction.

6. Distal Tibiofibular Articulation: Anterior (Ventral) or Posterior (Dorsal) Glide (Fig. 5.56)

Indication

To increase mobility of the mortise when it is restricting ankle dorsiflexion. 

Patient Position

Supine or prone.

Hand Placement

Working from the end of the table, place the fingers of the more medial hand under the tibia and the thumb over the tibia to stabilize it. Place the base of your other hand over the lateral malleolus, with the fingers underneath.

Mobilizing Force

Press against the fibula in an anterior direction when prone and in a posterior direction when supine.

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