Podcast
Questions and Answers
What is the function of the patellar tendon?
What is the function of the patellar tendon?
Which muscle is the only quadriceps muscle that attaches at two joints?
Which muscle is the only quadriceps muscle that attaches at two joints?
What is the pes anserine?
What is the pes anserine?
Which ligament is the primary restraint against lateral, or varus, stress at the knee?
Which ligament is the primary restraint against lateral, or varus, stress at the knee?
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What is the goal of PRT?
What is the goal of PRT?
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What is the adductor group responsible for?
What is the adductor group responsible for?
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What muscle can cause anterior hip pain and is often found at its origin on the ramus?
What muscle can cause anterior hip pain and is often found at its origin on the ramus?
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What is the PRT clinician procedure for the pes anserine?
What is the PRT clinician procedure for the pes anserine?
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Which muscle attaches at both the hip and knee joints?
Which muscle attaches at both the hip and knee joints?
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What is the function of the patellar tendon?
What is the function of the patellar tendon?
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Which ligament provides the knee with medial and rotatory stability?
Which ligament provides the knee with medial and rotatory stability?
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Which muscle group produces adduction and assists with hip flexion during open-chain movements?
Which muscle group produces adduction and assists with hip flexion during open-chain movements?
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What is the largest sesamoid bone in the body?
What is the largest sesamoid bone in the body?
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Which ligament is the primary restraint against lateral, or varus, stress at the knee?
Which ligament is the primary restraint against lateral, or varus, stress at the knee?
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Which muscle can cause anterior hip pain and is often found at its origin on the ramus?
Which muscle can cause anterior hip pain and is often found at its origin on the ramus?
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What is the goal of PRT?
What is the goal of PRT?
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What is the function of the patellar tendon?
What is the function of the patellar tendon?
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Which muscle attaches at two joints, the hip and knee?
Which muscle attaches at two joints, the hip and knee?
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What is the function of the medial collateral ligament (MCL)?
What is the function of the medial collateral ligament (MCL)?
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What is the pes anserine and what can overuse of eccentric hip rotation lead to?
What is the pes anserine and what can overuse of eccentric hip rotation lead to?
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Which ligament is the primary restraint against lateral, or varus, stress at the knee?
Which ligament is the primary restraint against lateral, or varus, stress at the knee?
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What is the function of the iliotibial band?
What is the function of the iliotibial band?
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What is the goal of Positional Release Therapy (PRT)?
What is the goal of Positional Release Therapy (PRT)?
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What is the PRT clinician procedure for the pes anserine?
What is the PRT clinician procedure for the pes anserine?
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Study Notes
Positional Release Therapy for Knee and Thigh Anterior Structures
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The patellar tendon is a continuation of the quadriceps tendon that runs from the inferior pole of the patella to the tibial tuberosity, providing mechanical advantage for knee extension and flexion as well as stability of the tibiofemoral joint.
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The quadriceps tendon is a convergence of the inferior fibers of the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis, providing patellar stabilization and transmission of force production to produce and slow knee movement.
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The rectus femoris is the only quadriceps muscle that attaches at two joints: the hip and knee, serving as a fulcrum for the production of joint force and movement.
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The patella, the largest sesamoid bone in the body, is located within the quadriceps femoris tendon, serving as an attachment site for multiple tissues and protecting the tibiofemoral joint.
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The medial collateral ligament (MCL) is composed of superficial and deep fibers to provide the knee with medial and rotatory stability, limiting valgus and rotatory knee stress.
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Palpation procedures involve locating tender points or fasciculatory response of the structures, noting their distinct borders, medial and lateral depressions, and respective attachment sites.
-
PRT clinician procedures involve applying posterior translational force, rotation, and fine-tuning of the tissues or femur, or both, to encourage knee hyperextension and treat corollary tissues such as quadriceps tendon, patellar retinaculum, and joint capsule.
-
PRT patient self-treatment procedures involve applying posterior translational force, shifting, tilting, and rotating the patella or quadriceps toward the hip, or both, to achieve maximal relaxation of the tissue coupled with a rise in the fasciculatory response while keeping the fingers on the area with submaximal pressure.
-
MCL palpation procedure involves strumming over the joint line, palpating up and down onto the femoral and tibial condyles, and noting the location of any tender points or fasciculatory response of the ligament and its origin and insertions.
-
MCL PRT clinician procedure involves applying a varus force at the knee using the far hand at the ankle, applying marked ankle inversion with the far hand, and internally rotating and compressing the tibia upward to fine-tune with the far hand.
-
Corollary tissues treated during MCL PRT clinician procedure include the knee capsule and patellar tendon.
-
The goal of PRT is to reduce pain, muscle tension, and tissue dysfunction by releasing soft tissue restrictions and restoring normal joint motion.Positional Release Therapy for Knee and Thigh Medial Structures
-
The pes anserine is a group of three tendons that provide rotatory control and stability of the knee during gait.
-
Overuse of eccentric hip rotation or lack of eccentric hip rotatory control can lead to pes anserine bursitis and tendinopathy.
-
The pes anserine can be palpated by sliding the fingers approximately 1 inch medially from the tibial tuberosity onto the bony insertion site.
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The VMO muscle stabilizes the patella against the pull of the lateralis and imbalance between these two muscles can lead to patellar maltracking and pain.
-
The VMO can be palpated by placing the fingers just superior and medial to the patella over the knee and instructing the patient to extend the knee.
-
The adductor group stabilizes the pelvic complex and lower articulations during locomotion and produces adduction and assists with hip flexion during open-chain movements.
-
The adductor group can be palpated by locating the common adductor tendon at the adductor tubercle of the inferior ramus of the pubis.
-
The pectineus muscle can cause anterior hip pain and is often found at its origin on the ramus, which can be palpated with light pressure.
-
PRT clinician procedure for the pes anserine involves placing the patient in a supine position and moving the knee into 40 to 60° of flexion while applying marked calcaneal and forefoot inversion.
-
PRT clinician procedure for the adductor group involves placing the patient in a supine position and moving the limb into straight-leg hip flexion while applying marked calcaneal and foot inversion.
-
PRT clinician procedure for the pectineus involves moving the hips into approximately 90° of flexion and applying adduction while internally rotating the hip.
-
Patient self-treatment procedure involves crossing the involved leg over the other and rest it on it or within the range of adduction where the greatest position of comfort and tissue fasciculation occurs.Sport Medics: Palpation and Treatment Procedures for Knee and Thigh Structures
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The popliteus muscle assists in the screw home mechanism of the knee and its superior fibers can be palpated when a popliteal lesion is present.
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The plantaris muscle and Achilles tendon are located in the posterior structures of the knee and thigh.
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The flexor digitorum longus muscle and flexor retinaculum are part of the intermediate posterior structures of the knee and thigh.
-
Hamstrings, including the biceps femoris, semitendinosus, and semimembranosus, assist in knee flexion and hip extension, and can be palpated by starting at the popliteal fossa and moving upward to the ischial tuberosity.
-
The adductor magnus and sacrotuberous ligament should also be explored when hamstring pathology is implicated.
-
The iliotibial band arises from the gluteal fascia and tensor fasciae latae muscle at the lateral hip and stabilizes the knee against varus and rotational stress.
-
The lateral collateral ligament is the primary restraint against lateral, or varus, stress at the knee and is associated with hyperextension.
-
Imbalance in the timing and strength of contraction between the vastus lateralis and vastus medialis can lead to patellar maltracking, and weak hip abductors may also play a role.
-
Palpation procedures for these structures involve placing the patient in specific positions and strumming or applying deep pressure to isolate the muscle or ligament.
-
PRT clinician procedures involve moving the patient's limb through specific ranges of motion while applying compression or translational forces to the tissue.
-
Corollary tissues treated during these procedures include the gastrocnemius, soleus, hamstrings, gluteal muscles, sacrotuberous ligament, posterior hip capsule, and peroneals.
-
Patient self-treatment procedures involve lying in specific positions for several minutes or applying heat or ice to facilitate relaxation and pain control.Palpation and Treatment Procedures for Vastus Lateralis Muscle
-
Vastus lateralis muscle inserts into tibial tuberosity via the quadriceps tendon and ligamentum patellae.
-
Its action is knee extension, and it is innervated by L2-L4 (femoral nerve).
-
The muscle can be palpated in a supine or side-lying position by locating the iliotibial band and sliding fingers off the band to feel the softer vastus lateralis.
-
The patient can actively extend the knee to accentuate the fibers for palpation.
-
Tender points or fasciculatory response of the muscle and its attachment sites should be noted.
-
PRT treatment procedure involves the patient lying supine, and the clinician applying a posterior force at the superior tibia below the patella and laterally translating the vastus lateralis muscle belly while monitoring its lesion with their fingers.
-
External limb rotation and a lateral patellar glide can be applied for fine-tuning.
-
The corollary tissue treated is the iliotibial band.
-
Patient self-treatment procedure involves the patient placing the lower leg and foot on a stool or couch arm and applying a downward pressure below the patella while translating the muscle belly diagonally away from the patella.
-
External limb rotation and a lateral patellar glide can be used for fine-tuning.
-
The vastus lateralis should be monitored for a fasciculatory response and tissue relaxation at the site of pain.
-
The treatment position should be maintained until the fasciculatory response abates or for three to five minutes.
Positional Release Therapy for Knee and Thigh Anterior Structures
-
The patellar tendon is a continuation of the quadriceps tendon that runs from the inferior pole of the patella to the tibial tuberosity, providing mechanical advantage for knee extension and flexion as well as stability of the tibiofemoral joint.
-
The quadriceps tendon is a convergence of the inferior fibers of the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis, providing patellar stabilization and transmission of force production to produce and slow knee movement.
-
The rectus femoris is the only quadriceps muscle that attaches at two joints: the hip and knee, serving as a fulcrum for the production of joint force and movement.
-
The patella, the largest sesamoid bone in the body, is located within the quadriceps femoris tendon, serving as an attachment site for multiple tissues and protecting the tibiofemoral joint.
-
The medial collateral ligament (MCL) is composed of superficial and deep fibers to provide the knee with medial and rotatory stability, limiting valgus and rotatory knee stress.
-
Palpation procedures involve locating tender points or fasciculatory response of the structures, noting their distinct borders, medial and lateral depressions, and respective attachment sites.
-
PRT clinician procedures involve applying posterior translational force, rotation, and fine-tuning of the tissues or femur, or both, to encourage knee hyperextension and treat corollary tissues such as quadriceps tendon, patellar retinaculum, and joint capsule.
-
PRT patient self-treatment procedures involve applying posterior translational force, shifting, tilting, and rotating the patella or quadriceps toward the hip, or both, to achieve maximal relaxation of the tissue coupled with a rise in the fasciculatory response while keeping the fingers on the area with submaximal pressure.
-
MCL palpation procedure involves strumming over the joint line, palpating up and down onto the femoral and tibial condyles, and noting the location of any tender points or fasciculatory response of the ligament and its origin and insertions.
-
MCL PRT clinician procedure involves applying a varus force at the knee using the far hand at the ankle, applying marked ankle inversion with the far hand, and internally rotating and compressing the tibia upward to fine-tune with the far hand.
-
Corollary tissues treated during MCL PRT clinician procedure include the knee capsule and patellar tendon.
-
The goal of PRT is to reduce pain, muscle tension, and tissue dysfunction by releasing soft tissue restrictions and restoring normal joint motion.Positional Release Therapy for Knee and Thigh Medial Structures
-
The pes anserine is a group of three tendons that provide rotatory control and stability of the knee during gait.
-
Overuse of eccentric hip rotation or lack of eccentric hip rotatory control can lead to pes anserine bursitis and tendinopathy.
-
The pes anserine can be palpated by sliding the fingers approximately 1 inch medially from the tibial tuberosity onto the bony insertion site.
-
The VMO muscle stabilizes the patella against the pull of the lateralis and imbalance between these two muscles can lead to patellar maltracking and pain.
-
The VMO can be palpated by placing the fingers just superior and medial to the patella over the knee and instructing the patient to extend the knee.
-
The adductor group stabilizes the pelvic complex and lower articulations during locomotion and produces adduction and assists with hip flexion during open-chain movements.
-
The adductor group can be palpated by locating the common adductor tendon at the adductor tubercle of the inferior ramus of the pubis.
-
The pectineus muscle can cause anterior hip pain and is often found at its origin on the ramus, which can be palpated with light pressure.
-
PRT clinician procedure for the pes anserine involves placing the patient in a supine position and moving the knee into 40 to 60° of flexion while applying marked calcaneal and forefoot inversion.
-
PRT clinician procedure for the adductor group involves placing the patient in a supine position and moving the limb into straight-leg hip flexion while applying marked calcaneal and foot inversion.
-
PRT clinician procedure for the pectineus involves moving the hips into approximately 90° of flexion and applying adduction while internally rotating the hip.
-
Patient self-treatment procedure involves crossing the involved leg over the other and rest it on it or within the range of adduction where the greatest position of comfort and tissue fasciculation occurs.Sport Medics: Palpation and Treatment Procedures for Knee and Thigh Structures
-
The popliteus muscle assists in the screw home mechanism of the knee and its superior fibers can be palpated when a popliteal lesion is present.
-
The plantaris muscle and Achilles tendon are located in the posterior structures of the knee and thigh.
-
The flexor digitorum longus muscle and flexor retinaculum are part of the intermediate posterior structures of the knee and thigh.
-
Hamstrings, including the biceps femoris, semitendinosus, and semimembranosus, assist in knee flexion and hip extension, and can be palpated by starting at the popliteal fossa and moving upward to the ischial tuberosity.
-
The adductor magnus and sacrotuberous ligament should also be explored when hamstring pathology is implicated.
-
The iliotibial band arises from the gluteal fascia and tensor fasciae latae muscle at the lateral hip and stabilizes the knee against varus and rotational stress.
-
The lateral collateral ligament is the primary restraint against lateral, or varus, stress at the knee and is associated with hyperextension.
-
Imbalance in the timing and strength of contraction between the vastus lateralis and vastus medialis can lead to patellar maltracking, and weak hip abductors may also play a role.
-
Palpation procedures for these structures involve placing the patient in specific positions and strumming or applying deep pressure to isolate the muscle or ligament.
-
PRT clinician procedures involve moving the patient's limb through specific ranges of motion while applying compression or translational forces to the tissue.
-
Corollary tissues treated during these procedures include the gastrocnemius, soleus, hamstrings, gluteal muscles, sacrotuberous ligament, posterior hip capsule, and peroneals.
-
Patient self-treatment procedures involve lying in specific positions for several minutes or applying heat or ice to facilitate relaxation and pain control.Palpation and Treatment Procedures for Vastus Lateralis Muscle
-
Vastus lateralis muscle inserts into tibial tuberosity via the quadriceps tendon and ligamentum patellae.
-
Its action is knee extension, and it is innervated by L2-L4 (femoral nerve).
-
The muscle can be palpated in a supine or side-lying position by locating the iliotibial band and sliding fingers off the band to feel the softer vastus lateralis.
-
The patient can actively extend the knee to accentuate the fibers for palpation.
-
Tender points or fasciculatory response of the muscle and its attachment sites should be noted.
-
PRT treatment procedure involves the patient lying supine, and the clinician applying a posterior force at the superior tibia below the patella and laterally translating the vastus lateralis muscle belly while monitoring its lesion with their fingers.
-
External limb rotation and a lateral patellar glide can be applied for fine-tuning.
-
The corollary tissue treated is the iliotibial band.
-
Patient self-treatment procedure involves the patient placing the lower leg and foot on a stool or couch arm and applying a downward pressure below the patella while translating the muscle belly diagonally away from the patella.
-
External limb rotation and a lateral patellar glide can be used for fine-tuning.
-
The vastus lateralis should be monitored for a fasciculatory response and tissue relaxation at the site of pain.
-
The treatment position should be maintained until the fasciculatory response abates or for three to five minutes.
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Description
Take this quiz to test your knowledge on Palpation and Treatment Procedures for Knee and Thigh Structures. Learn about the different muscles and structures in the knee and thigh region, their functions, and how to locate and treat them using Positional Release Therapy (PRT). The quiz covers topics such as the patellar tendon, medial collateral ligament, pes anserine, adductor group, popliteus muscle, hamstrings, iliotibial band, and vastus lateralis muscle.
