Knee Injuries In Adolescents And Adults: A Clinical Guide PDF

Clinical Guide to Positional Release Therapy Knee injury is common among children and young adults (DiFiori et al. 2014; Kraus et al. 2012; Swenson et al. 2013), but it is trending upward in the adult and senior populations (Gage et al. 2012). Between 1999 and 2008 in the United States, 6,664,324...

Clinical Guide to Positional Release Therapy Knee injury is common among children and young adults (DiFiori et al. 2014; Kraus et al. 2012; Swenson et al. 2013), but it is trending upward in the adult and senior populations (Gage et al. 2012). Between 1999 and 2008 in the United States, 6,664,324 knee injuries were seen in emergency departments, an incidence rate of 2.29 per 1,000. The highest rate of injury (3.83) was among those between 15 and 24 years of age. The 25 to 44 age group presented with the most knee injuries, and those over 64 years of age showed the greatest increase from previous years based on encounters with stairs, ramps, and floors. People younger than 24 were found to incur knee injury primarily during sports and recreation (73%); those over 25, at home (42%). Although the focus in the literature to date has been on knee and thigh injury sustained in the sporting population, particularly among females, the work of Gage and colleagues (2012) revealed no difference in injury rate between the sexes across the life span, and that knee injuries in older people may be as significant as those in the young. Researchers have pointed to the propensity for knee and thigh injuries incurred during the adolescent years to linger throughout the life span (Foss et al. 2012), potentially disrupting opportunities for scholarships and competitive and recreational play. They may also cause long-term disability, affecting the ability to participate in sports, work, and daily life (DiFiori et al. 2014). Foss and colleagues (2012) tracked 307 American middle school and 112 high school female basketball players over three seasons and found anterior knee pain to be the most prevalent diagnosis (26.6%). Based on these findings and previous reports of anterior knee pain in adolescents, Foss and colleagues (2012) reported that female adolescents diagnosed with anterior knee pain often continue to have symptoms as long as 15 years after the initial diagnosis, and 45% reported a negative effect on daily life. A previous knee injury has been identified as one of the most significant risk factors for future injury (DiFiori et al. 2014; Murphy, Connolly, and Beynnon 2013). Hewett, Di Stasi, and Myer (2013) found impaired neuromuscular control and abnormal biomechanics to be predictors of initial and future knee injury, and that initial injuries influence these predisposing factors long after resolution of the initial injury. Typically, physical activity improves health; however, vigorous physical activity in the athletic population has been 94 proposed to increase the risk of osteoarthritis (OA) of the knee (Neogi and Zhang 2013). Moreover, both varus and valgus knee malalignment have also been found to increase OA knee risk (Felson et al. 2013), requiring the health care professional to be focused on prevention and the early identification of extrinsic factors that might be mitigated, such as activity level and abnormal biomechanics. According to a systematic review by Van Gent, Siem, and Middelkoop (2007), U.S. runners demonstrated an incidence rate of running-related injury of 19.4 to 79.3%, and 7 to 50% of these injuries were located at the knee. Crowell and Davis (2011) speculated that the majority of runningrelated injuries (RRIs) are due to abnormal running gait mechanics that increase lower-extremity loading, and that most RRIs could be mitigated with gait retraining interventions. DiFiori and colleagues (2014) indicated that a significant factor in adolescent injury is improper training (high volume) and possibly burnout from sport specialization. Abnormal gait mechanics coupled with improper training volume may lead to knee and thigh injury if not corrected early in life. With over 27 million adolescents participating in team sports in the United States annually (DiFiori et al. 2014), the high incidence of knee injury, whether acute or attributed to overuse, presents a critical need for developing evidence-based prevention programming. Between 2005 and 2011 in the United States, 15.1% of high school athletes who were engaged in traditional sports (e.g., football, basketball, soccer, baseball, softball, volleyball, wrestling) incurred knee injuries; the majority (48.2%) were ligament sprains (Swenson et al. 2013). It is estimated that ACL injury in the United States alone may cost upward of $1 billion annually in the form of lost scholarships, rehabilitation, surgery, and lost work time (Smith et al. 2012). Approximately 100,000 ACL injuries occur annually in the United States (Sadohgi, von Keudell, and Vavken 2012), and a disproportionate number occur in the female population. Hip abductor weakness, particularly among females, has been an intensive area of investigation as a cause of ACL injury (Leetun et al. 2004), although the prevailing thought among researchers today is that multiple intrinsic and extrinsic factors are responsible for the increased susceptibility to lower-extremity injury (Murphy et al. 2003; Smith et al. 2012). Researchers posit that overuse injury among adolescents may be underestimated in terms of T. Speicher, Clinical Guide to Positional Release Therapy, Champaign, IL: Human Kinetics, 2016). For use only in Positional Release Therapy Course 2–Sport Medics. Knee and Thigh prevalence and impact on future injury rates across the life span (DiFiori et al. 2014). As a result, knee or ACL injury prevention programs tailored to the adolescent athletic population, particularly females, have received significant attention in the hope that they might limit the incidence of knee injury (Hewett et al. 2013). However, to date, the literature is mixed on the effectiveness of ACL injury prevention programs. Based on systematic review findings, Grimm and colleagues (2012) found no evidence of a reduction in ACL and knee injury rates among prevention program participants. Michaelidis and Koumantakis (2014) found limited evidence for ACL prevention among females engaged in only soccer and handball, and Noyes and Barber-Westin (2014) reported that three neuromuscular training programs provided a significant reduction in noncontact ACL injuries among adolescent female athletes. However, high compliance with neuromuscular training appears to reduce ACL and acute knee injury rates. Hägglund and colleagues (2013) observed an 88% reduction rate in ACL and acute knee injury rates among youth female Swedish soccer (football) players who demonstrated a high compliance with their neuromuscular training programs compared to controls. The researchers attributed the mixed ACL and knee injury rates seen in other studies to low program compliance. Is it possible that the high rate of knee injury (initial and recurrent) may be, in part, due to somatic dysfunction? No studies to date have examined the impact of PRT on orthopedic related injuries to the knee and thigh, but a few have examined its impact on hamstring flexibility. Birmingham and colleagues (2004) were the first to explore whether hamstring flexibility improved with strain counterstrain (SCS) in a healthy population. However, no difference in range of motion was found between the SCS group and the control group. Kaandeepan and colleagues (2011), in contrast, did observe a significant hamstring flexibility improvement with a PRT intervention among healthy females with the sit and reach test. The comparison group that stretched passively also improved. Although increased flexibility has not been shown to reduce injury risk (Herbert and Gabriel 2002), Kaandeepan and colleagues’ 2011 study is a promising step in the right direction. Prospective longitudinal studies are needed to validate the assumption that somatic dysfunction may be a factor in knee and thigh injury. Additionally, examinations of the prevalence and impact of somatic dysfunction on a variety of knee and thigh conditions is required. TREATMENT Common Anatomical Areas and Conditions for PRT Anterior Structures • Patellofemoral pain syndrome • Osgood-Schlatter disease • Chondromalacia patella Medial Structures • Pes anserine tendinitis • Meniscal injury Posterior Structures • Baker’s cyst • Capsular sprain Lateral Structures • Iliotibial band friction syndrome • Meniscal injury • Fibular head displacement • Patellofemoral pain syndrome T. Speicher, Clinical Guide to Positional Release Therapy, Champaign, IL: Human Kinetics, 2016). For use only in Positional Release Therapy Course 2–Sport Medics. 95