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Rectus Femoris acting as an external rotator

Discussion in 'Biomechanics, Sports and Foot orthoses' started by RobinP, Jun 5, 2010.

  1. RobinP

    RobinP Well-Known Member


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    Dear All,

    I have a patient who has a peculiar presentation with whom I would welcome any comment.

    Without going into full assessment (as I have provided an orthotic solution which is helping the problem), I want to get an idea of the mechanism of the pathology

    PC
    Rt knee pain on more vigourous activity, particularly at the start of propulsion to sprint(after a runaway grandchild as it happens!)
    Loaded flexion of the knee is painful

    RMH
    Rt knee scoped 12/09. ?partial meniscectomy. Discomfort in knee since
    Was fairly OK after surgery but has deteriorated over the past 2/12

    SH
    Active 60+
    Plays tennis and wears anti pronation runners
    Walking no problem

    OE
    Knee pain difficult to illicit today. palpation not painful. 1/3 knee bend test caused discomfort at the anterior of th knee, at heh distal border of the patella. Pain more like a muscular pain a opposed to grinding
    Mild excessive internal rotation at the knee on 1/3 knee bend test by comparison to sound Lt side.
    No knee instability and no sign of any meniscal problems
    Med rotated STJ axis Rt
    Hallux limitus - only 15 degrees d/f non WB and increased dorsiflexion stiffness again WB (functional hallux rigidus - to coin Mike's phrase)

    RECTUS FEMORIS CONTRACTURE BILAT RT>LT. A Duncan Ely test did not allow full flexion of the knee - 90 degree flexion only


    Probs

    1. WB flexion in single limb stance causes pain

    Treat

    1. Reduction of the internal rotation moments at the knee seem to cause reduction in pain - orthoses provided to correct excessive pronation at the foot and reduce medial rotaiton of the STJA.
    Pt also given hip abductor strengthening exercises as a result of the paper discussed on the thread about internal rotation at teh knee and power flow

    Diagnosis

    Sounds like patella tendinopathy

    This is where I am stuck. I feel sure that the Rectus tightness is responsible. So my question is this:-

    Can rectus femoris act as an external rotator when the knee and hip are in slight flexion ie similar to midstance in single limb stance?

    Thus, if contracted, can it cause excessive traction at the distal patella tendon as a result of the internal rotation moments occurring at the knee ?

    I hope what I am asking is clear, I'm not sure I have relayed it very concisely
    Many thanks for any help given

    Robin
     
    Last edited: Jun 5, 2010
  2. As a muscle that creates almost linear tension in a sagital plane I would consider that if the hip is internally rotating (or tibia) the tension created on the quadriceps and accompanying tendons and surrounding fascia would be pulled with it. Is it an external rotator? I don't think so and if it is, it is extremely weak. But a change in the mechanical axis will change the pull on the fascial network and muscles creating non-linear tension on the structures it attaches to. I would recommend palpating for fascial restrictions and consider sartorius where is crosses RF, as well as RF on top of and beside the vastus intermedius and lateralis respectively.
     
  3. RobinP

    RobinP Well-Known Member

    Hi Michael,

    At the risk of sounding like a thickie, how will I be able to feel fascial restrictions? I'm not terribly up on more proximal muscular defects.

    Thanks

    Robin
     
  4. Robin get yourself a Patient ie the trouble and strife and a good pysio mate and get the physio to go through all the proximal muscle stuff.

    or send the patient to the physio and go along for the ride and see the assessment and get a hands on demo.
     
  5. Hi Robin, sorry for the delay. m Weber is correct in that you need to find a colleague that specializes in this form of therapy. A good Physio, Chiropractor, Osteopath, or bodyworker (i.e. KMI or Rolfing) WITH THE knowledge and skills aligned to do good fascial work will definitely be helpful. I add the "with" comment as there are many professionals in each of these disciplines who may not work much with myofascial bodywork... who typically does what is different depending on the region you live in too. In North America I would recommend an Active Release Technique certified Chiropractor. In your region, a Sports Physio/Chiro/Osteopath will likely have these skills.

    As an add on to my first reply, lumbo-pelvic-hip stabilization in a single leg stance is essential so consider assessing and addressing any deficiencies there through exercise rehabilitation and movement strategies.
     
  6. RobinP

    RobinP Well-Known Member

    Thanks chaps. Not sur eif this person can afford to go private but I'll see what the physios in the hospital can do with the advice

    Much appreciated

    robin
     

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