Knee injuries are among the most common orthopedic injuries. Causes associated with injuries of the knee can range from direct trauma with instant damage; to overuse that can take a long time to degrade the tissue in and around the joint. Another, somewhat less obvious cause of knee injuries is misalignment of joints above and below the knee. Paired with repetitive movements and activities like walking, running, or work-related tasks, these misalignments can lead to accelerated wearing of joint surfaces. In the knee, the structures most prone to wear are the articular cartilages of the femur and patella and the shock absorbing medial and lateral menisci. The degradation of joint tissues leads to intra-articular deformities that cause things like clicking, grinding, and joint locking. Gone unchecked, these changes in the joint will eventually lead to pain and dysfunction.
Movements in the Pilates repertoire done on the equipment are very useful in the course of rehabilitation for the knee in terms of both assessment, as well as treatment of an injury. With assessment, the movements can be used to get an overall idea of how the joint moves and what the preference for movement is. In terms of treatment, the movements can be used to treat the injury on a more local arthrokinematic level by addressing the way the joint moves within the joint capsule. Elements such as roll and glide can be addressed in a supported environment as with footwork supine on the Reformer. Also, in this non-destructive environment more efficient muscle activation can be re-established. With movement and both tactile and verbal cueing through the range of motion, correct retraining of involved muscles can easily be achieved. As the individual gains increased confidence and control, the movements can be progressed to full weight bearing with deceased assistance from the springs. Movements such as standing leg pump without support of the hands, forward lunge on the Chair, side splits and front splits on the Reformer, and assisted squats with leg springs on the Trapeze Table; can all be used to challenge the recreated control at the knee joint. The course of rehab and progression through these exercises depends on different factors. The tissue that is injured and the severity, the length of time that the injury has been present and what kinds of compensatory mechanisms the body has adopted all play a role in the degree and how quickly an individual will be able to recover function.
These movements also afford the opportunity to address one of the subtle causes of knee injury mentioned earlier. The knee joint’s primary plane of movement is in the sagittal plane, which means that the joint is most comfortable with flexion and extension. Therefore, when we talk about turning the knee in and out or medial and lateral rotation of the knee, in most cases we actually are referring to rotation at the hip joint. If awareness and control is not cultivated at the hip as well the knee then, combined with a fixed foot in weight bearing activity, there is potential for the knee to be twisted out of alignment regardless of how strong the muscles around the knee are. Cueing to maintain control and alignment at the hip joint will ensure that the knee is positioned correctly between the hip and the foot preventing any unwanted torsion at the knee joint during loaded knee flexion. The outcomes of treatment are usually good because the Pilates repertoire allows focus on the specific issues relating to the injury. While treating and controlling these issues may help reduce destructive forces and allow tissues to heal, it may not reverse all structural changes that have occurred.
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