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. 2023 Feb 1;18(1):14-25.
doi: 10.26603/001c.65896. eCollection 2023.

My Top Five Concepts for Selecting Lower Extremity Exercises For Cruciate Ligament and Patellofemoral Rehabilitation

Rafael F Escamilla  1   2
Affiliations

My Top Five Concepts for Selecting Lower Extremity Exercises For Cruciate Ligament and Patellofemoral Rehabilitation

Rafael F Escamilla. Int J Sports Phys Ther. .

Abstract

This clinical commentary will address five key concepts that can be used by clinicians as criteria for selecting lower extremity weight bearing exercises (WBE) and non-weight bearing exercises (NWBE) employed for cruciate ligament and patellofemoral rehabilitation. The following will be discussed for both cruciate ligament and patellofemoral rehabilitation: 1) Knee loading varies between WBE and NWBE; 2) Knee loading varies with technique variations within WBE and NWBE; 3) Knee loading varies between different WBE; 4) Knee loading varies as a function of knee angle; and 5) Knee loading increases with increased knee anterior translation beyond toes.

Keywords: cruciate rehab; knee loading; patellofemoral rehab.

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Conflict of interest statement

The author of this manuscript affirm we have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. The authors of this manuscript also affirm they have no conflict of interest of any kind.

Figures

Figure 1.
Figure 1.. Forward lunge with (A) a short step at ground level, (B) a long step at ground level, (C) a short step up to a 10 cm platform, and (D) a long step up to a 10 cm platform.
Figure 2.
Figure 2.. Mean (SD) ACL and PCL tensile force between forward lunge long and short with a stride (step forward and push back to starting position) using a 12-repetition maximum load (12-RM). Significant differences (p < 0.001) occurred between 0°–80° knee angles.
Figure 3.
Figure 3.. Mean (SD) patellofemoral compressive force in lead knee for forward lunge with a long step and forward lunge with a short step with a stride (step forward and push back to starting position) using bodyweight only.
Note: Mean (SD) patellofemoral stress followed a similar pattern and results as patellofemoral force.
Figure 4.
Figure 4.. Mean (±SD) patellofemoral joint compressive force in lead knee for the forward lunge long and short with a stride (step forward & push back to starting position) using a 12-repetition maximum load (12-RM). Significant differences (p < 0.009) occurred between 70°–90° knee angles.
Note: Mean (SD) patellofemoral stress follows a similar pattern and results as patellofemoral force.
Figure 5.
Figure 5.. Mean (SD) patellofemoral compressive force in lead knee for forward lunge at ground level and forward lunge up to a 10 cm platform with a stride (step forward and push back to starting position) using bodyweight only.
Note: Mean (SD) patellofemoral stress follows a similar pattern and results as patellofemoral force.
Figure 6.
Figure 6.. Mean (SD) patellofemoral compressive force in lead knee between forward lunge with a stride (step forward and push back to starting position) and without a stride (lunging up and down with feet stationary). Patellofemoral force was significantly greater (p<0.009) between 10°-50° knee angles of the knee flexing phase and between 50°-20° knee angles of the knee extending phase.
Note: Mean (SD) patellofemoral stress follows a similar pattern and results as patellofemoral force.
Figure 7.
Figure 7.. Mean (SD) PCL tensile force during forward and side lunges with a stride (step forward and push back to starting position) using a 12-repetition maximum load (12-RM). Significant differences (p < 0.009) occurred between 40°–80° knee angles.
Figure 8.
Figure 8.. Forward lunge at ground level (A), side lunge at ground level (B), forward lunge up to a 10 cm platform (C), and side lunge up to a 10 cm platform (D).
Figure 9.
Figure 9.. Mean (SD) patellofemoral compressive force in lead knee between forward lunge and side lunge with bodyweight and a stride (step forward and push back to starting position) collapsed across step height. Significant differences (p < 0.009) occurred at 10° during the lunge descent,10° and 30° during the lunge ascent, 40°-100° during the lunge descent, and 50°-90° during the lunge ascent.
Note: Mean (SD) patellofemoral stress follows a similar pattern and results as patellofemoral force.
Figure 10.
Figure 10.. Mean (SD) patellofemoral compressive force in lead knee between forward and side lunges with a stride (step forward and push back to starting position) using a 12-repetition maximum load (12-RM). Significant differences (p < 0.009) occurred between 80°-90° during the lunge descent and at 90° during the lunge ascent.
Note: Mean (SD) patellofemoral stress follows a similar pattern and results as patellofemoral force.
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References

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