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PT, DPT, CSCS
Doctor of Physical Therapy @monarchclubs
Exercise Science, B.S.
Virtual Strength Coach
NU ‘21
SJC ‘17

🧹 Sweep Test- is a simple test to check knee effusion.

The test is used to test INTRA-Articular pathology, which includes the ACL, PCL, meniscus, or bony structures inside the joint.

How to: Clear the effusion on the medial side of the knee with a superior sweep/stroke a few times. After, provide a downward sweep lateral to the patella, then observe the medial aspect of the knee to see if fluid fills up the fossa medial to the patella. Perform a few times.

Grading 🤓 is a scale out of 3.

0/3- no fluid returns in the medial fossa (medial to the patella)
Trace- minimal fluid returns in the medial fossa (medial to the patella)
1+/3- moderate fluid returns in the medial fossa (medial to the patella), but clears with an upward stroke
2+/3- significant fluid immediately is present in the medial fossa (medial to the patella) and does not require a stroke from the lateral aspect of the patella
3+/3- fluid is present in the medial fossa (medial to the patella) and cannot be cleared

I do not use a lot of tests for diagnostic purposes but tests can help give information to see what a patient is tolerating throughout their plan of care.

1+/3 by @tblack.dpt

Lachman’s Test.

Here I am performing a Lachman’s test to assess the integrity of the ACL. This test is usually performed immediately after the suspicion of an ACL tear. Lachman’s test is performed at 20-30 degrees of knee flexion, as the ACL is the primary constraint in that range of motion.

The ACLs role is to limit anterior translation and internal rotation of the tibia. Notice the tibia moving forward as I perform an anterior glide of the tibia.

Stabilize the femur and anteriorly glide the tibia, you only have a few attempts before the patient’s body understands what is happening and the hamstrings activate to limit anterior translation. by @tblack.dpt

$After fracturing her ankle, Sarah struggled to regain mobility and strength with traditional rehab methods. Turning to Monarch Athletic Club for advanced rehabilitation, she found the expert guidance she needed from our Brentwood physical therapy team, led by @tblack.dpt. By addressing her range of motion and lower extremity strength, our team is helping Sarah unlock new levels of mobility and empowering her to reclaim her active lifestyle. #MonarchMade #AnkleRehab by @tblack.dpt$

Do not demonize foot pronation or high arches.

Just learn to control each and access all ranges in the foot.

The greater the supination in the foot, the greater the load on the lateral musculature in the posterior chain; lateral gastroc and bicep femoris. If you access pronation during these movements this will allow you to load the medial soft tissue in the posterior chain.

As you access pronation this will allow tibial internal rotation as well, which can help address knee discomfort.

Working here with a patient who sustained a lateral malleloi fx and 4th and 5th metatarsal stress reaction. by @tblack.dpt

Recording yourself is great feedback to assess certain joint positions when performing different movements.

Here I’m performing a single leg jump over a hurdle, while landing on a single leg.

These are a few objective variables I look for; joint angles at the hip, knee and ankle, along with trunk positioning. I use VALD often to look at jump height, landing force, flight time and ground contact time. I will dive deeper into that in the future.

As you can see in the frames, I achieve greater peak knee flexion on the left leg, compared to the right. Usually, this is a demonstration of being able to absorb force more confidently and trusting the limb. Also, there is greater knee valgus on the right vs left.

Record, assess, tweak, re-assess. by @tblack.dpt

End stage rehab should look like sports performance.

I use a lot of strength and conditioning principles to create adaptations for tissue to tolerate the end goal. My end goal is stay athletic forever, so I need to titrate proper stimuli to achieve that.

Using these principles will make rehab look like lifting, which is fine by me.

BUT make sure you are respecting:

1- Tissue healing timelines
2- Reactivity to imposed demands
3- Psychological preparedness
4-Quality of movement
5-Objective data

These are some variables I take into account while progressing patients. by @tblack.dpt

Simple movements I’ll use to unlock a few more degrees of range of motion on the course ⛳️

I do similar movements throughout the week, along with day of. These movements are targeting thoracic extension and extension, foot mobility, hip internal rotation, and posterior hip muscle length. These mobility drills are important but I think prepping the CNS via med ball drills and plyometrics have a greater return to access greater ranges and hit the ball further.

When I’ve been to a few tournaments I see a lot of table work done prior to the tournament, this is fine but should be followed up by more explosive drills to hit bombs. by @tblack.dpt

$Very common complaint when dealing with knee pain, whether it be post-op or non-operative is pain when the leg is in hip extension. Here are few different ways I work the quadriceps in a lengthened position, which is often ignored. After fracturing my patella, I never had pain when in hip flexion, only when the knee was in the trail position during hip extension. Do not forget to work in lengthened and a shortened position. by @tblack.dpt$

Lifting is relatively simple. And should be boring..

Pick a moderate/heavy weight push yourself past your perceived limits through YOUR full range of motion. I am more aggressive with horizontal pushing and pulling exercises like push ups and rowing compared to vertical movements.

Don’t forget to jump (if you are ready for it) and move weight FAST. If you are not, there are plenty of ways to re-introduce plyometrics into your routine.

I am trying to hit a golf ball far, feel healthy enough to sprint, run, play tennis, and board sports and let everything else fall in place.

Keep moving! by @tblack.dpt

Knee anatomy- Intra-Articular Structures 🦵

Anterior Cruciate Ligament (ACL): Resists anterior translation and internal rotation of the tibia relatively to the femur. The ACL is stressed greatest at 20-30 degrees of knee flexion.

Posterior Cruciate Ligament (PCL): Resists posterior translation and external rotation of the tibia relatively to the femur. The PCL is the strongest of the Cruciate ligaments and is stressed greatest at 90-120 degrees of knee flexion.

Meniscus: Has many roles and depends on medial vs lateral meniscus but the main function of the meniscus is joint congruency and force absorption for the knee.

Cartilage of the Tibiofemoral joint: Decreases the friction in the joint, absorbs force in weight bearing activities, and improves force distribution. Studies show the coefficient of friction in cartilage is .0002 which is ~5x less than ice. 🧊 by @tblack.dpt

There’s a lot of different ways to build the brakes for your lower body but don’t forget about the upper body.

You can use medballs, bent over barbell drops, pull up variations, or whatever this is.

At this height you must be careful landing on your hands (watch out for the TFCC) but I built up to this starting at 24” box and slowly made my way here. Used this to prep the upper body for a nice bench day.

Find ways to load tissue in various velocities, levers, and intensities to perform at YOUR highest levels. by @tblack.dpt

Simple exercise with some flare.

You can make almost any movement arm care. Here I am having @jackkaplan5 resist this towel, eliciting the flexor pronation mass and abductor pollicis. Stay proactive to build up the medial elbow strength and endurance to reduce the risk of injury.

#armcare #baseball #elbow by @tblack.dpt

Taylor Black PT, DPT, CSCS

@tblack.dpt