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open chain knee extension
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open chain knee extension - March 31, 2008 2:16:11 PM
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Kaden
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What advice to you give a bodybuilder with resovled knee pain about returning to open chain isolated knee extensions? Safe ranges, ways to alter the exercise, etc
Now I know the snap judgement would be to stay away from them and for the majority of patients I agree. But, bodybuilders use this to isolate that quads and reach complete fatigue of the quads which is important in there sport not necessarily for the majority of the population.
So with the particular population in mind, any advice.
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RE: open chain knee extension - March 31, 2008 2:29:17 PM
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rwillcott
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First of all what was his knee injury? Ligament sprain, PFPS etc.? I'm sure he's looking for that 'tear drop' muscle (VMO) of his quad. Before allowing him to perform OKC exercises make sure he's doing enough CKC exercises.
Rob
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RE: open chain knee extension - March 31, 2008 3:17:05 PM
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Kaden
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No specific injury and I am not thinking of one particular patient but more a general type of patient and this question came to mind.
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RE: open chain knee extension - March 31, 2008 7:28:23 PM
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TexasOrtho
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There are tons of biomechanical models supporting specific modes of OKC for various knee conditions. Unfortunately, I've found patients to be pretty diverse in their response to each mode.
Once symptoms are stabilized, I do tend to go from closed to open chain as a preliminary approach. You'd be suprised (or maybe not!) how many patients respond in the exact opposite manner. My end-game with a lot of knee patients is whatever exercise they can tolerate in a pain-free range.
With complicated cases (not responding to any conventional treatments), I've had moderately good success with eccentric open chain strengthening. I'm not 100% sold on this yet until I know I can't achieve the same thing with less rigorous methods.
My 2 cents.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: open chain knee extension - April 1, 2008 8:23:35 AM
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Tom Reeves DPT ATC
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I would recommend that they stop at least 30 degrees short of full extension. that is where contact area is the smallest and therefore compression force is maximized.
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RE: open chain knee extension - April 1, 2008 10:30:20 AM
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Kaden
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Thans folks for the advice and crevidence I definitely agree with your take on the weird culture of super body building types
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RE: open chain knee extension - April 2, 2008 9:29:00 PM
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rwillcott
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Crevidence,
Those are hiliarious examples. The sad thing is they don't suprise me. Have you ever seen the documentary about the man who's arms exploded? He was injecting steroids directly into his biceps. He ended up with an infection and was draining the swelling out of his biceps on his own. Might be on youtube somewhere.
People forget that these people are addicted to weight lifting and getting big. Much like heroin. Runner's can be a strange bunch as well wehn it comes to taking professional advice.
Rob
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RE: open chain knee extension - April 3, 2008 8:20:47 AM
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PTupdate.com
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Creavidence notes "utter disregard for medical advice from serious strength trainers"....you are right, this occurs, but why? Perhaps the medical community does not perform it's end of the bargain, and thus loses respect. Far too many physicians and PT's simply tell the person "don't do that any more", which ends up being a knee-jerk reaction that does not benefit anybody.
This thread might be a perfect example. What really IS the evidence with regards to a healthy person performing TKE in the gym? We can note the literature with regards to contact forces that have been measured at different portions of the range, often on cadaver specimens. But does the fact that the higher shear forces, or smaller contact areas really translate into cartilage damage? There are millions of heavy lifters performing this exercise, including pro athletes and even semi-gym rats such as myself. Those with knee problems seem to have more traumatic histories, usually previous surgery for meniscal or cruciate damage. I honest cannot think of one time in my 17 year ortho career when I ever treated an older person with knee problems that were even slightly traced back to open chain knee extension exercises.
I do like Rod's notation with regards to pain.......and I personally avoid any range that I have pain myself. I do my TKE with the entire stack 2x/week, and my knees feel quite good.
Other body parts do have some more evidence with regards to joint damage, including osteolysis of the distal clavicle, but again pain seems to be a factor, and the condition can resolve with appropriate education, coaching, and common sense.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: open chain knee extension - April 3, 2008 10:05:51 AM
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jesspt
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Are the self-sabotaging actions of the weightlifting set that much different than those we see in other populations such as competetive marathoners/long distance runners? I've foudn the fastest way to "lose" these patients is tell them to simply stop what they are doing. Duffy's post above states succinctly how to best handle patients that fit into these groups.
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: open chain knee extension - April 3, 2008 11:18:45 AM
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Tom Reeves DPT ATC
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John,
You mentioned common sense at the end of your post. If you have a finite amount of cartilage between your patella and your femur, recognize that contact area is the smallest in the terminal 30 degrees of knee extension, the mechanical advantage of the quads is at its worst requiring herculean amounts of compression to move the weight and are knowledgable about the physiology of articular cartilage and its ability to tolerate load, why not simply do a different exercise?
There are no studies to my knowledge that specifically, retroactively look at those with PF OA and ask them if they did OKC TKE. But if you apply the common sense you mentioned with known facts regarding physics and physiology, you can come up with some predictions.
We have had this discussion before, I am probably not going to change your mind I used to think just like you do. My mind was changed by evidence. Where is the evidence that TKEs do anything to help you whether it be by pure strength measurements or functionally? There is plenty of evidence and reasoning to say that there are better ways to strengthen the quads than OKC TKEs. The rationale for doing the TKEs has been in my mind blown up.
I think you are hanging on to dogma here. You don't with anything else, but this is your white whale.
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RE: open chain knee extension - April 3, 2008 12:06:08 PM
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PTupdate.com
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White whale? That's my WIFE's nickname for me....you been spending time with my wife?
Tom, you know I am open minded, and I'd certainly entertain the evidence you indicate exists, favoring CKC over OKC for quad development and strength.
For me personally, I need to perform OKC quads to develop them, and avoid the last 20 deg due to occasional discomfort. I am not quad dominant. Tomorrow will be my leg day at the gym, and I'll have 7 45's on each side of the decline leg press...and with the weight of the sled that's close to 700lbs, but I won't fatigue or even get a burn in the quads. Used to have the record at the clinic on the VersaClimber.....1000 feet in 6.2 minutes, mostly because I can climb and use little quad, instead I am glute/hamstring dominant.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: open chain knee extension - April 3, 2008 1:29:49 PM
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TexasOrtho
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I'm not a huge fan of heavy OKC knee extensions and stick to the theoretical guidelines for many of my patients with anterior knee pain. However, there is a small percentage that not only don't respond to closed chain activity, they respond much better to open chain exercises much better. To me, it's what allows me to hammer their legs as much as possible without tweaking their symptoms. I have patients whose knees just refuse to read the textbook.
It makes me think the textbook needs rewriting. I think the theoretical models make good sense, but this is where clinical intuition has to play a role. I work around the pain regardless of OKC or CKC. My 2 yen.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: open chain knee extension - April 3, 2008 1:49:46 PM
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Tom Reeves DPT ATC
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Geez, i just typed a big long (beautifully crafted i might add) response and my stupid laptop wiped it out for me. Vacation tonight, will be back in a week. If i get a no show or cancellation i will try again.
White whale, I love that John. I've seen your picture, white yes, whale no.
< Message edited by Tom Reeves DPT ATC -- April 3, 2008 1:52:10 PM >
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RE: open chain knee extension - April 4, 2008 7:28:20 AM
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rwillcott
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I know someone who was once the fastest 800m runner in Canada. He missed the 1996 Olympics by something like a hundredth of a second. I don't think a day goes by that he thinks 'what if'. 12 years later he still gets choked up talking about it. If there was a drug that he could have taken to gain that hundredth of a second he would take it regardless of the risks to his health.
He once told me that during the peak of his running career, when he was his fastest, that was the only time he really felt alive.
Rob
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RE: open chain knee extension - April 4, 2008 10:46:50 AM
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PTupdate.com
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On a similar line, just created a new topic that I hope everybody participates in
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Crevidence, you are absolutely correct - not a single person in the universe even cares! If you all knew just what it is like to be the best.... I'm telling you, there isn't enough time or space to convey the work that it takes! LOL