Answer 1

Structures to assess

Knee injuries are extremely prevalent in all sorts of sports. There are multiple structures that constitute the knee. Hence, identification of the specific injured part is necessary to manage the situation. More than one structure can be damaged depending on the type of injury. 5 common types of knee injuries with associated knee structures are discussed below.

1. Fracture: Patella is commonly known as knee cap, it protects other the internal structures of the knee, specifically the knee joint. When the knee of a person collides with any hard surface during fall or in any such situations, the patella first comes in contact and tends to crack at once.
2. Dislocation: Knee dislocation refers to the situation when the knee bones i.e. femur (thighbone), tibia (shinbone) and the patella (kneecap) come out of their usual locations. Fall, collision with hard surface can lead to this situation.
3. Ligament Injury: Overextension or unusual movement of the knee causes ligament injury. The cruciate ligaments of the knee are mostly injured in such situations. Cruciate ligaments of the knee are composed of 2 pairs of ligaments which include the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) which forms the ‘X-shape’ and the collateral ligaments are named as medial collateral ligament (MCL) and lateral collateral ligament (LCL) (Ascani et al., 2015).
4. Meniscus Tear: Jumping, twisting, frequent changes in direction are the situations when the meniscus cartilage of the knee might be torn (Cesar, Tomasevicz & Burnfield, 2016).
5. Tendon Tear: This usually happens due to awkward landing after jump, even middle-aged runner can experience this type of injury. Tendons fail to overstretch and get torn.  

Test to assess knee injury

First of all radiographic imaging must be done to assess any kind of knee injury. There are few tests which are performed to determine the exact injured part of the knee. Some of which are mentioned below.

1. Anterior Drawer Test: Suspects ACL tear.
2. Posterior Drawer Test: Indicates PCL injury.
3. Valgus or Abduction Stress Test: MCL injury is confirmed with this test.
4. Varus Stress Test: Evaluates LCL condition.

In this particular scenario, valgus or abduction stress test would reflect positive result since it is associated with MCL injury.

Answer 2

After the diagnosis of injury, it is advised to protect the knee for 3-6 weeks with the help of a short hinged brace. The athlete is advised to resume any kind of exercise only if the swelling and pain are lessened (Naqvi & Al, 2017).

Exercise for increasing range of motion

It is extremely important for an athlete to regain the range of motion of the knee after an injury. There can be multiple options that might be helpful. Considering the type of injury in this study i.e. MCL sprain, stationary bicycle is the recommended exercise to increase the range of motion initially (Silva et al., 2015).

Stationary bicycle is one of the exercise tools that aids in movement of knee joint and thus help in increasing the flexion process of the knee. Initially the injured person might not be able to pedal the entire way round, however the operated leg is to be kept on the pedal and only back-forth movement is suggested. Gradually improvement will be seen in knee bending and full cycling will be allowed. It has been observed a many times that people achieve full cycling capacity firstly with backward cycling and then follow forward cycling (mghsportsmedicine.org, 2020). The seat height must be set according to the height of the athlete. Athlete must follow below instructions regarding the use of stationary bicycle.

Days each week: 5 to 7 days.

Sessions each day: 1 to 2 times.

Time of each session: 10 to 15 minutes.

Exercise for maintain strength

In order to maintain the strength of the knee, isometric quads contraction can be chosen to start with. This should be performed very carefully to avoid further damage of the knee. Athlete can start this exercise soon after the improvement in swelling and pain. It could be done on daily basis. In this exercise, the quadriceps muscle should be contracted in front of the thigh and should be hold for at least 10 seconds. After that, 3 seconds of rest is suggested to relax the muscle. Athlete can repeat it for 10-20 times. A foam roller or rolled up towel can be placed under the knee to get some extra support. Lifting off the knee from the floor helps in strengthening of the knee.

Answer 3

Closed chain exercise

Closed kinetic chain exercises are beneficial for athlete to overcome the injury. Squat can be suggested to the injured athlete as a primary closed chain exercise. Squatting technique must be followed carefully. In the beginning, the athlete is to stand in a position where the feet are shoulder width apart. The feet must remain in a forward position otherwise deviation from the position can create pressure on the knee. After that as metal bar is kept on the shoulder of the athlete, specifically on the trapezius muscle. The person is then advised to go down in a squatting posture while the heels are kept firmly on the ground. The tibia and the trunk of the athlete should maintain a parallel position and femur bone should be kept parallel with the ground. There is no need for knee-flexion that is more than 90 degree. Athlete is advised to avoid medial or lateral overextension of the knee at any point of time. 10 repetitions can be performed. The position should last for at least 20 seconds in each of the repetitions (Qumbu et al., 2016).

Sports specific exercise

It is extremely important for a sportsperson to get back to his/ her functional areas. Sports specific trainings are essential and must be incorporated with other trainings to improve the performance. Goals of the training include equalization of force in the limbs, elevation of endurance power and improving stability as well as confidence with high-intensity exercises that involves change in directions.  Power training is considered one of the most essential sport-specific training programs since it accelerates regaining the power and strength of the athelete (Howatson, Brandon & Hunter, 2016). For tennis players it is very important to maintain their jumping techniques. Hence, before starting any kind of stroke practice exercises, Jump training is recommend in this specific scenario in order to improve the plyometric moves of the person on the real ground. The parameters are briefed below.

Figure: Jump Training Details

Source: Barber-Westin, Hermet, & Noyes, 2015.

References

Ascani, D., Mazzà, C., De Lollis, A., Bernardoni, M., & Viceconti, M. (2015). A procedure to estimate the origins and the insertions of the knee ligaments from computed tomography images. Journal of biomechanics, 48(2), 233-237.

Barber-Westin, S. D., Hermet, A., & Noyes, F. R. (2015). A six-week neuromuscular and performance training program improves speed, agility, dynamic balance, and core endurance in junior tennis players. J Athl Enhancement 4, 1, 2.

Cesar, G. M., Tomasevicz, C. L., & Burnfield, J. M. (2016). Frontal plane comparison between drop jump and vertical jump: implications for the assessment of ACL risk of injury. Sports biomechanics, 15(4), 440-449.

Howatson, G., Brandon, R., & Hunter, A. M. (2016). The response to and recovery from maximum-strength and-power training in elite track and field athletes. International Journal of Sports Physiology and Performance, 11(3), 356-362.

massgeneral.org. (2020). Massachusetts General Hospital. Retrieved 7 July 2020, from https://www.massgeneral.org/

Naqvi, U., & Al, S. (2017). Medial Collateral Ligament (MCL) Knee Injuries.

Qumbu, B. T., Ellapen, T. J., Swanepoel, M., & Williams, J. (2016) The Squat: An Excellent Final-Phase Knee Rehabilitative Assessment Tool.

Silva, L. P. D., Desai, C., Loureiro, N., Pereira, H., & Espregueira-Mendes, J. (2015). Knee Medial Collateral Ligament Injuries. In Football Traumatology (pp. 127-134). Springer, Cham.