Medical Background

Prevalence of Hip- and Knee concept

The Spine Concept, Hip & Knee Concept and Shoulder Concept in Fachklinik Bad Bentheim, Germany.

Human joints were designed by nature to last about 40 years. Degenerative diseases of the joints have become the main reason for pain and as a consequence, loss of life quality in the middle aged and elderly.

The popularity of football, ice hockey, and skiing has all contributed to the increased frequency of injuries like MCL tears. Increasingly there is consensus in the medical community that controlled physical activity can be a major contributing factor in preventing and healing various knee and hip problems.

It is a well proven fact that for many musculoskeletal illnesses that require surgery as treatment, the outcome has been significantly improved by rehabilitative muscle training.

Indications

Osteoarthritis (knee and hip)
Patellar instability
The medial collateral ligament
Patellofemoral pain syndrome
Meniscus Tears
Anterior Cruciate Ligament Tears

Movement as medicine

Several studies have shown that movement can act as medicine for painful joints. With joints like the knee, which are relatively simple structures, movements are simple and loading is easy to apply in a controlled manner, but special devices are required to isolate the target area to provide total control in the movement and loading.

All movements should start with limited range and low loading, within the pain tolerance. Time is essential since physiological changes are slow. Ideal treatment should run for three months with an ongoing program afterwards.

Diagnose Based Treatment

Osteoarthitis (Hip and Knee)

It is the most common cause of chronic disability among the aging population. Effects of illness are a complex interaction between biological, psychological, socioeconomic and environmental factors.

The effectiveness of exercise in knee and hip osteoarthritis is attributed to its ability to reverse muscle sensomotor dysfunction (weakness, fatigue, poor control) preventing abnormal movement and restore normal biomechanics, effecting better gait, relieving pain and improving function.

It has been shown that by muscle strengthening and weight reduction (as a result of regular exercise and additional dietary programs if needed) alone, patients can decrease the amount of pain medications needed on a regular bases and prolong the time until Total Joint Replacement surgery is needed.

The medial collateral ligament injuries

The medial collateral ligament is one of the most commonly injured ligaments of the knee. Most injuries result from a valgus force on the knee from direct contact or with cutting maneuvers when an athlete plants his/her foot and then forcefully shifts directions The popularity of football, ice hockey, and skiing has all contributed to the increased frequency of MCL injuries.

The treatment of medial-sided knee injuries has evolved from aggressive surgical treatments to mostly non-operative management with an appropriate functional rehabilitation program. The patient is allowed to bear weight as tolerated depending on their pain level with use of a hinged knee brace to protect the knee from further valgus stresses. Active range of motion is initiated early to prevent stiffness with concomitant strengthening exercises.

Patellar instability

Patellar instabiity describes patellar dislocation, patellar subluxation, and general symptomatic patellar instability. It accounts for 11% of the musculoskeletal symptoms and there is a higher incidence in females.

Patellar instability can often be treated successfully without an operation. Ideal rehabilitation requires the avoidance of pain during exercise. While strengthening of the quadriceps muscle and the vastus medialis obliquus is the initial management of many patients, stretching of the lateral retinaculum, hamstrings, quadriceps, Achilles tendon, and iliotibial band should also be performed.

Therapy should include closed-chain exercises and strengthening of the vastus medialis obliquus (the main dynamic stabilizer of the knee). Establishing proper core stability and functional alignment of the lower extremity is important.

Anterior cruciate ligament tears

The anterior cruciate ligament of the knee controls movement of the lower leg bone (tibia) relative to the thigh bone (femur) and guides knee extension. Injury to this ligament is most common, especially when playing sport, through rapid stopping with a twisting movement. Injuries consist of partial or total tears in the ligament itself or where it attaches to bone.

The goal of the treatment of ACL ruptures is to obtain the best functional level for the patient without risking new injuries or degenerative changes in the knee. There are many factors to be considered when deciding whether an ACL rupture should be treated surgically or conservatively.

Among these factors are the degree of instability, the presence of meniscal lesions, the patient’s level of athletic activity and the patient’s age. A widely advocated treatment strategy is to recommend early reconstruction in the highly active patients and to start with a non-surgical treatment for the less active patients.

The Hip and Knee Profile is similar to the Spine Profile. It provides a comprehensive analysis of the mobility and strength of the hip and knee joint. These values can be compared to a vast database of age, height and weight normalized data. Most of the test can be done uni- or bilaterally.

Technology

EVE (eValuated Exercise) Professional is a complete measurement and monitoring system designed to work together with the David Spine Concept and David Hip & Knee Concept.