Classification of knee retroflexion.
Knee retroflexion, also known as knee hyperextension, and knee anteversion, where the knee joint is angled backwards are all in this category.
According to the cause it can be classified as.
1. anterior knee paralysis or hypotonia type.
Due to paralysis of the quadriceps muscle or low muscle strength, the N rope muscle strength is weakened, the knee joint can not be stabilized in the straight position, forced to walk in the posterior extension position when bearing weight.
2. Posterior knee paresis or hypotonia.
N cord muscle and calf triceps muscle are paralyzed or low muscle strength, posterior knee including joint capsule, ligament, etc. relaxation, causing knee hyperextension.
3. Bone changes in the knee joint itself, resulting in abnormal knee position.
The first two are caused by the loss of proprioception in the knee joint due to poor control. Depending on the degree of knee retroflexion, they are classified as mild (below 10°), moderate (10-30°) and severe (above 30°). It can be divided into functional knee retroflexion and organic knee retroflexion based on the presence or absence of damage to the joint structure. It is a more severe deformity and its treatment is relatively slow and time-consuming. The current application of exercise therapy for functional training of children with retroflexion of the knee has yielded more satisfactory results.
Exercise therapy points to note.
(1), knee compression and whole foot method, ankle pulling method, ankle shaking method, and sacral flexor pulling training.
(2), knee flexion and extension, foot dorsiflexion training, improve the strength of the extensor muscles, coordination of antagonistic muscle tone.
(3), crawling training. (2), knee flexion position, which is conducive to the correction of antitension, while increasing the control of knee movement and coordinating its motor function.
(4), improve the strength of the national rope muscle to reduce the tension of the extensor muscle and coordinate the flexion and extension function of the joint.
(5), upper and lower step training. For correction of knee anteversion and coordination of gait has a greater role.
(6), increase the strength of the quadriceps muscle and thigh posterior group muscle strength.
Correction of “knee dystocia”, mainly to control the movement of the lower limb extensor muscles, generally mild cases to exercise training correction. The method is as follows: the child kneels on his hands and knees to support the mattress, the affected knee joint to do flexion and extension training, in order to coordinate the movement, the two knees alternate flexion and extension training, as the symptoms improve, to supine or standing position for correction, severe cases of lower limb correction or surgical correction. (For knee hyperextension phenomenon should be analyzed to produce the cause, roughly quadriceps weakness, quadriceps spasm, gastrocnemius spasm and several other causes)
Knee hyperextension phenomenon several causes.
1, a serious imbalance between extensor muscle strength and flexor muscle strength, i.e. flexor muscle strength is too small.
2, excessive tension of the knee extensor muscle.
3, weakness of the knee extensor muscle.
4, excessive tension of the triceps calf muscle/ i.e. foot drop, passive inability to cross the neutral position.
5. possibly related to hip control.
6, weakness of the quadriceps muscle is also a cause of knee hyperextension
7, weakness of one knee joint leading to compensatory knee hyperextension on the opposite side.
8. flexor spasm or contracture leading to knee hyperextension.
9, the use of compensatory knee hyperextension during collapsed knee gait.
10, spasm of the supporting phase knee extensors.
11, line of gravity falling in front of the center of the knee during forward trunk flexion, prompting posterior knee extension to maintain balance.
12, compensatory knee hyperextension due to Achilles tendon contracture.
How to improve knee valgus.
The so-called knee antalgia refers to knee extension greater than zero degrees, i.e. knee hyperextension, which is manifested by the leg popping backward when standing or walking, and the person’s center of gravity tilting backward significantly.
There are three causes of knee dystocia.
1, bony changes in the knee joint itself, resulting in abnormal knee position.
2. poor control of the knee joint under weight-bearing conditions, as evidenced by loss of knee proprioception, laxity of the periarticular ligaments, and weak or non-normal ratio contraction of the quadriceps and the country rope muscles.
3. Hyperextension of the knee joint can also be caused by contracture of the soleus muscles or high muscle tone. The main cause of knee hyperextension in children with cerebral palsy is hypotonia.
Specific training methods are.
1. foot method, ankle pulling method, ankle shaking method, and plantar flexor pulling training.
2. joint flexion and extension, foot dorsiflexion training to improve the strength of the extensor muscles and coordinate the antagonistic muscle tone. Crawl training, knee flexion position, is conducive to correcting the antalgia, while increasing the control of knee movement and coordinating its motor function.
3. National rope muscle strength to reduce the tension of the extensor muscles and coordinate the flexion and extension functions of the joint.
4.Up and down step training, for correcting knee anteversion and coordinating gait has a greater effect.
5, correction of knee varus, the main control of the lower extremity extensor movement, generally mild cases to exercise training to correct, the method is as follows: the affected knee kneeling position supported on the mattress, the affected knee to do flexion and extension training, in order to coordinate movement, the two knees alternate flexion and extension training, as the symptoms improve, change to supine or standing position for, severe cases of lower extremity correction or surgical correction.
In general, children can be promoted and strengthened according to normal developmental patterns. For children who will not stand due to knee dystocia, if crawling is not yet perfect we should first conduct crawling training and treatment, and also kneeling balance training, kneeling balance ability to a certain degree can be carried out in the standing position balance response promotion training, to give the child to support to promote correct standing, for children with knee dystocia must be inhibited For children with knee dystocia, we must inhibit knee dystocia training to induce the child’s ability to maintain balance actively. Lastly, when the child is trained to stand independently, attention should also be paid to suppressing the knee joint. It is best to instruct the child to control the knee joint by himself when standing, and if necessary, to control the knee movement to a certain extent with assistive devices.
Once there is a child with cerebral palsy in the family, the parents will have certain psychological reactions, which directly affect the child’s emotions and feelings at the same time. When their child has cerebral palsy, some parents are very negative about life and are afraid to take their child out for fear of being talked about or ridiculed by others. These children may have low self-esteem and depression due to the low contact with the outside world and the negative emotions of their parents, and may even be alienated from the group due to excessive care and pampering, which may affect the child’s social development, character formation, and interest in learning. Establishing a good relationship between children and the outside world makes them more relaxed, lively and happy, so that each affected child has a healthy psychology and a good character. In addition, some parents only care about their child’s gross motor development and want their child to walk as soon as possible, while neglecting upper limb function, ADL, language and cognition. For children with knee dystocia, standing and forced walking to promote straightening of both lower limbs is absolutely contraindicated. A holistic approach to the child’s rehabilitation allows them to fully develop their abilities in order to allow the child to truly go out into society.
Each child has different causes and problems, and a good treatment plan is crucial to the child’s rehabilitation. At the same time, as a therapist, you should also observe carefully to find and correct the poor posture of the child in time. Among the children with cerebral palsy I trained, there was one example: the child was in a “W” shape in sitting position, the left hip was internally rotated, and when he changed from supine to sitting position, he was in a supine – lateral – semi-kneeling – sitting position. The child was in a “W” shape when sitting, and when changing from supine to sitting, he was in the sequence of supine – lateral – semi-kneeling – sitting up. In fact, these problems can be solved by early correction, teaching the child to sit cross-legged and to change position from supine – lateral – sitting up cross-legged.
Training of knee hyperextension (knee dystocia) in children with cerebral palsy.
1. Achilles tendon pulling training.
With the child in supine or long sitting position, the parent holds the ankle of the child with one hand, the palm of the other hand is placed under the heel of the child, and then holds the heel of the foot so that the heart of the child’s foot is pressed against the forearm and pulled upward with force in the horizontal direction. Note that the palm of the ankle should be fixed in a good position, and the whole foot should not be pulled up; also note that the force we use is mainly pulling the Achilles tendon, not pressing the palm of the foot, otherwise it will easily lead to the destruction of the arch of the child’s foot. Each pulling time can last 1 to 3 minutes, and the number of pulls depends on the degree of plantar flexor contracture of the child.
2, use both hands to help the child or let him hold the bed rails or table or other objects, slowly squat down.
Note that when doing this, the body should not be bent, the knee joint should try to move forward, and the heel should not leave the ground. You can also let the child stand triangular plate, each pulling time can last 1-3 minutes.
3, improve the muscle strength of the anterior thigh group training.
The child in a long sitting position, do knee extension training, such as putting a towel roll under his knee joint, so that the knee joint from the bed or a certain distance from the ground. Then, have the child press the knee joint downward, hook the toes, and tense the thighs after 6 to 10 seconds, then relax. This can also be done in a seated position. Have the child sit on the edge of a chair or bed, hold the edge of the chair or bed with both hands, kick the foot straight for 6 to lO seconds, and then put it down. You can also have the child bend the knee and hip first, and we apply the block at the ankle of the calf, and then order him to straighten the leg to improve the muscle strength of the anterior thigh group. Or use the quadriceps trainer for training.
4, improve thigh, posterior group muscle strength training.
Let the child be in a prone position, the parents use one hand to hold the thigh, and the other hand to hold the ankle of the child, help the child to do the action of flexion and extension of the knee. When the child is able to perform this movement on his or her own, the parent can use both hands to hold the child’s hips to prevent them from buckling when the knee is flexed. Likewise, parents can use their hands or other heavy objects such as sandbags tied to the ankle as resistance for this training.
5.Improve foot dorsiflexor muscle strength training.
This training is especially important for children who have hyperextended knees due to plantar flexor contracture or high tone. Let the child is in a long sitting position, force to hook the toes upward, or use a rubber band or make a rubber band, set on both feet, one foot downward, one foot upward hook.
In addition to the above-mentioned training methods, in order to increase the fun, parents can also use colorful cloth to sew several sandbags of varying weights, so that the child try to pick up with the toes of both feet and put them not far from the basin, which can also achieve the purpose of training.
6, knee joint control training.
Parents face the child, let the child put his hands on the shoulders of the parents, parents put their hands on the outer side of the child’s knee joint to help the child control the movement of the knee joint. The child is then placed in an upright position, slowly squatting down and then slowly standing up. Note that the knee should be controlled in a normal position when the child is upright and should not be allowed to hyperextend. The magnitude of the squat should be determined by the child’s ability to control the knee joint. Generally, the child should move from small to large amplitude and from double to single leg.