Joint stability is important! When a joint is weak it makes it difficult to perform daily activities. When there is a dysfunction of the local stabilizers the neurological signal becomes phasic (signalling is switching on and off) instead of a tonic signal (continuous). The inhibition of the signal (turning off of the neurological signal) is caused by pain or a high load. Another cause of inhibition is improper recruitment (the body signals too much or too little) of muscle fibres. This can cause a delayed response in muscle contraction and the joint will not activate the secondary muscles of the knee. This can cause less of a force to bring the joint back to neutral (knee at extension). Secondary muscles are: hip adductors, hip abductors, iliotibial band (liagment) and glutes.
When one wants to practice recruitment of local stabilizers they need LOW LOADS of less than 25% of maximum contraction in a closed kinetic chain (keeping the leg fixed so that movements in other joints are prevented). When doing this, you want to perform the movements slow and controlled. Proprioceptive exercises are a good challange for the client as well.
Retraining local stabilizers is similar to practicing recruitment. Using low loads of approximately 25% of maximum contraction or force and working in a neutral joint position creates short levers and uses closed kinetic chains that are most suited for this rehabilition. Start with small ranges of motion and, as your client improves, increase the range of motion. Slow and controlled movements are better for training local stabilizers and remember to use proprioceptive tools and feedback. Try to use as many planes of motion as possible but proceed with caution because some directions may be more challenging to the client than others. Knee instability varies with each client. Local stabilizers are not direction spectific and you need to ensure that they will fire in all planes.
Exercise Ideas – Mat
- Knee folds
- Toe Taps
- Knee Circles
- Leg circles
- Hip sways
- Leg extensions
- Squats/Lunges – start supported
- Side Kicks
Equipment that can be added
- Elastic Bands
- Soft weighted balls
- Tonning balls/air balls
- Exercise balls
- Pilates Circles
- Reformer
Exercise Ideas – Reformer
- Footwork
- Shoulder Bridge
- Leg straps – depends on their stability
- Stomach massage
- Side kicks – can add straps or do on foot bar
– Canfit Pro Conference, Stott – The knee: Stabilty and Function notes, 2010