Maven Sports Medicine effectively combines our high standard of orthopedic rehabilitation practice with our clear understanding of elite fitness and sports performance. Maven’s Doctors of Physical Therapy have decades of combined practice experience in orthopedic rehabilitation, sports strength/conditioning, fitness, and athletic training. Our dedication to providing excellent evidence-based care to all our active and athletic patients remains consistent.

Bones of the Knee

The knee joint is comprised of three bones- the femur (thigh bone), the tibia (shinbone), and the patella (knee cap). The femoral condyles (distal end of the femur) are seated on top of the tibia (tibial plateau), where the medial and lateral menisci add improved congruency to the joint1. The patella serves an important role in increasing the efficiency of the knee extensor mechanism particularly during the last 30 degrees of knee extension, reduces friction, and helps to direct the movement of the quadriceps tendon during movement as well1.

As a hinge joint, the knee has two primary motions- knee extension (straightening the knee) and knee flexion (bending the knee), however, a small degree of rotational motion is also present.


Muscles of the Knee

Knee extension is executed through the activation of the quadriceps muscles
(the muscles on the front of your thigh), which, as the name implies, is comprised of four muscles- the vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. While the "quads" collectively extend the knee, the rectus femoris has the added function of flexing the hip, since it crosses the hip anteriorly.

Knee flexion is accomplished by the three hamstring muscles- semimembranosus, semitendinosus, and biceps femoris, located in the back of the thigh. The hamstrings also serve the function of extending the hip since they cross the hip joint posteriorly.

Other muscles with an action at the knee include the popliteus, which "unlocks" the knee from an extended position to a flexed position, the sartorious, tensor fascia lata, gracilis, and the gastrocnemius (one of your calf muscles).


Ligaments of the Knee

While the knee joint is well supported by large muscle groups, its stability is further enhanced by the presence of four major ligaments- the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL).

Physical Therapy Intervention- Knee strengthening is a predominant component of knee prehabilitation of the prior to surgery and post-op rehabilitation of the knee. The goal of strengthening is primarily to enhance the dynamic function of the knee during activities of daily living and return an athlete to full sport participation. For the ACL, strengthening of the hamstrings, in particular, is important since the hamstrings provide the knee with dynamic stabilization and assist this ligament in keeping the tibia from moving forward in a flexed position (as when "cutting"). For the PCL, strengthening the quadriceps is an important component of the strengthening.

Another focus of physical therapy for the injured knee is to help guide the restoration of joint proprioception, that is, the ability of a joint to know where it is in space; all ligaments contain proprioceptive nerve endings that are severed when the ligament is fully torn. Using balance and coordination activities early after injury or post-surgery is crucial in regenerating the necessary pathways that are associated with proprioception.

Manual therapy of the knee includes joint mobilization and massage. After surgical reconstruction of a ligament, the knee tends to stiffen and loses significant range of motion; if the joint range of motion is not restored, there is a high probability of joint contracture, which may result in the need for manipulation under anesthesia and significant delay in the return to daily life and/or sport.

Sport-specific rehab or prehab for the knee is a critical component in physical therapy for the athlete. To strengthen the impairments (strength, range of motion, pain, e.g.) after an injury or surgery is not enough for athlete to return to their sport; it is imperative that clinicians assume a sport-specific mentality from the initial evaluation to discharge. All therapeutic activities are geared towards returning a patient to their sport with full participation. For example, incorporating specific conditioning activities, speed and agility drills, quick reps, and plyometric activities to simulate sport activity that involves the lower extremity should be a mainstay to the plan of care for an athlete.