LS: R Distal Quad Strain and Anterior Knee Pain: Evaluation

  • 6-13-17
    • Subjective Report:
      • Patient reports 4-6 week history of mid to distal aterior thigh/quad pain that is worse after wrestling and with squats. Pain is most prominent on the R but has had a history of some anterior knee symptoms on the L
    • Objective findings:
      • Flexibility
        • Hip and lumbar mobility within normal range
        • hamstring flexibility mild restriction at 80deg
        • quad flexibility fairly symmetrical with no significant limitation
        • Mild limitation in L shoulder flexion compared to the R
      • Strength
        • Single leg balance with dynamic movement mild instability with significant shift of shoulders over the stance leg indicating glute med weakness in single leg position
        • Squat technique: quad dominant with increased weight on the toes with slight toe out on the R compared to the L
        • Single leg hamstring bridge on the physioball R 8reps L 5 reps
        • Single leg heelraise 11 reps bilaterally
        • Single leg bosu ball dynaamic balance 1:40sec prior to fatigue with moderate instability
        • Resisted hamstring strength: 4-/5 bilaterally
        • Resisted glute max strength 4-/5
        • Resisted glute med strength 3+/5
    • Summary
      • Quad to hamstring strength ratio with significant quad dominance and weakness of hamstring resulting in excessive quad strain with standing squatting movements
      • Weakness in glute especially glute med which controls knee position duirng squatting and especially single leg movements