Question

Mr B – an elite Australian Rules Football player presents with patella-femoral pain on the left side. It is aggravated by running and kicking as well as when he does squats as part of his gym program. Outline the biarticular muscles and structures you could assess that may play a role in the cause of his knee pain, stating the muscle length tests you would perform for these muscles and detailing the combination of hip and knee movements that would result in an effective length test and stretching program for him.

Answer 1

In the legs the most important biarticular muscles are the hamstrings, rectus femoris of the quadricep group and the gastrocnemius.

Since biarticular muscles span more than one joint, they are very important in running, sprinting and sports in general. In the legs, rectus femoris slows down hip movement and converts it to knee extension. The hamstrings slow down knee extention and convert it into hip extention. The gastrocnemius slows down knee extension and converts into planterflexion at the ankle joint.

Since the main energy generators in sprinting and squatting are the monoarticular muscles glutemax and the quadricep groups, so the exercises should be aimed at getting concentric energy from them, so that it can be transformed into efficient movementby the biarticular muscles.

To strengthen the muscles and reduce the knee pain, the following exercises will be effective--

* Sit up straight on a chair and slowly straighten the leg until straight with the foot pointing outwards. Squeeze the thigh muscles and hold on to this position for about 15 - 20 seconds. Keep tensing the thigh muscles while the leg is in this position for more effective results.

* Hamstring curls- lying on the floor, belly down, lift one or both feet off the floor by bending the knees. Then slowly straighten the legs. Weight can be added on the feet for quicker results

* Wall squats- stand against a wall and keeping your back still flat against the wall, bend your knees as if sitting on a chair. Put your hands on the knees or raise them to the level of your shoulders. This helps to strengthen the biarticular leg muscles and also the core muscles so as to give better support to the upper body. This alsohelps to stabilize the body at the hip.

* Side leg raises- this exercise targets the iliopsoas [ the anterior hip flexors] and the rectus abdominus muscle so that the body is better stabilized during motion. This exercise also helps to strengthen the inner thigh and butt muscles, which are key to core strength and stability

Lie on the right side, with the body in a straight line. Lift your left leg towards the cieling and then return to the starting position. After repeating this for about 10times, turn to your left and repeat the procedure. The whole exercise can be repeated again.

* Calf raises- Balance your body with your hands against the wall or a sturdy object. Rise the heels a few inches so as to be standing on the toes. Be in this position for a few seconds and then slowly lower the heels. This exercise helps strengthen the calf muscles.

* Step ups- This is done by using a woodden box, usually 12 to 24 inches in height. Ideally, the box should be high enough to result in a 90 degree angle between the knee and hip joint.

The front foot is placed on the box and then the other foot is also brought onto the box so that the person is standing on the box. Then step down, one foot first, followed by the other. It is like repeatedly climbing up and down one step only. This exercise helps to strengthen the quadriceps, glutes, hamstrings and calf muscles and involve both the hip and the knee joints.