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varus and valgus example

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How to understand and fix your CPPS and Hard Flaccid - (With starting exercises and routines)

How to understand and fix your CPPS and Hard Flaccid - (With starting exercises and routines)
(CPPS stands for chronic pelvic pain syndrome and is a term that applies to hard flaccid)
Make sure you have read these posts before continuing, any comments that are explained by material in these posts will be answered with a link to the post:
Why your Hard Flaccid isn't nerve damage + Understanding the role of fascia - Applies to HF/CPPS
Intro to Hard Flaccid - Applies to HF / CPPS
How Hard Flaccid works and why it manifests certain symptoms - (Only for those with HF)
I recommend you read or brush up on those posts. To fully understand how to fix CPPS and HF you have to buckle down and get some information and understanding. I am compiling ways for you to diagnose your specific problems, with basic exercise links to get you started. This will be a long post, you may have to read a little ways before you find the links.
With that being said, lets begin. I am separating this post in 2 parts: The Muscular System, The Fascial System, and Building your own routine. The muscular and fascial system are heavily intertwined and work together in accomplishing the same roles, however, they are fixed differently and cause different problems which is why I am separating them into parts.
The Muscular System - The problems here are what allow your fascial system to changed in the first place, and are the physical cause for your HF/CPPS. Therefore, I will be covering this first in the top half of the post. This part will contain: How to correct your muscle imbalances, fix posture, pelvic tilt, and strengthen + stretch the muscles that need it. (It will also come with attached links and examples for you to create your own routine!)
The Fascial System - The problems here are what allow your symptoms to be chronic, and be painful. As I explained in my other post, a very low amount of people with these conditions actually have nerve damage, it is pain travelling through the fascial system. Your fascia literally encapsulates the nerves, pain from irritated and tense fascia is normal. Though the medical world is far behind and is bad at treating fascial pain, since it is the main way people experience chronic pain, I will be covering the way to fix it for good.
Building your own routine - I've seen a very common problem, people don't know where to start and what to do. I am making a small section for people who cant figure out what they want to do or make for their own exercise routine.

Part one - The muscular system:


All the bodies muscles are connected. When thinking about how a muscle could effect others, simply look at its placement on the body.

As most sufferers know, almost all Hard Flaccid symptoms are due to a chronically tight pelvic floor, this applies to CPPS on a lesser extent. To figure out how to fix this tight pelvic floor, we have to asses not just the pelvic floor, but the entire body.
Many treatment methods of Hard Flaccid focus on direct relaxation of the pelvic floor. Things like dry needling, massage, reverse Kegels, and de-stressing. None of these work permanently because they do not target the body, only aiming for temporary relaxation of the muscles in question. This is often the problem with physical therapy, most physical therapist don't look at your body as a whole, and just try to treat the pelvic floor. This is why most HF/CPPS patients don't receive much help from physical therapy.
So, we need to target the body, not the pelvic floor. Where do we start? A better question is: What are we looking for? We are looking for anything that can compromise your movement patters in any way. Anything that shifts the load off of where its supposed to be will cause a gradual buildup of muscle imbalances and fascial buildup problems. Posture is a big example, as it compromises the spines ability to keep things stable, and shifts the job of keeping stability over to the deep abs, or pelvic floor. Lets look through some things that can cause problems like this before we go any further. Make a mental note of any of these problems you have, and their muscular causes.
We can check for some of the most common and self diagnosable muscle problems first. You will need a person to look at you, or a mirror / camera. Check the image captions for the muscles that cause these issues.
If an issue has a \*, then it is extremely common and you probably already have it.*
Pelvic Tilt - By far the most common issue in CPPS and HF cases. Causes very bad load distribution for the body, and generally sets you body up for failure. Normally gained from excessive sitting. Anterior, posterior, and lateral tilt all possible.**

Anterior pelvic tilt is caused by: Weak abs, Weak glutes, tight hip flexors, tight lower back. Posterior pelvic tilt is caused by Tight abs, Tight glutes, Weak hip flexors, weak lower back.

Lateral pelvic tilt is caused by tight low back, tight psoas (hips), weak glutes, and tight adductors on the raised side.
Pronated / Supinated feet - As unbelievable as it sounds, your feet can have an impact on HF/CPPS. They are what set up your walking mechanics for failure first if you have foot problems. Flat (supinated) or high arched (pronated) feet can affect how loads are placed on your whole body and walking mechanics.

Supinated feet are caused by weak foot arch muscles. Fix pronated feet by wearing looser, more comfortable footwear.
Inactive and possibly weak Transverse abs (Deep abs) - Most HF/CPPS sufferers have this. It sets your body up for failure as it cannot stabilize or breath properly. **

Inactive or weak transverse abs usually connect to inactive glutes
Inactive and possibly weak Glutes - Almost all HF/CPPS sufferers have inactive glutes. The glutes and the transverse abs are one in the same. When there is dysfunction in one, dysfunction in the other is almost guaranteed. When your glutes are inactive, your hip flexors are used to make the legs move forward (flexion) when normal walking patterns should be pushing off the glutes or optimal leg movement. **

Weak / inactive glutes usually caused by weak / inactive transverse abs
SIJ (Sacro-iliac join) dysfunction - Directly related to the glutes and deep abs, without proper SI join function, your pelvis cannot work correctly during movements, and thus it creates muscle imbalances and lower range of motion because of the lack of movement possible. *** nearly all cases of HF and CPPS have this

You could feel pain or no pain. All that matters is that your bio mechanics are not working properly, therefore your SI joint cannot rotate your pelvis properly and causes more problems down the line. Connected deeply to glutes and deep abs, usually caused by both being weak / inactive.
Valgus and Varus Knees - Directly affects walking mechanics and causes hip rotation. A no brainer.

Valgus knees are caused by strong adductors overpowering weak abductors. It is the other way around for Varus knees
There are more of these problems, but these are some of the more common ones.
Weak muscles need strengthening, tight muscles need stretching, weak and tight muscles need resistance stretching. Those are the basics for what you need. There are a few types of muscle contractions, eccentric being the most important for this condition. Eccentric contractions are when your muscle lengthens with a load on it, strengthening and relaxing it. This is more commonly referred to as a resistance stretch. Do them for your tight muscles as well, just in case they may be weak.

Types of muscle contraction, focus on the eccentric contraction.
Basic starting exercises for whatever muscles you need to work, or do them all, no harm in it:
Anterior Pelvic Tilt routine (Contains glutes, abs, hip flexors, and lower back): Scott Herman Fitness - Anterior Pelvic Tilt routine
Glutes: Glute bridge | One leg glute bridge | Resistance band glute stretch
Abs: Plank | 8 point plank | At home eccentric ab exercises
Deep abs: Deep Abs exercise compilation | 3 Deep ab exercises | 5 Pilates exercises to strengthen and active the Deep abs
Hip Flexors: Eccentric hip flexor stretches *Do not do non-resistance stretches for hip flexors
Quads & Hamstrings: Lunge and twist (Works many muscles, not just quads & hamstrings) | Deep Squat
Adductors: Copenhagen adductor exercise | Slider adductor exercises | Eccentric adductor groin strengthening
Abductors: Hip Abductions | Eccentric hip abductions (Hip drops)
Foot arches (For supinated feet): 3 Foot arch exercises | Flat feet exercise compilation
Lower back: 8 Regular lower back stretches | Eccentric back exercises
Psoas (Hip muscle): 3 Psoas exercises | Psoas stretches
All around eccentric exercise compilation: Eccentric exercises full body
Free compilation of resistance stretches specifically for CPPS/HF (PDF): Resistance stretches for CPPS/HF
\Notice there are no stretches or exercises for the pelvic floor, since it isn't actually the pelvic floors fault for the problems, there is no need for stuff like Kegels, and they can make your problem worse.*
Exercises to avoid: Sprinting, Biking, Heavy weightlifting
Those are some exercises to get started, but you can also google more and use them, when fixing the muscular imbalances, expect the progress to be slow. You are changing body tissue. Do the exercises consistently to really feel change. All changes will be over time and gradual. For HF Cases, you will see your symptoms disappear 1 by one, for CPPS cases, if you have symptoms they will disappear over time. If you only have pain this will not treat it but you still need to do these exercises to correct the pain. Which brings me into the next topic:

Part two - The Fascial System


The clear casing over the muscle is fascia, that is how closely related to the muscles it is.
The fascial system plays a huge role in many HF/CPPS cases. There are many fascial lines throughout the body that will carry tension and pain, went over in my post about "Why hard flaccid isn't nerve damage", refer to that post for the images. I covered most of the fascial topics in that post but I will go over them shortly again. When your muscular imbalances cause the issues gone over above, it decreases their ROM (Range of motion), which slowly but surely causes your fascia to adapt and compensate for this. It condenses and forms knots and tight cords that reduce range of motion further. In addition, excess fascia builds up to compensate for body orientation issues and around muscles and joints.
The fascial system needs hydration, normally, the hydration would be transferred all the time. When the range of motion is reduced, the hydration does not transfer. Causing some fascia to become tight, hard, and dehydrated. This creates "tight" fascia, it binds up in a double helix like DNA. Tight, dehydrated fascia which encases all nerves, muscles, and organs. You do the math one what happens next. Symptoms can be digestive dysfunction, pain, and lost range of motion. This tight fascia causes frictions and irritates the nerves and creates more tightness in the muscles. This is how most cases of HF/CPPS become chronic, by the time you develop CPPS, your fascial issues have probably already started.
So how do you get rid of this buildup of fascia? Well, you don’t get rid of your fascia, you’re just unwinding it and untightening it. Here is an analogy: A muscle knot / tightness / trigger point / etc. forms like a screw being driven into a piece of wood. The twisting motion drives the screw down, twisting all the wood (tissue) around and locking it in tight and compacting it, twisting your tissue and muscles and changing your posture and body.
So how would you get this screw out? You wouldn't press on it (like a massage). You wouldn't strengthen the wood. You would use force and pressure to to slowly remove the screw which would unlock the area that was screwed tight. But you still need to keep the wood (surrounding muscles) strong so you have the strength to pull out this screw.
Analogies aside, the only way to unwind fascia is with gradual, repeated force. Contracting the muscles and bringing back the range of motion, as well as lengthening and slowly unwinding the fascia. The best way to do this is with Eccentric muscle contraction, as was gone over earlier in the post. You need to target your problem areas (where you feel pain, tightness, or symptoms) and find resistance stretches or eccentric contractions to hold to release the fascia over time.
Fascia requires approx. 1,800 lbs. of force to change instantly, the only way to make fascial change is through repeated light force over time. This is the reason myofascial release therapy does not work.
I cant really list common fascial problems as they are extremely case by case. All I can recommend in this section is googling your problem areas and then searching YouTube for eccentric contractions or resistance stretches to do for your problem areas.
While controversial, the program known as DCT (Dynamic Contraction Technique) is very good for releasing fascia and treating CPPS. I will not endorse them, I am just simply letting you know of their existence in case you would like to research them more. A lot of their stuff is available for free on YouTube.

Part Three - Building your own routine


Your routine shouldn't be too hard to make. First set a schedule. Like this:
Mondays, Tuesdays, Fridays - [Some exercises]
Wednesdays, Thursdays - [Some other exercises]
Sunday - [Day off]
Feel free to change up the days however you want, but try to get at least 30 minutes of these types exercise into all days except your rest day. Normally you would fill those slots with strengthening, stretching, and resistance stretching. Maybe Monday Tuesday and Friday will be for strength while the other days are for stretching and breaking down fascia. Feel free to throw together the exercises included in the post + some more you find on google and use them in your routine!
Its also very important to add a functional, low impact exercise. Swimming is great for passively breaking down some fascia and building strength, and walking is great for re-learning and using our walking mechanics more often. Try to get at least 30 minutes of this type exercises 5 days a weak.
Here was my routine while I was fighting HF, I'll use it as an example. You don't need to total as much time as me, but the more time you put in, the quicker results you will get:

Monday, Wednesday, Friday - 30 extra min glute activated walking and 1hr swimming, pull-ups, pushups, normal plank, Leg strengthening hold
Tuesday, Thursday - 1 hour boxing, glute bridges and 8 point plank, hip adductions and leg lifts weighted) some hamstring resistance stretches and exercises, ab roller, single leg glute bridge, some arch exercises deep squats, lunges, 1 hour glute activated walking, and APT Routine (Core activation exercises, hip flexor resistance stretch, quad stretches and wide squat + deep lunge hold and rotation)
Saturday, Sunday - Glute activated walking

When I refer to glute activated walking, I refer to the correct type of walking that uses the glutes to push off instead of lifting the leg with the hip flexors. Video tutorial: https://www.youtube.com/watch?v=-fD2TSL2s7I&ab_channel=RehabandRevive

I hope this was able to give you guys a good grip of your condition, and where to start. Thanks for reading, and good luck with your recovery!

- Benjamin Calvit
submitted by btcalvit to Hard_Flaccid [link] [comments]

Is it more correct to say "the reason for X is because Y is Z" or "the reason for X is that Y is Z"

I have the Grammarly extension for chrome and it keeps telling me I should be using "that" instead of "because." Here is an example of part of one of the sentences it wants me to correct:
"The reason the knee is flexed 30 degrees during varus or valgus stress testing is because the ACL and PCL are tight in the neutral position, and have more slack when the knee is slightly flexed, so in the flexed position only the MCL or LCL integrity is being tested when a medial or lateral force is applied."
submitted by AndrogynousAlfalfa to grammar [link] [comments]

Many NBA players have a strong knee valgus (knees turn inward). How doesn't it cause issues to their knees?

I'm too lazy to link any pictures or videos but I can't be the only one that's noticed it. Look at just about any player you can think of when they're jumping off two feet or changing directions laterally. Just some of the players I'm thinking of right now: Harden, Curry, Westbrook, Kyrie, Kobe... MJ is maybe the most ridiculous example. Then when I think of players who don't have that, like LeBron and Butler, they instead seem to have a strong knee varus (knees turn outward). In fact I can't think of a player who has supposedly "normal" straight knees. And these guys, though some of them have had some knee issues, still are some of the most explosive and durable human beings on the planet, putting constant pressure on their joints over long 82-game seasons. Isn't this weird considering that especially the valgus of the knee joint is usually heavily associated with knee issues?
submitted by BentAmbivalent to nba [link] [comments]

Science: squats and nordic curls

I did a search for scientific research on bodyweight leg training. It's hard to find articles that are not related to barbell squatting, and there's very little on single-leg squats. Considering that it's not a lot of information, and it's possible that there's nothing new, I still hope you guys find something useful here.

General guidelines for the bodyweight squat, Myer et al, 2014

(Edit: as you can see in the comments section, these guidelines can be contested, to say the least. I was referred to the Starting Strenght approach for a different breakdown of the squat movement.)
From the great review above:

Positioning

Head Position The athlete’s head should be maintained in a neutral position (to slight extension) in relation to the spine
Gaze Point of focus for gaze is instructed to be either straight ahead or slightly upward
Thoracic spine should be slightly extended and held rigid.
The chest should be directed outward and upwards to bring the torso angle to a more vertical position
The trunk should remain as upright as possible
The hips should remain symmetrical
The tibias should remain perpendicular to the floor (edit: this was not well explained. From the article: "Excessive mediolateral movement of the knees signals a functional deficit. Valgus or varus frontal plane movement can be attributed to poor neuromuscular control and lack of function or strength of the lower extremity musculature, especially the posterior chain complex."
So, what they mean is avoiding lateral movement of the knees (valgus or varus)
The feet should be kept entirely on the ground.

The movement

The descent: initiated with the breaking of the hips (‘hip hinging’) while maintaining a rigid, upright trunk. The athlete should reach back as if sitting in a chair. Bodyweight should be transferred to and supported by the athlete’s posterior chain musculature, particularly the hamstrings and gluteals, and not placed anteriorly on their knees.
Depth: The athlete achieves full depth with the tops of the thighs at least parallel to ground without any disjointed deviations noted at the knee, ankle or hips.
Ascent: The ascent of the squat should follow the same path as the descent in the reverse direction. The torso should remain upright during the entire ascent phase.
You can read solutions for common technique mistakes in another article by the same authors. I’ll leave here one of the many useful tables:
Criteria Cue example
1. Head Position "Hold head flat"
2. Thoracic Position "Widen your chest"
3. Trunk Position "Point bellybutton forward"
4. Hip Position "Square your hips"
5. Frontal Knee Position "Point knee caps straight ahead"
6. Tibial Progression Angle "Straighten your shin"
7. Foot Position "Grip the floor with your heels"
8. Descent "Reach back for a chair"
9. Depth "Hips are at least knee height"
10. Ascent "Lead with your chest"

Recent evidence for heel squat

Using cadaveric lower limbs, Hale et al, 2018 compared a heel squat (knees in line with toes) with a toe squat (knees anterior to the toes) at peak knee flexion. They concluded:
the heel squat medial/lateral contact area ratio is a more natural and a healthy loading ratio then that of the toe squat at maximum depth and during eccentric contraction.

Nordic curls

Comfort et al, 2017 tried to assess differences on muscle activation between doing Nordic curls in dorsiflexion or plantar flexion. They did not find any significant difference. However, they add:
However, hamstring injuries tend to occur during the terminal leg-swing phase when sprinting whereby the ankle is in a DF position to prepare the lower limb for the initial contact phase.
Van der Horst, et al 2015 showed lower rate of hamstring injuries in soccer players, after Nordic curls training during 13 weeks, in a randomized controlled trial.
Presland et al, 2018 showed that eccentric strength gained by doing nordic curls was maintained after a 4-week period of detraining. However, the architectural changes returned to baseline levels after 2 weeks. This may indicate that the injury prevention adaptations promoted by nordic curls, may revert quicker than the strength gains.

References

Myer GD, Kushner AM, Brent JL, et al. The back squat: A proposed assessment of functional deficits and technical factors that limit performance. Strength Cond J. 2014;36(6):4-27.
Kushner AM, Brent JL, Schoenfeld BJ, et al. The Back Squat Part 2: Targeted Training Techniques to Correct Functional Deficits and Technical Factors that Limit Performance. Strength Cond J. 2015;37(2):13-60.
Hale, R., Green, J., Hausselle, J., & Gonzalez, R. V. (2018). Quantified In vitro Tibiofemoral Contact during Bodyweight Back Squats. Journal of Biomechanics.
Comfort, P., Regan, A., Herrington, L., Thomas, C., McMahon, J., & Jones, P. (2017). Lack of Effect of Ankle Position During the Nordic Curl on Muscle Activity of the Biceps Femoris and Medial Gastrocnemius. Journal of Sport Rehabilitation, 26(3), 202–207.
Van der Horst, N., Smits, D.-W., Petersen, J., Goedhart, E. A., & Backx, F. J. G. (2015). The Preventive Effect of the Nordic Hamstring Exercise on Hamstring Injuries in Amateur Soccer Players. The American Journal of Sports Medicine, 43(6), 1316–1323.
Presland, J. D., Timmins, R. G., Bourne, M. N., Williams, M. D., & Opar, D. A. (2018). The effect of Nordic hamstring exercise training volume on biceps femoris long head architectural adaptation. Scandinavian Journal of Medicine & Science in Sports, 28(7), 1775–1783.
submitted by nunped to bodyweightfitness [link] [comments]

Shoes or Boots with Ankle Support - Lets discuss the effects it has on the ankle, knee, and hip joints

I tend to get a fair amount of joint pain (mostly knee and hip) when backpacking, so I did a bit of research. I want to determine if boots with ankle support are beneficial or harmful for other joints like the knee & hip. I'd like to hear your experiences with ankle support (and any effects it had on your knee pain), knee braces, and reducing pain in the joints in general.
I found a couple of studies so far (none specific to backpacking of course) using different methods and coming to different conclusions. For example:
Study 1: "FINDINGS: The use of an ankle brace resulted in reduced trunk axial rotation during the ball catching tasks, and increased knee axial rotation during the target touching tasks.
INTERPRETATION: The results of this study showed that the effect of the ankle brace on the knee axial rotation depended on the context of the tasks performed. Under situations that required forceful trunk turning movement while standing on a single leg, the ankle braces may cause an increase in the knee axial rotation indicating higher risk of knee injury.
Study 2: Conclusions: By limiting motion at the ankle, taping increased mechanical stability at this joint. Ankle taping also provided protective benefits to the knee via reduced internal rotation moments and varus impulses during both planned and unplanned maneuvers. Medialcollateral and anterior cruciate ligament injuries may, however, occur through increased valgus impulse during sidestepping undertakenwith ankle tape.
submitted by Yellow_Rain to backpacking [link] [comments]

C&P exam notes and questions

Can someone with a lot of experience in C&P exams help me out this and tell me based on the notes what my rating would be? Thanks, I greatly appreciate it!
Indicate method used to obtain medical information to complete this document:
 [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information 
on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence.
 [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using 
the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence.
 [ ] Examination via approved video telehealth [X] In-person examination 
a. Evidence review
 Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If no, check all records reviewed: [X] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment 
records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other:
b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No
  1. Diagnosis

    a. List the claimed condition(s) that pertain to this DBQ: bilateral patellofemoral pain syndrome
    b. Select diagnoses associated with the claimed condition(s) (Check all that apply):
    [X] Patellofemoral pain syndrome Side affected: [ ] Right [ ] Left [X] Both ICD Code: M22.2x1 and M22.2x2 Date of diagnosis: Right 2012 Date of diagnosis: Left 2012
    c. Comments (if any): No response provided
    d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A
  2. Medical history

    a. Describe the history (including onset and course) of the Veteran's knee and/or lower leg condition (brief summary): Bilateral patellofemoral pain syndrome diagonsed in the Marines following a fall from a height when he landed on his knees. He has continued to have pain in both anterior kneessince then. He has not had care for his knees since discharge in 2013.
    b. Does the Veteran report flare-ups of the knee and/or lower leg? [ ] Yes [X] No
    c. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ, including but not limited to repeated use over time? [X] Yes [ ] No
     If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Pain with walking, climbing or decending stairs, and with prolonged standing. He has pain with pressure on the anterior knees, so he 
    cannot kneel down.
  3. Range of motion (ROM) and functional limitation

    a. Initial range of motion
    Right Knee
    [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain)
     Flexion (0 to 140): 0 to 70 degrees Extension (140 to 0): 70 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: pain with flexion of the knee joint and when walking. 
    Description of pain (select best response): Pain noted on exam and causes functional loss
    If noted on exam, which ROM exhibited pain (select all that apply)? Flexion
    Is there evidence of pain with weight bearing? [X] Yes [ ] No
    Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No
    If yes, describe including location, severity and relationship to condition(s): pain with palpation of the patella and the anterior joint line. 
    Is there objective evidence of crepitus? [ ] Yes [X] No
    Left Knee
    [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain)
     Flexion (0 to 140): 0 to 70 degrees Extension (140 to 0): 70 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: pain with flexion of the knee joint and when walking. 
    Description of pain (select best response): Pain noted on exam and causes functional loss
    If noted on exam, which ROM exhibited pain (select all that apply)? Flexion
    Is there evidence of pain with weight bearing? [X] Yes [ ] No
    Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No
    If yes, describe including location, severity and relationship to condition(s): pain with palpation of the patella and the anterior joint line. 
    Is there objective evidence of crepitus? [ ] Yes [X] No
    b. Observed repetitive use
    Right Knee
    Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No
    Left Knee
    Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No
    c. Repeated use over time
    Right Knee
    Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No
    Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Lack of endurance
     Able to describe in terms of range of motion: [ ] Yes [X] No If no, please describe: Increased pain with ambulation and standing. 
    Left Knee
    Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No
    Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Lack of endurance
     Able to describe in terms of range of motion: [ ] Yes [X] No If no, please describe: Increased pain with ambulation and standing. 
    d. Flare-ups No response provided
    e. Additional factors contributing to disability
    Right Knee
    In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None
    Left Knee
    In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None
  4. Muscle strength testing

    a. Muscle strength - Rate strength according to the following scale:
    0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength
    Right Knee: Rate Strength: Forward flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No
    Left Knee: Rate Strength: Forward flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No
    b. Does the Veteran have muscle atrophy? [ ] Yes [X] No
    c. Comments, if any: No response provided
  5. Ankylosis

    Complete this section if the Veteran has ankylosis of the knee and/or lower leg.
    a. Indicate severity of ankylosis and side affected (check all that apply):
    Right Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis
    Left Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis
    b. Indicate angle of ankylosis in degrees: No response provided
    c. Comments, if any: No response provided
  6. Joint stability tests

    a. Is there a history of recurrent subluxation?
    Right: [X] None [ ] Slight [ ] Moderate [ ] Severe
    Left: [X] None [ ] Slight [ ] Moderate [ ] Severe
    b. Is there a history of lateral instability?
    Right: [X] None [ ] Slight [ ] Moderate [ ] Severe
    Left: [X] None [ ] Slight [ ] Moderate [ ] Severe
    c. Is there a history of recurrent effusion?
    [ ] Yes [X] No
    d. Performance of joint stability testing
    Right Knee:
    Was joint stability testing performed? [X] Yes [ ] No [ ] Not indicated [ ] Indicated, but not able to perform If joint stability testing was performed is there joint instability? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Posterior instability (Posterior drawer test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Medial instability (Apply valgus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Lateral instability (Apply varus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) 
    Left Knee:
    Was joint stability testing performed? [X] Yes [ ] No [ ] Not indicated [ ] Indicated, but not able to perform If joint stability testing was performed is there joint instability? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Posterior instability (Posterior drawer test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Medial instability (Apply valgus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Lateral instability (Apply varus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) 
    e. Comments, if any: No response provided
  7. Additional conditions

    a. Does the Veteran now have or has he or she ever had recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment? [ ] Yes [X] No
    b. Comments, if any: No response provided
  8. Meniscal conditions

    a. Does the Veteran now have or has he or she ever had a meniscus (semilunar cartilage) condition? [ ] Yes [X] No
    b. For all checked boxes above, describe: No response provided
  9. Surgical procedures

    No response provided
  10. Other pertinent physical findings, complications, conditions, signs,

    symptoms and scars

    a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No
    b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No
    c. Comments, if any: No response provided
  11. Assistive devices

    a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No
    b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided
  12. Remaining effective function of the extremities

    Due to the Veteran's knee and/or lower leg condition(s), is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.)
    [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No
  13. Diagnostic testing

    a. Have imaging studies of the knee been performed and are the results available? [X] Yes [ ] No
     If yes, is degenerative or traumatic arthritis documented? [ ] Yes [X] No 
    b. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No
    c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided
  14. Functional impact

    Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No
    If yes, describe the functional impact of each condition, providing one or more examples: The Veteran has significant pain in both knees with walking, standing and kneeling so that he would have a difficult time perorming duties which would require those actions.
  15. Remarks, if any:

    No response provided
submitted by DirtyBulking to Veterans [link] [comments]

varus and valgus example video

The causes of knee valgus are plentiful. Some of the cases of knee valgus are caused by bone deformities and complications such as Osteoarthritis, Rickets and Scurvy.. Genetics has also been known to play a part with some people developing it early and some people developing it later in life.. Knee valgus is common in young children, with more than 20 per cent of kids under the age of 3 having ... In a cubitus varus involving the elbow, for example, the elbow would be turned towards the body. The genu valgum, involving the knee, creates a bowlegged appearance over time. Another common form of varus deformity is the talipes varus, which occurs in the ankle. A varus deformity will likely require surgery. Active Valgus. A valgus knee can be caused by long-term weakness in the hip. For example, weak butt muscles (gluteus Maximus) have been associated with medial knee collapse. Early on, long before the knee arthritis or change in shape of the knee is seen, it’s these weak muscles that allow the knee to collapse inward during stress (as shown here). Look for instability of the joint, leg length inequality, marked valgus or varus deformity. 0 Less commonly, valgus deformity of the knee will be seen in association with lateral compartment osteoarthritis. Varus-valgus moment as a function of knee valgus angle. Thethick line gives the passive varus-valgus torque and its positive direction is in varus (the passive tissue pulling the leg in the direction of varus at a valgus position). The thin lines give the total varus-valgus moment with the positive direction in varus (muscle moment). Varus knee is a condition that’s commonly referred to as genu varum. It’s what causes some people to be bowlegged. ... The opposite of varus knee is valgus knee, which makes some people knock ... We performed a randomised, prospective study of 80 mobile-bearing total knee arthroplasties (80 knees) in order to measure the effects of varus-valgus laxity and balance on the range of movement (ROM) one year after operation. Forty knees had a posterior-cruciate-ligament (PCL)-retaining prosthesis … Valgus deformities are often visually more striking than varus deformities and may have a higher negative impact on limb use because the normal limb most often has 5° to 10° of valgus. For example, a medial deformity of 20° in a dog with an initial valgus of 10° will lead to a manus orientation of approximately 10°, a reasonably discrete ... Theflexibility of hindfoot varus—for example, in forefoot-driven hindfoot varus—can be tested by means of the Coleman block test (see Fig. 1).29 Range of motion (ROM) at the ankle, subtalar, and Chopart joints is assessed. Reduced ROM at any of those joints helps to identify the locus of rigidity and deformity. Varus deformity, or medial side tightness, is corrected by a stepwise release of the medial soft tissue structures, the capsule, the pes anserine tendons, and the medial collateral ligament.. In correcting valgus deformity, there is no stepwise sequence. However, preserving the integrity of the iliotibial band and protecting the lateral collateral ligament are thought to prevent overcorrection.

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varus and valgus example

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