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INJURIES TO THE PELVIS AND LOWER EXTREMITIES

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resting that forearm on top of the athlete’s involved leg. Place the other hand on the anterior portion of the ankle. With the knee at full flexion, ask the athlete to raise the lower leg while applying isometric resistance. Feel for any strength changes and look for deformities as the athlete extends the leg through the ROM. Test the involved knee in the same way. Compare the strength of the quadriceps in both legs and note any dif- ferences. Weakness in the involved knee indicates injury or deformity of the quadriceps. This test may also be performed with the athlete seated. However, this will limit the range of motion because the table will interfere with flexion.

Flexion Strength Test for the Knee: Instruct the athlete to lie in the prone posi- tion with both legs extended. Place one hand at the distal end of the athlete’s tibia; with the other hand, palpate the hamstring area and feel for deformities (Figure 18-31). With the uninvolved leg at full extension, apply isometric resistance at the ankle as the athlete brings the leg into full flexion. Feel for any differences in strength and look for deformities as the leg goes through full ROM. Test the involved side in the same way. Compare the strength of the hamstrings in both legs and note any differences. Weakness in the involved knee indicates injury or deformity of the ham- strings. This test may also be performed with the athlete seated. However, this will

INJURIES TO THE PELVIS AND LOWER EXTREMITIES 475 resting that forearm on top of the athlete’s

limit the range of motion because the table will interfere with the available ROM.

FIGURE 18-31 Knee Strength, Flexion, Athlete Supine

INJURIES TO THE KNEE AND LOWER LEG

All of the injuries discussed in Chapter 14 can affect the knee and lower leg. Many of these injuries are also discussed in previous sections of this chapter. To avoid unneces- sary repetition, only injuries that have not yet been discussed will be addressed in detail in this section.

Fractures

Patellar fractures are very rare, but the possibility of their existence should never be overlooked. These usually occur from a direct blow, but may also be caused by repeated stress. Fractures of the tibia and fibula are more common. Like patellar fractures, these fractures may be caused by direct blows or repeated stress. Avulsion fractures may occur to the knee and ankle where the ligaments attach to the bones. Sports that carry an increased risk of fractures to the knee and lower leg include contact sports, cross-country, skateboarding, BMX, and motocross. If there is rea- son to suspect a fracture or if unsure about an evaluation, refer the athlete to a physician for diagnosis and treatment. See Chapter 14 for a detailed discussion of the symptoms and treatment of fractures. See also “Injuries to the Hip and Thigh” in this chapter.