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Lee E. Brown, Michael Whitehurst, and David N. Buchalter

A 67-year-old male underwent bilateral total knee replacement surgery and was subsequently placed on a bilateral isokinetic knee rehabilitation program. Isokinetic knee testing was performed on unilateral dominant (UD; right) and nondominant (UND; left) limbs as well as bilateral limbs (BLs) before and after a three-times-per-week, 8-week protocol during which the patient followed a bilateral isokinetic velocity spectrum (60 to 300°/s) rehabilitation program. The protocol was made possible by the introduction of a new bilateral isokinetic knee attachment developed by the authors. The BL extension and flexion peak torque increased 41% and 51% at 60°/s, respectively. The UD and UND extension peak torque increased 22% and 37%, respectively, while flexion peak torque increased 68% and 52%, respectively. The bilateral deficit decreased with increasing velocity for both extension and flexion. These results demonstrate that a bilateral isokinetic approach to rehabilitation may be a legitimate technique to increase knee extension and flexion peak torque both unilaterally and bilaterally following bilateral total knee replacement surgery.

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Brent C. Mangus, Laura A. Hoffman, Mark A. Hoffman, and Peter Altenburger


Knowledge and understanding of the principles and applications of joint-mobilization techniques are becoming commonplace for entry-level certified athletic trainers.

Data Sources:

Various textbooks written on this topic.

Data Synthesis:

The authors collected information from commonly used textbooks on joint mobilization in both athletic training and physical therapy curriculums.


Undoubtedly, before using joint mobilization, the clinician should demonstrate mastery-level understanding of joint biomechanics, application principles, and indications and contra-indications. This article provides basic information on the principles of joint mobilization.

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Joseph B. Lesnak, Dillon T. Anderson, Brooke E. Farmer, Dimitrios Katsavelis, and Terry L. Grindstaff

angle of 90° was selected because it is easier to replicate in a clinical setting, would place minimal stress on an ACL graft 11 and meets safety criteria of early phase knee rehabilitation protocols. 13 During the warm-up, the researcher identified the maximum torque value obtained, which was used

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Lori A. Bolgla, Scott W. Shaffer, and Terry R. Malone


Knee extension exercise is an important part of knee rehabilitation. Clinicians prescribe non-weight bearing exercise initially and progress patients to weight bearing exercise once they can perform a straight leg raise (SLR).


Compare VM activation during a SLR and weight bearing exercises.


One-way repeated measures design.


University Laboratory.


Fifteen healthy subjects.


One SLR exercise and 6 weight-bearing knee extension exercises.

Main Outcome Measures:

Electromyographic amplitudes for the VM expressed as a percent maximum voluntary isometric contraction.


The SLR had greater activation than the single leg stance and bilateral squat exercises. The step-up and unilateral leg press exercises had the greatest activation.


SLR performance can be an important indicator for exercise progression. These results provide foundational knowledge to assist clinicians with exercise prescription.

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Peter A. Schaub and Teddy W. Worrell

During knee rehabilitation, squats are a commonly used closed kinetic chain exercise. We have been unable to locate data reporting electromyographic (EMG) activity of lower extremity musculature during maximal effort squats and the contribution of gastrocnemius and gluteus maximus muscles. Therefore, the purposes of this study were (a) to quantify EMG activity of selected lower extremity muscles during a maximal isometric squat and during a maximal voluntary isometric contraction (MVIC), and (b) to determine ratios between the vastus medialis oblique (VMO) and vastus lateralis (VL) during maximal isometric squat and MVIC testing. Twenty-three subjects participated in a single testing session. Results are as follows: intraclass correlations for MVIC testing and squat testing ranged from .60 to .80 and .70 to .90, respectively. Percentage MVIC during the squat was as follows: rectus femoris 40 ± 30%, VMO 90 ± 70%, VL 70 ±40%, hamstrings 10 ± 10%, gluteus maximus 20 ± 10%, and gastrocnemius 30 ± 20%. No statistical difference existed in VMO:VL ratios during MVIC or squat testing. We conclude that large variations in muscle recruitment patterns occur between individuals during isometric squats.

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Mastour S. Alshaharani, Everett B. Lohman, Khaled Bahjri, Travis Harp, Mansoor Alameri, Hatem Jaber, and Noha S. Daher

Context: Protonics knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking. Objective: To compare the effect of Protonics knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome. Design: Randomized controlled trial. Setting: Loma Linda University. Participants: There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m2 participated in the study. Intervention: Subjects were randomized to 1 of 2 treatment groups, the Protonics knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks. Main Outcome Measures: Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test. Results: Both groups showed significant improvement in the outcome measures. However, the Protonics knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction. Conclusions: Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome.

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Matthew Zaremba, Joel Martin, and Marcie Fyock-Martin

or inhibit full recovery. Current best evidence supports the use of BFR-RT to improve KE strength, function, and pain following an acute or chronic knee pathology. Importantly, the implementation of BFR-RT with lighter loads during the early stages of knee rehabilitation can successfully improve

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Gabriel Andrade Paz, Lohanne Almeida, Larissa Ruiz, Sabrina Casseres, Giovanna Xavier, João Lucas, Haroldo Gualter Santana, Humberto Miranda, Scott Bonnette, and Jeffrey Willardson

presented a more irregular signal during the VFLS set for the single-leg squat. Despite these results, a trivial effect size was noted for all muscles and protocols investigated. Bilateral squats are a staple exercise in most knee rehabilitation programs. Despite its popularity in gyms, sports medicine

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Mojtaba Jahanshahi, Mohammad Hossein Nasermelli, Robert L. Baker, Pouya Rabiei, Maarten Moen, and Michael Fredericson

Res . 2017 ; 31 ( 5 ): 1165 – 1176 . PubMed ID: 28135219 doi:10.1519/JSC.0000000000001794 10.1519/JSC.0000000000001794 44. Graham VL , Gehlsen GM , Edwards JA . Electromyographic evaluation of closed and open kinetic chain knee rehabilitation exercises . J Athl Train . 1993 ; 28 ( 1 ): 23