Real-Time Visual Feedback Functional Movement Retraining on a Female Soccer Player with Medial Collateral Ligament Sprain: A Case Report

摘要

Background: The knee joint is the most commonly injured joint in the body, and the medial collateral ligament (MCL) is the most commonly injured ligament in the knee joint. Currently, patients are able to return to sport after traditional therapy for the MCL but have been shown to have varying outcomes in the future. Standard knee rehabilitation typically does not include training to address poor knee mechanics. Visual feedback with functional movement retraining has been shown to address poor knee mechanics that could be leading to additional knee problems in the future. Objective: Due to the varied future prognoses with traditional therapy, the purpose of this literature review was to systematically review existing literature for evidence of MCL treatment using visual or verbal feedback compared to traditional therapy. Data sources: PubMed, CINAHL, PEDro, and Cochrane Library using the terms teenage, adolescent, knee pain, knee injury, medial collateral ligament sprain, MCL sprain, MCL injury, medial collateral ligament injury, medial collateral ligament pain, mirror therapy, mirror visual feedback, visual feedback, standard rehab, standard care, exercise therapy, physical therapy, therapeutic activities, knee valgus, knee biomechanics, verbal numerical pain scale, pain scale, pain rating, and genu valgus. Nine studies met the inclusion criteria. They included a systematic review, three randomized control comparison trials, and five nonrandomized control trials. Results: One study showed that there is a relationship between hip abductor and external rotation strength and knee mechanics, one study showed that resistance training to the hip abduction and external rotation muscles improve knee mechanics, and seven studies showed varying results with visual or verbal feedback on knee mechanics. Conclusions: There is limited evidence on the effect of visual or verbal feedback on knee mechanics. In addition, no articles were found on the use of feedback for improved knee valgus angles in MCL injury patients. Visual feedback alone has shown to be the most consistent in improving knee valgus movement patterns. Case Study Objective: The purpose of this case study was to explore the effect of real-time visual feedback during a six-inch drop jump on knee valgus compared to standard knee rehabilitation alone in a female high school athlete with knee stability with movement coordination impairment. Case Description: The patient was a 14-year-old female high school soccer player who presented with acute right medial knee pain. She reported 2 out of 10 pain at rest that could increase up to 6 out of 10 pain with activity. Outcomes: At the end of four sessions of visual feedback training during a drop jump, the patient reported 0 out of 10 pain as well as demonstrated decreased knee valgus during drop jumps. Discussion: The findings suggest that real-time visual feedback during a drop jump may be a feasible method of addressing poor movement patterns that may contribute to future injury in individuals with medial collateral knee sprain.