Anterior and Posterior Drawer Test – Knee Screen
The anterior and posterior drawer test is a really simple yet objective screen which tests the integrity of both the Anterior Cruciate Ligament and the Posterior Cruciate Ligament.
An Anterior Cruciate Ligament injury (or ACL in short) is perhaps more commonly heard of, especially amongst sports men and women however, depending on the nature of the injury, both are subject to injury and trauma.
During today’s post, Bonnie leads us through the methodology for screening the ACL and the PCL as well as looking at what indications could suggest a positive test. If your client does test positively, we would recommend that you refer your patient on to their GP or physiotherapist as a first port of call.
As Pilates Therapists, we do not diagnose nor suggest that we replace the need for medical practitioners of any kind. Our role is to support these practitioners and use Pilates as a form of exercise to rehabilitate and facilitate movement once they have been medically cleared to do so.
Anterior Cruciate Ligament:
More commonly referred to as the ACL – This ligament is one of the major ligaments involved in stabilising the knee. It attaches from the femur (thigh bone) to the tibia (shin bone) and it’s primary function is to restrict the tibia excessively shifting anteriorly off of the femur. It also helps to restrict hyper-extension of the knee.
Posterior Cruciate Ligament:
The PCL is more self-explanatory when followed after the definition of the ACL, it does the opposite really! So it’s primary function is to restrict the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. The posterior cruciate ligament is located within the back of the knee connecting the tibia to the femur.
Performing the Drawer Test Screen:
Start by having your client in the supine position (laying on their back) Bending one knee to 45 degrees with the foot on the ground and the other leg straight. The practitioner should then sit on the leg to stabilise the foot and the leg. Placing your thumbs on to either side of the tibial tuberosity, wrapping your hand around the knee and holding the back of the tibia.
You can perform either the Anterior or Posterior Drawer Test first however, we would recommend testing the Posterior first because if there is an issue with the PCL then it can obscure the testing for the Anterior screening afterwards.
Posterior Drawer Test – Apply a slight pressure, pushing into your thumbs to draw the tibial tuberosity posteriorly.
Anterior Drawer Test – Apply a slight pressure, pulling into your fingers to draw the tibial tuberosity anteriorly.
A positive test…
When performing this screen, you should feel an element of rigidity or stability.
A positive screen would mean you’re feeling for a soft and spongy end of range feel or around 6mm of movement or give.
If your client does test positive then ideally you’d be looking to strengthen the musculature around the knee to help stabilise the tibia bone. Muscles like your hamstrings or quadriceps would be an ideal place to start! But it would also be a good idea to look at the mechanics of your client’s knee movement. Observing how they flex and extend the knee in particular – We cover this in a lot more detail on our Knee and Foot courses!
Once your client has seen a medical practitioner and has been cleared for Pilates exercise, there are many things you can do to help and potentially improve their condition. We delve deeper into this on our Knee and Foot courses and we still have a few spaces free should you wish to join us and learn more! So if you’re interested, please feel free to visit our Courses page or why not drop us an email at firstname.lastname@example.org