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Special Test for the Knee: Eccentric Step Down Test
The Eccentric Step Down Test is an orthopedic test used to assess the strength and integrity of the stabilizing muscles surrounding the knee joint. It involves having the patient stand on one leg while stepping down on the other and controlling their leg's descent. During the descent, the patient is instructed to focus on keeping their knee steady and not allowing it to move inward or outward, with the goal of building strength and stability. Additionally, the patient's ability to resist and control the lower leg
Transcript
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This is Brent of the Brookbush Institute and in this video
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we're going to do the eccentric step-down
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test, which is possibly the only patella femoral pain syndrome test I use on a
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regular basis. I'm going to have my friend Melissa come out, she's going to help me
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demonstrate. Now the reason I only use this test for patella femoral pain
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syndrome is because essentially functional-patterns; squats, step ups and
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lunges, and this eccentric step down test are actually more reliable than
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all of the other special tests for patellofemoral pain syndrome. They either
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lack sensitivity or they lack specificity, it's just not a good look
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for special tests at the knee. So we can go right back to okay Melissa you came
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in and you complained about left knee pain, all we really need to do as
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practitioners is find a concordant sign, something that provokes her symptoms. Why
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do we need that, because we're going to assess, address and reassess. One of the
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things I use often is this eccentric step-down test because it is so
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provocative, and any of you who have had some flared up knees, you get knee
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pain like I do, you know that stepping up stairs is okay, stepping down
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stairs especially slowly can be really really tough on days that your knees
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really really hurt. So I'm going to have Melissa go ahead and step up and to
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increase the reliability of this test, we want to make sure we do it the same
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way every time. I do find that 12-inch steps are a little mean, I know a lot of
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people who go straight for the plyo box, usually plyo boxes start at
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12 inches. I would start maybe something more like this that's like 8 or 10
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inches. We want to provoke knee pain we don't want to flare
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somebody up. The other thing I'm going to have Melissa do is put her hands on her
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hips and then I'm going to give her this cue -I want you, if we're testing the
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left side now she's going step forward with her right leg. So the knee
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that's left behind is the one we're testing, I want you to step down as
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slowly and smoothly as you can.
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How does that feel? That's her pain, yeah that's the symptoms she was talking
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about when she came in, and that's perfect now we have a concordance sign.
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Especially an athlete like Melissa, let's say she was having knee pain two
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miles into her runs, she might squat and not have knee pain. Can you show me a squat?
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Just do an overhead squat, there we go, cool does that hurt?
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Nope she has no pain, can you give me a lunge?
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Sure how's that feel? Other leg, all right that's fine. How about a step up?
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Yep that's okay, and you get this a lot with athletes, but again this is why we
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came back to the eccentric step-down test. Hands on your hips, step forward
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with your right leg, how does that feel? That's pain. Now you can see why
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this test keeps creeping its way back into my assessments, because if I had
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done a squat with her and I did a bunch of therapeutic interventions, and once
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again she's the type of person who's complaining about knee pain two-miles,
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three-miles into her workouts, how am I supposed to know if I did a good job?
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What just wait for her to come back the next session and go oh I still hurt. We
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want something that will provoke her pain now, that I can do some interventions
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and reassess right now. Alright so give this a try, eight- or ten-inch step,
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maybe you could even go lower, maybe have a six-inch step ready. These type of
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steps come in really handy, maybe not jump straight for the 12-inch
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