The physiotherapy treatment of injured knees
Injuring the knee is one of the most common general and sporting injuries and can give long-term problems with pain, stability and functional activities. Physios begin with the subjective examination, asking about the cause of the injury, the amount of force involved, whether the knee swelled up quickly or the knee was unstable afterwards and the person found it difficult to weight bear.
The amount of pain a patient suffers indicates the severity of the injury involved and the particular location of the pain can point to which anatomical structures have been injured. As the knee will be very difficult to walk on in the presence of a fracture these injuries are rarely missed in diagnosis. During the examination the physiotherapist will test the knee structures to look for the cause of the injury.
The Knee Examination
The physiotherapist will look at the knee and check for effusion by observation or doing the patellar tap test. The knee can swell greatly and be very tight, needing aspiration by a needle. How well the knee can move when not weight bearing is assessed by the physio. Knee extension is the movement of straightening the knee out and flexion is bending the knee. The knee does have a certain degree of rotation but that is rarely checked in the initial period.
The reaction to examination testing indicates how the treatment plan should proceed. The pain level, ease of joint movement and reaction to tests are included in this assessment. The patient moves the joint actively with the physiotherapist adding passive movement to test the joint further. The power of the main antigravity muscles, the hamstrings and quadriceps, are tested by manually resisting the knee movements or asking the patient to perform weight bearing movements.
The medial and lateral collateral ligaments of the knee give side to side stability to the joint, and the anterior cruciate ligament and posterior cruciate ligament provide front to back stability. Provided pain is not severe the physiotherapist will test these ligaments manually, pushing the knee into knock-knee and bow-leg for sideways stability and the forward and backward movement of the shin bone to assess cruciate function. The physio will palpate round the joint manually to search for clues to injured structures.
Physiotherapy treatment plan
An acutely painful knee is treated using the PRICE technique, starting with protection of the joint if necessary by using a brace to stabilise it. Crutches or sticks can be used to reduce weight bearing on the knee and allow a good walking pattern. Ice treatment, or cryotherapy, is a first line treatment for an acute knee, reducing pain and the swelling which permits increased movement and progression of treatment. A neoprene knee sleeve may be worn to squeeze the swelling and increase stability.
A reduction in swelling and pain allows the physiotherapist to give exercises to improve the knee’s ranges of movement and strength. The largest and most powerful muscles are the quadriceps and the hamstrings. The quadriceps allows knee power for getting up from sitting, going up and down stairs and walking, keeping the knee stable. After the knee copes with exercise on the plinth the physio will move to exercises in weight-bearing and in more active activities.
A normal knee joint involved in activity sends a stream of impulses up to the brain, informing us of the joint position at all times, the degree of muscle activity and movement. This is known as joint position sense (JPS) or proprioception, which is lost to some degree after injury and restoring it to a normal level is vital if the knee is to successfully return to activity. The physio starts with balancing on one leg and progresses to standing on a wobble board and finally works on active, dynamic exercises in preparation for sport.
Tags: Alternative Health
