« Business Plan - Style and Presentation | Home | Global Resorts: Perpetual Leverage or Franchise Ownership? »
Physiotherapy treatment of knee injuries
By Jonathan Blood-Smyth | November 22, 2008
The knee is particularly vulnerable to injury and accidents due to its position in the leg, and injuries lead to pain, joint instability and loss of normal leg function. The initial part of the examination looks at the injury cause and the forces involved, how fast the knee effusion came up, the presence of joint instability on walking and whether the patient is unable to take normal body weight on the knee.
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.
Objective Examination of the Knee
Knee effusion or joint swelling is an indication of the degree of inflammation present in the knee and the physio will check the amount of swelling manually. If the swelling is severe it can be drained using needle aspiration to relieve the pressure which can interfere with normal muscle recruitment and function. The physio records the movements of the knee on the plinth non weight bearing, assessing straightening and bending of the knee (extension and flexion) and the small degrees of rotation.
The physiotherapist decides where to start treatment by their findings - how much the patient can easily move the knee, how much pain they have and how the knee behaves on testing. Active movement the patient can do themselves and the physio may gently push the joint further to test weakness or guarding. The physio will test the strength of the quadriceps and hamstrings which straighten and bend the knee respectively, seeing how much the pain or weakness affects the knee function.
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.
Exercises to increase the strength and movement are instigated once the pain and effusion have begun to settle, working on the major weight supporting muscles of the thigh, the quadriceps and the hamstrings. The knee extensors (quadriceps) push us up from a chair, control the knee in running and walking and push us steps. Exercise progression by the physiotherapist involves non-weight bearing exercises initially, followed by rehab exercises in the gym and finally sport-focused activities.
Proprioception is the body’s natural joint position sense, with the brain sensing the moment to moment position changes of the knee and co-coordinating the muscle actions needed keep the joint within safe bounds. Physio treatment is balance practice, starting with standing on one leg, then balancing and catching balls on a wobble board and finishing with running, changing direction suddenly, hopping and jumping. Once the swelling has settled and the strength and co-ordination ability restored the knee is ready to rejoin normal and sporting activities.
Topics: Health&Fitness |
Comments
You must be logged in to post a comment.
