Knee injuries are very common in accidents and sporting incidents and can cause chronic pain, loss of joint stability and difficulty with daily activities. Physiotherapy starts with a subjective examination, enquiring about how the injury occurred, what forces were involved in the event, how quickly the knee swelling appeared, whether there was knee instability or difficulty putting full weight on the knee.
The pain levels after injury indicate important things about the state of the joint. Knee fractures are fairly clear as there are high levels of pain and there is therefore little chance of missing this injury. The type of knee injury gives pain in specific areas which indicate which structures have been damaged. The physio will test these structures later in the examination.
Objective Examination of the Knee
Checking the knee for swelling or joint effusion is one of the first observations a physio will make, squeezing the fluid into the centre of the joint and tapping the patella down to confirm the presence of fluid. Knee effusions can be tense and require needle aspiration by a doctor to relieve the pressure. The physiotherapist then checks the quality of knee movement on the plinth and without any weight on the joint. Knee ranges of movement are assessed including extension, flexion and the small rotatory movements.
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.
Manual testing of the knee ligaments by the physiotherapist tells him or her about these important stability structures. The physio levers the knee inwards and outwards to test the medial ligament and the lateral ligament (the collateral ligaments) and pulls the shin bone back and forward to test the anterior cruciate ligament and the posterior cruciate ligament. Manual palpation around the joint and adjacent structures can help indicate which structure has been injured.
Physiotherapy treatment of the injured knee
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.
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. - 14130
The pain levels after injury indicate important things about the state of the joint. Knee fractures are fairly clear as there are high levels of pain and there is therefore little chance of missing this injury. The type of knee injury gives pain in specific areas which indicate which structures have been damaged. The physio will test these structures later in the examination.
Objective Examination of the Knee
Checking the knee for swelling or joint effusion is one of the first observations a physio will make, squeezing the fluid into the centre of the joint and tapping the patella down to confirm the presence of fluid. Knee effusions can be tense and require needle aspiration by a doctor to relieve the pressure. The physiotherapist then checks the quality of knee movement on the plinth and without any weight on the joint. Knee ranges of movement are assessed including extension, flexion and the small rotatory movements.
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.
Manual testing of the knee ligaments by the physiotherapist tells him or her about these important stability structures. The physio levers the knee inwards and outwards to test the medial ligament and the lateral ligament (the collateral ligaments) and pulls the shin bone back and forward to test the anterior cruciate ligament and the posterior cruciate ligament. Manual palpation around the joint and adjacent structures can help indicate which structure has been injured.
Physiotherapy treatment of the injured knee
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.
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. - 14130
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Kensington.
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