Physiotherapy treatment of knee injuries
by Jonathan Blood-Smyth
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.
The Knee Examination
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 patient is asked to move the knee and the physio judges
how keen they are to move in the presence of pain,
indicating where rehab needs to be started. Once the active
range (what the patient does for themselves) is known the
physiotherapist may try and push the joint a bit further to
see if there is a problem or just guarding. Muscle testing
of the quadriceps muscle for knee extension and the
hamstring muscles for knee flexion inform the physio about
the state of the muscles and how much strength the patient
can exert without too much pain.
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
Cryotherapy, or cold treatment, is an initial treatment for
an acute painful knee and is used to reduce the swelling and
pain. If pain is reduced then movement can occur more
readily, allowing rehabilitation to progress to the next
stage. A compression sleeve useful to compress the effusion
as swelling inhibits the function of knee muscles. Of the
knee is unstable on weight bearing a brace can be used to
stabilise and protect it, with crutches or a stick necessary
if the patient cannot weight bear well or achieve a
reasonable gait.
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. - 15668
Jonathan Blood Smyth is a Superintendent
(http://www.thephysiotherapysite.co.uk) 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
(http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/london/kensington)
Physiotherapists in Kensington.
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New Unique Article!
Title: Physiotherapy treatment of knee injuries
Author: Jonathan Blood-Smyth
Email: david.ravech@overlandassociates.com
Keywords: knee injuries,sports injuries,physical injuries,physiotherapy,physical therapy,physical medicine,health,fitness,well-being,alternative medicine,medicine
Word Count: 662
Category: Health & Fitness:Alternative Medicine
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