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 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.
Stability is confirmed on a mechanically unstable joint by the ligaments and muscles. Physiotherapy testing of the collateral ligaments of the knee, the medial and lateral ligaments, is done by stressing the knee into knock-knee and bow-leg. These ligaments provide side-to-side stability to the knee. The anterior cruciate ligament and the posterior cruciate ligament are tested in the same way, giving front to back and rotatory stability to the joint. The joint structures are then palpated by the physio to confirm the diagnosis.
Physiotherapy treatment plan
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.
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.
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.
Article Source: http://www.alltopinfo.com
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.
Please Rate this Article
Not yet Rated
Additional Articles From -
Home |
Health 
