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 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
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 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.
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 plan
The PRICE technique is used by physiotherapists to manage acutely painful joints, with a brace used to protect the joint in the presence of instability. Walking aids may be needed to reduce the stresses through the joint and to encourage a good walking pattern. Rest is essential in settling an inflamed joint and the I in PRICE stands for ice treatment, packs or cold water compress applied to the joint to reduce pain, inflammation and swelling. This and a compression splint can reduce pain, increase range of movement and allow treatment progression.
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. - 16083
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
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 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.
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 plan
The PRICE technique is used by physiotherapists to manage acutely painful joints, with a brace used to protect the joint in the presence of instability. Walking aids may be needed to reduce the stresses through the joint and to encourage a good walking pattern. Rest is essential in settling an inflamed joint and the I in PRICE stands for ice treatment, packs or cold water compress applied to the joint to reduce pain, inflammation and swelling. This and a compression splint can reduce pain, increase range of movement and allow treatment progression.
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. - 16083
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.
