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.
The Knee Examination
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 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 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.
The ability to sense the position of our joints is a vital part of normal joint function. The brain constantly checks the position of the knee and coordinates the pattern of muscle response to prevent dangerous postures. Balance work such as standing on one leg and progressing to working with balance on an unstable wobble board is started. Balance and coordination are practiced until the knee can manage rough ground and dynamic activities such as running and jumping. Good movements with a small amount or no pain, good strength and balance with normal walking mean that the knee has recovered. - 15995
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.
The Knee Examination
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 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 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.
The ability to sense the position of our joints is a vital part of normal joint function. The brain constantly checks the position of the knee and coordinates the pattern of muscle response to prevent dangerous postures. Balance work such as standing on one leg and progressing to working with balance on an unstable wobble board is started. Balance and coordination are practiced until the knee can manage rough ground and dynamic activities such as running and jumping. Good movements with a small amount or no pain, good strength and balance with normal walking mean that the knee has recovered. - 15995
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 hepublishes if you are looking for Physiotherapists in Kensington.
