Knee injuries are one of the most common injuries that we see in physical therapy, whether it is sports-related or just degenerative changes that occur as we age. Some of the most common injuries are sprains and strains, osteoarthritis, ligament injuries and meniscus injuries. All of these cause pain, weakness and a decrease in functional activities.
Ligament injuries
These injuries more commonly occur with the more active patient population. Sports such as soccer and basketball that involve jumping, planting the leg or a quick change in direction can cause ACL tears. This is a significant injury that requires physical therapy, then possible surgery to repair the tear and then post-surgery rehabilitation to help return the patient to their previous functional levels. Therapy before surgery is much more common these days as it can increase range of motion and strengthen the knee. This helps the patient come out of surgery with a better outcome. Initially, rehabilitation post-surgery involves focusing on increasing range of motion, decreasing swelling and pain and then improving strength. Later phases of therapy address:
- Higher level balance deficits
- Return to running
- Sports-specific drills
Meniscus Injuries
These can occur suddenly with sports that involve twisting or quick pivots. The older patient population is also prone to meniscus tears as degeneration of the meniscus occurs over time. When the meniscus degenerates, your knee has less cushioning and therefore less shock absorption. Recent research has shown that physical therapy should be the first course of action to treat the meniscus. This is because while immediate surgery may help with the pain, in the long run, it predisposes the patient to osteoarthritis.
When a patient has meniscus surgery, a piece of it is removed and therefore the cushioning of the joint is removed. This allows closer approximation of the top leg bone (femur) to the bottom, weight-bearing leg bone (tibia), which can cause an earlier onset of arthritis. Therapy works to improve knee range of motion, strength (supports the joint), improved balance, and therefore decreases pain and improves function.
Arthritis
Arthritis involves inflammation of the joints which causes pain, swelling and stiffness. This can make it very difficult to do normal daily activities such as walking, stairs, and staying in one position for too long. With knee arthritis, the cartilage around the bones of your knee wears down and become frayed and rough. This in turn decreases the joint space and causes bone on bone. Physical therapy is a great first line of treatment for knee arthritis. Therapy will focus on restoring range of motion, strength, balance, and decreasing pain in order to make every day activities easier. If the arthritis is bad enough a knee replacement may be needed. If that is the case, patients come to physical therapy before surgery to get as much mobility and strength as possible, so that after surgery outcomes are usually better.
By Devin Wurman, DPT
