What to do with a knee injury

Knee injuries that we see in our office are characterized in a few ways:

  • Ligament tears (e.g. Anterior Cruciate Ligament (ACL) tear and Medial Collateral Ligament (MCL) tear). These can tear from partially to completely during a sudden instance of twisting the knee
  • Meniscus injury can occur with a ligament tear, 64% - 77% of the time3
  • Articular cartilage lesions (bone bruises) can also occur, 70 - 92% of the time3 alongside a ligament tear
  • Pain from inflammation (e.g. arthritis, tendinitis), degeneration (e.g. Runner's Knee), over use

At OCPT we pay special attention to sudden (acute) knee injuries that occur with sports that require quick changes of direction (pivoting or twisting of the knees) such as soccer, volleyball, football, tennis.

Since several parts of the knee can be damaged, you should immediately seek help from an expert that understands knee kinesiology. Below are two scenarios you may find yourself in: First, you've had a tear or lesion occur and are not sure whether it can heal on it's own or if you may need surgery. Second,  if you've already decided on surgery but now you want to regain range of motion and confidence in your knee.

Scenario 1: Pre-surgery Knee Rehabilitation

If you've injured your knee within the last 3 months, and have not had surgery, a 2011 study from The Journal of Orthopedic Sports Physical Therapy showed that a 5 week exercise program led to significant improvement in knee function early after an anterior cruciate ligament (ACL) injury1. The knee rehabilitation program had emphasis on heavy resistance strength training and neuromuscular exercises. After the program, patients felt much more confidence either deciding not continue with surgery, or go ahead with it.

The 5 week program consisted of plyometric exercises, balance and stability, perturbation training. Patients recorded a personal written exercise diary, and were motivated to undergo rehabilitation. Improvements in quadriceps femoris, hamstrings, and gluteus maximus muscle volume were significantly greater even after following up with patients 1 year later. 

What do the results mean? For an ACL tear, MCL tear, meniscus injury, or bone bruise, seek physical therapy within 3 months1. In this period of time a physical therapist can can perform scientifically backed programs to help you decide if surgery is even needed.

Scenario 2: Post-surgery Knee Rehabilitation

So you've had knee surgery and now need to heal in the best way possible. You might be worried that you'll never be the same as before you got injured. The short answer is: don't wait! There is strong evidence that the speed and safety of which someone returns to sports  depends largely on the protocol that your physical therapist creates for you immediately after surgery. Again, don't wait longer than 3 weeks4. If you seek post surgery knee therapy that includes recovery of your Range of Motion (ROM) and eccentric exercises, you could have greater thigh and hamstring muscles 1 year after surgery. Specifically, a clinical trial showed that those who started progressive eccentric exercises within 3 weeks after knee surgery had both higher volume quadriceps femoris and gluteus maximus muscle compared to those that completed traditional resistance exercises.The overall magnitude of muscle improvement was 50% greater in the group that performed eccentric exercises. 

A systematic review of 32 knee rehabilitation programs2 came to the conclusion that more aggressive exercise programs resulted in better healing. Also, accelerated protocols produced similar patient oriented outcomes compared to standard (longer) protocols.

What does this mean? You really can go back to pre-injury activity much faster with a physical therapist, compared to letting it heal on your own.

Types of Knee Therapy Exercises After An Injury

Knee rehabilitation protocols  involve eccentric exercises, closed and open chain kinetic exercises, bracing, hop tests, neuromuscular exercises, pain tests, and range of motion recovery. We don't recommend trying these at home, as a trained professional will be much more accurate and keep you scientifically studied thresholds. One review of sports medicine literature showed that immediate weight bearing exercises after ACL surgery is recommended, and having a trainer allowed patients to more easily overcome their fears4

The Benefits of Physical Therapy for a Knee Injury

Helps you decide whether or not to have surgery: One of the major benefits of physical therapy is that a trained professional can help you avoid a trip to the operating room. Your injury may not be severe enough, or with a guided protocol you can strengthen the knee to the point where surgery is no longer needed. Conversely, going through a program may give you confidence that surgery is in fact the right choice. Knee surgeries themselves are extremely successful. It's regaining confidence that is difficult.

Rehab After Surgery:  Neuromuscular training to regain confidence in using your knee is paramount. It has been shown that people are afraid of re injury, and this severely prevents returning to your sport of choice. With a physical therapist guiding your post surgery protocol, you can gain mental confidence back in the activities you enjoy. Commonly after surgery, there is range of motion loss in knee extensions. This is in turn causes scar tissue formation, and then subsequent joint contact pressure. A proper rehab program utilizes hyperextension so that both knee extensions are symmetrical.

Preventing Injuries from Happening: Physical therapy can also play a role in preventing injuries from happening in the future, such as runner's knee. Physical therapy can be used to improve the strength, flexibility, and range of motion of a certain body part. By improving the qualities of the body part, it is better able to resist stresses and forces that might lead to a serious injury. Trust physical therapy to make this happen.

Trust the Team from Orange County Physical Therapy

When someone has been diagnosed with a knee injury, he or she might wonder how the recovery process is going to unfold. At Orange County Physical Therapy, we take a unique approach because we prioritize the needs of the patient ahead of our own. We do this by tailoring our physical therapy regimens to meet the needs of our patients. We believe that placing the patient first allows us to provide the care and compassion that everyone deserves. To learn more about our services, please call Orange County Physical Therapy today to schedule an appointment. We would be honored to help you.


References

1. Eitzen, Ingrid, et al. "A Progressive 5-week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury". J Orthopedic Sports Physical Therapy. 2010 Nov; 40(11); pp. 705-21.

2. Grinsven, S Van, et al. "Evidence-based rehabilitation following anterior cruciate ligament reconstruction".  Knee Surgery Sports Traumatology Arthroscopy. 2010 Aug. Vol 18(8). pp. 1128-44.

3. Wilk, Kevin E, et al. "Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries". J Orthopaedic & Sports Physical Therapy. 2012; Vol 42 Issue 3; pp. 153-171.

4. Gerber, JP, et al. "Effects of Early Progressive Eccentric Exercise on Muscle Size and Function After Anterior Cruciate Ligament Reconstruction: A 1-Year Follow-up Study of a Randomized Clinical Trial". Physical Therapy. 2009. Vol 89 Number 1; pp. 51-9.

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