Physical Therapy Guide to Knee Pain

Dear Friends,

I usually use this space in the newsletter to share a personal story relating it in some way to my growth as a person and the role this growth had on the development of our clinic. This newsletter contains a different theme. This letter is about the importance of patients taking charge of their health and their health care.

It has been a year since COVID-19 hit our area. We have heard stories regarding patients who had Covid and others who were treated like they had Covid but did not. We had patients who had surgery and were treated with Telehealth who had some success, but most who did not. Most of the patients we saw following a repaired shoulder, knee or hip found themselves with scarring or frozen joints. This was a frustrating, painful issue for all those patients who finally decided seeing a physical therapist was much more important than waiting for Covid to pass. We even had a physician, who had a rotator cuff surgery, fall to the Telehealth physical therapy visits, and end up with a severe frozen shoulder. He ended up driving 40 minutes to our clinic , twice a week for 4 months. In the end, he achieved range of motion, strength, and function of his shoulder, that even we he had questioned was possible at the age of 60 years.

How does this happen? How do we find better ways to get the best care possible for whatever our injury, surgery or pathology might be? My answer, when patients call me, is to have them take the necessary time to research what kind of care they need. It is truly worth the time to do some research, ask friends and family if they have had similar injuries, surgeries, or pathologies to get the best care. Leaving it up to one physician, specialist or even physical therapist is not good enough. Everyone needs to take the time to ask at least 2 healthcare providers who specialize in your injury or pathology before making a quality decision on your health and future.

We had one of our own physical therapists misdiagnosed because of Covid. We all let her mysterious symptoms go for a couple of weeks before a patient who was a physician, suggesting strongly what we needed to do! I can tell you right now, if we didn’t respond to our patient’s guidance, our colleague would most likely not be with us today!

For the record, after many months of being in critical care and being rushed down to a specialty hospital in Indianapolis, things are looking better than we could have ever hoped. Thankfully, we had a little angel in our clinic, who was this physician, who knew enough to get us all off the conveyor belt of average care to a more proactive care and treatment.

Did we step over the normal protocols of care? Absolutely! Did we call the specialists involved and try to stay closely in communication with them so that they may have felt us a bother? Guilty once again. However, when you are speaking of one’s health and future, shouldn’t we all want the best care possible?

Let me make my point as simply and clearly as possible: As patients, you do have a choice when it comes to your physician – especially your specialists, such as orthopedic, neurosurgeon, general surgeons, etc... You also have the right to choose in deciding where you go for your physical therapy. Regardless of what painful condition you have, I would hope, you would want a healthcare professional sitting down with you, listening to your story, and directing you on a path that makes the most sense for your present life and future. If the healthcare provider fails to listen, you need to move on and get to someone who will.

Most of us think there are few options in our community. This is not the case. When you look more deeply into your pain or weakness you may find you don’t need surgery, and you just need a conservative treatment to move on with your life.

I have seen patients, who have fallen and could not raise their arm or move their leg, back or neck. Luckily, after treating patients in our community for over 32 years, we have a good enough reputation that they were directed to us, and we walked them through our very thorough 45–60-minute examination. After the examination, as is the case often, they were able to regain their strength, motion, and function without surgery. This same type of process has helped most of our patients over the last 32 years. The only difference for most of these patients is that they chose to look first for someone who could objectively examine their injury without any bias toward surgery.

I am not saying that we can save every patient from surgery. We do examine patients, call orthopedic surgeons and neurosurgeons we trust, and refer certain patients up for their needed surgery. All I am saying, is that we all need, when we get any kind of pain or injury which is limiting our lifestyle, to take a moment to seriously take the time to research all avenues to help us get our health back to where we hope to be in the future. Most times it is much easier and less invasive than any of us might think.

After 1 year of being under siege of this extremely complex Covid situation, I hope we can all get up and get going to take our health and lives back. Many of us have been very sedentary and have lost strength and endurance. Many cannot walk as long or travel like they once could. As the vaccinations begin to rollout and people begin having less fear, I hope you will all take the time to find ways to get back to a healthier and happier life.

We are and have been for over 32 years, assisting our community, making them stronger and more independent every day with our expertise in movement and conditioning. If you are ready to get back to functioning how you were before Covid hit, please feel free to call and have any one of our physical therapy specialists assist you to achieve a possibly healthier life than ever before.

Enjoy,

Fran McDonald, PT,DPT,OCS

Physical Therapy Guide to Knee Pain

Knee pain can result from disease, overuse injury, or trauma. Among American adults, approximately 25% have experienced knee pain that affects the function of their knee. Knee pain and conditions related to the knee are common. In runners, the knee is the part of the body that is injured most often. Changes to the knee related to aging (osteoarthritis) commonly occur in people over the age of 50. Thousands of steps, squats, and twists to the knee over a long life can cause changes to cartilage and other parts of the knee.

Knee pain also occurs in growing children. Pain can reduce their participation in physical activities, which may lead to other problems later in life. Changes in the posture of the knee as well as the lower extremity (hip, leg, and ankle) during growth can cause pain in children and teenagers. These developmental changes can affect knee function.

Knee pain can be mild, or it can be severe and sharp. Knee injuries can result from a direct blow to the knee or a sudden movement that strains the knee beyond the normal range of motion. Knee pain can make it hard to walk, rise from a chair, climb stairs, or play sports. Physical therapists are trained to diagnose and treat knee pain and to help ease your pain and restore movement. They also can work together with other members of your health care team.

How Can a Physical Therapist Help?

Your physical therapist will develop a personalized rehabilitation program for your condition. This program can help you safely return to your desired activities. Some general treatment techniques may include:

Patient education. Your physical therapist will work with you to identify and change any factors causing your pain. They will work with you on the type and amount of exercise you do, your athletic activities, and your footwear. They will recommend improvements to your daily activities. Your physical therapist will develop and teach you a personalized exercise program to help you return to your desired activities as much as possible.
Pain management. Your physical therapist will design a program to address your pain that includes applying ice to the affected area. They also may recommend modifying some activities that cause pain. Your physical therapist will use and teach you pain-management techniques to reduce or eliminate the need for medication, including opioids.
Range-of-motion exercise. If the mobility (movement) of your knee is limited, it can cause increased stress on your knee. Lack of movement in your hip, foot, or ankle also may be forcing your knee to work at a disadvantage. Your physical therapist may teach you stretching techniques to decrease tension and help restore the normal motion of your joints. These will focus on joints from the pelvis/hip region down to your foot.
Manual therapy. Your physical therapist may treat your condition by applying hands-on treatments (manual therapy) to gently move your muscles and joints. These techniques help to restore and improve proper motion. They also may be used to guide your joints into a less stressful movement pattern. Your physical therapist may provide gentle resistance as you perform certain movements, to improve your strength.
Muscle strengthening. Muscle weaknesses or imbalances can cause some knee conditions and continued symptoms. Based on your specific condition, your physical therapist will design a safe resistance program for you. This program likely will include exercises to strengthen your core (midsection) and your lower extremities. They may begin your program with exercises done while lying on a table, bed, or the floor. You then may advance to exercises done in a standing position (e.g., standing squats). Your physical therapist will choose what exercises are right for you based on your age and physical condition. They may have you use resistance machines in the clinic, and advise you on what equipment to use at home or at the gym.
Functional training. Once your pain, strength, and motion improve you will need to safely and slowly return to more demanding activities. It is essential to learn safe, controlled movements so you can minimize the stress on your knee. Based on your unique condition and goals, your physical therapist will provide you with a series of activities to help you use and move your body correctly and safely.
Braces and other assistive devices. Depending on your condition, your physical therapist or other members of the health care team may recommend braces, walking aides, wraps, or tape. These devices may assist in your recovery.
A cane, walker, or crutches can help reduce your pain and improve your ability to walk. Your physical therapist may recommend that you use these walking aids for a short time. Or, if you have specific conditions, such as osteoarthritis, you may need to use them longer.
Your physical therapist may recommend a brace to stabilize your knee during the initial recovery phase. They can assist you with fitting the brace and teach you how to use it.
Wrapping your knee to reduce swelling may be recommended. Your physical therapist will use specific wrapping techniques. They also may recommend the use of compression stockings.

Your physical therapist may refer you to an orthopedic doctor who specializes in knee conditions and injuries. They may recommend diagnostic imaging (i.e., X-ray, MRI). An X-ray helps to identify bone abnormalities (e.g., osteoarthritis, fractures). An MRI will help confirm the diagnosis of tendon and ligament injuries and provide a different view of your bones and cartilage.

Call us today for an evaluation, no doctor referral is needed.