It is said that when the mother of the mythological Greek hero Achilles dipped him in the River Styx, she held him by the heel, leaving that spot unprotected. For most of us mortals, however, that most vulnerable spot is two joints higher.
The knee is a relatively simple joint that is required to do a complicated job – to provide flexible mobility while bearing considerable weight. While walking down the street, our knees bear three to five times our body weight. When climbing stairs, that force can multiply to seven times our body weight.
That force is borne by compact structures of bone and cartilage, supported by muscles and ligaments. When the knee is overstressed in sports or in everyday activities, those structures can break down and knee injury can occur.
This article will discuss knee injury and how your licensed physical therapist can help you recover function. We’ll discuss ways you can prevent future injury and reduce your risk of knee injury in the first place.
The Knee Joint
The knee joint is really two joints: the patello-femoral joint, where the large bone of the upper leg connects with the knee cap; and the tibio-femoral joint, where the upper leg bone hinges with the large bone of the lower leg.
These bones are held in place by a system of passive restraints, the fibrous ligaments that hold the joint in place. The joint is further supported by muscle tissue, a system of dynamic restraints. When conditioned and strengthened, these muscles apply forces that help hold the joint together.
The menisci are pads of cartilage that further stabilize the bones, and provide shock absorbency.
Anatomy of a “Bad Knee”
Injuries to the knee can be grouped into two categories: acute macro-traumatic, or injuries that result from a single event; and micro-traumatic, repetitive injuries that occur over time.
Acute Macro-Traumatic Injury
An example of this type of injury is a rupture or tear of a ligament, part of the passive restraint system of the knee. Perhaps most common among these injuries is rupture of the anterior cruciate ligament, a condition usually caused by over-rotation of the joint. This type of injury can occur in both sports and occupations where there is excessive twisting.
Micro-Traumatic Injury
Micro-trauma due to overstress of normal tissue. Instead of damage from one event, the knee suffers many repetitive injuries over a period of time. Another name for this condition is overuse syndrome. Micro-trauma often occurs with a sudden increase in exercise level, such as when a runner increases distance or a tennis player plays extra sets.
Treatment of Knee Injuries
There is, unfortunately, no quick cure for a knee injury. Physical therapy plays a key role in treating and rehabilitating the knee, but you and your attitude toward recovery are the biggest factor in achieving a successful outcome.
Physical Therapy
Your licensed physical therapist will design a phased treatment plan with two main components:
1. Maximum protection, a series of exercises designed to help motion. Activities in this phase might include water walking, swimming, leg presses, and mini-squats; and
2. Return to function and maintenance, an exercise sequence to restore strength. These activities are a functional progression, that is, a gradual return to normal activities using exercises that simulate the knee stresses of your normal activities.
Surgery
Advances in surgical approaches to the knee joint have made repair to these structures practical in many cases. Arthroscopic surgery employs small incisions to access the joint. The surgeon views the damaged area through an arthroscope, hence the name.
These procedures are quick, involve a minimum of discomfort, and enjoy an excellent success rate. Such surgery is indicated when:
• Repair is needed for ruptured ligaments or torn menisci, or
• Some level of disability accompanies injury.
Preventing Your Knee Injury
Your knee’s tolerance for stressful activities will decrease with age and loss of conditioning. So, stresses that would not have caused injury last year could hurt your knee today. A decrease in your level of activity over a period of time will also contribute to the vulnerability of your knees.
There are things you can do to help prevent injury so that you can continue to enjoy sports and exercise. Pursuing an exercise program designed by your physical therapist, and applying some good common sense, can be your best protection from injury.
The first step in designing your exercise program is an evaluation by your physical therapist. He or she can identify your predisposing factors, those body traits that may make you more or less vulnerable to a knee injury.
Based on this assessment, your physical therapist can design a program that will help you gain your optimum levels of strength and conditioning.
How Physical Therapy Can Help Your Knee Problems
One way to think about your physical therapist’s role is as a coach — a caregiver and mentor to lead you through a course of action toward achieving your goals for your health, comfort and lifestyle.
It’s important to recognize that you, the patient, are the most important participant in the healing and prevention process. They are, after all, your knees. Whatever treatment you receive from others is just as important as the treatment you give them, day in and day out.
Whether you’re currently suffering from a knee injury, or trying to avoid one, your physical therapist has the skills to help. It all starts with a careful evaluation.
Evaluation. Physical therapy places great emphasis on this process. Your therapist will take the time to talk with you and perform a thorough physical evaluation to identify your knee condition or predisposing factors.
Therapy. Your physical therapist will plan a treatment regimen suited to your individual condition, and begin working to restore motion and muscular performance.
Teaching. You don’t need to become an “expert” to avoid or overcome injury, but you may need to learn some new habits. Your physical therapist will help you continue therapy on your own, with a home program of exercises designed to fit your needs.
Aftercare. The goal of physical therapy is to return you to normal life as soon as possible, with the skills you need to prevent reinjury. You probably won’t need to visit your therapist again unless you have another injury or pain.
Come into BaySport and talk with one of the Physical Therapist regarding your knee concerns.
Reproduced from the APTA knee brochure.
