Commonly affecting all ages, it is easily injured and gradually becomes painful with activity, eventually immobilising the patient. Due to its constant usage, this part becomes very prone to wear and tear. Physical therapy can help with a combination of manual therapy techniques, exercises, stretches, and deep tissue mobilisation. A program of stretching exercises in conjunction with deep tissue mobilisation for the tight muscles, coupled with strengthening other surrounding muscles, helps restore pain-free sporting activity. Assessment of other contributing biomechanical and sporting factors can help return to sport. At Hallmark physiotherapy, we focus on strengthening conditioning and fitness to improve pain and activity levels.

1) Ligament and meniscus injuries

  1. ACL tears
    The cruciate (or crossing) ligament stabilises the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.
    ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.
  2. PCL TEAR
    The posterior cruciate ligament (PCL) is stronger and less commonly injured. Motor vehicle accident, when the knee(s) forcefully impact the car dashboard, is a common mechanism of injury. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. Surgery is not typically required.
  3. MENISCAL tears
    The menisci (plural for meniscus) are cartilage pads which function to cushion the compressive loads in the knee. One or both of these pads can be torn, which often occurs when the lower leg is forcefully bent and twisted. Signs and symptoms include joint line pain, locking and swelling of the knee. The tear often has a bucket handle or parrot beak shape. Treatment should consist of rest, ice, compression and elevation. Arthroscopic surgery is indicated for a large tear. Due to its nature in controlling movements in weight-bearing status, physiotherapy is indicated.

2) Osteoarthritis and Total Knee replacement

Osteoarthritis occurs when the cartilage coverings on the end of the femur and the top of the tibia wear out. The tibia has two special cartilage pads called menisci (one is called a meniscus). This cartilage becomes flattened, bone spurs form, the joint becomes inflamed, range of motion is lost, and there is ensuing weakness, pain and difficulty with walking, climbing stairs, and getting in/out of chairs. Physical therapy can help recover range of motion, strength, walking skills, and pain management. Aquatic therapy (often involving a customised exercise program) can be helpful.

3) Knee Replacement

ABOUT TOTAL KNEE REPLACEMENT

Joint replacement is becoming more common, and hips and knees are the most commonly replaced joints. In 2006, 542,000 total knee replacements and 231,000 total hip replacements were performed.

The new joint, called a prosthesis, can be made of plastic, metal, or both. It may be cemented into place or uncemented. An uncemented prosthesis is designed so that bones will grow into it.

Total knee replacement is often the answer for people when x-rays and other tests show joint damage, when moderate-to-severe, persistent pain does not improve adequately with nonsurgical treatment, and when the limited range of motion in their knee joint diminishes their quality of life.

In the past, patients between 60 and 75 years of age were considered the best candidates for total knee replacement. Over the past two decades, however, age range has broadened to include more patients older than 75, who are likely to have other health issues, and patients younger than 60, who are generally more physically active and whose implants will probably be exposed to greater mechanical stress.

About 90 per cent of patients appear to experience a rapid and substantial reduction in pain, feeling better in general, and enjoying improved joint function.

PHYSICAL THERAPY PRE AND POST-SURGERY

There are a number of reasons why you should see a physical therapist before you consider a knee replacement and after surgery as well.

  1. Physical therapy is proven to be a successful treatment for arthritis; therefore, a physical therapist-directed program could help you delay or avoid knee replacement.
  2. Seeing a physical therapist before surgery and going through a “prehab” program (a set of rehabilitative exercises before surgery) is proven to increase strength and speed the post-surgical recovery process.
  3. Post-surgical physical therapy for knee replacement patients is a must. While most knee replacement patients experience a significant reduction in pain, almost all knee replacement patients suffer from considerable muscle weakness, loss of range of motion, and limited function. Seeing a physical therapist after surgery can greatly improve your strength, mobility and function.
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