Category Archives: Knee

physical therapy knee pain

How Physical Therapy Helps Knee Rehabilitation

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PT&Me Knee Rehabilitation

Physical therapists can provide more than pre/post surgical knee rehabilitation for patients experiencing knee pain.

What Causes Knee Pain?
The knee is a relatively simple joint 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 the knee is overstressed in sports or in everyday activities, these structures can break down — and a knee injury occurs.

Common Knee Problems Seen by Our Physical Therapists:

  • Strain / Sprain
  • Arthritis Pain
  • Muscle Weakness
  • Ligament Sprains
  • ACL Tears
  • Tendinitis (ie: Patellar, Pes Anserinus)
  • Chondromalacia Patella
  • Patellofemoral Syndrome / Knee Pain
  • Pre / Post Operative Therapy

How Physical Therapy Provides Knee Rehabilitation
Rehabilitation acutely after knee surgery or a knee injury primarily centers around decreasing swelling in the knee joint. Even a small amount of fluid inhibits the quadriceps muscle on the front of knee by slowing the signal for movement traveling from the brain to the muscle. Manual techniques to decrease muscle spasm and improve length tension relationships of soft tissue are also incorporated. Gradually, exercises to increase strength, range of motion and functional mobility are introduced.

Treatments Offered Include:

  • Comprehensive evaluation with an emphasis on determining the source of the problem
  • Individualized and specific exercise programs
  • Manual therapy (hands-on treatment)
  • Modalities as needed
  • Work and sport specific simulations
  • Progressive home program to help restore independence and self-management

Knee Rehabilitation Goals:

  • Reduce Pain
  • Improve Mobility
  • Movement Awareness/Gait Training
  • Functional Strength
  • Patient Education

For more information on knee injuries visit our PT & Me Knee Injury Center page by clicking here.

The PT & Me Injury Center goes over diagnoses on how physical therapists treat specific injuries.

To find or search for a local participating PT & Me physical therapy clinic in your local area please click here.

knee injuries physical therapy

Common Causes of Knee Injuries

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While most of us take our knees for granted, injuries can occur quite easily and for a variety of reasons. Only when you suffer a knee injury, do you realize how much we rely on these joints on a day to day basis. Knee injuries cause discomfort and pain, but that’s not all. They can also be extremely debilitating and in serious cases, result in dramatically reduced mobility. So let’s take a look at some of the most common causes of knee injuries, and what to do in case you experience one.

What Are the Most Common Knee Injury Causes?

Well, there are a number of them – some more serious than others. Let’s take a look at some of the most common ones!

  • Fractures: Fractures are very common knee injuries and can affect the patella, which is the most commonly fractured bone around the knee. Fractures can also affect the ends of the tibia and femur in the area where they come together to form the knee joint. Incidents such as serious falls and road traffic accidents are common causes of fractures. And sometimes even the best knee brace for running or other sports won’t be able to prevent a fracture.
  • Dislocated knee: Knee dislocation is another common knee issue and it occurs when the knee bone is either partially or totally out of place. This could include the patella slipping or the femur and tibia sustaining injury that forces them out of alignment. Various different sports activities as well as falls and other high impact trauma can cause this injury.
  • Torn ligament: Tearing of the anterior cruciate ligament is also a common type of knee injury. This is more common among those that take part in athletics and sporting activities. Some of the common causes of this injury include a rapid change in direction when running or incorrectly landing from a jump. In many cases, this sort of injury also comes with additional injuries to the cartilage.
  • Torn tendons: This type of injury is more common among older people, particularly those who are active runners or do any sports that require a lot of running. The tendons of the patella can become stretched and then torn during this type of activity. Direct force to the front of the knees, falls, and incorrect landing following a jump are all common causes of a torn tendons.

There are many different causes of knee injuries, but usually they involve some sort of high impact trauma. This is why these types of injuries are often sustained by athletes as well as people who are keen on physical activities. Falls, incorrect landings following a jump, and the twisting of the knee can all cause various different knee injuries.

The knees are among the most easily injured joints in the human body, and also one of the most common reasons for people seeing their doctor. So in the event of a knee injury, no matter what the cause, it is important to seek medical advice because a knee injury can escalate from simple twisting of the knee to a dislocation or worse pretty quickly. Because the treatment for a knee injury varies based on the severity as well as the type and cause of the problem, ranging from medication and physical therapy to even surgery, consulting a medical professional is the first step to treating your knee successfully.

More information about common knee injuries can be found in the PTandMe injury center.

total knee replacement

Physical Therapy Following a Total Knee Replacement

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There are over 600,000 total knee replacements done each year in the U.S. As the workforce ages and as obesity levels continue to rise, this number is expected to increase.

Candidates for a knee replacement include patients experiencing difficulty doing simple daily activities, including walking or going down steps, and where conventional treatments are no longer helping. Common causes that lead to a replacement include pain with simple ADL’s (activities of daily living), pain at rest, chronic swelling, inflammation not improving with medication, knee deformity, knee stiffness, or trauma to the joint. When you are scheduled for a total knee replacement, ask to see your physical therapist for a pre¬surgical exercise and stretching program. This will help your knee recover its range of motion and strength.

Surgery consists of resurfacing the knee’s damaged and worn joint surfaces with artificial parts made of metal or plastic. Most patients are in the hospital for an average of 3¬5 days. And more than 90 percent of people report significant decrease in pain and improvement in ability to perform ADL’s within one month after surgery. Currently, many knee replacements are lasting 20 years or more with appropriate activity modification. One of the most important factors in success after a total knee replacement is follow up with physical therapy and a lifelong exercise program. Physical therapy typically starts during the hospital stay with the goals being to get the individual up and walking decreasing swelling in the knee and increasing knee ROM (range of motion). Upon hospital discharge, patients either go home and receive home physical therapy for one to two weeks, or to an extended care facility to continue their therapy.

Typically, patients need outpatient physical therapy after therapy at home, which usually begins two to four weeks after surgery. Outpatient physical therapy is recommended for three times a week for up to three months. Therapy goals initially are to reduce swelling and pain, and improve knee range of motion in both directions. To achieve these goals, treatment may consist of soft tissue massage to increase circulation and decrease swelling, stretching to improve flexibility, patellar mobilization, range of motion exercises, and modalities such as ice and electrical stimulation to help decrease pain and swelling. Physical therapy will progress to lower extremity strengthening exercises, balance activities, and fine tuning the gait pattern. Various activities and techniques will be used to improve strength, balance, and gait. As patients reach the end of their course of physical therapy, a personalized home exercise program is developed with the focus on independence with all ADL’s and returning to activities such as walking, swimming, dancing, golf, and biking. It is important for patients to stay active and maintain strength, flexibility, and endurance.

PREHAB Knee Replacement

PREHAB Move to Improve Your Goals: Total Knee Replacement

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PREHAB Home Preparation
Before total knee replacement surgery there are a few simple things you can do in your home to make it safer and more comfortable during recovery.

  • Consider keeping a cordless phone near you or carry your cell phone in your pocket.
  • Move furniture to keep a clear wide path to your kitchen, bathroom and bedroom.
  • Remove throw rugs that may cause you to slip or trip. Tape down any loose edges of large area rugs that cannot be removed. Make sure extension cords are out of traffic areas or tape them down if needed.
  • Wear rubber sole shoes to prevent slipping.
  • Keep commonly used items in your home at waist level within easy reach. This will prevent you from bending over to reach items. Use a reacher to grab objects and avoid excessive bending at the knee.
  • Make sure there is adequate lighting in the house. Add night lights in hallways, bedrooms, and bathrooms.
  • It may be helpful to have temporary living space on the same floor if your bedroom/bathroom is located on the second floor of your home. Walking up/down stairs will be more difficult immediately following surgery and could increase your risk for falls.
  • Arrange for someone to collect your mail and take care of pets or loved ones if necessary.
  • Prepare frozen meals in advance to assist you with cooking.
  • Stock up on groceries, toiletries, and any needed medications you might need.
  • A shower chair or a tub bench will make bathing much easier. Do not take soak baths until your physician allows you to do so.
  • An elevated toilet seat will be helpful with toilet transfers and with following post surgical precautions or guidelines.
  • Assistive devices for dressing such as a reacher, extended shoe horn and / or sock aid may be necessary during your post operative recovery.

While it’s important to prepare your home before surgery, PREHAB should also include physical therapy. Physical therapists will work with patients to create an exercise program before surgery that can help improve performance and decrease recovery times after a total knee replacement. Talk to a PT near you and learn about the benefits of PREHAB before total joint replacements.

Total Knee Replacement Prehab: Move to Improve Your Outcomes

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Many people with arthritis favor their joints over time in an effort to relieve pain and thus become weaker in their leg muscles or lose range of motion. However, the better shape you are in before surgery the better your results will be after surgery so it is important to strengthen your leg muscles and work on your range of motion. Before surgery your physical therapist will teach you appropriate exercises to help improve strength, range of motion, and balance. They will also teach you how to walk with an appropriate assistive device such as a walker or cane in the immediate post operative recovery period. Finally, they will discuss precautions and advise you in a few short term home adaptations such as removing loose rugs to help make your recovery easier and safer.

Prehab Goals
• Develop an exercise program with your PT to help you
• Improve strength
• Improve range of motion
• Improve balance
• Gait training — Review walking with an appropriate assistive device such as a walker or cane in the immediate post operative recovery period
• Discuss precautions and review a few short term home adaptations that can help make your recovery easier and safer

walker lady

Pre Surgery Exercise Plan
Make every effort to begin these exercises as early as possible before your surgery. Only do what you are able to do without increasing your pain. It is important for you not to exacerbate your pain prior to surgery. Ice packs for 15 minutes following your exercises may be helpful to reduce any soreness in your knee.

This information was written by STAR Physical Therapy, an outpatient physical therapy group with 60 locations in Tennessee, offering more than 15 comprehensive specialty services. STAR Physical Therapy was established in 1997 with one clinic and one mission – to serve. Today, they’ve grown to offer that direct service in more than 60 clinics. While they’ve grown, one thing that has not changed is their commitment to you, their communities, and their employees. For more information click here.

More about knee replacements and physical therapy can be found here:

total knee replacement

feet cause pain

Can Your Feet Cause Pain in Your Knee, Hip or Back?

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Can your feet cause pain in other areas of the body?  Yes it can.  The foot is an arch and arches decrease compressive forces by distributing them across the span of the arch. Engineers use arches in building and bridges to hold up greater weight across longer spans.  The human foot has 3 arches that all work together to distribute the forces our bodies put on it.  This allows us to walk, run and jump.

We start running into problems when the arch is either too flat or too high – causing the forces put through the foot to be abnormally distributed, resulting in strain.

  • Flat feet limit the range of motion of our ankle, causing our hips to rotate inward and move towards the center of our body.
  • High arches do the opposite to our hip joints.
  • These changes cause strain to our ankle, knee and hip joints, and our back.

knee pain

People can be unaware that their feet cause pain throughout the body because they were born with flat feet or high arches and they do not know what “normal” feels like.   As physical therapists we have treated many children who didn’t realize that their feet are not supposed to be sore.  But instead of seeing them for prescribed foot pain, they come for pain in their joints or back.

Orthotics were developed to correct or adapt to changes in the foot.  Orthotics should be fitted by a healthcare professional trained in assessing the foot and gait.  Standing on a pressure plate in the store is not good enough.  Why?  If your foot hurts are you going to stand on it normally?  Probably not.  This results in an abnormal reading.

An orthotic by itself is not the best treatment.   A physical therapist will assess your function, strength, flexibility and range of motion.  Patients will present with other problems as the result of abnormal arches.  Treatment with orthotics combined with strengthening and stretching exercises, balance training, functional training and manual therapy is necessary to restore full function.

This article was written by Scott Van Bramer, PT, Partner/Clinic Director of Phoenix Physical Therapy.  Phoenix Physical Therapy is an outpatient physical therapy clinic in Canal Winchester, OH. For more information about Phoenix Physical Therapy in Canal Winchester, please call the clinic directly at 614-834-2995 or visit them online at www.phoenixptohio.com

ice hockey injuries

Common Ice Hockey Injuries

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Ice hockey is one of the most popular sports played in North America. Physical therapy can provide specific treatment to a number of specific ice hockey injuries. Here are a few injuries that can happen during a hockey game or practice:

Common Ice Hockey Injuries

BACK INJURIES
Hockey players are at risk for low-back injuries due to the flexed (forward) posture of skating and the frequent hyperextension (backward) stress. Low-back pain and/or a pulled muscle are the most common injuries. Stretching of the hip flexors along with strengthening of the back and abdominal muscles will help avoid these injuries.

HIP INJURIES
The hip joint and groin muscle are susceptible to injury due to the mechanisms of the skating stride. Some of the most common soft tissue injuries in hockey players include a groin strain and a hip flexor strain. Off-season strengthening and dedicated stretching before and after practice are important to prevent these injuries. In addition, a direct blow to the outside of the hip can cause a hip pointer or trochanteric bursitis. Hockey pants with reinforced padding over these areas may help protect them.

KNEE INJURIES
The medial collateral ligament is the most susceptible to a sprain because of the leg position – pushing off the inside edge of the skate blade – and contact to the outside of the knee. Anterior cruciate ligament (ACL) disruption and meniscus tears (torn cartilage) can also occur but are less common in hockey that in other sports such as football, soccer and basketball.

hockey_goalie

SHOULDER INJURIES
The most common shoulder injuries in hockey are a shoulder separation and a broken collarbone. These injuries occur from direct contact of the shoulder with another player, the boards or the ice. Treatment can include a sling, rest and in serious cases surgery.

ELBOW INJURIES
The point of the elbow is a frequent area of contact, which can result in the development of bursitis. Thick and scarred bursal tissue (which feels like bone chips, but isn’t) can be a source of recurrent inflammation. The best prevention method is wearing elbow pads that will fit well and have an opening for the elbow, soft padding and a plastic outer shell.

WRIST INJURIES
A fall on the outstretched arm or contact with the boards that forces the wrist up or down, may cause a fracture. Players should try bracing themselves against the boards using their forearms instead of their hands.

dry needling physical therapist

Trigger Point Dry Needling

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Dry needling uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a relaxation. This leads to a reduction of pain, improvements in flexibility and a restoration of normalized movement when combined with corrective exercises.

WHAT IS A MYOFASCIAL TRIGGER POINT?
A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that produces local or referred pain. The trigger point can lead to increased pain, decreased flexibility and decreased muscle function if not treated. Trigger point dry needling is a safe, effective and efficient treatment technique to release these painful spots.

dry needling

WHAT TYPE OF PROBLEMS CAN BE TREATED?
Muscle dysfunction can be the primary or secondary contributing factor to many neuromusculoskeletal conditions.

WHAT YOU NEED TO KNOW:
• Dry needling must be specifically prescribed by a physician.
• Dry needling is not covered by insurance, it is a cash based modality.

This information was written by The Jackson Clinics, a locally owned physical therapy practice in multiple locations throughout Northern Virginia. They specialize in outpatient orthopedics and sports rehabilitation. Their therapists and assistants possess advanced clinical skills in spinal disorders, sacroiliac joint dysfunction and peripheral joint problems, including rotator cuff injuries, knee injuries and foot and ankle pain. They also also have specialty programs in breast cancer rehab, vestibular rehab, pediatrics, post-cancer rehab, aquatic therapy and women’s health. For more information click here.

postoperative physical therapy

Postoperative Physical Therapy

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Postoperative physical therapy after a Total Hip Replacement is essential to your recovery. Your physical therapist will follow your physician’s protocol and will focus on range of motion exercises, progressive strengthening exercises, gait training, balance training, and activity specific training to meet your specific needs. Modalities such as ice and e-stim may be used to help reduce discomfort and swelling. It is very important to complete your home exercise program as directed by your physical therapist and physician.

RANGE OF MOTION EXERCISES
Swelling and pain can make you move your knee less. Your physical therapist can teach you safe and effective exercises to restore the range of motion to your knee so that you can perform your daily activities.

STRENGTHENING EXERCISES
Weakness of the muscles of the thigh and lower leg is typical after surgery. Your physical therapist can determine the best strengthening exercises for you with the goal of no longer needing a cane or walker to walk.

post op

BALANCE TRAINING
Specialized training exercises can help your muscles “learn” to adapt to changes in your world such as uneven or rocky ground. When you are able to put your full weight on your knee without pain, your physical therapist may add agility exercises so that you can safely and quickly change directions or make quick stops or starts. They may use a balance board that will challenge your balance and knee control. These exercises will be safe and fun.

GAIT TRAINING
Your physical therapist will work with you in retraining your gait following your surgery using appropriate assistive devices such as a walker or cane. They will make sure that you will be able to safely and confidently go up and down stairs, negotiate curbs, and inclines, etc.

ACTIVITY SPECIFIC TRAINING
Depending on the requirements or your job or the type of recreational activities you enjoy, your physical therapist will tailor your program so that you can meet your specific demands.

This article about postoperative physical therapy was written by STAR Physical Therapy, an outpatient physical therapy group with over sixty locations in Tennessee. Established in 1997 with one clinic and one mission – to serve. Today, they have grown to offer that direct service in more than 60 clinics, and while they’ve grown, one thing that has not changed is their commitment to you, their communities, and their employees. For more information click here.

Recovering from knee surgery

Self-Care: Safe Positions & Movement After Knee Surgery

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ACTIVITY GUIDELINES
Recovering from knee surgery does not have to prevent you from moving or taking care of yourself. Listed below are guidelines on how to do some common movements and activities without hindering the healing process.

SLEEP & POSITIONING
• It is very important that when recovering from knee surgery you get enough rest following your surgery. If you cannot get comfortable in your bed, please talk to your therapist.
• Sleep on a bed with a firm mattress. Ideally, the bed should come up to your mid-thigh while you stand.
• Sleep flat on your back and position your leg so your toes and kneecaps point at the ceiling.
• Do not place pillows under your operative leg. If you wish to elevate your leg, support the whole leg with pillows while keeping the knee straight.

Sitting Up In Bed:
• If possible, get out of bed toward non-operated side so that the operated leg is supported as much as possible.

From Sitting on the Side of the Bed to Standing with the Walker:
• Straighten the operated leg in front of you before standing.
• Ensure you have good sitting balance with the walker close in front of you.
• Push up from the bed with both hands and keep weight on the non-operative leg.

From Standing to Getting Into Bed:
• Sit down on the edge of the bed; place at least one hand on the bed as you lower yourself. Remember to keep the operated leg further ahead to avoid straining it.
• Enter your bed leading with the operated side if possible.
• Bring your legs onto the bed while lowering your upper body with your hands then elbows.

BATHING/SHOWERING:
You may shower in a bathtub or shower stall only after your doctor has given their permission.

Getting Into the Tub to Take a Shower:
• Have the tub bench or tub chair placed in the direction facing your shower faucets.
• Using your walker, back up to the bench.
• Reach back with one hand to the bench and sit down with your legs outside of the tub.
• Place one leg at a time into the tub.

Getting Out of the Tub:
• While seated on the tub bench/chair turn your body and place your legs one at a time outside of the tub.
• Push up from the tub bench and stand using both hands on the walker.

knee brace

TOILET TRANSFERS:
When recovering from knee surgery the low surface may cause excessive painful bending at the knee. If this is the case, your therapist may help you with getting a raised toilet seat or a three-in-one commode that can be used over your toilet.

Getting Up and Down From a Toilet:
• Back up to the toilet.
• Reach back for the armrests/raised toilet seat/seat.
• Slide your operated leg slightly forward and lower yourself slowly onto the toilet.
• To stand, use a grab bar or place your hand at the middle of the center bar of the walker.
• Stand up and get your balance before placing both hands on the walker.

DRESSING:
• Put on your top or shirt as you normally would while seated.
• Do not twist the knee too much when dressing or putting on shoes.
• Your therapist may recommend a sock aid, dressing stick, reacher or long-handled shoe horn to help with dressing.

STAIRS:
You should only try to go up or down stairs when your doctor or therapist says it is okay. Do not try to use stairs while using a walker.
• When going up the steps, first step up with your non-operative leg, followed by the operative leg.
• When going down steps, first step down with your operative leg, followed by the non-operative leg.
• Complete only one step at a time and always have help.

CAR TRANSFERS:

While you are recovering from knee surgery you will need someone to help you with getting in and out of the car for both your safety and comfort. The seat would ideally be at the height of your mid thigh. Avoid cars with low or bucket seats.
• Have someone slide the seat back as far as possible prior to entering the car, preferably on the front passenger side.
• Slightly recline the seat back if possible.