What should I do if I have knee pain?

By: | Tags: , , , , , , | Comments: 0 | December 21st, 2014

The Physio Crew website offers information for educational purposes only. We take no responsibility for the application of this advice without proper diagnosis from a healthcare professional.

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What should I do if I have knee pain?

Knee pain is common and there can be many different causes. Common things The Physio Crew see are ligament injuries, muscle sprains, anterior knee pain (tradesman/taxi drivers/office based) osteoarthritis and post op rehabilitation.

Why is diagnosis important?

There are many causes of knee pain and the most important thing is being seen by an expert to get the right diagnosis or at least rule out what it isn’t.

The most important part of my assessment is the 15minutes we talk for at the beginning of a session.

Through this I gain your story. A history of how the condition began. Was it a trauma? Did it come on over time? Was it due to a change in routine? These key questions help us to understand what the most likely cause of your symptoms are.

Pain that results following trauma often needs to be assessed quickly to ensure you are doing the right thing from the initial onset to facilitate the healing process. Many peoples natural reaction when they have a trauma is to rest but often you can be doing gentle exercises to help reduce swelling (through muscle contraction). In some cases it is necessary to rest from weight bearing ( such as a fracture).

Shouldn’t I just see a doctor? 

All physiotherapists are autonomous practitioners and you can self refer without seeing a doctor first (unless your insurance requires this ie BUPA). I have experience diagnosing fractures/dislocations/concussion and severe ligament injuries. If after you see me I feel you require and Xray or onward referral I will write a letter to your GP (free of charge) explaining my findings and requested relevant imaging.

What if its something sinister in nature?

All physiotherapists are trained to recognise symptoms that do not fit into a musculoskeletal pattern. We will always contact the GP and refer you back should we feel you require further imaging

Why are the benefits of seeing a physio first?

At The Physio Crew we have 45 minutes which allows us to listen to your story and formulate a specific program for you. We are experts in sports injuries and therefore can assess you based on experience working in elite sport with international players. Nicole Jones works with the Bristol Ladies premiership rugby team as a pitchside support and has completed the RFU recognised ICIS course for assessing and managing life threatening injuries.  We can make an accurate

I’ve tried exercises on the internet and there not working. Why would physio be any good for me 

Patients often come to me and say well I’ve tried physio, I’ve tried loads of exercise but none of them are working. Trying exercises you have seen or read about before is a start however does not replace the expert analysis of movement and experience in facilitating the recovery process.

Physiotherapy is a combination of clinical massage, soft tissue mobilisation, electrotherapy, acupuncture and exercise. However these treatments are not the skill of a physiotherapist. A good physiotherapist will listen to your problem and apply the right exercise at the right time. This is why The Physio Crew are different. We strive to diagnose the problem and treat the cause not the symptoms. We educate so that you understand what is going on and we give you tools to apply at home in conjunction with hands on therapy to resolve or mange your pain.

Knee pain following trauma: 

First 48 hours

Although ice relieves pain it also inhibits insulin like growth factor 1 which may delay healing (read more here-http://drmirkin.com/public/ezine111410.html)

Ice is a fantastic pain relief though so if you are finding it difficult to manage pain apply crushed ice wrapped in a tea towel so the area. Do not leave on for longer than 20 minutes as can cause damage to the nerves.

Take paracetamol/ codeine rather than NSAIDS such as ibruprofen/neurofen. Pain relief needs to be taken regularly to help manage initial pain. NSAIDs have an anti inflammatory effect. Although we want to settle swelling inflammation is necessary for healing. There are some studies that suggest that the use of NSAIDs in the early phases may delay healing (Please follow @Physowizz for regular updates on evidence). That being said NSAIDS such as ibruprofen have a fantastic analgesic effect so if necessary you may need to take this to manage pain.

Elevation: Remember to put your foot onto a foot stool or pillow in bed. Elevation helps to manage swelling which may cause secondary problems.

If there is an obvious fracture attend your local minor injuries or A and E depending on the severity of the injury.

If you are not sure whether it is broken or feel it may be ligaments, nerve, cartilage or other soft tissue then get an assessment from a specialist physio. We can have a look to rule out damage to the bone (ie break/fracture) or other soft tissue and apply tape, brace or splint when necessary. We can then formulate a program for you to get you back to fitness or refer to you GP who can organise further investigations (such as Xray or MRI) when necessary.

Once you have a diagnosis you can then either choose to rehabilitate yourself based on that diagnosis or attend follow ups to support you through that process and change exercises at each stage of the healing process. If is only affordable to attend once let us know and we can try to give you guidelines or when you can start doing new things without causing harm.

As a general rule it is important to get the knee moving and re educate a normal gait pattern to prevent secondary muscle loss and compensation. This ensures that good movement patterns are reestablished so that as you are able to move on as soon as the tissue is healed and are not held back by muscle wasting.

In summary 

Consider:

ICE for pain relief only : If unable to manage pain.

PAIN RELIEF: Ideally avoiding NSAIDs where possible.

ELEVATION: To reduce swelling

PHYSIO: to gain diagnosis.

EXERCISE: as tolerated.

Cryokinetics at a later stage.

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