ASK A PHYSIO

KNEE INJURIES


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I used to be an avid soccer player but now I only play once in a while. Recently, during a game, I fell and heard a click from the right side of my knee. I stopped playing for about 3 months and the right side of my knee seems to be fine now. However, I am experiencing an ache behind my kneecap towards the left side. While the pain is mild, I feel that my knee is weaker, especially when I try to run. When I exercise I experience pain and it feels like my knee is going to give out. It doesn't seem swollen and I don’t know how the pain shifted to the left side after the right side healed. Can you explain what's going on? I am very worried and am anxiously awaiting your reply.

Given your description of the injury, I would recommend following up with a doctor and/or a physiotherapist. These professionals can perform special tests on your knee and, if appropriate, a doctor could to determine what might be causing your sensation of weakness. A physiotherapist would be able to work with you to strengthen the muscles above and below your knee to help provide support to the joint as it continues to heal. Pain is not always a good indicator of where there is tissue damage, as it is only one of a number of factors that are used to help diagnose an injury. To further help us determine the best course of treatment, it would be helpful to know if the pain moved from one side of your right knee to the other side of the same knee – or from knee to knee?

Give us a call at North Shore Sports Medicine to start working with a physiotherapist today: (604) 973-0242!

What should I do after an MCL sprain? It's been one week since the injury.

An MCL sprain usually takes 3-6 weeks to heal. In the first few weeks of recovery, avoid exercise and movement where you might twist your knee.

  • Can I walk?

Walking on flat surfaces is okay. Other activities you can try are swimming or using exercise equipment such as a spin bike or elliptical to insure the movements are controlled

  • Should I take some rest?

If at any point you feel pain during physical activity or walking, this is an indication that more rest is needed for your knee to heal.

  • Are there any exercises I can do to speed up recovery?

Movement of the knee in a controlled environment (swimming, walking, spin bike or elliptical) can help promote healing. You could also try strengthening your knee; the stronger the muscles are around your knee, the more you will protect your knee from future injury. A great exercise to try is squats using just your body weight. However, you should only do this if it is not painful to perform. If any movement causes pain in your knee, that is a good indication that your knee needs more time to heal before you perform that activity.

Are Stairmasters bad for knees? I have heard this from other physiotherapists.

Anything done to excess can risk overuse injuries. That said, we are designed to move and you don’t need to think of your knees as a finite resource. In an activity like the Stairmaster, you can’t actively be using the joint without using the muscles around that joint, so you will be doing some strengthening as well as receiving the cardiovascular benefits.

Blood delivers oxygen and other materials such as nutrients to our cells, including those in our bones, ligaments and tendons in joints. Perhaps the physiotherapists you were speaking to were referring to the cartilage in the knee – which like all cartilage, does not contain any blood vessels. However, weight bearing exercise, like the Stairmaster, has been shown to improve cartilage health.

We encourage you to continue being active and try to vary your activity including different forms of cardiovascular exercise (like Stairmaster, running, elliptical, swimming) as well as specific strengthening exercises (weights).

I have had an ACL surgery 8 months ago. I did several rehabs sessions but definitely not enough to get my quads and hamstrings to optimal levels, or to even match my healthy leg. I played soccer few days ago and as I was kicking the ball with my good leg, my repaired knee bent and I felt the same feeling I felt before surgery when I used to kick the ball. What does this mean?

It is possible that you have just not rehabbed your knee enough, or perhaps you have re-injured it. Without a full assessment it is difficult to determine what might have occurred when you kicked the ball. Questions that would help determine what happened include: Did you experience pain during/after kicking the ball or just a feeling of instability/weakness? Did you get redness/swelling in your knee after the game? Have you experienced pain/weakness/buckling of the knee since that time? Is it possible that when you initially injured your knee other structures were also damaged (meniscus)?

A physiotherapist could do an assessment of your knee to check the integrity of the ligaments and cartilage, muscles and tendons that support the joint. It is never too late to continue rehabbing your knee and to strengthen your quadriceps, hamstrings and gluts. The best way to keep your knee healthy and pain free is by progressing the right exercise routine slowly, and continue doing a maintenance program so you can enjoy the sports you love in the long run and reduce the risk of trouble with your knee in the future.

I had a soccer game yesterday and got hit in my knee by the studs of the other girl’s cleat. There was immediate bruise and bleeding, and it didn’t stop until the end of the game. I kept on playing because I only felt stinging from the wound and the knee itself wasn’t that painful. But, maybe an hour or so later it became a bit swollen. Today it is significantly swollen on the side and there is a big bruise and five little wounds from the studs. I have problems trying to bend or straighten the knee, can’t walk without limping and even the slightest touch hurts me. I tried to put some ice on it but it was so painful that I couldn’t bear it for more than 20 seconds. Can you tell if it’s something serious after all and should I maybe go see a doctor? Thanks in advance for your answer.

I am sorry to hear about your injury. The day after an injury the inflammatory process sets in and can be associated with a lot of pain and swelling. It is certainly a good idea to see your family doctor or a physiotherapist if you are concerned about a more serious injury. A physiotherapist can diagnose any problems, as can most family doctors. In the mean time it is important to deal with the swelling, and if you see a physiotherapist they can also provide you with treatment and exercises to help you start healing and keep you on the right path to recovery.

To deal with the inflammation you should practice RICE. R = rest; avoid using your knee in the short term. You can continue to bend it and straighten only as far as it is not painful, and also continue to stand on as long as it is relatively pain free. You should only be walking if you are not limping. I = ice. I know you said it is painful to ice your knee – is this due to the abrasions?Try wrapping your ice pack in a soft cloth, or use a pack of frozen peas that is nice and light and shapes to your knee. Ice for 10 minutes at a time or until the skin becomes cold to the touch. Be sure to keep checking your knee to see that it hasn’t gone white or lost sensation. C = compression. You could try wrapping a tensor bandage around your knee to help reduce swelling. Make sure this bandage isn’t too tight and that you can fit at least 2 fingers in between the bandage and your knee. Finally E = elevate. Try to keep your knee above the level of your heart as much as possible.

I had a knee injury while playing cricket. I fell down few times while batting as my knee twisted. It’s been more than 3 months now. I took medication from doctor but that doesn’t help. I went to MRI scan, and the outcome is ‘ bucket handle tear of lateral meniscus’ and partial tear of ACL. Can this be healed by physiotherapy?

Given your type of injury physiotherapy is important and can be started immediately to help reduce pain and swelling, and to help you strengthen the muscles around your knee. Physiotherapy can help to facilitate healing the torn structures, although the tear will likely not fully heal. A bucket handle tear of the meniscus can sometimes block you from fully straightening your knee, and can make your knee feel unstable and may require surgical repair to unblock the joint. Current standards suggest that conservative treatment, as in physiotherapy, is the initial treatment of choice unless there is significant locking and/or giving way of your knee.

The ACL tear may also require surgical intervention, so you may wish to get on a waitlist for an orthopedic surgeon to expedite the process should you require surgery. If you do require surgical repair, physiotherapy both before and after surgery will help get you back to sport as fast as possible and ensure the best outcome from your surgery.

Give us a call at North Shore Sports Medicine to start working with a physiotherapist towards recovery.

When is it ok to stop doing post op physio exercises for total knee replacement? What time frame may I expect?

After a knee replacement the initial physiotherapy will focus on reduction on inflammation and pain management, you will work on increasing range of motion and with time increasing strength and return to regular activity. If you go to a physiotherapist regularly (once a week) and follow through with your exercise program you should be returning to regular activities, have good range of motion and little/no pain in your knee by approximately 12 weeks post-op. This time line will vary depending on the fitness/strength you had going into the surgery, if you have any post-op complications, how diligent you are with your home exercise program and the activity level you wish to return to.

A physiotherapist will use manual therapy to help reduce inflammation and increase range of motion and will work with you to create an individualised home program to aid in optimum healing including regaining range of motion and strength. You would consider stopping your post-op exercises once you are back to your desired level of activity for about a month.

How soon after ACL surgery can you start rehab/physio?

Seeing a physiotherapist prior to and following ACL surgery is a key element in optimising healing and helping you return to work, sport and recreation. Prior to surgery a physiotherapist will help you maintain/gain strength and ensure you don’t start compensating putting yourself at risk of further injury. In the first week post surgery a physiotherapist will aid with inflammation reduction and work with you to regain range of motion.

As time progresses a physiotherapist will help you safely build strength and address any issues that put you at risk of injury in the first place both in the clinic and between appointments with a home exercise program.

I have been diagnosed with spontaneous osteonecrosis of the left knee. Initially I have been advised to keep weight off the knee (use of crutches) I have looked at exercises I can do to help quad strengthening etc. but would like to know if use of exercise bike on light setting would be OK.

The amount of weight bearing advised for non-surgically managed osteonecrosis of the knee is dependent on the size of the lesion and is based on symptoms. I would advise you to check with your orthopaedic surgeon prior to using the bike to confirm this in-line with their treatment approach. If you do use a spin bike, use no resistance at all to begin and spin slowly for 10 minutes.

If you have any increase in symptoms including pain, redness or swelling during or in the 24 hours after using the bike this would be an indication it is an inappropriate approach for you. In the mean time you could get in a pool and try either swimming or pool running.

Both of these activities would help get your heart rate up and strengthen upper and lower body while protecting your knee.

Differential diagnosis for knee pain/ swelling along with calf pain. Have ruled out: cancer, no tendinitis, there are no tears, meniscus is healthy, no bakers cyst, symptoms: swelling above the knee. Inability to achieve terminal extension and cannot fully flex my heel to my ass in a standing quad stretch. Pain in the outside of my calf radiating down from the knee into the ankle. cannot run (apply full pressure when running. this is my left leg. this swelling has happened once before and regained almost full range of motion, however, lost terminal extension and can no longer run.

Things that would need to be considered include: Did the pain come on suddenly at a given point in time, or was it a subtle and slow on set? Has it been changing over time? Is it worse with activity? What activity? Is it better or worse when you first wake up in the morning? Is there any redness and heat that accompanies the swelling? Can you achieve terminal extension passively (if someone else moves your leg into position)?

Is the loss of terminal extension due to pain and/or weakness? Have you sought treatment for this? Radiating pain may indicate neurological involvement – does the pain/swelling change at all when you bend at your waist? Do you have any history of low back pain? Does the pain/swelling change depending on the bed you have slept on? There may also be a vascular cause for your symptoms. If you come in for help from a physiotherapist you will receive a full assessment to determine the cause of the pain and swelling.

After the assessment is complete the appropriate course of action to treat this injury will be put in place – this would most likely include a combination of manual therapy and exercise prescription.

Left knee is making a strange audible click every time I climb stairs, no pain or previous injury, it has been like this for 3 months

Our bodies are constantly making crackles, clicks and pops. These noises can be meaningful and should be investigated when associated with pain, or a decrease in available range of motion (the amount you can bend or straighten your knee) or a decrease in strength. You say that there is no history of injury – the click didn’t start immediately following a trip, or a time you may have planted your foot and twisted your knee?

If this is not the case, and there is no obvious swelling or bruising, you can still fully straighten and bend your knee, you don’t have any pain with any activity and you haven’t noticed a decrease in strength in your left leg it is unlikely something you need to worry about or requires treatment.

I ruptured my ACL around ten years ago mountain biking. I currently decided to get back into it but am worried if I crash I might do it again. When I did it the first time I actually ran down the landing of the jump after tossing my bike to the side. The soft dirt and the fact that my hips were twisted caused my knee to blow out the side as my foot planted sideways. I have looked into CTI braces but cannot stomach spending that sort of money. I found another brand called a shock doctor model 875 (their best sports model) it has hinges on the side and a hyper extension stop but I’m unsure if it will stop it from blowing out the sides. I’m not doing motocross sized jumps but they are still fairly big. It’s a common thing for me to huck the bike and try to run it out if I’m not going to make something. I feel like my knees are pretty strong and feel good when I ride but crashes worry me. Sorry for the long question but I didn’t know who else to ask. Thank you so much for your time.

The best person to talk to about specific braces would be an Orthotist. In addition to your brace, the best way to protect your knee when getting back into sport is to ensure all the musculature around your knee is strong and you ease into things. Make sure you have done exercises for your quadriceps, as well as your hamstrings, gluts and hips. When you re-enter a sport that you were once doing at a high level, it is sometimes tempting to start at the level you were once performing at. Instead, start with something that you once thought of as a beginner ride.

Set yourself up for success and take it slow ramping things up. A physiotherapist could develop a specific strength routine to protect your knee, and work with you to develop a plan for gradual re-entry to mountain biking.

I had an ACL surgery on my left knee in the month of June and it’s been almost 2 months now but I still hear popping and crackling sounds while straightening and bending my knee. I’ve googled these symptoms and I’m convinced that all these are common complaints of many patients so I assume it is normal. However, one thing I am still concerned about is that I get that feeling of my knee ‘giving away’ while bending my knee when I do it lying on my back or on my belly (exercises told by my physiotherapist) Can someone please help me?

The recovery from ACL surgery can be a long road! It is important that you continue to do the exercises prescribed by your physiotherapist and progress these exercises to strengthen all of the muscles around your knee. You are right that popping and crackling are very common, and as long as they not associated with pain or weakness they are usually nothing to worry about. The sensation of giving away is worth investigating. Some questions that might help you figure out what is causing this sensation: How did you injure your knee, as in what exactly happened to damage your ACL?

Do you know if the only structure that was damaged during your original injury was the ACL? Was there an isolated incident since your surgery where you heard a pop associated with pain? You could follow up with your surgeon or physiotherapist to ensure your recovery is going as expected. It could simply be that you are not strong enough yet to fully control your knee joint.

Tell them about the sensation of giving away and they can assess your knee to make sure everything is healing well and there are no signs of any residual injury

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