Clinical guidelines for the treatment of knee pain

Clinical guidelines for the treatment of knee pain

Knee pain

Knee pain is a very common complaint among people being referred to physical therapy.  The knee joint is a complex structure that consists of 3 bones and a number of ligaments and tendons that hold the bones together with cartilage surrounding the joint to cushion the bones and provide extra stability to the joint. Pain is usually a result of damage or disease to any of these structures. 

Common causes of knee pain

• Knee arthritis: Osteoarthritis and Rheumatoid arthritis are the most common disorders that can cause pain in the knee joint.
• Injuries to the ligaments: Tears and injuries of the collateral ligaments, tears and injuries of the cruciate ligaments.
• Meniscal injuries: tears and injuries of the menisci
• Patellar tendonitis
• Patellofemoral pain syndrome
• Iliotibial band syndrome

Less common causes of knee pain

• Bone Tumors
• Dislocated knee joint
• Osgood- Schlatter Syndrome

Clinical guidelines

At Reddy Care Physical and Occupational Therapy, patients receive a 4-phased approach to their plan of care to help improve their symptoms and restore their mobility. Physical therapists perform a thorough and detailed assessment to assess the quality of the pain, movements, and overall mobility levels after which therapeutic interventions are established to help achieve functional goals and improve mobility.

• Phase 1- Pain relief (Week 1 to 2)

This phase involves interventions directed towards the relief of pain. Through a combination of skilled manual techniques, joint mobilization, and modalities our therapists help reduce pain levels for patients suffering from knee pain. Through careful assessment, our physical therapists will evaluate weight bearing patterns that increase pain and educate patients on proper gait mechanics to prevent onset of pain.

The primary goal is to achieve relief of pain both at rest as well as during activity.

• Phase 2- Improving mobility and flexibility (Week 2 to 3)

During this phase, the focus is placed on improving the patient's mobility and flexibility. Through stretching and flexibility exercises patient’s movements and range of motion are improved without an increase or recurrence of pain. The focus will also be placed on improving the flexibility of the hip and ankle joints.  Therapists provide passive as well as active manual stretching techniques to help improve range of motion and teach the patient safe exercises to help assist with improvement in mobility. 

The primary goal is to improve the range of motion in the knee as well as hip and ankle joints to achieve the ability to move joints without the onset of pain and/or stiffness

• Phase 3- Improving strength, stability, and coordination (Week 3 to 4)

This phase involves therapeutic exercises are designed to improve muscle strength and improve stability of the joint. Patients will receive skilled therapeutic exercises to improve muscle strength of the quadriceps and hamstrings to improve both static as well as dynamic stability of the knee joints. Isometric contraction and re-education are also provided to improve the ability to weight bear without lack of stability from weakness of the quadriceps and patellar tendon. 

The primary goal during this phase is to achieve increased strengthening of the adjoining muscles demonstrated during the session and assessed by the physical therapist on a continued basis to increase resistance and weights as needed.

• Phase 4- Improving functional endurance and aerobic conditioning (Week 4 to 5)

During this phase, patients are re-educated on functional movements to help return to prior levels of activity without recurrence of symptoms of pain and decreased mobility. Our therapists help patients identify functional goals and ensure that patients can safely perform all activities of daily living as well as recreational activities without the onset of pain. Our therapists will also re-educate patients so they can return to their previous athletic ability with the focus on preventing a recurrence of the injury or symptoms by promoting the use of correct body mechanics. 

The primary goal is to help patients return to their activities of daily living and/or recreational/athletic activities. These goals are established in the beginning and all the phases are directed towards achieving these goals with the latter weeks focusing on functional and ADL re-education.

Through this approach, our therapists can help patients achieve reduction in pain levels as well as improve their ability to perform their daily activities without pain and improved body mechanics. A detailed and personalized home exercise program is also provided to all patients to ensure that progress achieved is maintained and patients are able to safely return to the pre-injury status in terms of their activities of daily living. 

At Reddy Care Physical and Occupational Therapy, we can get you set up with the right therapist for you. Call today to schedule a consultation!
Reddy Care Great Neck (Great Neck Physical Therapy): 516-829-0030
Reddy Care Farmingdale (Farmingdale Physical Therapy): 516-420-2900
North Shore Towers: 718-224-8480
In-Home Physical & Occupational Therapy (Home Care): 516-829-0030
*Home therapy servicing Long Island, Queens, Staten Island, Brooklyn & Manhattan

References

Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183

https://www.verywellhealth.com/knee-pain-symptoms-2549628

Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. Journal of Pharmacy & Bioallied Sciences 2013 Jan-Mar;5(1):30-38. doi:%2010.4103/0975-7406.106561

Author

Dr. Stanline Anto, PT, DPT, CAFS Dr. Stanline Anto, DPT has been working as a physical therapist for almost 9 years now. Dr. Anto, DPT graduated with a Bachelor’s in Physical Therapy from Rajiv Gandhi University of Health Sciences, India and received his Doctorate in Physical Therapy from Utica College, NY. He has been with Reddy Care for over 3 years now and is proud to be part of a team that is such a powerful force in driving our profession forward. Dr. Anto, DPT works as the Clinical Director for In-Home therapy at Reddy Care and also treats patients as an In-Home physical therapist. One of his main goals is to make sure that all our patients receive unparalleled patient care during their road to recovery. Dr. Anto, DPT supports, supervises and mentors all our PTs and OTs who perform In-Home therapy. He also ensures that therapists are able to provide the best possible patient care with ongoing professional development.