At Zona Physical Therapy, I love helping people overcome knee pain. As stated before, a proper examination can give a better idea of what is happening in a knee (and what’s causing pain) than an actual picture of the inside of a knee. The reason why this holds true is due to the way different structures present when injured. Agitated capsules present in a capsular pattern. Patellar tendon issues show pain with palpation and an otherwise negative exam. Extensor mechanism problems will show differently than the other two. This is why I look, touch, and feel the knee.
Subjective
In my examination, the first thing I do is ask questions. Specifically:
- Who?
- What?
- When?
- Where?
- Why?
- To what extent?
Asking these questions allows me to get the bigger picture. I come up with the top 3 diagnoses before I even touch the knee in question. This process not only helps me improve my examination skills but also helps me rule in or out problems that resemble each other.
Objective
Take osteoarthritis (OA) and activated arthritis for example. If you took an X-Ray of 2 patients, one with OA and the other with activated arthritis, they would look similar. If you asked both of them the same 6 questions listed above, the answers would also be similar. However, when a clinical examination and treatments are performed, they would feel and look differently. The three biggest things I look at are Quality, Quantity, and Provocation.
During an examination, the first thing I do is look at the knee. Is there swelling in the knee or atrophy of the quad muscle? Then I check for additional swelling with physical tests. After, I test for capsular problems. I test for ligamentous integrity. After, I look at the meniscus and muscles. After the exam, I palpate different structures for pain.
There are times that the clinical exam is negative, and that can give just as much information as if it were positive. The force that a clinician can put into ligaments and muscles during an exam is nowhere near the amount of force that comes from running or lifting weights.
Once an examination is finished, I can take a look back and look at ALL the data that I’ve gathered, and then treat. I look at treatment as a tool to help diagnose. If the treatment is effective, then my diagnosis was correct. The additional help of treatment as a diagnostic tool helps reinforce and confirm my thought process is correct. If the treatment is not working (a patient should be 80% better after 3 sessions), then a new plan of care should be followed.
Conclusion
In the words of Craig Smith PT, a good clinical examination is a “cheat code” for diagnosing. Once a correct diagnosis is made, then the treatment is easy. Better Diagnosis = A greater chance to overcome knee pain, surgeries, and missed workouts. And that means getting back to what you love doing, faster.
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