You may have been searching Google recently with a common phrase: treatment for knee pain. If that’s the case AND ended up here, go back to parts 1 and 2 of this series before continuing. I’m not telling you to do this for more views on past posts; I’m proposing this because what I’m going to write next needs context. Your knee pain can’t be treated by simply taking a supplement, or exercising a ton, or even an injection (despite those amazing ads on ESPN and Facebook). Knee pain NEEDS a diagnosis. YOUR knee pain needs a diagnosis (which I discuss in the former installments). When your diagnosis is clear, the treatment can be specific and healing can occur.
Take a recent patient I had for example. She had a total knee replacement 2 weeks ago, but her pain sat right in the knee joint. For some, that wouldn’t make sense because that is the exact place that she had replaced with metal components. However, following an examination, I found out it was her knee capsule. I treated the capsule and the pain went away within 5 minutes. Knee pain pathologies are like apples and oranges. Apples and oranges are both delicious and fruit, but the taste and preparation are different. I see that structures in and around the knee can all cause knee pain, but they should be treated and looked at differently. Take the capsule for example.
Apples and Oranges
Treating the knee capsule requires manual therapy and specific movement to reduce pain. This includes a form of knee mobilizations and something low force, like cycling. I always make sure a patient avoids stretching with this type of injury while he/she heals to improve range of motion. This is different from a patellar tendinopathy, which I’ll discuss next.
Patellar tendinopathy can have pain reduced with a cross friction massage and soft tissue work. To keep the pain off, an examination is needed to figure out why the quad and patella are being overloaded. The same goes for extensor mechanism issues. It does not, however, go for ACL/PCL sprains, MCL/LCL sprains, or meniscal lesions.
Task Based Approach
When I see these injuries, I follow a task-based approach, whether my patients have had surgery or not. The tasks are as follows:
- Task #1: Reduce pain, swelling; increase range of motion to 120 degrees of flexion
- Task #2: Progressive loading of specific muscles
- Task #3: Single Limb Loading
- Task #4 Integration
- Task #5 Return to Play
None of my patients will move on from task #1 if they have not met all of the requirements. The same goes for each task. If a patient is in task #4 and starts to swell, they will return to task #1 until swelling has reduced. This will continue until the patient has fully returned to his or her sport. I have seen this to be effective in treating ACL tears WITHOUT surgery, to the simple feeling of instability due to a meniscal lesion. The results from a task base approach are VERY effective for many huge injuries that would often require surgery.
Sometimes, surgery is the answer. If it is, then I will still take a patient through this task-based approach before and after the surgery for the best results. I tell my patients to wait 3 months before surgery to see if they cope and heal.
Conclusion to Treating Knee Pain
With all of these strategies, Seth and I have effective treatment for knee pain with an average of 1.5 visits till discharge at Zona Physical Therapy. Our specific diagnosis and treatment gives you less time in the clinic, and more time doing the things you love the most, pain free.
Dr. Tyler Burton, PT
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