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August 2018

On The Case: Knee Pain

By | Case Study, Treatment | No Comments

In our new On The Case series, we’ll be taking a look at some of the real-life challenges our patients face and how we helped them regain their mobility!

About nine months ago, Henry* came to the clinic indicating pain on the inside of his knee. When he would climb small hills, take the stairs, squat, engage in other activities like gardening, he would experience pain for the rest of the day. This pain started affecting his regular activities like walking, golfing and curling. Henry also mentioned he experienced stiffness in his knee for the first 10 minutes of walking every morning. The inside knee pain wasn’t something Henry could shake off.

After consulting with his nurse practitioner, Henry went for X-rays which confirmed mild to moderate arthritis in his knee. He was given a referral for physiotherapy and he showed up, limping, at our office one morning last September.

On assessment, we observed that Henry had difficulty bending his knee past 90 degrees, climbing stairs and squatting lightly. He felt pain when we touched the inside of his knee and we also noted a weakness of the buttock muscle and poor control of the kneecap (patella) tracking.  This was a key finding for this arthritic knee.

 

Clinical tidbit:  Cases of mild to moderate knee arthritis are often accompanied with weak buttock muscles which result in poor thigh control. This condition puts a strain on the inside of the knee and contributes to  over-strained ligament and tendon structures.

 

After this preliminary evaluation, we worked to make Henry’s knee more comfortable and less stiff.  The intervention focused on improving range of motion, and also included a discussion on muscle flexibility, balance exercises and how to manage pain and activities at home. He was given a buttock strengthening program that would not increase his knee pain. And he was also fitted with a supportive knee brace. Henry reported a reduction in the pain which was a result of the compression and stabilizing design of the brace.

We saw Henry for a total of seven visits over a month-long period.  In the first week, he reported a 30 to 40% reduction of his knee symptoms. Over the course of his subsequent visit, we gradually progressed the strengthening and flexibility program and noted an improvement in Henry’s knee bending and straightening.

By the third week, Henry was not yet ready to walk his regular three to four kilometres but we encouraged him to find alternative or modified activities to accelerate the healing (and avoid further aggravation of the knee).

Our suggestions included:

  • Walking for the same amount of time in a pool would reduce the load on the knee
  • Throwing the rock with the curling stick would avoid the deep squat but keep Henry in the game
  • Golfing with a cart would avoid the excessive walking and hill climbing.

By the fourth and fifth week, Henry reported that 90% of his discomfort had dissipated.  This was a good spot to be in. In this phase of rehabilitation, strengthening of the legs (specifically gluteus, quadriceps and hamstring muscles) is key.  The common mistake here is to stop progressing the exercises. Failing to continue would most likely result in another flare-up. Luckily, Henry kept with the program and did his exercises once and at times twice daily.

At this point, he was able to resume one to two kilometre walks without symptoms, and could handle stairs and hills without knee pain—when not repetitious.  We provided Henry with a home exercise program and a follow-up visit for the next month.

One month later, Henry had returned fully to his activities. He integrated our prescribed exercise program into his weekly routine. Henry sometimes feels occasional knee stiffness when he increases load but overall, he reports he has been pain-free.

In Henry’s case, integrating flexibility and strengthening exercise changed the impact of his mild to moderate arthritic knee on his everyday activities.

If he should continue with his program, the effects will be long-lasting.

Let’s remember: Exercise is medicine. Not only does it allow us to function with fewer symptoms, but can prevent further progression of hip and knee arthritis. Ask me for the research on this—there is no shortage of it!

 

* Name changed to protect confidentiality.