Comprehensive Recovery Protocol: Knee Injuries
June 6, 2018
The knee joint is one the largest and most complex joints in the human body. It consists of four bones: The femur (thigh bone), the tibia (shin bone), the fibula (outer shin bone) and the patella (kneecap). Various ligaments, muscles, and tendons are also involved in order to hold the joint together and allow it to move through its full range of motion. Because the structures of the knee are highly interconnected, an injury to one area of the joint can affect the other areas as well.
Fortunately, not all injuries require surgical intervention. The treatment for your injury will depend on its severity. Mild to moderate injuries can be treated at home with conservative methods. Severe injuries, by contrast, should be evaluated by an orthopaedist who will recommend a specific form of treatment.
The following information will help you identify whether conservative treatments are appropriate for your injury, the types of treatments that you can utilize, and when you should contact an orthopaedic specialist.
Mild to Moderate Injuries
While the knee is susceptible for many forms of injury—including sprains and strains, ligament tears, fractures, and inflammation—some instances are so mild that they don’t even require a visit to an orthopaedist. Many mild to moderate knee injuries resolve on their own with rest and time.
Conservative forms of treatment are often appropriate for the following injuries.
Low Grade Sprains and Strains:
When the knee is moved through a greater range of motion than it was meant to tolerate, the tissue that holds it in place will be stretched or torn. Sprains refer to the stretching and tearing of ligaments. Strains refer to the stretching or tearing of a muscle or tendon. These types of injuries are classified according to a grading system. The two classifications for minor sprains and strains are:
- Grade I – The ligament, muscle, or tendon features mild stretching and microscopic tears, but the knee continues to function normally.
- Grade II – The ligament, muscle, or tendon is partially torn, leading to periodic giving out of the knee while standing or walking.
Stress Fractures: While acute, direct trauma such as a fall can cause any of the four bones associated with the knee to break, stress fractures are also relatively common. A stress fracture is a small crack in a bone that is caused by overuse. Both athletes, as well as those in certain professions, are susceptible to this form of injury. The vast majority of stress fractures will heal on their own with rest within 6 to 8 weeks. During this time, conservative treatments can help ease painful swelling and expedite the recovery process.
Treatment for Mild to Moderate Injuries
While a mild to moderate knee injury may heal on its own, RICE (rest, ice, compression, and elevation) can help expedite healing and reduce painful swelling.
RICE Method for Injuries
Rest the Knee: Stop, change, or take a break from unnecessary activities that put weight on your knee. You may need to use crutches for a short time in order to avoid further injury.
Ice the Knee: Apply ice or a cold pack to the knee immediately following an injury in order to prevent or minimize swelling. Place a towel between the ice or cold pack and your skin. Do not apply ice directly your skin. You can continue to apply ice for up to 30 minutes at a time every 3 to 4 hours in order to reduce swelling.
Compress the Knee: Wrap the injured knee with an elastic bandage, ensuring that it is moderately tight. Wrapping the knee will decrease swelling; however, wrapping it too tightly will cause more swelling below the affected area.
Elevate the Knee: Elevate the knee on a pillow when you are sitting or lying down. Try to keep the knee above the level of your heart to help minimize swelling.
Stretches for Knee Pain
Taking time off from sports and exercise can help minor injuries heal but it can also cause the muscles and tendons that connect the knee to become weak and tight. Stiff muscles can cause pain and so it’s important to still keep your hips, glutes, hamstrings, calves, and quads limber even if you’re taking a break from your ordinary activities.
While it may seem counterintuitive, stretching your knee when you have a mild or moderate injury can provide you with some relief. As always, it’s important that you talk to your orthopaedist or physical therapist before starting any exercise program. Moreover, it’s important that you only perform stretches that are pain-free. Do not continue a stretch if it causes you pain.
Supine Hamstring Stretch
Step 1: Lie flat on your back on the floor or a mat adjacent to a wall corner or a doorway. Raise one leg to rest against the wall or frame of the door while the other leg remains flat on the floor past the wall edge or entryway. You can adjust your position so the back of your raised leg is closer to the wall or doorframe for a deeper stretch. Extend your arms outwards at shoulder level with your palms facing upwards.
Step 2: Pull the toes of your raised leg downwards towards your body in order to stretch your hamstrings and calf muscles. Do not allow any movement in your hips or lower back during this stretch.
Step 3: Hold the stretch for 15 – 30 seconds while taking slow, deep breathes and then switch sides.
Standing Calf Stretch
Step 1: Face a wall, standing about 12 inches away from it.
Step 2: Extend one leg behind you, keeping both feet flat on the floor and your rear knee straight.
Step 3: Lean toward the wall until you feel tension in the calf muscle of the extended leg. You can press your hands against the wall for support.
Step 4: Hold the stretch for 10 seconds and then switch sides.
Step 1: Stand tall with your feet hip-width apart.
Step 2: Bend one of your legs, bringing its heel towards your butt. Grasp the raised foot with the hand opposite to it.
Step 3: Hold the stretch for 30 seconds and then switch sides.
A variation of this exercise can be performed while lying on the floor or a bed on your stomach. Loop a yoga strap either foot and gently pull the strap so your heel moves towards your butt. Hold for 30 seconds and then switch sides.
Step 1: Stand tall with your feet hip-width apart and your feet facing straight ahead.
Step 2: Shift your weight over to one leg, bending the knee until it reaches a 90-degree angle and the other leg is straight.
Step 3: Return to the center and then switch sides.
More specific forms of treatment are required for injuries involving:
- Extensive ligament, muscle, and tendon tears
- Multiple ligament, muscle and tendon tears
- Instability of the knee joint
- Decreased range of motion
- Significant fractures
Grade III sprains and strains, anterior cruciate ligament (ACL) injuries, and severe instances of patellofemoral syndrome are examples of conditions that need to be evaluated by an orthopaedist. While RICE can still be beneficial in the early stages of your condition, it’s crucial that you see an orthopaedist as early as possible. If you and your doctor decide that surgery is appropriate, a recovery protocol will be provided to you based on your specific surgery.
Talk to an Orthopaedist Specialist
Contact an orthopaedist if your knee remains painful and swollen or if it cannot bear weight. Only a certified orthopaedic physician can accurately diagnose your condition and recommend a comprehensive treatment plan.
The expert team of orthopaedic surgeons and physical therapists at Beacon Orthopaedist and Sports Medicine can help you achieve a full recovery. If you would like to talk to an expert about what to expect following knee surgery or how to improve your current recovery program, schedule an appointment with one of our board-certified knee specialists.