September 2024 - Fit and Flow Physiotherapy

Knee pain can generally be categorized into two types:

Acute Injuries: These occur as a result of a specific incident or trauma. Acute injuries typically require early evaluation to determine the extent of the damage. This then may involve imaging or a referral to a specialist, and a rehabilitation program will be initiated to help you return to your activities as quickly and safely as possible.
Chronic Injuries: These are conditions that develop gradually over time. While they may occasionally require imaging or consultation with a specialist, they usually benefit more from a tailored strength program and continuous management. With the right approach, you can manage these conditions effectively, minimizing pain and preserving your quality of life. Ongoing care is essential to ensure these issues don’t interfere significantly with your daily activities.

How can Physio help?

Physio’s are usually the first professionals people consult when experiencing knee pain. We have the expertise to evaluate your knee, identify the underlying injury or cause of pain, and determine the next steps. This may involve referring you for imaging or a specialist consultation, or initiating a rehabilitation program to address the issue.

Rehab will involve a period of relative rest and recovery.
Our aim is to keep you as active as possible while allowing your knee pain to settle. We will identify exercises you can do or make adjustments to your work, so you can continue working or participating in activities without exacerbating your knee pain.

Once pain has settled we then work on the strength, control and power to get you back to your former level of activity. We make your rehab specific to your goals. For example, getting back to a physical job might involve lifting and lunging type exercises, whereas returning to a sport like netball will involve running, change of direction, and powerful movements in the gym.

Delaying surgery

Discussions around surgery in both acute and chronic knee injuries are important to have.
Surgery increases an individual’s chances of developing osteoarthritis later in life, it also exposes you to risks such as infection, nerve damage and tissue scarring that could affect function. Whenever possible, it is recommended to explore rehabilitation options before considering surgery.

For acute injuries, most meniscus tears are typically managed with conservative treatment, and if addressed early, individuals can often return to their previous level of function. Additionally, recent research supports non-surgical rehabilitation for ACL injuries. New techniques are available to promote healing without surgery, and there is promising long-term data showing that effective function can be maintained over the years with non-operative approaches.

Physiotherapy plays a crucial role in non-surgical management, especially when structural knee stability has been compromised. It’s essential to ensure that functional stability is maintained through strengthening the muscles around the knee, improving neuromuscular control to avoid positions that could cause further damage, and enhancing muscle power if the individual’s goal is to return to sports.

In chronic conditions, surgery is usually only considered if function and quality of life are severely affected. This means that function is preserved for as long as possible before surgery becomes an option. To preserve function, strength and control are the main priorities.
There are several reputable resources backed by reliable research that offer exercises designed to help manage and slow the progression of knee arthritis. The primary goals are to enhance quality of life and reduce the need for surgery. Physiotherapists and exercise physiologists are specially trained in this field, making them valuable resources for managing and mitigating the impact of arthritis.

How rehab can fast track your recovery

The stronger your knee, the better it can handle various loads. Improved balance and control enables you to perform more complex movements without risking injury. Typically, an injury occurs when loads exceed the capacity of your muscles, joints, and tendons.

While the body can most of the time resolve inflammation and heal tissues on its own, there are strategies you can use to support and speed up this process. More importantly, there are strategies you can employ, to help strengthen your knee beyond the basic level needed for daily tasks, or the demands of sport, to enhance overall function and resilience.

Phase one:
Reduce pain, support healing
Physiotherapists employ techniques to help reduce pain and provide guidance on what to avoid to prevent aggravating the injury. They also offer recommendations on activities you can do to maintain strength and mobility, which can accelerate the rehabilitation process.

Phase two:
Physiotherapists can prescribe targeted exercises to strengthen the muscles and tendons around the knee, as well as improve neuromuscular control. This approach is crucial for preventing future injuries and reducing the risk of recurring pain.

Phase three:
Physiotherapists have the expertise to prescribe exercises tailored to the intensity and complexity of your chosen sport. This ensures a smooth and low-risk transition from rehabilitation back to athletic activities.

Hurting your back can be scary, but most lower back injuries are treated similarly to other injuries, with the potential for a full recovery and a return to your usual activities.

Anatomy

Your spine is divided into four sections: the cervical spine, which forms your neck; the thoracic spine, which makes up your upper back; the lumbar spine, which is your lower back; and the sacrum, the lowest part of your spine, also known as your tailbone. When we talk about lower back pain, we generally mean injuries affecting the lumbar spine from the upper segment (L1) to the lowest segment (L5), and occasionally involving the upper segment of the sacrum (S1).

Your spine consists of bones called vertebrae, which are linked by joints and ligaments. Between each vertebra are intervertebral discs that help absorb shock and enable movement. In front of these discs is the spinal cord, through which nerves travel from each spinal level to different parts of the lower body, extending all the way down to the feet.

These nerves innervate the muscles and skin of the lower body, providing movement and sensation.

Injury

The structures of the spine are similar to structures elsewhere in the body (bones, joints, ligaments and nerves) therefore we manage them in much the same way.
However, with lower back pain, the proximity of the spinal cord and nerves which control movement and sensation, can lead to additional symptoms such as pins and needles, numbness, or weakness in the hips, legs, and feet.

Inflammation or nerve compression in this area may contribute to these symptoms. As physiotherapists, we use specialised assessments to identify the specific location and cause of your symptoms, enabling us to target and treat the root of your lower back pain effectively.

Will I need Surgery?

90% of back pain cases do not end up needing surgery, and in fact most cases of lower back pain don’t even require imaging (XRays or MRI’s).

Imaging is required if symptoms indicate a more serious pathology, which will be indicated when seeing your Physio or Dr.
For most cases though, a physical assessment will tend to reveal enough information to treat the cause of pain and resolve symptoms.

Imaging may pick up on some abnormalities within the spine, but these are not necessarily the cause of pain. Similar to scars on your skin, they are present, and an indication of use, but do not cause pain or affect the function of your skin.
For that reason, clinicians tend to steer away from imaging in the early stages and focus on improving function and movement quality.

Surgery is a last resort option if all other conservative forms of management fail, and if there is indication of a structural cause for the pain.

Recovery

If all red flags (serious conditions) have been ruled out after assessment, lower back pain is treated much like any other injury in your body

Phase 1: Rest and recover
Modification to daily tasks allows your back pain to settle, and supports healing. These changes will be dependent on the type of injury, and the tasks that are required of the individual. This is why assessment is so important in the early stages. The quicker we can identify the triggers for pain, the quicker we can assist in healing.

Although we encourage relative rest, it is still important to maintain as much movement as possible without aggravating the injury. There are usually some gentle stretches and movements that can assist in range of motion as well as support the healing process.

Phase 2: Load and strengthen
When the initial inflammation and pain starts to settle, we will start to load your spine to restore strength and to ensure you can not only return to your former activity, but do it in a way that will reduce your risk of re-injuring. It is within this phase that we identify range of motion, strength or movement pattern issues that may have contributed to your initial injury, and we focus on improving these and developing better ways to move to protect your back.

Phase 3: Integration back into previous activityYour rehab exercises will start to mimic movement patterns you require during the day, whether that be specific to your job, your sport or daily activity, we start to increase your daily loads and encourage returning to your former activities.
There will always be ongoing maintenance exercises necessary to remain injury-free.

Future prognosis

Like any other injury, the presence of previous injury, increases your likelihood or re-injury. Recurrence of lower back within the first year of injury can range from 15% – 85%. Often the cause for the higher incidence in re-injury is failing to identify the cause of the injury and addressing it correctly, or failing to complete or carry on with a rehabilitation program.

For this reason it’s important to get a thorough assessment and follow through with a rehab plan completely.