From the Guidelines
Knee physiotherapy is a highly effective treatment approach for reducing pain and improving function in patients with knee conditions, with the most recent and highest quality evidence supporting the use of knee-targeted exercise therapy. For optimal results, a typical regimen includes range-of-motion exercises (like gentle knee bends and straightening), strengthening exercises (such as straight leg raises, wall squats, and hamstring curls), and balance training, as recommended by experts and patients alike 1.
Key Components of Knee Physiotherapy
- Range-of-motion exercises to improve mobility and reduce stiffness
- Strengthening exercises to enhance muscle strength around the knee joint
- Balance training to improve overall stability and reduce the risk of falls
- Education on proper movement patterns and techniques to promote long-term improvement
Implementation and Progression
Start with 10-15 repetitions of each exercise, performed 1-2 times daily, gradually increasing as tolerated. Apply ice for 15-20 minutes after exercise to reduce inflammation. For acute injuries, follow the RICE protocol (Rest, Ice, Compression, Elevation) for the first 48-72 hours. Incorporate low-impact activities like swimming or cycling as your condition improves. Consistency is crucial—most knee rehabilitation programs require 6-12 weeks of regular exercise to achieve significant improvement, though this varies based on the specific condition and its severity.
Evidence-Based Recommendations
The most recent and highest quality evidence supports the use of knee-targeted exercise therapy, with high certainty evidence for short-term pain reduction (SMD 1.16,95% CI 0.66,1.66) and moderate certainty evidence for short-term function improvement (SMD 1.19,95% CI 0.51,1.88) 1. Additionally, a systematic review and meta-analysis of 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions, leading to the recommendation of knee-targeted±hip-targeted exercise therapy underpinned by education, with additional supporting interventions tailored to a patient’s needs and preferences 1.
From the Research
Knee Physiotherapy
Knee physiotherapy is a crucial aspect of rehabilitation for various knee-related injuries and conditions. The following points highlight the key aspects of knee physiotherapy:
- Exercise Therapy: Exercise therapy is a primary component of knee physiotherapy, as evident from the study 2. It involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
- Quadriceps and Hamstrings Coactivation: The coactivation of quadriceps and hamstrings muscles is essential for knee stability and function. A study 3 found that certain exercises, such as single-limb dead lift and lateral-hop, can facilitate balanced activation of these muscles.
- Strength Training: Strength training is vital for knee rehabilitation, particularly for quadriceps and hamstrings. However, a study 4 found that greater relative quadriceps strength in the injured leg can increase the risk of a second ACL injury.
- Rehabilitation Programs: Rehabilitation programs for knee injuries, such as hamstring strain injuries, should incorporate neuromuscular control exercises and eccentric strength training, as recommended by a study 5.
- Assessment and Treatment: A comprehensive assessment of knee function and pain is necessary to develop an effective treatment plan. This may involve the use of measurement instruments, such as the Patient-Specific Complaints Instrument and the Numeric Pain Rating Scale, as suggested by a study 6.
Key Considerations
When developing a knee physiotherapy program, the following considerations are essential:
- Individualized Treatment: Treatment plans should be tailored to the individual's specific needs and goals.
- Progressive Loading: Exercise programs should involve progressive loading to promote strength and function.
- Pain Management: Pain management is crucial for effective rehabilitation, and may involve education, exercise, and other interventions.
- Return to Sport: Criteria for return to sport should be based on objective measures of musculotendon recovery and readiness, rather than traditional criteria alone.