What is the treatment for a knee sprain?

Treatment for a Twisted Knee (Knee Sprain)

For a knee sprain, you should rest the injured knee, apply ice for 20-30 minutes several times daily, use compression wraps, elevate the limb, and avoid activities that cause pain until medical evaluation if symptoms persist. 1

Initial Management

The treatment for a knee sprain follows a structured approach based on the severity of the injury:

1. Rest and Activity Modification:

   • Avoid activities that cause pain in the injured knee 1
   • Limit use of the injured extremity to prevent worsening of the injury 1
   • Painful extremity injuries that limit use require medical attention 1

2. Cold Therapy (Ice Application):

   • Apply cold therapy using ice and water in a damp cloth for 20-30 minutes, 3-4 times daily 1
   • Never place ice directly on skin to prevent cold injury 1
   • Cold application decreases pain and swelling in the acute phase 1, 2

3. Compression:

   • Apply a compression wrap to promote comfort 1
   • Ensure the wrap doesn't compromise circulation by overtightening 1
   • Compression may provide pain relief in the acute timeframe 1

4. Elevation:

   • Elevate the injured knee above heart level when possible to reduce swelling

When to Seek Medical Attention

Seek immediate medical attention if:

• Unable to bear weight on the injured knee
• Significant pain that limits movement
• Severe swelling or bruising
• Pain persists beyond 4-6 weeks 3
• Numbness or coldness in the foot 3

Rehabilitation Phase

After the initial 72 hours:

1. Progressive Movement:

   • Begin early functional rehabilitation with normal walking as tolerated 3
   • Gradually increase activity as pain allows
   • Avoid activities that cause pain 1

2. Strengthening Exercises:

   • Start progressive strengthening exercises within 48-72 hours if tolerated 3
   • Include resistance band exercises, heel raises, and balance exercises 3
   • Proprioceptive exercises are crucial to prevent recurrence 3

3. Return to Activities:

   • Return to light activities when pain-free walking is achieved 3
   • Progress to more demanding activities when full range of motion and strength are restored 3
   • Consider using a semi-rigid support for sports activities for at least 6 weeks 3

Common Pitfalls and Considerations

• Overreliance on RICE alone: While RICE (Rest, Ice, Compression, Elevation) is commonly recommended, evidence suggests it should be followed by early functional rehabilitation 3, 4

• Inadequate cold application: The greatest tissue cooling is achieved using a bag filled with ice and water surrounded by a damp cloth, not just ice alone 1

• Overtightening compression wraps: This can compromise circulation and cause additional problems 1

• Returning to activity too soon: This can lead to re-injury and prolonged recovery time 3

• Ignoring persistent symptoms: Persistent pain lasting more than 6 weeks may indicate inadequate rehabilitation, impingement, or other complications requiring medical evaluation 3

By following this structured approach, most knee sprains will heal effectively, allowing for return to normal activities while minimizing the risk of recurrence.