OCCURRENCE OF THE KNEE INJURY AND THE TREATMENT ON ORTHOPEDY
Adult female in age 34 fell on down on her inline skates (2. 5. 2013) in order to not hit 2 mothers with strollers, who were walking in the line for skaters.
During the fall, she rotated her knee, where she then felt pain on the inner side of the knee, she also felt pain on touch around the patella and in the area of the patellar tendon inside the knee. Client described to us also that she feels unstable with her knee, as if the cartilages slide against wach other during walking.
On the examination, orthopedist didn’t exclude the possibility of rupture of the anterior cruciate ligament (ACL) or damage of the meniscus, because the functional tests were positive to this damage. But the knee itself wasn’t significantly painful, but there was still significant swelling. Client was sent to get an X-ray image. She wasn’t sent to MRI (magnetic resonance), which would prove accurately wheter it is rupture of the ACL (anterior cruciate ligament) or damage of the meniscus or surrounding ligaments.
The doctor recommended to stay in bed, use ice compress and rest the knee slightly elevated above the body.
The client visited us for the first time the same day of the injury. From the examination we also got positive results on the damaged ACL (anterior cruciate ligament) and inner meniscus. Painfulness of the knee was significant due to the constantly growing edema. Painfulness of the joint was increased also because of the protective tension of the adductors of the thigh.
We applied functional tape on the knee (elastic cotton band) - lymphatic technique, for lowering the swelling, for lowered knee joint and for further increase of the stability in the knee joint. At the same time we used tape (elastic cotton band) for lowered muscle tension of the adductors and sartorius muscle.
Second visit 3. 5. 2013
Because it was acute injury, we invited the client even the following day, it order to stop the problems as soon as possible and stimulate the regeneration of the tissues.
Client also described the same day that the swelling was lighter in the knee joint but there was a more significant pain on the inner side of the knee. She evaluated the condition as stabilized and it didn’t worsen from then on. She still needed crutches for walking, and during the night she was woken up and she needed to position her knee differently.
We measured every movement restriction in a flexion motion (98 degrees), and extension motion (5 degrees). Test on the medial (inner) meniscus was positive. We applied lymphatic drainage on her legs, which we supported again with the functional tape (elastic cotton band) for stabilization of the knee and lowered muscle tension. This time we also applied focused shock wave therapy on the medial (inner) and ventral (front) and lateral (outer) side of the knee.
The client had to work again on 4. 5. 2013 (walking, sitting, standing + 300 km ride in a car), the leg was therefore in a pressure. Client felt a slight pain during the day, however the range of the joint was in full mobility. In the evening when she returned home, the knee was slightly swelled and painful, but it wasn’t serious. The following day the condition was more or less the same.
6. 5. 2013 the client again felt pain and the swelling was more significant, and the mobility of the joint was restricted between 0 - 120 degrees.
Third - sixth visit
7. 5. 2013 the pain in the knee increased, and the mobility was between 5 - 90 degrees. We applied again focused shockwave therapy in the range of the whole knee joint, as well as pressotherapy for 2 hours and then we also used lymph tape on the thigh in the area of the groin nodes and popliteal nodes (back of the knee). The following day we again used the focused shockwave therapy and pressotherapy for 3 hours split into 2 sessions, in the morning and evening. After that we again applied the lymph tape into the same area.
9. 5. 2013 the client felt significant relief, the knee was looser, it didn’t hurt, kneeling was still a little painful, and the client wasn’t able to kneel for very long, but the range of mobility improved in flexion.
On friday 10. 5. 2013 the client didn’t feel any pain, nor was there any swelling, so we applied “fresh” kinesio tape on the knee and thigh. The client tried to lightly run and jump, and she didn’t feel any instability in the knee, nor was there any pain or tension in the soft tissues. But to make sure, after the weekend we applied the focused shockwave therapy once more along with pressotherapy.
FINAL ASSESSMENT OF THE THERAPY EFFECTIVITY
Therapy after the knee injury was very fast, even though at first the examination testified about damage of the anterior cruciate ligament and damaged menisci, after more than a week, the client felt completely healthy. She continued to run lightly in order to avoid the possible pain.
This case proves that thanks to Focused shock wave and radial shock wave in combination with pressotherapy can be therapy of acute conditions after injury very effective and fast in comparison to standardly led rehabilitation, magnetotherapy, ultrasound etc… if we forget the fact that the client received prescription for rehabilitation from the doctor after several weeks of peaceful regime.
Unfortunately, focused shock wave therapy is not paid by any health insurance company, and the client is therefore forced to pay it himself. However the effectivity and speed of this treatment is without a doubt worth the money which you would otherwise lose by longer working inactivity. We evaluate the procedure of this therapy as a very fast healing of the soft tissues in the knee joint without any consequences. But we have to point out that the therapy started within the day of the injury, and it was going on basically every day, and therefore the client had the best chance for a fast recovery.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from a private practice from a physiotherapeutic field, FYZIOklinika