We have discussed therapeutic exercise/movement many times on this blog before.
Not too long ago we went over the different phases of healing and discussed appropriate measures to take in loading tissues to help with healing. Movement is a great way to reinforce the manual therapy you help your patient with while they’re on the table, so we encourage you to start making a practice of tissue loading and movement once they’re off of it.
After you’ve done your interview and concluded it is safe to begin loading (which you can read about here), here are some progressions for the knee you can do right in your treatment room. These are good for someone with anterior knee pain, a quad contusion, patellar tendinopathy, or a quad strain.
If the injury is more severe like a ligament tear, more specific interventions and movements should be chosen.
In the acute stage, (the first 24-48 hours) these isometric exercises (joint angle doesn’t change during contraction) would be appropriate. You’ll notice there is some movement to get into a bent knee, but then the contraction is actually a hold with the knee kept bent.
When your patient comes in for their second treatment, you can start to progress the movement as you are now in the proliferative phase of healing.
In this case, you can progress to an eccentric load, but make sure to stay within the patient’s pain tolerance. A little bit of discomfort is okay, but we don’t want to aggravate the injury by causing any significant pain.
Hopefully, by this point, your patient is getting into more pain-free movement because you’ve been doing lots of great treatment and also getting them to load the tissue.
So, if they could do the above eccentric movements by the third or fourth visit, you can progress them to concentric movements as they have probably progressed to the remodelling phase of healing.
Here is a final progression you can try if your patient is up for it.
Plyometrics! It may take a bit of encouragement to get them to try, but if they can do this, it’s a great progressive load for athletes who may be on a return to play rehab scenario or a return to work for an injured worker.
If the patient has any balance issues, it might be best to avoid this until they regain more strength and their balance has improved.
- Make sure you are monitoring the area for swelling, redness, and heat, or anything else that could indicate chronic inflammation.
- Encourage the patient to move, they may be apprehensive to start a loading program.
- Communication is essential both for the instructions you give, and the feedback you get from the patient.
- Educate them on how a little bit of pain and discomfort is okay during the movement, they just don’t want to overdo it.