After knee injury or knee surgery many of us have been instructed to go up with the good leg and down with the bad leg when negotiating stairs with an assistive device such as a cane or crutch. The sequence is right; however, physical therapy students are no longer taught to refer to a body part as bad or good.
Students are now taught to refer to the body part being rehabilitated as “involved” rather than “bad,” when training a patient to resume walking or resume stair climbing after an injury or surgery, Recently, I have discovered why this simple reference is so important to the success of physical therapy rehabilitation, especially with the knee.
Many of my patients suffer with chronic knee pain rather than acute knee pain. Acute trauma to the knee results in immediate pain and swelling. The knee does not tolerate forced rotation well. Twisting the knee or being struck violently at the side of the knee, which is a common football injury, can result in a ligament sprain or a meniscal strain and has to be managed by rest, ice, compression and elevation. This RICE recipe is surely the most successful in managing the swelling and pain after an acute trauma. Chronic knee pain, lasting more than three months, has to be cared for differently.
The most common chronic problem is degenerative meniscus, the wearing away of the cartilage between the bones of the knee. The meniscus acts as a shock absorber as we bear weight through the lower extremities. The most common site of degeneration is the inside or medial aspect of the knee. Pain can begin with a mild ache while descending stairs and may exacerbate with an increase in walking or running duration. It becomes the “bad” knee — uncooperative — and takes the blame for discontinuing exercise. We all know that putting exercise on hold affects psychological and physical well being.
I say “address” the knee with kindness; it might not be its fault. Maybe a flat foot has worsened and now is putting more stress on the meniscus, or footwear is old and no longer supports the arch. Another cause might be a small curvature in the spine, which may lead to weight bearing asymmetrically. Isolating the body part from the rest of the body, which often results in a gait disturbance, prolongs the chronic nature of the symptoms and can lead to disuse and atrophy as the muscles and supportive structures weaken.
So, think of your symptomatic knee as “involved” rather than “bad.” It’s involved because of undue stress that has been placed on it or an old injury that now has decided to flare up. Nurture the involved knee; try to manage it by reducing those stressors and rehabilitate by strengthening the structures around it. Even if arthroscopic surgery is indicated to repair the meniscus or partially remove it, strengthening exercise is indicated. It might remain involved but no longer bad.
Dr. Denise Plastiras is a physical therapist with Maximum Performance in Greenport. She teaches postural balance after injuries.