Crisis Plan Series
Acute osteoarthritic knee
Acute exacerbation of knee joint osteoarthritis (joint degeneration) is a painful and debilitating condition due to its inability to bear weight. Commonly prescribed anti-inflammatory and analgesics are most important but physiotherapy could also help even in the early acute stage.
Most patients do not understand how to rest. The knee should be rest from any weight-bearing activities and preferably raised above the heart at about 30 degrees bend at its loose pack position (least joint compression position). Allowing the knee to stiffen up in such position is detrimental, as full extension (straightening) is required to walk. The patient should be taught to bend and straighten the knee gently but only as far as comfortable. Such gentle movements may be performed in any positions such as supine (lying face up), prone (lying face down), sitting and standing. Frequent cold pack may help to reduce pain and inflammation. A light compression bandage or a knee brace may help to reduce swelling and support the knee when weight-bearing (standing and walking). The hamstrings (back of the thigh muscles) and calf (lower leg) muscles may tighten up very quickly causing more joint compression, hence swelling and pain. Very gentle muscle stretches could be taught without irritating the inflamed joint. With care and skill, very gentle manual therapy could be helpful in reducing pain and ensuring early mobilization of the knee.
Early mobilization is paramount in preventing stiffness and deformation that happen so often in knee joint osteoarthritis. Since knee extension is often the first movement to be restricted, gentle passive accessary movements should be performed as soon as possible. Techniques such as tibia traction, postero-anterior glide and external rotation are very effective in restoring knee extension. Passive patello-femoral (knee cap) joint mobilizations are also important as stiffness in the patello-femoral joint often exacerbates degeneration of the tibio-femoral (knee) joint. Some of these mobilization techniques could be taught to patients who may perform their self-treatment at home so as to encourage more proactive treatment approach to prevent deterioration and improve overall function of the knee.