Postural exercises for the knee
Postural exercises are not just for the spine. They may also promote best possible limb alignment to minimize further injury and ensure speedy recovery of a peripheral (arms & legs) joint or soft tissue injury. A case report may help illustrating the importance of postural exercises for a knee condition. The patient presented with persistent stiff and painful left knee of an insidious onset (unknown cause) 3 years ago. Despite continuously seeking medical treatment, he had to use a quadripod (a stick with 4 legs) but still walked with a severe limp as he was not able to straighten his knee to weight bear. His condition had recently been severely aggravated by attempting to strengthen his knee by performing ski-squat (half squatting as a stance) exercises. On examinations, his whole left knee was generally swollen and tender especially by the patello-femoral (knee cap) joint. Knee extension (straightening) was very stiff and painful and lacked 35 degrees. Flexion (bending) was very painful at 60 degrees. Lateral (side) and infra-patellar (underneath the knee cap) region was thick and tender. Patello-femoral joint was extremely stiff laterally with very coarse crepitus (clicking) . There were no signs of other ligament injury. Calf (back of the lower leg) muscles and the hamstrings (back of the thigh muscles) were extremely tight. Quadriceps (front of the thigh) muscles were very weak due to pain inhibition and disuse (not able to use due to pain). Clinical presentation suggested worsening of his initial patello-femoral (knee cap) joint dysfunction due to inappropriate management over the last few years! He had been resting his knee in a comfortable but poor posture at 35 to 40 degrees bend. Such resting or loose pack position certainly minimized the knee joint pressure and ligament/muscle tension and could temporarily be adopted in the very acute inflammatory stage of the condition. Such comfortable posture of the knee was however non functional. Prolong resting in such poor posture caused muscle and soft tissue contracture (shortening) and joint stiffness especially after an initial severe inflammation. Any attempt to correct such posture by straighten the knee was painful, hence a vicious cycle for the patient to stay stuck in such knee bend position. Walking required almost full extension (straightening) of the knee. No matter what pathology or problems it might be, the primary aim was to restore the functional mobility of the knee, the ability to extend or straighten. A set of knee and patello-femoral (knee cap) joint mobilizations, deep friction massage, mobility and stretching exercises aiming to restore extension had been given. He was warned to stay away from his poor knee posture. To his delight, he was able to restore his knee extension to lacking only 8 degrees in 3 weeks and he was able to walk a lot better. The prime factor for such success was the patient's understanding to avoid poor posture and to perform his postural exercises, knee extension (straightening) in this case. The most effective technique I performed was the repeated reassurance of the approach of avoiding poor posture and to perform postural exercises.