Physio insights case study Mr F
Assessment of Mr F
A 66-year-old male presented to physiotherapy with right sided knee pain for many years. He had previously been offered joint reconstructive surgery 10 years ago, however, decided that at that stage, he was able to manage his symptoms so cancelled the surgery. He had physiotherapy 6 years ago and had been managing well up until recently.
He was complaining of lateral knee joint pain aggravated by descending stairs, and he was unable to kneel due to stiffness and pain. It did not limit his walking ability on the flat and the pain was not waking him during the night. Previous x rays 2 years ago demonstrated moderate right sided lateral tibiofemoral compartment OA.
Clinical findings
On examination he had wasting of his right quadriceps and gastrocnemius, a fixed flexion deformity of 10 degrees and 100 degrees of knee flexion, limited by stiffness. He had reduced quadriceps and hamstring strength of grade 4/5 and very poor vastus medialis activity and decreased patellofemoral range of motion.
Intervention and restoration of function
In order for Mr F' s knee function to improve, it was important that range of movement was restored as much as possible especially into extension, to improve quadriceps control of the knee and enable him to strengthen surrounding muscles more efficiently. Manual therapy (joint mobilisations and passive stretches) was used in combination with a home stretching programme and graded strengthening exercises within pain free limits. We were able to achieve full knee extension and 105 degrees flexion within 4 treatment sessions and grade 4+/5 quadriceps and hamstring strength with much improved vastus medialis activity. He has still been unable to kneel due to ongoing restriction to knee flexion, however all other functional activities are comfortable and unlimited.
Preventative strategies
With range of motion, strength and function improving in his knee, it is important that optimal neuromuscular control of the knee is maintained, to help minimise ongoing pain and dysfunction. Encouraging a regular exercise programme that can be completed independently is a good way to encourage self-management of this chronic condition, with education of the importance of this ongoing self-management being paramount to compliance.
