In physiotherapy, a knee examination is conducted as part of a physical examination or when a patient appears with knee discomfort or a history that implies a knee joint disease.

The test is divided into various sections:

  • Position/lighting/draping
  • Inspection
  • Palpation
  • Motion

The phrase “see, feel, move” is typically used to recall the latter three stages.

Patient History

Physiotherapy for knee pain begins with writing down the patient’s history. 

This means a thorough history should be taken before undertaking a physical examination of the knee joint. During the physical examination, a comprehensive history might aid in determining the likely pathological location. The mechanism of injury, location, and nature of the knee pain, the presence of a “pop” sound at the time of injury indicates ligament tear or fracture, swelling, infections, walking and standing condition stand or walk, instability (suggestive of subluxation), and any previous traumatic injuries to the joint are all historical features to consider. Soft tissue inflammation, injury, and osteoarthritis are the most frequent knee disorders. The mechanism of a knee injury might provide insight into the structures that could be affected.

A valgus force on the knee, for example, can rupture the medial collateral ligament, whereas a varus force can tear the lateral collateral ligament. The anterior cruciate ligament can rupture when a person rapidly slows down while jogging, twisting, or rotating with valgus stress applied to the knee. The posterior cruciate ligament can be injured by posterior dislocation of the tibia. The meniscus can be torn by twisting and turning while bearing weight. Knee fractures are less common, however, they should be evaluated if there has been direct trauma to the knee, such as during a fall. Tibial plateau fractures, lateral condyle of femur fractures, medial condyle of femur fractures, and patellar fractures are all examples of knee joint fractures.

Questions of Particular Interest – A historical analysis of a given region.

  1. Do you have any back or leg pain? (Is the pain in a dermatomal location – back pain might refer to the knee)
  2. Is there any discomfort in your hips or ankles? (Knee discomfort might be transferred from the hip or caused by the ankle’s biomechanics.)
  3. Did the patient hear a snap or click when he or she was hurt?
  4. Is there any give in the knee? (ligament instability/rupture)
  5. Is your knee locked? (true locking of the meniscus is linked to rips in the bucket handle)
  6. Is your knee swollen? How fast do you think it will happen? What is the source of the swelling? (Intra Articular/extra-articular; acute swelling generally suggests knee trauma, such as ligament injury.)
  7. Was there any kind of bruising? (Immediate bruising suggests a serious injury.)
  8. Is it painful to cough or sneeze?

These are some of the questions that our physiotherapists ask you in a digital physiotherapy session and make sure that no stone is left unturned to provide you with the best online physiotherapy service.

Also, these are a few additional questions that the physiotherapist asks the patient.

  • Past Medical History (PMH) is a term that refers to a person’s medical (Pre-existing medical conditions).
  • Drug history (DH) Are there any relevant medications?
  • Social History (SH) Affecting work/sports/hobbies?

After this, the next step in physiotherapy for knee pain is looking out for any red flags.

Also Read: How to Exercise with Arthritis of the Knee and How Digital Physiotherapy Helps it?

Warning Signs

These are the unique inquiries that might signal the presence of anything more nefarious. Patients should be sent back to their doctor with their concerns documented if they feel the condition is not musculoskeletal and/or anything serious is going on.

  • Pins and needles or numbness in the LL on both sides.
  • Problems with bowel and bladder function in which the patient does not feel the need to go to the bathroom.
  • Incontinence.
  • In the Groin area, there is paraesthesia.
  • Pulse loss in the lower limbs (Vascular compromise).
  • Deformity is obvious.

If the symptoms are not serious but are more severe than you may expect, get guidance from a senior on whether an A&E referral is more appropriate. What force was exerted through the leg, and what was the mechanism of injury? Was it sufficient to cause a tibia/femur fracture? Pulse loss in the foot might signal vascular problems.

General Examination

The physiotherapy for knee pain begins with gait analysis to look for any anomalies when walking. Gait analysis can help distinguish between actual knee discomfort and pain transferred from the hip, lower back, or foot. A duck walk might be requested of a person. This necessitates the individual squatting and walking in that position. A person must be free of ligament tears, knee effusions, and meniscal tears to do a duck walk. You might alternatively ask the person to stand with both feet together. This posture can be used to check for valgus or varus deformities in the knees, which might indicate osteoarthritis. To check for quadriceps muscle wasting, measure the diameter of each thigh. Psoriasis, hematoma, rash, abrasions, lacerations, or cellulitis, which might be key causes of knee pathology, can also be seen on the skin around the knee.

After this, the next phase of our knee examining in online physiotherapy service consists of clinical reasoning.

Clinical Reasoning

Knowing the past might help you figure out which structures have been impacted. It is critical to understand the mechanism of harm. If you can determine the force of the injury, you’ll be able to determine which tissues are likely to be strained or injured (valgus force may suggest an MCL sprain, varus pressure could suggest an LCL sprain, foot grounded and twisted may show an ACL sprain/rupture).

Unless there is a specific mechanism of damage, rule out the back and hip, since the knee can be a referred location of pain for both of these regions. Swelling and bruising that occurs right away typically suggests considerable damage and may necessitate an X-ray to rule out tibial plateau fractures, bone bruises, or an MRI to assess ligament integrity

The next step of our digital physiotherapy is the preparation of a working hypothesis for their objective examination by our physiotherapist. Use unique tests to confirm or reject their idea and physical examination to find the malfunction.

Objective

Our physiotherapist can use the objective assessment to rule out which structures are implicated and to revisit the following therapy to see whether there has been any improvement or worsening.

General Observation

  • Posture
  • Movement Patterns

Functional Tests

  • Small knee bend
  • Sit to stand
  • Squat
  • Jump
  • Hop
  • Run

Inspection & Palpation

Inspection

  • Effusion
  • Poor Alignment
  • Muscle Wasting

Palpation 

  • MCL
  • LCL
  • Joint Line
  • Patella
  • Retinaculum
  • Patellar Tendon
  • Hamstrings Tendons
  • Popliteus.

Movement Testing

  • AROM, PROM, and Overpressure Movement Testing
  • Length and strength of muscles
  • With complete AROM and overpressure, the hip and ankle are clear.
  • Add passive intervertebral mobilisations if the lumbar spine is suspected (PA spinous processes, PA transverse processes).

So, this is a piece of brief information about knee examining and the flow of it that is conducted by our physiotherapist during digital physiotherapy.

Book an online physiotherapy consultation session with our expert physiotherapists today at Phyt Health.
Phythealth, India’s first AI-assisted digital physiotherapy service, customizes treatment plans based on your risk factors, providing you a holistic treatment plan for physiotherapy for knee pain on their digital physiotherapy platform.