A recent article in the North American Journal of Sports Physical Therapy addresses a problem that many orthopedic physical therapists have been talking about for years – the prevalence of knee flexion contractures in painful knees. Irrespective of the type of anatomic problem that afflicts the knee, the end result is something this article refers to as deconditioned knee syndrome.
What Is a Knee Flexion Contracture?
Knee flexion contracture (the inability of the knee to fully straighten due to pain and stiffness) has long been seen by orthopedic physical therapy specialists as the most important and first problem to be tackled in any knee rehabilitation program, and recent published research supports that conclusion. The old orthopedic adage “A straight knee is a happy knee” conveys the idea succinctly – a knee that does not properly straighten is a knee that will not gain strength, and will continue to be painful, swollen, and prone to giving way, even in the absence of any significant anatomic abnormality.
This article defines the deconditioned knee, describes how it develops, and relates the presence of the deconditioned knee to knee arthrosis, failed rehabilitation after knee surgery, and several other common conditions and scenarios. Subjects in this study were put through a rehabilitation program that emphasized flexibility only until knee range of motion had been restored, and then were advanced to simple strength training exercises as needed. The program in this case was mostly home-based.
Study subjects were instructed in a few simple exercises to perform three times daily, as well as “habits” such as locking the knee back into full extension while standing, that they could perform throughout the day – effectively giving them several hundred repetitions of certain movements. For those that still had difficulty in achieving full extension, a device was issues that each subject used three times a day to attempt to achieve full extension. They reported their progress via a functional index (series of questions about pain and function) which indicated that the largest amount of improvement occurred during the first month of treatment, but continued for the rest of the year the subjects were followed.
What Were the Study Conclusions? How Do They Apply in the Read World?
Some items of interest to consider when generalizing this study to the real world:
- The physical therapy intervention in this case was very minimal, and did not address patients with more advanced functional needs such as running and cutting.
- Because of the minimal nature of the program, improvement in symptoms and function was seen over the course of a year. Although the largest amount of improvement overall was seen in the first month, there was significant improvement in function overall seen between months 1 and 3 as well.
- A well-trained orthopedic physical therapist can very quickly find and eliminate a knee flexion contracture with some simple hands-on techniques. An increase in functional abilities (walking, balance and strength) is nearly immediate, and this allows quick progression into strength training and higher level functional activities.