How to Evaluate Knee Injury and Pain: Our Evaluation Process at Reload
Finding the Potential Causes of Knee Pain or Injury
Ah, the human knee. A marvelous junction of bones, ligaments, and tendons that allows us to run, walk, jump, crawl, dance, and more. But what happens when it goes awry?
“We see a surprising number of people with knee injuries or knee pain,” says Dr. Marc Jacobchick. “Typically, they will have received some form of diagnosis from a doctor. This could be related to arthritis, a meniscus tear, a ligament sprain, or even torn ligaments in the knee.
“When they come to us, they usually describe experiencing pain during specific activities like going up or downstairs, squatting, kneeling, or running (in case of running-related injuries). They mention various types of pain in different parts of their knees and the knee as a whole.”
The problem is that knee pain is ambiguous. There are many potential causes. Our first job at Reload is to figure out the underlying issues causing the knee pain.
In this article, Marc examines how to evaluate a knee injury.
The challenges of evaluating knee pain
Every individual describes a unique narrative of pain, pinpointing it to different regions of the knee. It’s our responsibility to decode these stories, to demystify the underlying issues causing the pain.
However, there’s an exception. The aftermath of a traumatic incident – think a grave car accident or an unfortunate fall off a motorcycle – is an injury that requires instant medical attention, typically in an ER.
Yet, after surgical procedures, many come to us seeking rehabilitation and strength restoration.
We must carefully assess the condition and decide what changes and improvements can be made through rehabilitation.
In addition, we need to consider the limitations of exercise and the natural healing processes of the body when dealing with such injuries. Some aspects of their injury might be more challenging to address, and that’s something we have to evaluate during the triage process.
Does knee pain always mean there’s a problem with the knee itself?
The knee, often deemed the ‘middle child’ of the lower body, doesn’t always scream in pain for its own sake. Dysfunction in either the hip or ankle can manifest as knee pain.
“Knee dysfunction may involve weakness, stiffness, mobility issues, or coordination problems,” says Marc. “When someone comes in with knee pain, it’s rarely just an isolated knee issue, unless it’s a dramatic injury or accident.”
Therefore, we take a meticulous approach, which includes examining calf, thigh, and hip muscles. We’re assessing in terms of strength, flexibility, and coordination. This is a crucial part of our evaluation process.
Hence, our strategy is comprehensive. Beyond knee evaluation, we assess the hip and ankle function, identifying any discrepancies that might be causing the pain.
“If there is an issue at the hip or ankle, and we only focus on relieving knee pain, the knee pain will likely return when you resume your activities, because the root problem hasn’t been addressed,” Marc explains.
“During our evaluation, we assess the function, mobility, flexibility, and strength of all the muscles in the calf, thigh, and hip. But most importantly, we also observe how all these parts work together in larger movements like squats, deadlifts, and lunges. If we notice any obvious movement faults that could be contributing to the knee pain, we address them.”
A common fault is where people alter their movements to avoid pain. You may feel pain when you put pressure on your feet with your toes in front of your knee. To avoid the pain, you modify how you walk or run. By understanding these movement modifications, we design training programs that help correct movement faults and restore proper function.
Reload’s Comprehensive Physical Evaluation
Curious about our evaluation procedure at Reload PT? It’s not about glancing at MRI results or gauging pain levels. We delve deeper. Our mission is to measure the disability caused by injury or pain. An ailment’s severity isn’t just about medical diagnostics but its impact on daily life.
“MRI or X-ray results (and even the level of pain experienced) can be unreliable,” says Marc. “Therefore, in our evaluation process, we focus on assessing how much disability you have due to the pain or injury you are experiencing. For example, if the pain prevents you from going up and down stairs, standing from a chair, walking, or riding a bike, and these activities are essential for your daily life, then you are quite disabled.”
During our evaluation, it’s our job to determine what you can do well, and the hardest thing you can do well. This becomes the baseline for a successful exercise program. Our goal is to make that hardest thing even better and then progress to the next hardest thing. As you build a foundation of challenging movements that you can perform well, you earn the right to attempt more challenging exercises.
“An example of this approach is if someone with knee pain can’t do a lunge or split squat, and struggles to get up from the floor. We might start with a single-leg bridge as the hardest thing they can do well. We gradually increase the difficulty as they make progress, adding resistance or reducing assistance in their exercises.
“By leveraging the body’s natural ability to adapt to physical stimuli through exercise, we help them make steady progress and move forward in their recovery journey.”
How Much Time Does Reload Spend Explaining the Process to a Client?
Ever wondered how long we spend elucidating the process? Two enlightening hours.
This time is when we sit and talk to our clients, immersing ourselves in an individual’s narrative, and integrating their history with their aspirations. This is a crucial time to understand your story and where you’re coming from.
“By gaining insight into their history, the duration of the issue, triggers, relievers, goals, stress levels, sleep patterns, exercise, and injury history, we can tailor the rest of the session accordingly,” explains Marc.
There’s a transfer of knowledge that happens organically when you undergo the procedures we discuss. It’s less of a lecture and more of a shared journey.
“Feeling is believing.” Says Marc. “When you feel the changes happening in your body or understand how certain movements affect you, it becomes easier for you to comprehend our recommendations.”
An example?
When we say you need to push your body hard to induce change, or we need to stretch or mobilize a specific area, you’ll understand it better if you can feel the difference during the session. Sometimes, we may try an exercise that causes discomfort initially, but then we modify it slightly, and you feel an improvement. Experiencing such changes helps you grasp the process and build confidence in the methods we’re using.
The magic of this approach is that it encourages greater understanding, motivation, and engagement from our clients. They become more receptive to the process and more committed to making progress.
How do you evaluate someone’s progress with knee pain?
Progress isn’t solely determined by numbers. Sure, we establish KPIs early on. For example, we might wish to see how long you can hold a specific position. Sometimes, the easiest thing to measure is how much weight you can lift in a certain way.
However, it is not only quantitative measures and goals that we must focus on. So, we’ll ask questions like:
How much discomfort are you feeling in a certain position or at a certain point in an isometric or lifting a certain amount of weight?
Are you feeling like you’re getting better?
We’ll also assess to see if you are improving at an exercise and beginning to master movement.
“There’s a lot of factors we track,” Marc says. “The measure of progress is an amalgamation of qualitative and quantitative measures. Assessing technical skill, observing mastery in movement, and evaluating overall improvement provides a comprehensive picture of progress.”
The road to recovery is paved with gradual improvements. It all starts with the initial evaluation. To take the first step on your journey to full recovery, book a comprehensive 90-minute body evaluation with Reload.
