Twisted Knee Pain (Part.2)


Twisted Knee Pain (Part.2)


Twisted Knee Pain Part 2

As the knee is a complex joint, the types of injuries that can occur are greatly varied. Consequently, treatment of a knee injury is very individualized to the patient and the injury itself. With the knowledge of a physiotherapist, a treatment and prevention plan will be devised that not only treats the knee pain, specific to the injury, but also addresses and corrects the causes and additional factors that resulted in the injury.

The knee joint is made up of the bones of the upper and lower leg. These bones are:

  • Femur
  • Tibia
  • Fibula
  • Patella

These bones, along with four main ligaments and additional tissues such as tendons and cartilage, work to stabilize the knee and allow it to produce the hinge and slight rotational movements. This allows the ability to walk, run and perform other locomotive movements with ease and injury-free. A knee at its optimum should be able to perform a hinge movement of up to 150 degree.

These four main ligaments are:

  • Anterior Cruciate Ligament (ACL) – restricts anterior transalation of the tibia
  • Posterior Cruciate Ligament (PCL) – restricts posterior translation the tibia
  • Medial Collateral Ligament (MCL) – on the inside part of the knee joint
  • Lateral Collateral Ligament (PCL) – on the outside part of the knee joint


Treatment for twisted knee pain:

Initial treatment for a twisted knee should include the PRICE principles:

  • Protection: Protect the knee from any further injury. This includes avoiding weight-bearing and any activities that may further worsen the pain and injury.  Often with liagment strains or tears a knee brace is very helpful in providing additional support.  Ace Physio can measure and fit you for a custom knee brace in Toronto.
  • Rest: Allow the injury tissues to heal by resting.
  • Ice: Cold therapy should be applied for 10-15 minutes every hour for the first 24-48 hours, if pain persists. In some cases, such as a suspected anterior cruciate ligament (ACL) sprain or tear, cold therapy of up to 72 hours is advised. A cold therapy compression wrap is also a great option to combine cold therapy and compression, to relieve pain and reduce swelling.
  • Compression: Use a compression bandage to relieve swelling.
  • Elevation: Elevate the knee if possible without pain to reduce swelling and pain.

It is recommended that the patient see a medical professional as soon as possible to rule out any fractures or tears, and to seek a diagnosis of the injury to be able to treat it effectively and efficiently. Commonly, doctors will prescribe anti-inflammatory and pain relief medication to help the patient to manage the injury and associated pain during the initial stages of recovery.

A MRI or an x-ray are sometimes also advised by a medical professional to assess if the twisted knee has resulted in a sprain or a tear of the anterior cruciate ligament. If there is a visible tear, this may result in the medical professional referring the patient to a orthopaedic surgeon to pursue surgery to repair the injury.

Listed below are treatment options advised for injuries that commonly occur after a knee has been twisted.

  • Anterior cruciate ligament sprain or tear
    • Diagnosis and a full assessment is conducted by a medical professional. This initial assessment will usually decide whether surgery is the best treatment option for optimal recovery of the ACL injury. This is usually decided upon the following factors:
      • Age of the patient
      • Severity of injury
      • Work and lifestyle of the patient
  • Use of a custom knee brace is advised to restrict rotational movements and stabilize hinge movements.
    • Treatment option 1: Surgery
      • Surgery is either advised as soon as possible post-injury or a few weeks post-injury once swelling has subsided.
      • Pre-surgery exercises are advised to maintain muscle strength and a full range of motion for the best results post-surgery.
      • Recovery can range between 4 months, up to 1 year. However a full recovery back to pre-injury is rarely observed.
    • Treatment option 2: Conservative / Non-surgical
      • Rehabilitation prescribed by a physiotherapist involves mobility and strengthening exercises that will gradually progress to enable the knee to heal and rehabilitate back to a pre-injury state and increase stability to avoid re-injury.
      • Additionally, your physiotherapist will incorporate proprioception exercises into the rehabilitation program. Proprioception exercises help the patient’s knee learn again where it is in space and train the muscles around the knee how to react to adverse movements quickly enough to avoid re-injury.
  • Posterior cruciate ligament sprain
    • Diagnosis and a full assessment is conducted by a medical professional. They may refer to get a MRI or x-ray done to assess the extent of the damage. Depending on the outcome, two treatment options are advised.
    • Use a knee brace to support the knee and prevent adverse movements. Preferably a hinged knee brace.
    • Treatment option 1: Surgery
      • Surgery is rarely required, unless the PCL is one of many injuries that have occurred in the knee joint or the knee is not responding to other treatment well.
    • Treatment option 2: Conservative / Non-Surgical
      • Treatment modalities such as TENS and ultrasound are used to relieve pain and inflammation, and the enhance healing process.
      • Physiotherapy: manual therapy and a rehabilitative exercise program will work to strengthen and mobilisation of the knee.
      • Exercises that target balance and gait are sometimes also incorporated to prevent re-injury
  • Medial collateral ligament sprain or tear
    • Diagnosis and a full assessment is conducted by a medical professional.
    • Treatment modalities such as massage, ultrasound therapy TENS to relieve pain and inflammation, and enhance the healing process.
    • Taping and a knee brace, preferably a hinged knee brace, can be used to stabilize and support the knee joint. A hinged knee brace prevents sideways movement, however grade 2 and 3 injuries may require a knee brace which limits movement to allow full healing of the structures.
    • A rehabilitation exercise program prescribed by a physiotherapist will involve strengthening and mobility exercises.
    • Recovery time, depending on the severity of the injury, can vary from 3 weeks to 12 weeks.
  • Lateral collateral ligament sprain or tear
    • Diagnosis and a full assessment is conducted by a medical professional.
    • They may refer to get a MRI or x-ray done to assess the extent of the damage. Depending on the outcome, different combinations of treatment will be prescribed.
    • Grade 1 to 2 injuries usually incorporate a rehabilitation program of mobilisation and strengthening exercises. This program will be utilised in collaboration with treatment modalities such as massage, laser, taping and ultrasound to not only reduce pain and inflammation, but also to enhance the healing process.
    • Grade 3 injuries sometimes also require surgery, especially if the lateral collateral ligament is not the only structure damaged. However recovery time is greatly increased post-surgery.
    • Grade 2 and 3 also benefit from the use of a hinge knee brace to provide stability and support to the knee joint during the healing process.

If you are experiencing any kind of knee pain, it is recommended to see a medical professional as soon as possible to rule out any breaks or tears that can cause debilitation long term if left untreated. At Ace Physio, we would be more than happy to help you through your journey to full recovery.

To book an appointment with one of our Toronto Physiotherapists, please call (416) 900-6653 or book online today!

About the Author

Brad SaltzBrad is a Registered Physiotherapist at Ace Physio, a highly respected Physiotherapy clinic in downtown Toronto. Ace Physio provides high quality one on one Physiotherapy that combined state-of-art technology such as; Shockwave Therapy, Laser Therapy, and Spinal Decompression with traditional Physiotherapy.View all posts by Brad Saltz