Orthopaedic Surgery - Discharge advice - Low energy knee injury

We are sorry to hear you had an injury. This advice is designed to help you get better as quickly as possible. During your recovery we may contact you to improve the service for future patients.

What is a low energy knee injury?

Low energy knee injuries happen to people of all ages. They are simple musculoskeletal injuries and will usually get better by looking after them yourself.

Common knee injuries include sprains (over-stretching of the ligaments), strains (over-stretching of muscles and tendons), injury to the cartilage that lines the joints (meniscus) and irritation of the kneecap joint (patellofemoral).

When soft tissues such as ligaments and muscles are damaged, there is pain, swelling and sometimes bruising.

Pain is usually as its worst in the first 3 days.

What should you do?

Follow the advice discussed with the clinician who saw you in the Emergency Department.

As the pain settles down after the first few days, gradually increase your level of activity. Start with walking and gentle exercise; move as much as you can without causing pain.

Most people fully recover within 6 weeks.
 
Your knee may be very painful, stiff and/or swollen. Therefore, you should follow the procedure known as “PRICED”.

P = Protect: Use any walking aids provided – this will offload the joint. Use a walking stick in the hand opposite the painful knee.

R = Rest: Partial rest is often recommended, but you should move the knee as pain allows. This will aid your recovery.

I = Ice: A bag of ice/frozen peas/ice pack wrapped in a towel can be applied for 15 minutes, every 2 hours, to reduce pain and swelling*

C = Compression: There is limited evidence that knee supports may help, however, if you find this helpful, it may be used in the short term.

E = Elevation: Elevating the knee above the heart level will help reduce any swelling.

D = Drugs: Sensible use of simple painkillers, e.g. paracetamol, will reduce pain and allow you to start moving. Check it is safe for you to take any anti-inflammatories**

* Warning: Check the skin after 5 minutes for ice burn. Do not use if you cannot feel the sensation of hot/cold.

**Warning: Follow patient information advice leaflet found in all medicines

Non-steroidal anti-inflammatory drugs – rub-on painkillers

These are also called topical painkillers. It is unclear whether rub- on anti-inflammatory painkillers work better than tablets.
However, the amount of the medication that gets into your bloodstream is much less with rub-on painkillers, and there is less risk of side effects.

* Warning: Only take painkillers as instructed on the patient information leaflet

It is important to keep the knee moving

Exercise helps your knee to recover

Goals:

• Start walking as pain allows. You may have been given a walking aid - put weight through the injured knee as pain allows. Stop using the walking aid if you are able
• Slowly increase the amount of time you are on your feet. Try building up walking gradually
• Improve your balance as able

Exercises

• These exercises will be most effective if completed 'little and often'.
• Remember to start exercising slowly and build up gradually.
• Patients tell us that initially their pain can increase but usually settles again within a few days of starting the exercises

Knee bend

Sit on the floor or your bed with your legs stretched out in front.
Keeping your heel to the floor, slowly bend your injured knee as far as you feel it is comfortably stretched. Hold for 5 seconds.
Straighten your leg as far as you can and hold for 5 seconds.
Gently repeat 10 times.

Straight-leg raise (sitting)

Sit well back in a chair with good posture.
Straighten and raise your injured leg.
Hold for a slow count to 10, and then slowly lower your leg.
Repeat this gently at least 10 times.

Straight-leg raise (lying)

Bend your uninjured leg at the knee.
Hold your injured leg straight and lift the foot just off the bed/floor.
Hold for a slow count of 5, and then lower.
Repeat 10 times.
Try doing this exercise in the morning and at night while lying in bed.

Leg cross

Sit on the edge of a table or bed. Cross your ankles over.
Push your front leg backward and back leg forwards against each other until the thigh muscles become tense.
Hold for 10 seconds, and then relax.
Repeat 10 times.
Switch legs so the other ankle is on top and repeat exercise.

Knee squats

Hold onto a chair or work surface for support.
Squat down until your kneecap covers your big toe.
Return to standing. Repeat at least 10 times.
As you improve, try to squat a little further.
Don't bend your knees beyond a right angle.

Step-ups

Step onto the bottom step of stairs with the right foot.
Bring up the left foot, then step down with the right foot, followed by the left foot.
Repeat with each leg until you get short of breath.
Hold on to the banister if necessary.
As you improve, try to increase the number of steps you can do in 1 minute and the height of the step.

Lifestyle Changes

There are several ways you can help yourself, including:

• Lose weight (if you are overweight)
• Stop smoking
• Regular exercise (both muscle strengthening and general fitness exercise)
• Reducing stress on the affected joint (pacing activities, using a walking aid, or wearing appropriate footwear)
• Using pain killers or anti-inflammatory creams, gels and tablets
• Warm-up before exercise
• Use activity-appropriate footwear and equipment
• Take care when exercising on uneven or slippery ground

Important information about smoking

FACT - Smoking affects healing rates. In extreme cases it can stop healing altogether.

GOOD NEWS - Stopping now will make the difference and give you the best results.

HELP - Go to www.smokefree.nhs.uk or https://www.salford.gov.uk/health-and-social-care/health-services/quit- smoking/ or have a chat with your GP.

Nutrition tips

• You can help your body to recover by eating the right food
• Drink lots of water
• Protein, calcium, and vitamin D work together to help your body to repair
• Food high in protein: Seafood, meat, dairy, eggs, beans, and soya
• Food high in calcium: Dairy, almonds, seeds, oily fish, beans and lentils
• Dark leafy greens like kale, broccoli and cabbage also help calcium absorption
• Food high in vitamin D: Oily fish, milk, cheese and eggs
• Eat less sugar and alcohol, as sugar reduces calcium absorption

Returning to physical activity: work, hobbies and sport

• Returning to sport and work will depend on the demands of your job and chosen hobbies and sport
• Recovery is faster if you stay at or get back to work as early as possible - if you are on your feet all day you may need to do a phased return to work, do lighter duties to start with or have regular breaks to rest your knee
• Once you have regained your movement, strength and balance, you can start to increase your activity

Physiotherapy

If you live in Salford, you can refer yourself online to our physiotherapy department using this website www.northerncarealliance.nhs.uk/go2physio

If you do not live in Salford or have no internet access, then ask your GP to refer you.

Osteoporosis

If you’ve fractured a bone AND are over 50 years you may be at risk of having Osteoporosis (weakening of bones). You may be contacted separately by letter from Salford Fracture Liaison Service offering you a telephone risk assessment; if you live outside of Salford please speak to your GP.

What should you watch out for?

If you experience any of the following you should return to A&E:

• You develop a sudden, sharp increase in unremitting pain to your knee
• You develop a sudden loss of movement to the knee
• Your knee becomes hot, red and swollen
• You begin to feel generally unwell with any of the above symptoms

You should see your GP if your pain is not generally improving after 6 weeks.

Remember...

• It’s very important to keep your knee moving
• Early exercises will aid your recovery and may reduce the incidence re-injury
• Consider referring yourself to the go2physio service Website: www.northerncarealliance.nhs.uk/go2physio

Further advice and guidance can be found on social media. But we recommend...

• Versus Arthritis – information leaflet: Website:  www.versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-knee/
• Versus Arthritis – knee exercises document: Website: https://www.versusarthritis.org/
• Link to NHS Knee Arthritis: Website: https://www.nhs.uk/conditions/arthritis/
• NICE clinical recommendations: Website: https://cks.nice.org.uk/osteoarthritis