Article by Brian Gilmer, MD
My knee twisted and I think I felt a pop, now what?
This is a line that every athlete, and every knee surgeon comes to dread. After you are hurt it’s normal to feel concerned, uncertain, and anxious in addition to any pain and loss of function.
The board-certified knee specialists at Swift Institute are available to streamline your care and recovery whether your injury is mild and will heal well on its own or whether you need further treatment and care. This is what we pride ourselves on doing each day.
While all individuals and all injuries vary, there are a few things you can expect in the evaluation of any knee injury, and the good news is that these can be handled through the Swift Orthopedic Urgent Clinic at any time during business hours without an appointment.
1. You should be evaluated by a healthcare professional who is experienced in the examination of knee injuries.
Even if a knee is swollen, an experienced examiner can often, but not always, detect ligament injury and instability. Meniscal injuries will cause tenderness near but not in the same place as a ligament injury. ACL tears often cause pain and swelling several hours after an injury. The examination can give you an idea of the nature of the problem and its severity. This information can give you a sense of how and how quickly your knee should be re-evaluated.
2. You should obtain x-rays.
Even when you feel like you may not have broken anything, there are subtle injuries and findings that an experienced knee specialist will see that aid in diagnosis and treatment. Additionally, combined with an exam, the this will allow you to know whether it may be safe to place weight on the knee.
3. The knee should be protected.
This can mean a brace and or crutches. Sometimes a simple brace, for example with milder injuries of the MCL or meniscus or with tendon strains, is adequate. In other cases a larger hinged brace is provided to give comfort, support and stability. Examples of injuries benefitting from a longer hinged knee brace are ACL injuries, some meniscal tears, and dislocations of the patella. The Swift orthopedic Urgent Clinic carries a variety of braces in a variety of sizes and can provide crutches or other assistive devices like a walker, if needed.
4. Have your questions answered and make a plan.
It’s impossible to get all the answers immediately after a knee injury but having a clear plan and knowing your options can reduce the stress and anxiety of being injured.
Not all knee injuries require and MRI, but some do. Cases with severe swelling or a sense of instability or loss of range of motion are some reasons an MRI may be ordered at the time of injury. In other cases, it may be reasonable to wait and have the knee reexamined after some rest.
MRIs are a 3D image of your knee that examine the bones, ligaments, cartilage, and soft tissue. MRIs typically require authorization by your insurance which can take several days. This process can be started from the urgent care, and the SWIFT authorizations team will facilitate your MRI to be performed at a location that best suits your location and availability.
Whether an MRI is required or not, all but the mildest of injuries will benefit from follow up with a dedicated Orthopedic specialist. The Swift orthopedic Urgent Clinic providers can provide referrals to one of our dedicated orthopedic knee specialists based upon your preferred timing, location, and provider.
These visits can be scheduled within 1-3 days in most cases.
While you are waiting for your next appointment or to proceed with an MRI there are several steps that you can take to begin your recovery. Below is information about icing and reduction of inflammation.
Here are some precautions to guide your upcoming weeks:
- Try to walk as normal as possible, if you walk with a painful limp, consider use of crutches and/or brace as directed by your provider
- Avoid pivoting or high impact activity
- Avoiding exercises when your foot is not in contact with the ground
- Have soreness guide your day-to-day activity. If you do too much one day and are still sore the following day, that day should focus on range of motion and to reduce swelling. Avoid strengthening exercises on that day.
The primary goals in the early treatment of any knee injury are to:
1. Reduce swelling and inflammation.
Over the counter ibuprofen can be used to reduce swelling if you do not have any medical reasons that would preclude it’s use, or unless you were told not to take it by your doctor.
Cold will help alleviate the pain and reduce swelling to the area. With the combination of compression, the therapeutic benefits of cold can penetrate deeper while causing a pump-like mechanism of the tissue to help flush out swelling.
2. Improve gentle range of motion as pain and swelling allow.
Even small movements within your comfort zone will help reduce pain and swelling. Motion should be done gently and continued several times and hour unless there is a sensation of a block or abnormal snapping and popping. Achieving 90 degrees of knee flexion is a good goal.
3. Maintain active quadriceps muscle tone.
Knee swelling and disuse rapidly lead to muscle wasting and weakness which can be hard to regain later even with physical therapy. Simply tensioning this muscle frequently can maintain muscle mass.
4. Gradually achieve and then maintain the ability to keep the knee straight at rest.
It’s often most comfortable to rest with the knee straight however, it is important to rest the knee straight to prevent stiffness that can later result in a limp.