Week 2.3 Entry

After our last experience of someone with “just knee pain” we were a bit more prepared for a few more possible scenarios. Would be great if the referring doctors could put down a bit more detail on the patients they are sending our way but I’m sure I’ll be waiting along time for that miracle to happen. The patient had injured her L knee from overuse approximately 9/52 ago without a single specific incident causing the pain. She had surgery 10/12 ago on the same knee to clean out debris and lose cartilage but had suffered no further pain after this which was interesting considering the period between that and her current pain. From the outset we could sense that this patient was impressed with her own ability to withstand pain and exaggerate the pain experience. This made it somewhat difficult at times to decipher exactly what the extent of pain was and how it was actually limiting her and what it meant in the scheme of things. Once again I learnt that even though you may ask about every possible joint and issue the patient will still miss fairly significant pieces of information. In this case she had dislocated her right patella twice with no further complications but this then lead to us learning that there is a family history of unstable patellas and this could be contributing to the current problem in her left leg. Maybe we should make an extra special point of clearing all possible problems with the contralateral side.

The patients sensitivity to movements meant she had only approximately 20° of mvt (could not be moved passively). Strength could not be measured as a result and no other special tests were possible. Despite all this we agreed that the most important course of action was improve the ROM. We were not to sure as to whether we should be pushing her beyond her pain limits (10/10 at EOR) but our supervisor realised that no further damage was going to be done and increasing her ROM was paramount. I have realised that there is a certain amount of bullying of patients that needs to be done to get results but only when it’s safe and within limits. This requires a great amount of trust in the PT by the patient.

It was important to make it very clear to the patient that the sooner we can get her to full function the sooner she could return to work and this means a lot of hard work and most likely an amount of pain. We need to make her aware that pushing beyond the pain will be required sometimes but this will still need to be monitored closely as it could get to a point where additional damage is being caused. With other patients I will push them a bit more beyond their initial pain to enable a better assessment and treatment result.