A dislocated knee is a serious injury. Not only is it extremely painful, it has the potential to result in long-term adverse effects. These may impair the sufferer’s ability to return to recreational, social, and work-related activities that require physical movements.
If this occurs, initial management may experience complications. While uncommon as it only accounts for approximately .2% of all orthopedic-based injuries, it does occur regularly. If you or someone you know has experienced this unfortunate event, physical therapy may be needed to rehabilitate the knee.
What is a Dislocated Knee?
A knee dislocation indicates that the three bones that are part of the knee are now out of place and misaligned. When this type of situation arises, it may be possible that the shin bones and/or the thigh bones become slightly out of place.
Many confuse the issue with a dislocation of the kneecap; however, it is completely different. A dislocated kneecap occurs when the actual kneecap simply slips from its proper place. This is referred to as a “patellar subluxation” or a “kneecap subluxation”. When a knee becomes dislocated, it is imperative that medical attention is sought immediately.
Causes of a Dislocated Knee
When a knee dislocates, it means that the thigh bone and the shin bone are no longer in contact with one another. This situation often occurs when a high-impact injury has occurred. Examples include a fall, an injury experienced while engaged in a sporting event or physical exercise, an automobile crash, or similar activity. It may occur in some at birth.
In most instances, a knee dislocation stems from a forceful thrust of the bones that are part of the knee joint. When it occurs, it is considered to be a medical emergency. It is marked by an extreme amount of pain.
Dislocated Knee Symptoms
The first and most obvious symptom that a knee dislocation has occurred is an immense amount of pain – usually caused by a forceful jarring of the body. The pain is typically so intense that it is impossible to move the knee or leg and/or straighten the knee and/or leg out. It may be accompanied by a loud popping sound. In addition to this, the knee may feel as if it is extremely unstable and unusable.
Bruising commonly occurs, along with an immense level of inflammation.
The joint may appear to be severely deformed or out of place. The sufferer will be unable to engage in activities that are normally participated in. Many people find the pain so unbearable that they experience dizziness, nausea, and vomiting. If a dislocation is suspected, it is considered to be a medical emergency. If left untreated, the following could occur:
- The nerve that runs along the outside region of the calf – the peroneal – may experience compression or damage.
- The popliteal artery – which is located at the back side of the knee – may become obstructed or ruptured.
- An issue called “deep venous thrombosis” or “DVT” may develop.
According to medical professionals, if a vascular obstruction does occur and is not treated within a time frame of 8 hours, the chance that an amputation will have to be performed increases to 86%. In addition to this, several other health complications may occur.
One example is, if a clot develops in the leg, it could break and travel in the bloodstream and go to the lungs. This could then result in pulmonary embolism. This could result in damage to the tissue in the lungs. It can also reduce the blood oxygen levels in the body, which could result in damage to other organs within the body and possibly death.
Dislocated Knee Treatment
The treatment of a knee dislocation will depend heavily upon the severity of the injury. In most instances, treatments are broken down to two categories -non-surgical and surgical. Below, you will find relevant information pertaining to each:
- Non-Surgical Treatments – If the injury is not severe, a doctor may attempt to pop the dislocated bones back into place. Given the amount of pain that this process involves, the medical professional will offer medication to help offset the discomfort. Immediately thereafter, a splint will be placed on the leg. Movement and weight-bearing activities will be restricted. This will allow the dislocation to successfully heal. You may then be referred to a physical therapist.
- Surgical Treatments – If the injury is considered to be severe, surgical intervention will be required. This will help to resolve the dislocation and will help correct any other issues that occurred with the injury – such as damage to the blood vessels, other breaks in the bones, nerves that have been damaged, and ligaments that have been torn. The surgery may not happen right away. It all depends on the amount of inflammation that is present. If surgery must be delayed, instructions to wear a splint, keep the knee iced, and elevated will be provided. Once surgery has occurred, various types of braces will need to be worn through the healing process. Once healing is complete, you will be sent to a physical therapist.
Dislocated Knee Physical Therapy
Once a dislocation of the knee has occurred, a physical therapist will be required for the rehabilitation of the knee. You will be provided with various exercises that will aid in strengthening the knee. These exercises will work the muscles that surround the knee first.
It will then progress to exercises that help to restore the range of motion back to the knee and the leg, in general. It is important that the initial stages of your physical therapy program are supervised because the goal is to prevent an additional dislocation from occurring. By working closely with a physical therapist and adhering to their guidelines, the muscles around the kneecap are gently worked and pulled evenly.
Physical therapists avoid bending the knee 90 degrees. The purpose and intent is to retrain the muscles surrounding the knee while rehabilitating the knee without placing undue pressure on the region. The rehabilitation program most often lasts up to six weeks for minor injuries and up to six months for more severe injuries.
Even after the therapy is stopped, patients are encouraged to continue with the exercise program for the duration of their lifetime. This is because of the fact that once a knee dislocation occurs, one is more prone to experiencing another dislocation in the future. By keeping up on the activities outlined by a physical therapist, one has less risk of going through the experience again in the future.
The beginning of all physical therapy programs will start with range of motion activities. Then, it will progress to exercises that are designed to strengthen. Depending on the injury and its severity, a physical therapist may start with strengthening and progress to range of motion exercises. Eventually, strengthening exercises will become the main aspect of care, with a special emphasis on the hamstrings and the quadriceps. As the muscles in the legs become stronger, it is permissible for more weight-bearing activities to take place. These types of activities will occur for up to 12 weeks.
Once the initial rehabilitation occurs, a physical therapist will focus on more complicated movements and activities. One may engage in exercising on a stationary bike, perform exercises on an elliptical machine, and even workout on a cross-country skiing machine, or similar type of exercise machine. Then, an emphasis will be placed on coordination-type exercises. These and the activity-based exercises will continue on for the remainder of the rehabilitation program. By the time that the program ends, the knee should be fully healed and completely recovered. Immediately thereafter, the doctor on the case may make the suggestion for continued strength training activities for the knees and impacted leg.
A kneecap subluxation is a partial dislocation of the kneecap. This is also referred to as “patellar subluxation”. Many medical professionals may refer to it as “kneecap instability” or “patellar instability”. The patella (kneecap) is a small type of bone that connects to the bottom region of the thigh bone. When up and down movements are performed, it moves up and down in a grooved area that is called a “trochlea”. The kneecap is connected to muscles and ligaments. When these become injured, the kneecap will slip out of the grooved section. This results in problems with flexing the knee and immense pain.
In most instances, the kneecap is pushed towards the outside area of the knee. The following outlines the symptoms that are often experienced in a kneecap subluxation:
- The knee may seemingly buckle, catch, or appear to lock up.
- The kneecap will slip over to the outside of the knee.
- If one sits for an extended amount of time, they may suffer from pain in the knee and leg.
- If the kneecap is dislocated, it is common to suffer from pain immediately following engaging in physical activities.
- The knee may pop or crack. While these pops and cracks may be heard, they are most often felt within the knee area when engaging in physical activities.
- The knee will likely experience inflammation.
- The knee will likely feel and actually become quite stiff.
In most instances, it is possible to diagnose a kneecap subluxation on one’s own; however, it is important to seek medical attention. This injury is most often caused by a fall, participating in sports, or a strong blow to the knee. In most instances, they affect younger people, but may happen in older individuals -especially in those that have fallen. To diagnose, a physical examination, an x-ray, and an MRI may be performed. In most instances, rest, RICE, braces and/or crutches, and elevation will help correct the issue. Physical therapy will also greatly aid those that suffer from kneecap subluxation.
We Are Here to Help
Back to Motion specializes in helping rehabilitate knee dislocations and/or a kneecap subluxation. If you are ready to rehabilitate, strengthen up, and improve your range of motion, you will be pleased with the services and activities that we offer. We focus on patient-centered treatment plans in order to boost recovery times and effectiveness. If you live in the Denver area, read about Physical Therapy for your Knees and call us to make an appointment