Physiotherapy Case Study: Knee Pain Treatment after Anterior Cruciate Ligament Surgery with Online Physiotherapy
by Physiotherapist Dr. Suveda Kothari (PT) (BPT, MPT – Cardio respiratory)
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Online Physiotherapy for Knee Pain: ABSTRACT
A young male patient Aaryan (name changed) had knee pain along with stiffness and specifically painful right knee even after one month from knee surgery. A bike accident had resulted in fall causing ACL tear: complete tear of anterior cruciate ligament, partial tear of posterior cruciate ligament, undisplaced fracture, ligament sprain and muscle contusion. Orthopedic surgeon advised ACL reconstruction surgery followed by physiotherapy for knee. [You can learn more about ACL Tear : Recovery by clicking on this link]
Owing to COVID-19 related lockdown, he was unable to take in-person physiotherapy after the surgery. Once he found about ReLiva’s tele-physiotherapy services, he chose to go for physiotherapy treatment remotely. It helped him not only for knee pain relief but also helped in completing recovery and regain mobility after surgery.
Online Physiotherapy for Knee Pain: PREFACE
Mr Aaryan (name changed), 29 yr old, male patient was operated for Anterior Cruciate ligament reconstruction of right knee, a month ago.
Patient had sustained fall from his bike 2 months ago after which he could not walk properly. He had swollen knee and right knee pain. After consulting Orthopedic doctor, he was advised to do MRI scan of his right knee.
MRI of knee revealed a near complete tear of anterior cruciate ligament (ACL tear), partial tear of posterior cruciate ligament, undisplaced fracture of medial and lateral tibial cortex. It also suggested a lateral collateral ligament sprain and muscle contusion along popliteal muscle.
Patient was operated for ACL reconstruction on 14 March, 2020. He was shown few basic knee exercises by the physiotherapist at hospital before discharge. The operating orthopedic surgeon advised him to perform same exercises and walk with long knee brace at home for next 4 weeks. After which he was supposed to start physiotherapy exercises for knee rehab under supervision of a physiotherapist. Meanwhile the country was in a lockdown. Hence the patient could follow up with neither the physiotherapist nor the orthopedic doctor at hospital.
Patient approached Reliva Physiotherapy & Rehab through internet, came to know about Tele-physio services, and opted for online physiotherapy.
Online Physiotherapy Appointment & Scheduling:
Once Mr. Aaryan contacted ReLiva, the appointments team helped schedule a convenient appointment for him with an orthopedic physiotherapist best suited for his condition. He was given details about how online physiotherapy will progress, approximate session duration and packages available.
He opted to take his video sessions via Whatsapp video call.
Online Physiotherapy Consultation:
Knee Pain History:
After surgery, patient continued with the movements and exercises suggested by the hospital physiotherapist. Even after one month from surgery, the patient still complained of right knee pain and stiff knee on his right side.
Since the patient is a young and active person, he was very anxious about his recovery. He was apprehensive about persistent knee pain and restricted knee movements. He was eager to restart his workouts and get back to his fitness routine as well resume driving as soon as possible.
Online Physiotherapy Assessment:
Physiotherapist Dr Suveda Kothari (PT) connected with him on the scheduled day and time for initial consultation and assessment of his condition and symptoms. The patient shared his X-ray, MRI reports and surgery notes, prescriptions etc with her via Whatsapp.
During consultation, patient was asked to perform specific movements & demonstrate posture. He was assessed for the following:
- Current discomforts – Patient complained of knee stiffness
- Knee pain – Patient complained of sharp pricking pain (7/10 on pain rating scale)
- Range of motion – approximately 80 degree on the right knee
- Gait pattern
The patient was also asked on the video call to demonstrate the exercises that he was already practicing.
Online Physiotherapy for Knee Pain:
Patient was advised to use ice pack to reduce pain and swelling around his right knee. [Read here to understand how cold pack works differently from hot pack]
After watching him perform the exercises, the physiotherapist identified that the patient had a poor form for doing the exercises. This was causing a delay in his recovery. He could not achieve the desired effect of exercises in terms of getting knee pain relief and gaining mobility. He was advised corrections on his form for exercise. The physiotherapist also corrected his gait pattern.
At Reliva, physiotherapists use Education to empower the patients towards their recovery. On the same lines, Mr Aaryan was explained about the biomechanics of the knee and how it is altered due to the fall as well as surgery. Based on these learnings, he was guided through the process of setting appropriate recovery goals.
- Short term goals for reducing pain, increasing mobility and improving knee strength
- Long term goals for improving overall endurance
He was advised to do home exercises as per a specific dosage in the corrected form taught to him during the session. The time and day for next session was finalised.
Online Physiotherapy Treatment: Session 2 (Day 3)
Next session was done after 2 days. His progress was reviewed across various parameters.
- Knee pain had considerably reduced. NRS was 2/10 on pain scale.
- Range of motion had increased to 90 degree.
Patient was still apprehensive to take any weight on his operated leg. However, it was noted that the patient reported considerably lower sharp pain while walking.
His exercises were revisited and progressed appropriately. It was emphasised to use “Exercise as Medicine” and that correct form and dosage both matter for overall recovery.
Online Physiotherapy Treatment: Session 2 (Day 3)
Next session was done after 2 days. His progress was reviewed across various parameters.
- Knee pain had considerably reduced. NRS was 2/10 on pain scale.
- Range of motion had increased to 90 degree.
Patient was still apprehensive to take any weight on his operated leg. However, it was noted that the patient reported considerably lower sharp pain while walking.
His exercises were revisited and progressed appropriately. It was emphasised to use “Exercise as Medicine” and that correct form and dosage both matter for overall recovery.
Online Physiotherapy Treatment: Session 3 (Day 6)
When we evaluated patient’s progress during the next session, we found that:
- Pain: Patient did not report any pain
- Range of Motion: Patient could achieve almost around 110 degree of knee bending
- Gait: Patient was walking much more confidently without limping
Patient was very happy with his progress on knee treatment.
Online Physiotherapy Treatment: Maintenance
The patient was already seeing improvement due to regular exercises in correct form, as per the specified dosage. Home exercise prescription was revised to ensure he continues to progress and achieve his goals.
Online Physiotherapy for Knee Pain: CONCLUSION
Anterior cruciate ligament (ACL) reconstruction is a common procedure and Rehabilitation of the reconstructed knee is critical for the successful return to activities.
Physiotherapy based knee rehabilitation aims to restore range of motion and stability to the knee, whilst protecting the reconstructed ligament. Physiotherapist Dr Suveda (PT) remarks, “In this case tele physiotherapy worked perfectly to correct exercise form, attain pain relief and eventually enable the patient to attain walking without limp.”
If you, or someone you know would benefit from physiotherapy treatment and you do not have access to it right now, please register for an online physiotherapy session here or simply call us at +91 99209 91584 and we will connect you with a physiotherapist best suited for your requirement.
Related Case Studies for Online Physiotherapy:
Back Pain Treatment with Online physiotherapy
Shoulder Pain Treatment with Online Physiotherapy
Online Physiotherapy for Fracture Treatment: a Case Study
Hemiplegia Treatment: Online Physiotherapy
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