Chronic Knee Pain

Case Description: Patient is a 75 y/o female.   She had a multiple year history of progressive knee pain was set to undergo a R knee replacement just prior to starting PT, however this procedure was cancelled due to complications from congestive heart failure.  She had never had conservative treatment in the form of physical therapy for her chronic knee pain.  Her pain and weakness had led to multiple falls or near falls and she was using a walker at all times.  Imaging showed severe degenerative changes

Objective Measures: Patient was seen for 8 physical therapy visits over 6 wks

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
VAS for Pain	2-8/10 diffuse knee pain	0-2/10
LEFS impairment	63% disability	24% disability
Gait Pattern	Walking with walker at all times and antalgic even with use of an AD. Hx of multiple falls	No longer needing walking.  Indep ambulation in home.  Cane for longer distances
Daily Tasks	Multiple near falls entering her 2nd floor apartment, struggling to walk household distances, strong UE support for transfers	SLS 5+ s either LE, stairs reciprocally without issue, walking in community with cane only, 9 sit to stands in 30 sec without pain

Take-aways from care: Physical therapy should be a first line option for those dealing with knee pain, even in the setting of images showing arthritic/degenerative changes.  These changes on imaging are not always associated with function/pain and in order to minimize risk, more conservative treatment should be considered prior to surgery. 

Sincerely,

Luke Vander Zouwen, DPT
Full Potential Physical Therapy