Emergency and Urgent Care - Knee Injury Service

What is a knee injury?

They are simple musculoskeletal injuries and will usually get better by looking after them yourself.

Common knee injuries include:

• Sprains – over-stretching of the ligaments
• Strains – over-stretching of the muscles and tendons
• Injury to the cartilage (meniscus)
• Irritation of the kneecap (patellofemoral)

When soft tissues such as ligaments are damages, there is often pain, swelling and bruising. The pain is usually at its worst in the first 3 days after injury.

Depending on the extent of your injury, you may have been given a brace (cricket pad splint). You will have been given instructions on how to use this.

Your knee may feel stiff at first, but it is important that you continue to move it as this will help your recovery. The ligaments within the knee need to be kept on moving so that they don’t heal in a tightened position. As the pain settles down after the first few days, gradually increase the level of activity; move as much as you can without causing pain.

Recovery

Healing of the ligaments normally takes about 6 weeks, although everyone recovers from injuries at different rates. Healing time is related to how severe your injury is and any other medical problems you may have.

As healing gets underway, it is important that you begin a series of exercises to help you get back the full use of your ankle by improving its flexibility and strength. This will help to reduce the risk of further sprains.

P - Painkillers: it is important that you take regular painkillers to reduce the pain and help you keep moving around. Paracetamol and ibuprofen are effective painkillers if they are taken regularly and can be taken at the same time. These medications can be easily purchased over the counter at supermarkets and pharmacies. Please carefully read the instruction leaflet with the medication and only take the recommended dose; there may be reasons why you cannot take these medications, a pharmacist will be able to help you with this.

R - Rest: will help prevent further injury and allow the healing process to begin. For the first 2 days reduce the amount of walking you do and gently exercise your knee to prevent stiffness. Avoid forceful and strenuous activity, such as running, until you can walk without it causing pain.

I - Ice: can help reduce swelling and reduce pain. Make an ice pack by wrapping a small bag of frozen peas or some crushed ice cubes in a damp towel – DO NOT put ice pack directly onto skin. Put the ice pack on the knee for up to 20 minutes every 2 hours for the first 3 days after the injury. Then use the ice pack 3 times a day until the swelling has gone down. DO NOT eat food that has been thawed and refrozen.
 
M - Mobilisation: walking will not damage your knee any further. Always try to walk normally by putting your heel down first. In the early stages after your injury, spending a lot of time on your knee may cause increased pain and swelling. You may be given crutches for a short time to help with this. Gradually increase your activity as the pain and swelling subside. DO NOT go back to sport until you are fully fit or when advised by your physiotherapist.

E - Elevation: your knee will probably swell up after the injury. When this happens, keep your knee raised as much as possible to keep the swelling to a minimum. You can do this by resting your leg on a footstool or on pillows; your knee should be higher than your hip.

What to avoid

H - Heat: hot baths, saunas and heat packs will increase swelling and bleeding.
A - Alcohol/Smoking: reduces healing and increases swelling and bleeding.
R - Running: or any form of weight bearing exercise which may increase further injury.
M - Massage: may increase swelling and bleeding.

Exercises:

• These exercises are aimed at increasing joint movement, preventing stiffness, increasing muscle strength, reducing pain and improving function
• The exercises will be most effective if practised “little & often” repeating a few times every hour, and at least every 2 hours
• Try to build up repetitions
• You may have been given crutches to help you walk normally; it is important that you put as much weight through your injured leg as possible and walk with a straight knee to aid healing. Stop using them when you are able

Knee Bend

• Sit on the floor or your bed with your legs stretched out in front
• Keeping your heel to the floor, slowly bend your injured knee as far as you feel it is comfortably stretched
• Hold for 5 seconds
• Straighten your leg as far as you can and hold for 5 seconds
• Repeat 10 times

Straight-leg raise (sitting)

• Sit well back in the chair
• Straighten and raise your injured leg
• Hold for a slow count to 10, and then slowly lower your leg
• Repeat 10 times

Straight-leg raise (lying)

• Bend your GOOD leg at the knee
• Hold your BAD leg straight and lift the foot just off the bed/ floor
• Hold for a slow count of 5, and then lower
• Repeat 10 times
• Try doing this exercise in the morning and at night whilst lying in bed

Leg Cross 

• Sit on the edge of the bed and cross your ankles over
• Push your front leg backward and back leg forwards against each other until the thigh muscles become tense
• Hold for 10 seconds and then relax
• Switch legs so the other ankle is on top and repeat exercise

Knee Squats 

• Hold onto a chair or work surface for support
• Squat down until your kneecap covers your big toe
• Return to standing
• Repeat at least 10 times
• As you improve, try to squat down a little further
• Don’t bend your knees beyond a right angle

Hamstring curls

• Stand holding onto the back of a chair or work surface for support
• Bend your BAD knee, taking the heel backwards towards your bottom
• Slowly lower the leg down to the floor
• Repeat 10 times

Step-ups

• Step onto the bottom step of stairs with your right foot
• Bring up the left foot onto the step, then step down with the right foot followed by the left foot
• Repeat exercise starting with the left foot first
• Continue repeating until you are short of breath 
• Hold onto the banister if necessary
• As you improve, try to increase the number of steps you can do in 1 minute and the height of the step

Returning to physical activity

• Returning to sport and work will depend on the demands of your job or chosen sport
• Recovery is faster if you stay at work, or go back to work as early as possible
• If you are on your feet all day you may need to gradually return to work, do light duties initially, or have regular breaks to elevate your leg
• Once you have regained movement, strength and balance you can slowly start to increase your activity back to your previous level

Driving

It is important that you contact your insurance company to let them know about your injury. You may be able to drive once you are able to perform an emergency stop safely and fully operate your vehicle.

Physiotherapy

If you are unsure about what to do and feel you need support with your rehabilitation, then you can always go to see a Physiotherapist.

If you live in the Heywood, Middleton and Rochdale area, you can refer yourself by using the following link:
www.physiodirect.northerncarealliance.nhs.uk

Things to watch out for:

If you experience any of the following you should return to the Urgent Care Centre or attend an Emergency Department:

• You develop a sudden, sharp increase in pain that is not relieved by painkillers
• You develop a sudden loss of movement to the knee
• Your knee becomes hot, red and swollen
• You begin to feel generally unwell with any of the above symptoms

If you knee does not seem to be improving after 2 weeks or is not significantly better by 6-8 weeks after your injury, you need to be re-assessed. You should visit your GP for this.

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form, follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.

Possible complications

If follow up has been arranged, you should attend this.

If your injury does not require, follow up you will have been given an approximate recovery time during your visit to the Urgent Treatment Centre.

• If the pain is ongoing despite treatment and analgesia
• You experience tingling/change in sensation to the leg
• You develop signs of a DVT such as a hard swelling and redness to back of leg or knee please contact Rochdale Urgent Treatment Centre on 01706 517023 or return to the department.