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Three easy keys to recovery post patella dislocation!

Three easy keys to recovery post patella dislocation!

I’ve been lucky and avoided the trauma of experiencing an acute patella (kneecap) dislocation, unfortunately this was not the case for my sister. She recalled the event where she was running and went to step. She suddenly felt a big ‘pop’ in her knee as she fell to the ground in pain. Fortunately for her, the patella popped back in no sooner than it went out, but the pain remained for some time. My question is, how can we manage this and do we need surgery? Before I can answer these questions, I wanted to know one thing.

What do I do if the knee pops out?

If you are reading this while your knee is dislocated, I wish my hand could reach out of this text and slap you – you need to go to emergency and get it relocated! Fortunately, most dislocations will relocate spontaneously when you straighten your leg, like my sisters’. After this initial injury, still use the principles of RICE (rest, ice, compression, elevation).

It’s generally recommended to brace the knee straight for a couple of weeks to allow the ligaments time to heal. This principle holds true across most acute injuries – the joint is immobilised, so the fibres that are torn have a chance to repair. There are a couple of ways to do this – either a brace, or a taping strategy, which glides the kneecap in. Click here to see it in YouTube.

After the initial immobilisation I have found three easy keys to recovery:

   Key #1 – Just walk normally

After 2-3 week of bracing it’s time to get stuck into restoring normal movement. The main priority in this stage, is to walk as normally as possible. I find that if you can manage this early, your knee will loosen naturally, as it’s moving like it was designed to. Work on walking with your heel first, and bending the knee as you lift it to take a step.

I have two quick tips to help you with your walking pattern. Try walking backwards – this helps to fire up your gluts and hamstrings, encouraging those big muscles to pull their weight. Next, put some small objects on the ground about 1.5m apart, then as you walk forward, step over them. Step over firstly with your good leg, so your sore leg must bend at the knee to get over the object. Your body will try to cheat by lifting your hip instead of bending the knee behind you, watch out for this!

   Key #2 – It’s all about strength

Especially if you play sport – but even if you don’t – you need to get your muscles strong to avoid this happening again. First time dislocations have about 17% chance of it happening again, but if it does dislocate a second time, the chances that it will keep happening sky-rockets to 49%! The moral of the story is to strengthen while you can.

I like to start with quadriceps – particularly the inside muscle called your VMO (vastus medialis oblique). You can do this with a simple seated knee extension. Sit on a chair and straighten the knee all the way to the end – put a weight on your foot to make it harder on the quadriceps. Please have a look at our youtube clip for the whole exercise!

Just focusing on quads alone will help, but there are other muscles which are important. As in my previous anterior knee pain blog, you need to get hips and trunk muscles strong! Check out that blog to see some exercises that will help with this.

  Key #3 – Get back to doing sport and stuff

This stage is all about getting your knee ready for the load you use to put through it. Interesting fact, when you run there is approximately 4-7 times your body weight going through the knee! Start jogging straight before adding twisting and turning. Make sure the knee is strong and feels stable. The main take-home here is start slowly and when you are confident, continue to progress.

To get back to being sport-ready, start with straight line running, then add slow small cuts (side-step), then increase the speed and angle of your cuts. After you’re confident here, then progress to uneven ground. Finally, move to training before you start back at any games to see how the knee goes.

So, will I need surgery?

It is advisable to get an X-ray after a knee dislocation because sometimes a little bit of bone can be dislodged in the impact. If this is the case, it would be prudent to get a surgical opinion, even if it is your first dislocation. Below is an X-ray of a dislocated knee cap.

As mentioned above, if your knee has only popped out once, just strengthen like crazy – provided there wasn’t anything funky on the x-ray. It’s when the knee dislocates more than once that you would need to consider surgery.

For those of you that just skipped to my conclusion…

First time dislocations with no bony problems on x-ray should be managed with physiotherapy. If you have dislocated your knee more than once, it’s wise to get an orthopaedic opinion as you have a 50% chance of continuing dislocations.

For any help with getting you back on track, don’t hesitate to book an online appointment at Click Physiotherapy. We want to see you fighting fit and sport ready!