Assessment of your Knee Injury

This includes a detailed subjective history, assessment of imaging, and thorough objective examination (both functionally and non-weight bearing). A differential diagnosis will be provided along with discussion around appropriately staged rehabilitation, time frames and expectations. Plus if required, priority onward referral to Melbourne's leading sports physcians or surgeons whom we work closely alongside.  This is perfect for physiotherapists not getting the desired results from patients they are treating, or for people wanting a second perspective to assist with management options.

Return to Sport Testing

After Anterior Cruciate Ligament reconstruction, it is important to assess the appropriate timing of your return to sport while keeping re-injury risk minimal. Certain factors increase your re-injury risk eg. strength, movement control, female gender, age < 20 years, time from surgery, family history of ACL injury (e.g. parent/sibling), non contact injury (landing or side stepping), and return to a change of direction sport (e.g. AFL, netball or Ultimate Frisbee). 

Your local Physio can refer for this testing procedure (see attached referral pack). After your test you will be provided a 2 page report and recommendations.

Testing generally comprises 2 parts:

Part 1) Ideally done first, Isokinetic testing of quads and hamstring power @Swinburne University. The reason this is done first is assess if you are ready for the functional component

Part 2) @ Prahran Sports Med- Functional component

a) Clinical assessment of your knee 

b) Functional testing - hopping power, endurance and control (complexity dependent on outcomes of Isokinetic testing and general control for safety purposes)

c) Questionnaires regarding symptoms and confidence

d) Discussion around individualised risk vs readiness for more complex tasks, along with recommendations regarding rehab progression

Screening & Prevention Program

We are passionate about keeping people active and injury-free. Our state of the art facilities at Prahran Sports Medicine include a functional testing pod, along with strength and power testing equipment normally found only in research labs. Our specialist and sports physiotherapists have formulated evidence based testing protocols using these physical tests combined with clinical questioning to determine an individuals injury risk for a particular sport. From these screening findings, we tailor a prevention program consisting of targeted strength and neuromuscular control training, and advice. Our specialized gym facilities are also available to clients to use to complete their programs.

Strength and Isokinetic Testing

Muscle strength is the force a muscle can generate. Power is the ability to generate this force at speed (ie. for jumping, landing, sprinting). We use specialised strength and power testing equipment to measure the symmetry of leg muscle groups (difference between left and right limbs) and to assess an individuals strength compared to others of their age and gender. This is a more reliable indication of physical capacity than hand held strength testing tools. It also provides objective assessment of risk factors and contribution to certain injuries and conditions along with measuring rehabilitation progress.

We offer 2 types of strength and power testing:

a) In-house isotonic strength and power testing on our state of the art pneumatic Keiser equipment. This is done quickly and easily and can assess many lower limb muscle groups. Depending on your individual knee, strength testing is either completed at one, four or eight repetition maximum. These test results can then be sent to your referrer, used to gauge progress with rehab or to identify targets for further rehab. They can be used to set individualised training programs to achieve specific goals at each phase of rehabilitation e.g. hypertrophy (muscle growth).

b) Isokinetic power testing provided by our research biomechanics colleagues at Swinburne University Hawthorn. This testing is gold standard and assesses quadricep and hamstring power at slow, medium and fast speeds. We use it as part of our baseline pre-operative testing process (uninjured leg) and our late stage (return to sport) testing process, a protocol also used by several of our knee orthopaedic surgeon colleagues. This data is interpreted in 4 main ways: limb symmetry (right vs left), ratios (hamstrings vs quads), power at fast vs slow speeds, and assessing your strength compared to age/gender matched uninjured populations.

For all referrals- please refer to our contact page or call 9529 8899 for bookings

GLA:D

Advanced and later stage rehabilitation

Good Living with Arthritis: Denmark (GLA:D) is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthrtitis (OA).

Research has shown great results in pain reduction and improved function in people completing the GLA:D program, without causing flare ups. This is consistent with current national and international clinical guidelines recommending patient education, exercise and weight loss as first line treatment for OA.

What's involved? An initial appointment assessing your suitability for GLA:D, explaining the program and conducting a few basic physical tests. Two education sessions teaching you about OA. Group exercise sessions twice a week for 6 weeks focusing on strength and limb control. This helps improve movement patterns at the knee and hip which leads to reduction in symptoms and improved quality of life. 

Rehab from a knee injury is often a long process and it’s common for people to lose their way.

If you feel like your progress has stalled, you’ve lost motivation, your knee is still symptomatic despite best efforts, or you’re not sure how to get to where you’d like to be (no matter how long ago your injury or surgery was)- give us a call.

We can thoroughly assess where you’re at by discussing your current symptoms, rehab and exercise, examining your knee and getting some objective baseline measures to accurately determine why you’re not making the progress you’d like. From there, we can plan how to get back on track with rehab, be very specific with what you need to be doing (be it with gym strength programming, running drills, more complex jumping and landing, or maybe taking things right back to basics) and set appropriate goals. In certain cases, we may recommend you discuss specific symptoms further with your orthopaedic surgeon.

Many people work very diligently on their rehab in the early days but drift a bit once their knee feels fairly good. They are also commonly discharged from physiotherapy earlier than is ideal, without guidance through the critical and more complex stages of building full strength, power and control along with returning to complex sporting scenarios safely. Conversely, often people are given too complex rehab drills without having an adequate base of strength and control. We are the experts in knee specific exercise rehab and return to performance throughout the entire process. If you like, we can also work with you and your current physiotherapist, personal trainer or exercise physiologist to make sure that your rehab is knee appropriate and tailored to you as an individual.

Knee Osteo Arthritis (OA) 

What is knee OA?

Knee OA is one of the most common chronic musculoskeletal conditions seen by physiotherapists, and affects a large number of Australians. It is generally considered a degenerative condition (ie, occurs via wear and tear).

Hyaline articular cartilage is a special type of tissue that coats the ends of the bones located inside joints. In the knee, articular cartilage covers the ends of the femur and tibia, and the back of the patella along with its groove. It is made of cartilage cells (chondrocytes), collagen, water and various proteins. Its role is to provide a smooth, friction-free surface to allow the joint to glide, while helping transmit load to and protect the underlying bone (subchondral bone).

OA is a condition in which the hyaline articular cartilage thins, develops cracks and can eventually wear away. This can result in a rough joint surface and reduce the cartilage’s ability to protect the subchondral bone. OA doesn’t, however, just affect the joint cartilage. As OA progresses, bone spurs can form in the joint, the subchondral bone can form cysts and the menisci (washer-type cartilages within the knee joint) often develop degenerative tears. The layer of tissue which surrounds the inside of the knee joint (synovium) can also become inflamed and increase production of joint fluid, leading to swelling. All of these changes are thought to contribute to the pain and various other symptoms of knee OA.

What causes knee OA?

The articular cartilage of the knee is kept healthy by movement and load. OA develops when the articular cartilage is either exposed to higher loads than it can withstand, often over a long period of time, or when the cartilage itself isn’t able to withstand relatively normal loads. Knee OA is therefore caused by a variety of factors including:

·Age. Though knee OA can affect younger people, it is significantly more common with each decade above the age of 45.

Weight. Being overweight increases the risk of knee OA, and increases the likelihood of it progressing. This is because the knee is a load bearing joint and as such, loads on the articular cartilage of the knee are relative to body weight.

Gender. Before the age of 50, men have slightly higher rates of knee OA, but after the age of 50, the rates are higher in women.

·Past history of trauma or surgery to the knee (eg, ligament reconstruction). This may lead a person to develop knee OA at an earlier age than average due to specific damage to the cartilage at the time of injury, or the strength and stability able to be regained in the knee post-injury.

·Family history of knee OA. Some people may have inherited a form of articular cartilage which is less robust than average, reducing its ability to withstand load over time.

Heavily physical occupations. These can place a lot of load on the knees over many years.

·Natural leg posture. For example, in a person with ‘bow legs’ the inner aspect (medial compartment) of the knee will bear more load than the outer aspect (lateral compartment). This load accumulates over the years and can cause early wear and tear of the cartilage in the medial compartment of the joint.

·Biomechanics. For example, in a person with long-term patella (kneecap) maltracking, the repeated rubbing of the patella against its groove can cause early wear and tear to the articular surfaces of the patellofemoral joint.

·Muscle weakness. Especially in the quadriceps (front of thigh) muscles can contribute to increased loads being placed on the joint surfaces.