Denise manages a scholarship program and bowls regularly. She fell at work and fractured her patella (kneecap) and had it surgically repaired. She was braced for several weeks with her knee slightly bent. When she reported for therapy she had a knee flexion contracture, severe weakness, and was unable to bend her knee due to stiffness.
Although she obviously needed work to restore her ability to bend the knee without pain, initially our first goal was to restore her ability to lay the knee straight. An ancient orthopedist once proclaimed “A Straight Knee is a Happy Knee” meaning that any knee that cannot lay straight is going to continue to cause difficulties with pain, weakness, and stiffness. While aggressively working on her knee extension with manual therapy and home exercise, she also began the long process of regaining her ability to bend her knee by performing exercises several times each day.
Although her actual therapy was more or less uncomplicated, her situation presented challenges – Denise’s injury was covered by her employer’s worker’s compensation plan. Because her knee had been bent and braced for so long, her recovery needed a few more visits than “the textbook” called for, and her worker’s compensation reviewer balked at the prospect of any more therapy. At that time, her knee only bent to about 90 degrees, and she was still unable to straighten it fully, and needed a cane to walk.
Working with her nurse case manager we were able to continue her therapy – making sure that her therapeutic needs were met while being responsible and responsive to payer concerns. Much of Denise’s program and progress relied on repetitive activities performed several times each day. Those activities were reviewed and Denise performed those as requested, so her clinic therapy program focused only on those items which required the specific skill of a therapist to accomplish. As a result, we decreased her clinic therapy schedule to 1-2 times a week to allow her knee time to recover once she could straighten it fully, and then less than once a week once we were able to return her slowly to exercises and drills specifically tailored to her bowling.
Denise was released from therapy able to bowl about 4 frames before her knee becomes sore, but reports that each time she bowls, her pain is less. She is expected to make a full recovery without the need for additional therapy – regaining her ability to bend, squat, lift and bowl – on a timeframe that matches the ability of her body to reinforce the bone in her knee cap.
“Guy gave me the ability to overcome my injury.”