Children’s knee injury – soft tissue

Immediately after a knee injury, it is important to manage it correctly, it is very important to keep your knee moving as best as possible as well as trying to reduce the pain and swelling.

The current guidance on treating soft tissue injuries follows PEACE and LOVE principles.

PEACE

• Protection – Avoid activities and movements that increase pain during the first few days after injury.
• Elevation – Raise the injured limb higher than the heart as often as possible.
• Avoid Anti-Inflammatories – Avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing.
• Compression – Use elastic bandage or taping to reduce swelling.
• Education – Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role.

LOVE

• Load – Let pain guide your gradual return to normal activities. Your body will tell you when it is safe to increase the load.
• Optimism – Condition your brain for optimal recovery by being confident and positive.
• Vascularisation – Choose pain-free cardiovascular activities to increase blood flow to repairing tissues.
• Exercise – Restore mobility, strength and proprioception by adopting an active approach to recovery.

If you follow this advice leaflet your injury should take around 6-8 weeks to heal.

However, everyone recovers from injuries at different rates and it is dependent on the severity of the injury, the soft tissue that was involved and the presence of any other medical problems.

0 – 2 weeks after injury

If you have been given a splint and/or crutches in the Emergency Department (ED) use these as required in the early stages. You should attempt to wean off them within the first 48 hours and resume normal activities as soon as your knee feels comfortable and you feel able to.

It is safe to move and put as much weight through your leg as you feel able to both with or without crutches. It is also safe to start the exercises in this leaflet right away.

2 – 4 weeks after injury

Start to try and add in some gentle cardiovascular activity like cycling or swimming as you feel able to as well as keeping other parts of your body moving like doing core stability exercises or upper body exercises if you have access to a gym.

If after 2-3 weeks, you are still struggling with any of the following, please contact the physiotherapy department on 0131 3121079 and ask to make a self-referral:

• Still having difficulty fully bending and straightening your knee
• Still have significant swelling (small amounts of swelling may remain)
• Are unable to put all of your weight through your leg without crutches
• Have a feeling that your knee is going to give way when walking

4+ weeks after injury

Gradually progress through all of the exercises in this leaflet over the next few weeks.

If you have followed all of the exercises within this guide and gradually built up your activity levels it is safe to start re-introducing more challenging activities such as gentle running and jumping.

You can also start adding in more sport-specific activities as you feel able to and make a gradual return to training.

Remember to always be guided by your knee – a little bit of pain and or swelling that goes away quickly is normally nothing to worry about but if you are experiencing high levels of pain and or swelling that don’t settle quickly you should contact the physiotherapy department on 0131 3121079

Try and start working through the following exercises as soon as you can – it is safe to start these exercises right from the day after your injury.

Exercise 1

Sitting with your legs out and a roll under your injured knee, pull your toes up and lift your heel off the floor. Try and hold your knee as straight as possible for 5 seconds and then gently lower it back to the ground.

It may be difficult to fully extend your knee initially but keep working to make it go as straight as you can manage.

Repeat 3×10 times, twice a day.

Exercise 2

Elevate your leg regularly, especially if you have been at school all day or doing a lot of walking around. This can be done lying on the floor with your leg up on the sofa or bed or lying on the sofa with your leg up on the armrest. Try and keep your foot and ankle moving whilst your leg is elevated which will help reduce swelling in your leg.

Aim to have your leg elevated for approx 10-15 mins at a time.

Exercise 3

Sit in a chair with both feet flat on the floor, pull your toes up and lift your foot off the floor. Try and hold your knee as straight as possible for 5 seconds then gently lower it back to the ground.

It may be difficult to fully extend your knee initially but keep working to make it go as straight as you can manage.

Repeat 3×10 times, twice a day.

Exercise 4

Practice standing on your injured leg. Initially do this at the kitchen side where you can hold on for support and try to hold your balance for 30 seconds to a minute.

Think about working your thigh and bottom muscles to keep your leg straight and strong.

You can progress this exercise by balancing on one leg whilst you are cleaning your teeth, throwing and catching a ball or looking up or down and side to side whilst standing on one leg.

Physiotherapy video

Start these exercises as soon as your movement has returned and your pain has settled.

Exercise 1

• Stand with your back against a wall and feet about 30cm out from the wall, keep your weight even between both legs.
• Bend your knees into a squat position.
• Hold for 5 seconds.
• Stand back up again.

If you have a ball that you can put between your knees squeeze into the ball as you are sitting down and standing up. Don’t worry if you don’t though, this exercise can be done with or without it.

Repeat 3×10 times a day.

Exercise 2

• Stand on the edge of a small step if you have one or just the floor on your affected leg.
• Push slowly up onto your toes as high as you can.
• Hold for a couple of seconds.
• Slowly lower back down.

Repeat 3×10 times a day.

Exercise 3

• Stand on your affected leg in front of a sturdy chair.
• Slowly sit down in the chair until you touch it with the bottom or back of your legs.
• Stand back up again.

Repeat 3×10 times a day.

Exercise 4

• Stand at the bottom of your stairs or in front of a high step.
• Place your injured leg up onto the step and step up like in the picture, try to keep your other leg off the step.
• Slowly step back down keeping the movement smooth and controlled.

Repeat 3×10 times each day.

Physiotherapy video

Once your knee is no longer painful and the movement is much better you can gradually return to gentle activities.

As your knee continues to feel better you can gradually return to your usual activities ensuring you warm up and cool down fully. If you feel you can you do not have to wait for the go-ahead from a health professional to return to your normal activities.

If you have regained full movement at your knee can walk and run pain-free and have been able to return to your normal sports and activities you don’t need any further assessment or treatment.

If you do have any concerns or are struggling to return to your normal activities please call the physiotherapy department to make a self-referral.