- 1 hour on-demand video
- 9 articles
- 33 downloadable resources
- Full lifetime access
- Access on mobile and TV
- Certificate of Completion
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- understand the situations that raise the risk of knee stiffness after injury or surgery
- recognise the critical window of opportunity for managing the early stiff knee and regaining range of motion
- grasp the key principles of rehabilitation to restore range of motion
- be sure when rehabilitation is progressing inadequately and know when to refer to a surgeon
- understand the surgical options for early knee stiffness
- understand the surgical options for established arthrofibrosis
- understand why a team approach is necessary after surgery for established arthrofibrosis
- grasp the special rehabilitation requirements after surgery for established arthrofibrosis
- There are no prerequisites other than an interest in knee rehabilitation.
This course is for anyone involved in the early rehabilitation after knee injury or surgery. It would also be of value to trainee physiotherapists.
Because internal joint scarring, if it is going to occur, is likely to trigger early in the rehabilitation process, then it is the patient and the physiotherapist who need to be looking out for the danger signs. If they understand the issues and what to watch for, then management can be optimised before there is a progression to the tragic outcome of intractable scarring (arthrofibrosis) with irreversible stiffness of the knee.
The course explains the issues, anatomy and terminology - with loads of easy to follow illustrations and videos - so that your rehabilitation programme will really start to make proper sense. You will learn what the physiotherapist is trying to do, and why. You will learn about those surgical procedures that may be helpful in the process of freeing up movement again.The course should take four hours to complete, but there is no need for any pre-knowledge as it is fully comprehensive.
- This course is for ordinary people who have had a knee injury or surgery and who want answers about how best to get their knee moving fully again. No prior knowledge is needed, and lectures are fully illustrated.
- There is also plenty here for physiotherapists and doctors, who want to really understand why their patients are having problems with rehabilitation.
Meet your hosts - Sheila Strover and Sebastiano Nutarelli, and find out what makes them both passionate about the topic of knee stiffness.
Sheila Strover BSC(Hons) MBBCh MBA
Medical doctor based in the UK. Founder of the KNEEguru website, which is dedicated to helping people with knee problems find the information they seek and the help that they need.
Physiotherapist in training. Based in Italy but studying in Switzerland.
Find out what it means in practical terms for both men and women going about their daily lives with a knee that they cannot fully bend or fully straighten, and how this impacts not only their work and leisure, but also their relationships.
Learn how men and women differ in how flexible their knees are. Gain a clear idea of your own range of motion goals, and whether you should focus on your extension or your flexion - so that you can work with the physical therapist and understand what is going on.
Look into the knee like a keyhole surgeon! See the internal ligaments and shock absorbers of the knee - the cruciate ligaments and menisci - and locate the boundaries of the capsule from the inside. This will help you to understand the later sections on the kinds of knee surgery for the stiff knee.
Get to grips with the subtle anatomical details that help you to both really understand modern 'manual' techniques of physiotherapy and also to understand some of the procedures of 'salvage' when scar tissue demands such surgery.
Learn how the knee muscles can both power movement by contracting, and also allow the opposite movement by paying out slack, so that opposing muscle groups act in concert with one another to ensure that movement is controlled and smooth.
Learn why you need to be alert in the important first two months so that the propensity for stiffness is minimised and any progression towards stiffness is met with an informed and urgent response - once the knee is already stiff then the journey to rehabilitation will be much harder.
Life can be a challenge when you have a stiff knee. It is not just the discomfort of activities of daily living, but there is also the social impact when your knee affects others - whether strangers on a bus or your closest partner. You may be encouraged to accept a less than perfect result, but remember that the person who is proposing this does not have to live with it for the rest of their life.
Physiotherapists will fall into two camps - those who know all this stuff we are teaching at this course, and those who do not. The former group are likely to be able to explain clearly what is happening to your knee, and will be pro-active in referring you back when necessary to the surgeon. The latter group are likely to be frustrated and confused by the lack of progress, and embarrassed to ask the surgeon for help. This is where your new knowledge will be invaluable.
Training to be a knee surgeon can take well over a decade, but very little time is devoted to formal teaching about rehabilitation. Of course, it can be argued that rehabilitation is clearly the domain of the physical therapist, but to our mind each needs to be fully cognisant of the principles of the other's work, so that the surgeon can understand the issues the therapist faces and vice versa.
The surgeon does not have many options at his disposal to deal with adhesions once the physical therapist has declared that rehabilitation progress has stalled. These options include 'lysis of adhesions', 'manipulation under anaesthesia', 'anterior interval release' and 'joint insufflation'.
One of the problems with communication about joint scarring is that terms are used without a precise definition of what the clinician is dealing with. Such terms may include 'fibroarthrosis', 'flexion contracture', 'arthrofibrosis', 'arthrofibrosis syndrome', 'chronic extensor lag', 'chronic flexion deficit'. At the end of this course, you should have a very clear idea of the best descriptors.
Scarring in the region of the patellar tendon can close up the anterior interval and as the scar matures it shrinks and tugs the tendon down until it is virtually stuck to the tibia.