Guidelines - Knee Pain and Mobility Impairments

This tool provides information to facilitate the management of knee pain,
mobility impairments, knee meniscal and articular lesions.

Focused examination

1. Patient History 

  • Rule out risk factors for major structural or other pathologies. If required, refer to an appropriate healthcare provider.

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.

  • Address prognostic factors that may delay recovery.

Major structural or other pathologies (red flags):

  • Sharp pain, persistent nagging ache, unexplained deformity, swelling, or redness of the skin, weakness not due to pain, fever/chills/feeling ill, pain at rest

Examples of other conditions/co-morbidities:

  • Physical conditions: back pain, headache

  • Psychological conditions: depression, anxiety

  • Co-morbidities: diabetes, heart disease

Examples of prognostic factors that may delay recovery:

  • Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization

2. Physical Examination

  • Rule out major structural or other pathologies.

  • Assess for neurological signs.

  • Identify patient's baseline status relative to pain, function and disability; detect asymmetries; assess global knee function; determine the patient's readiness to return to activities using appropriate assessments.

Clinical findings of mensicus injury:

  • Twisting injury, tearing sensation at time of injury, delayed effusion (6-24 hours post injury), history of 'catching' or 'locking', pain with forced hyperextension, pain with maximum passive knee flexion, pain or audible click with McMurray's maneuver, joint-line tenderness, discomfort or sense of locking or catching in the knee over either the medial or lateral joint line during the Thessaly test when performed at 20° of knee flexion

Clinical findings of articular cartilage injury:

  • Acute trauma with hemarthrosis (0-2 hours), insidious onset aggravated by repetitive impact, intermittent pain and swelling, history of 'catching' or 'locking', joint-line tenderness

3. Management 

  • Offer information on nature, management, and the course of knee pain and mobility impairments.

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.

Therapeutic Management 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider early progressive active and passive knee motion 

  • Consider early stepwise progressive weight bearing 

  • Consider early progressive return to activity 

  • Consider in-clinic exercise and home-based exercise with education

  • Consider progressive range-of-motion exercises, progressive strength training of the knee and hip muscles, and neuromuscular training 

  • Consider neuromuscular stimulation/re-education to increase quadriceps strength, functional performance, and knee function 

*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.

Care Pathway for the management of knee pain

4. Reevaluation and Discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.

  • Monitor for any emerging factors that may delay recovery.

5. Referrals and Collaboration

  • Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.

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CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

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