“Successful treatment: multiple factors at play”

In the sixth episode of the digital event series Bauerfeind TALKS hosted on the bauerfeind-life.com platform, experts from Germany, Austria and Switzerland discussed the subject “indication-specific treatment in cases of acute knee pain”.

From diagnosis to mobilization: what exactly does indication-specific treatment in cases of acute knee pain entail? This is what Bauerfeind TALKS presenter Michál Zacharias asked his guests who had tuned in. These included Dr. Ursula Diregger, Specialist in Orthopedics and Orthopedic Surgery, Pirmin Reichmuth, self-employed physical therapist and competitive athlete, Christian Teusch, Specialist in Specialist in Orthopedics and Trauma Surgery, and Mattis Hohmann, Expert Orthotist and Team Manager for Orthopedics Training at Bauerfeind.

Main causes of knee pain: acute or degenerative

The participants agreed that typical knee patients can be divided into two groups: they either suffer from acute symptoms, for example following trauma, or gradual, usually age-related degeneration. With the latter representing the larger group in Dr. Ursula Diregger’s experience. The main goal for patients is eliminating their pain. “The next step would be to restore their everyday mobility” – from going shopping to exercise, reported the specialist, how owns her own practice in Vienna. She points out to her patients how important physiotherapy is for mobilization to accelerate this process.

Pirmin Reichmuth agreed and noted that the group of generally older patients showing degeneration is more difficult to treat. “After acute trauma or surgery, the problem is obvious,” the physical therapist explained. “But with chronic pain, you first have to work out how you can help to alleviate some of the discomfort.” He feels his task is to consider the patient’s needs and overall situation and to promote compliance. This also applies to medical aids, added Mattis Hohmann. “The best orthopedic product will be of no use if it’s just lying in a drawer and is not worn.” The initial question must therefore be: “For what type of use should the product be designed?” The Director of the Bauerfeind Academy emphasized the large spectrum, ranging from very ambitious weekend athletes to geriatric, potentially obese patients.

A hands-on approach

One of the questions asked before the event was: how do I obtain the most important information about the symptoms? Christian Teusch answered that his first questions about when and where the patient experiences pain: “At rest or when subjected to strain, when climbing the stairs, when starting an activity or during an extensive walk? Does the patient feel pain on the inside, the outside or behind the kneecap, is it piercing or dull?” However, the specialist and trauma surgeon singled out the physical examination as an “important diagnostic tool”: “We must take a hands-on approach during the physical examination of the knee.” He allocates 15 to 20 minutes for an initial appointment, though it depends on whether the patient is a footballer that comes to see him after an accident or an older patient with chronic pain where the cause has to be identified first. Oftentimes, the knee might not be the main problem.

For Dr. Ursula Diregger, imaging is usually a part of the initial case history – at least taking X-ray scans. Despite these images, it does happen, however, that there no success can be achieved in geriatric patients even after several weeks of treatment. “In these cases, we can’t stick with believing the problem is down to wear, but we also have to check whether the meniscus has torn, for example,” she explained, emphasizing the importance of close monitoring. Both physicians named, as yellow or even red flags during the initial consultation, tenderness, severe swelling, redness and heat, which may indicate inflammation.

According to all participants, tried-and-tested initial measures include rest, support and stabilization by elevating the leg, wearing supports, using pain medication and injections as well as home remedies, such as quark poultices. Exercise is key for subsequent mobilization, based on instructions given by a physical therapist, which can also include wearing active supports. If there is still no progress after two to three treatment sessions, Pirmin Reichmuth pricks up his ears: “I then ask patients if they’re not resting their knee enough, or I send them back to the physician.” Other patients, however, don’t get involved enough, according to the physical therapist. “I make it very clear to them that treatment can only be successful if they do their exercises. Otherwise, we have to discontinue with treatment.”

The most important tips at the end

When asked by presenter Michál Zacharias for a proven tip relating to diagnosis, Dr. Ursula Diregger recommended that patients with diffuse pain should put a finger right on the area where they feel acute pain: “You can usually find the main problem faster when this area is pointed out specifically.”

Pirmin Reichmuth observes his patients’ movements, when climbing the stairs, for example. “Then it’s quite obvious where the pain comes from.”

“Look at the entire leg axis,” recommended Christian Teusch. A lot of problems can be identified in this way from a possible misalignments of the foot, knee or hip.

Mattis Hohmann agreed and added: “You may be able to treat a foot misalignment with orthopedic foot orthoses, which can have an effect on the knee pain.” All in all, there are many factors at play that need to be combined to achieve comprehensive treatment
and mobilization of the patient.

Bauerfeind TALKS – always up-to-date

A recording of the discussion group has been stored in the Bauerfeind media library and can be accessed at any time on
www.bauerfeind-life.com/talks.

More about the Swiss wrestler Pirmin Reichmuth

Images: Bauerfeind