Caroline Hennigan is one of five expert physiotherapists at Blizard Physiotherapy who see scores of patients each week, many of whom are often convinced their issue will take months to be resolved.

However, here Caroline gives an example of how one of her clients - who is by no means an unusual case - made a quick recovery from a knee ailment after receiving highly individual care and treatment at the clinic.





Case Study
Mrs A, aged 55

This lady presented with intermittent left knee pain which she described as discomfort and a sense of restriction “under the kneecap”. She was finding that the knee was stiffening after rest, stairs were painful and she was unable to run.

Her problem had been caused by falling heavily onto her left knee 10 days prior to her appointment. She was two weeks away from running a marathon and thought this was now out of the question.

On examination, the signs of inflammation evident at the time of the injury (redness, heat, swelling) had resolved. There was through range resistance on bending the knee and the last part of this movement was lacking. Examining the patella under compression reproduced the patient’s symptoms.

This patient had suffered from a moderately severe compression injury of her patellofemoral joint. This case highlights the relevance of knowing the biology of the healing process and the importance of timely intervention.

The healing process can be considered in four overlapping phases.

• At the time that the injury occurs there is bleeding. The amount depends on the severity of the injury and the type of tissue affected.
• Quickly following on from this, inflammation will build, typically over a 24-72 hour period.
• Chemicals are released into the area causing blood vessels to enlarge and become leaky.
• Several types of cell can then enter the area which will create a clot to stop the bleeding, clean up toxins and debris to prevent infection and begin the rebuilding and repair phase.

As you can see, in the context of an injury, this inflammatory process is absolutely essential to the healing process even though the resulting pain, heat, swelling and redness are unpleasant. Whilst it is of benefit to manage this initial inflammatory phase, we shouldn’t be trying to eliminate it.

As the inflammation subsides, the repair process continues with the laying down of scar tissue and the delivery of oxygen and nutrients via newly formed blood vessels. This scar tissue will strengthen and be refined over the ensuing months.

For many, the road to recovery is smooth and uncomplicated. For some, however, this is not the case. What we refer to as ‘barriers to recovery’ can be numerous, and could range from the patient's incorrect self management, to the influence of general health problems, to other issues in the neuromusculoskeletal system.

This is where physiotherapy is beneficial.

By considering the processes occurring at the site of the injury whilst also considering the neuromusculoskeletal structure as a whole, we can create the ideal environment for healing and remove any barriers to recovery.

In the case of Mrs A, we were able to use passive manual therapy techniques to ease the pain and restore smooth, full and symptom free movement.

The patient was unclear as to the correct self management strategies to employ, and we were able to steer her in the right direction. She was surprised at how much movement I encouraged her to do, and that it was okay to work into the resistance she could feel, but by explaining the healing process, she could see the value of this, and could see how her self management strategies would compliment what we were achieving with treatment in the clinic.

Because Mrs A received the right treatment, and employed the right self management strategies at the right time, she was able to complete her marathon two weeks later in her fastest time for five years.

Had she not sought treatment, her injury would have got better (probably) - but it would have taken longer, she would have missed out on her marathon, and to bounce back psychologically would have been harder.