You have been treated for your knee injury. You have had a thorough examination and are now considered fit to be discharged. The following instructions will aid your recovery.
Caring for your injured knee
You may have injured your knee by damaging either the ligaments (sprain) or the muscle or tendon (strain). This may cause pain, swelling and a limp. An X-ray is not always necessary.
What is the treatment for a knee ligament injury?
Self-help treatment
For the first 48–72 hours think of:
- Paying the PRICE – Protect, Rest, Ice, Compression, Elevation; and
- Do no HARM – no Heat, Alcohol, Running or Massage.
Paying the PRICE:
- Protect your injured knee from further injury.
- Rest your affected knee for 48–72 hours following injury. Consider the use of crutches to keep the weight off your injured knee. However, many doctors say that you should actually not keep your injured knee immobile for too long. You can usually start some exercises to help keep your knee joint moving and mobile. Start these as soon as you can tolerate the exercises without them causing too much pain. You can ask your doctor to advise when you can start to move your knee joint and what exercises you should do.
- Ice should be applied as soon as possible after your knee injury – for 10–30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin, as it may cause ice-burn.) A bag of frozen peas is an alternative. Gently press the ice pack on to your injured knee. The cold from the ice is thought to reduce blood flow to the damaged ligament. This may limit pain and inflammation. After the first application, some doctors recommend reapplying for 15 minutes every two hours (during daytime) for the first 48–72 hours. Do not leave ice on while asleep.
- Compression with a bandage will limit swelling, and help to rest your knee joint. A tubular compression bandage can be used. Mild pressure which is not uncomfortable or too tight and which does not stop blood flow is ideal. A pharmacist will advise on the correct size. Remove before going to sleep. You may be advised to remove the bandage for good after 48 hours. This is because the bandage may limit movement of the joint which should normally be moving more freely after this time. However, bandages of the knee are sometimes kept on for longer to help keep swelling down and to keep the affected knee more comfortable. Ask your health professional what is best in your case.
- Elevation aims to limit and reduce any swelling. For example, keep your foot on the affected side up on a chair with a pillow under your knee when you are sitting. It may be easier to lie on a sofa and to put your foot on some cushions. When you are in bed, put your foot on a pillow. The aim is that your affected knee should be above the level of your heart.
- R is sometimes added to this list to make PRICER. R stands for Rehabilitation which is the most important part of the treatment for knee ligament injuries – to get you and your knee back to normal. You may need to see a physiotherapist or sports therapist for advice about exercises to do to strengthen and stretch the muscles around your knee if your symptoms persist.
Avoid HARM for 72 hours after injury. That is, avoid:
- Heat – for example, hot baths, saunas, heat packs. Heat has the opposite effect to ice on the blood flow. That is, it encourages blood flow. So, heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat may then be soothing.
- Alcoholic drinks, which can increase bleeding and swelling and decrease healing.
- Running or any other form of exercise which may cause further damage.
- Massage, which may increase bleeding and swelling. However, as with heat, after about 72 hours, gentle massage may be soothing.
Medication
- Paracetamol and codeine: paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. If the pain is more severe, you may be prescribed codeine, which is more powerful but can make some people drowsy and constipated.
- Anti-inflammatory painkillers: these medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. There are many types and brands. You can buy some (eg, aspirin and ibuprofen) at pharmacies, without a prescription. You need a prescription for others. Side-effects sometimes occur with anti-inflammatory painkillers. Stomach pain, and bleeding from the stomach, are the most serious. Some people with asthma, high blood pressure, kidney failure, bad indigestion and heart failure may not be able to take anti-inflammatory painkillers. So, check with your doctor or pharmacist before taking them in order to make sure they are suitable for you.
- But note: National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS), a well-known source of guidance for doctors in the UK, do not recommend that anti-inflammatory painkillers be used in the first 48 hours after the injury. This is because of concerns that they may delay healing. The logic is that some inflammation is a necessary part of the healing process. So, it may be that decreasing inflammation too much by taking these medicines may impair the healing process. This is a supposed (theoretical) concern, as no trials have proved this point. Further research is needed to clarify the use of these medicines following an injury.
- Rub-on (topical) anti-inflammatory painkillers: again, there are various types and brands of topical anti-inflammatory painkillers. You can buy some, without a prescription, at pharmacies. You need a prescription for the others. There is debate as to how effective rub-on anti-inflammatory painkillers are compared with tablets. Some studies suggest that they may be as good as tablets for treating sprains. Some studies suggest they may not be as good. However, the amount of the medication that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.
If you have been given crutches to help you walk, please bring them back when you can walk without them. They can be left at the emergency department reception desk at any time.
Exercises
- Lying on your back with legs straight. Bend your ankles and push your knees down firmly against the bed. Hold 5 sec. – relax. Repeat 10 times.
- Lying on your back. Bend one leg and put your foot on the bed and put a cushion under the other knee. Exercise your straight leg by pulling your foot and toes up, tightening your thigh muscle and straightening the knee (keep knee on the cushion). Hold approx. 5 sec. and slowly relax. To make the exercise harder put a small weight around your ankle. Repeat 10 times.
- Lying on your back with one leg straight and the other leg bent. (You can vary the exercise by having your foot pointing either upwards, inwards or outwards). Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20 cm off the bed. Hold approx 5 sec. – slowly relax. Repeat 10 times with both legs.
- Sit on a chair. Pull you toes up, tighten your thigh muscle and straighten your knee. Hold approx. 5 sec. and slowly relax your leg. Repeat 10 times.
All above exercises can be completed with ankle turned out to the side
- Sit on a bed with one leg straight out in front of you. Bend your upper body forwards keeping your back straight until you feel a stretch in the back of your knee. Hold for 30 sec. slowly ease into the stretch do not bounce. Repeat 10 times
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