When is PT not appropriate for knee pain?

In some cases, patients with knee pain will be referred to a different provider. While this is rare, we want to be certain we, as physical therapists, are able to help.

Some of the symptoms we look for include:

• Fever, chills, night sweats (increased risk of infection or cancer)
• Weight loss (concern of cancer or infection)
• Recent infection (increased risk of infection)

Medication-specific concerns include:

• Steroids (risk of osteoporosis)
• Anti-coagulants (risk of bleeding)
• Immunosuppressants (risk of infections)

The Pittsburgh knee rules are used to determine if a patient requires a knee X-ray following a fall or blunt trauma. Patients younger than 12, older than 50 or cannot walk four weight-bearing steps  should have X-rays. These rules do not apply for patients who present more than six days following an injury, those with only superficial laceration and abrasions, those with a previous history of knee injury or surgery on the affected knee and those being reassessed for the same injury.

References:

1. Seaberg, David C et al. “Multicenter Comparison of Two Clinical Decision Rules for the Use of Radiography in Acute, High-Risk Knee Injuries.” Annals Of Emergency Medicine, Vol. 32, No. 1, 1998, pp. 8-13. Elsevier BV, https://doi.org/10.1016/s0196-0644(98)70092-7.

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