New York State Medical Treatment Guidelines for
Knee Rehabilitation in workers compensation patients
The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Rehabilitation .
These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.
The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.
Rehabilitation of Knee Injury
Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.
Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.
Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.
To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.
To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.
- Physical / Occupational Therapy
Physical / Occupational Therapy is recommended – to enhance function, including strength and range of motion.
Frequency/Dose/Duration: With evidence of continued objective functional Improvement, the total number of visits could be as low as two to three for individuals with modest functional impairments or as high as 12 to 15 for those with more severe deficits.
If there is evidence of functional improvement toward particular objective functional goals (such as increasing range of motion or improving capacity to conduct work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments. A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.
Indications for Discontinuation: Pain, intolerance, lack of effectiveness, or noncompliance are all resolved.
- Activities of Daily Living (ADL)
Activities of Daily Living (ADL) is recommended – in select patients as clinically indicated.
Frequency: Usually, two to three times per week, with a maximum of three weeks as clinically required and a minimum of four to five treatments needed to make an impact.
- Functional Electrical Stimulation
Functional Electrical Stimulation is recommended – clinically appropriate in a subset of patients.
Indications: Include muscle atrophy, weakness, and slow muscle contraction brought on by pain, injury, neuromuscular dysfunction, peripheral nerve lesions, or situations where atrophy is possible. Possibly a suitable treatment when combined with an aggressive exercise programme.
Frequency: Typically, three times each week, with a maximum of eight weeks as clinically advised, and two to six treatments required to generate impact.
- Gait Training
Gait Training is recommended – in select patients with lower extremity injury or surgery.
Indications:Include the need to promote a normal gait pattern while using assistive devices; instruct in the safety and proper use of assistive devices; instruct in the progressive use of more independent devices (such as a cane or platform walker); instruct in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall; and/or instruct in equipment to limit weight bearing for the protection of a healing injury or surgery.
Frequency: Typically, two to three times per week, with a maximum period of two weeks as clinically required and a requirement for three to four treatments to produce an impact.
- Neuromuscular Re-Education
Neuromuscular Re-Education is recommended – in select patients as clinically indicated.
Indications: Degenerative joint diseases of the patella-femoral and retropatellar types may be indicated.
Frequency: Two to three times per week, with a minimum of three to four sessions required to see results.
Optimum/Maximum Duration: Two weeks.
- Therapeutic Exercise
Therapeutic Exercise is recommended – in select patients as clinically indicated.
Indications: Include the need for cardiovascular fitness, decreased edema, higher bone density, enhanced connective tissue strength and integrity, improved muscular strength, increased range of motion, improved muscle recruitment, and encouragement of typical movement patterns. the use of movement therapy as a supplemental or alternative treatment.
Frequency: Typically, three to five times per week, with a minimum of eight weeks as clinically indicated and two to six treatments needed to create an impact.
- Wheelchair Management and Propulsion
Wheelchair Management and Propulsion are recommended – in select patients as clinically indicated.
Indications: for patients with repeated traumas, who are unable to employ ambulatory assistive equipment, have bilateral lower extremity injuries, or who are otherwise unable to ambulate.
Frequency: Typically, two to three times per week, with a maximum period of two weeks as clinically required and a requirement for two to six treatments to produce an impact.
- Continuous Passive Movement (CPM)
Continuous Passive Movement (CPM) is recommended – in select post-operative patients.
Indications: When used soon after surgery, CPM is useful in avoiding the onset of joint stiffness. It should continue until the edema that restricts joint motion stops growing. The joint’s range of motion is initially limited by the patient’s tolerance, and it is then gradually extended twice a day as tolerated. Home visits could be necessary to use this equipment.
Frequency: Up to four times per day for up to three weeks post-surgery.
- Contrast Baths
Contrast Baths is not recommended
- Electrical Stimulation (Physician or Therapist Applied)
Electrical Stimulation (Physician or Therapist Applied) are recommended – as a component of a comprehensive treatment plan.
Frequency: Two to three times a week for a maximum of up to two months.
Not Recommended – as a stand-alone treatment.
- Fluidotherapy
Fluidotherapy is Recommended – in select patients as clinically indicated.
Include the need to lessen muscle guarding, lower inflammation, and improve collagen extensibility before stretching.
Frequency: Typically, one to three times per week, with a minimum of one month as clinically indicated and a minimum of one to four treatments required to produce effect.
- Infrared Therapy
Infrared Therapy is not recommended
- Iontophoresis
Iontophoresis is not recommended
- Kinesiotaping, Taping or Strapping
Kinesiotaping, Taping or Strapping are recommended – in select patients.
Indications: Acute joint immobilisation (for example, acute ankle sprain)
Kinesiotaping, Taping or Strapping are not recommended – for acute or non-acute pain.
- Manipulation
Manipulation is recommended – clinically appropriate in a subset of patients. Symptoms include a locked knee, contracture, or pain and range-of-motion limitation brought on by adhesions or contractures.
Frequency: Typically, with immediate effect and a maximum of ten treatments as clinically necessary, one to five times each week (depending on the severity of participation and the desired effect).
- Manual Electrical Stimulation
Manual Electrical Stimulation is recommended – in select patients as clinically indicated.
Indications: include muscle spasm (including TENS), atrophy, decreased circulation, osteogenic stimulation, inflammation, and the need to facilitate muscle hypertrophy, muscle strengthening, muscle responsiveness in Spinal Cord Injury/Brain Injury (SCI/BI), and peripheral neuropathies.
Frequency: Typically, three to seven times per week and a maximum duration of two months as clinically indicated.
Massage: Manual or Mechanical are not recommended.
- Mobilisation (Joint) of Rehabilitation
Mobilisation (Joint) of Rehabilitation is recommended – in select patients as clinically indicated.
Indications: Include the desire to enhance joint motion, enhance intracapsular kinematics, or lessen discomfort brought on by tissue impingement or maltraction.
Frequency: usually three times a week, and up to ten treatments, if clinically necessary, are needed to produce results.
- Mobilisation (Soft Tissue) of Rehabilitation
Mobilisation (Soft Tissue) of Rehabilitation is recommended – in select patients as clinically indicated.
Indications: Include neurological compression, trigger points, adhesions, and muscular spasm surrounding a joint.
Frequency: Usually two to three times per week, with effects appearing after two to three weeks. Clinically indicated, a maximum of 10 treatments may be given.
- Paraffin Bath
Paraffin Bath is not recommended
- Superficial Heat and Cold Therapy
Superficial Heat and Cold Therapy are recommended – in select patients as clinically indicated.
Indications:Include acute pain, edema, and haemorrhage. You also need to lower muscle spasms, encourage stretching, and enhance your pain threshold. includes the use of heat at acupuncture sites and portable cryotherapy equipment that is applied just above the skin’s surface. may be delivered by the patient on their own or in conjunction with other active therapy.
Frequency: Usually, two to five times a week, effective immediately, for a maximum of two months.
Optimum duration: Three weeks as a starting point, or up to two months if used sporadically as a supplement to other treatment techniques.
- Short-Wave Diathermy
Short-Wave Diathermy is not recommended
- Traction
Traction is not recommended
- Transcutaneous Electrical Nerve Stimulation (TENS)
Treatment with Transcutaneous Electrical Nerve Stimulation (TENS) should involve at least one tutorial on how to use it correctly.
Transcutaneous Electrical Nerve Stimulation (TENS) is recommended – in select patients as clinically indicated.
Indications: Include the management of concurrent pain, atrophy, and muscle spasm in the workplace. Pulse rate, pulse width, and amplitude modulation should be the bare minimum TENS unit specifications. Prior to the deployment of a home unit, consistent, verifiable functional improvement must be demonstrated and the likelihood of chronicity must be determined. TENS therapy should be used in conjunction with physical therapy that is active.
Time to produce effect: Immediate.
Frequency: Variable.
Optimum duration: Three sessions.
Maximum number of sessions: three. Invest in or include a home unit if useful.
- Ultrasound
Ultrasound is recommended in select patients as clinically indicated.
Indications: Include the need to expand muscle tissue or hasten the healing of soft tissues, as well as scar tissue, adhesions, contractures, and muscle spasm.
Frequency: Include the need to expand muscle tissue or hasten the healing of soft tissues, as well as scar tissue, adhesions, contractures, and muscle spasm.
- Vasopneumatic Devices
Vasopneumatic Devices is not recommended.
- Whirlpool of Rehabilitation
Water is exposed in a whirlpool at temperatures that best produce the intended effect (cold vs. heat). If the temperature is higher than the tissue temperature, it has the same thermal effects as hot packs and typically involves a massage using water powered by a turbine or Jacuzzi jet system.
If water of a similar temperature is utilised, the thermal consequences are the same as with cold application.
- Whirlpool
Whirlpool is recommended in select patients as clinically indicated.
Indications: Include the requirement for analgesics, lowering joint stiffness, easing muscle spasm, improving mechanical debridement, and facilitating and preparation for exercise.
Frequency: Typically, three to five times per week, with a maximum of two months as clinically required and two to four treatments needed to create an impact.
Optimum duration: Three weeks as a starting point, or up to two months if used sporadically as a supplement to other treatment techniques.
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