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Need medical attention? The Ottawa Knee Rules can help you determine if a client should visit a doctor

American Fitness, May-June, 2004 by J. P. Saleeby

Whether you participate in low-or high-impact aerobics, step or KickBoxing classes, you are likely to see or be prone to knee injuries. Organized aerobics classes are now one of the most popular exercise forms--approximately 27 million men and women are currently enrolled in them. With these numbers, it is not surprising that aerobics instructors replaced gymnasts as the athletes with the highest incidence of sports injuries. An estimated 75 percent of aerobics instructors have sustained at least one musculoskeletal injury while teaching aerobics classes. Of the three major lower extremity joints (i.e., hip, knee and ankle), the knee may be the most susceptible to injury during repetitive movement exercises. Since the knee joint only has flexion and extension ranges of motion, it depends on a series of ligaments to maintain alignment and thus is less forgiving to lateral forces and twisting motions. Although skiing is inherently more dangerous to the knee, with the anterior cruciate ligament (ACL) injury commonly found on ski slopes, taking aerobic classes .also poses a risk for injury to this joint.

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When the knee suffers injury from blunt trauma, as in a fall, or a twisting injury, in which your foot goes one way and your torso another, it is important to know when to seek medical attention. Despite an obvious major injury (e.g., a compound fracture, severe swelling and/or deformity), applying some well-tested rules will make you more keenly aware of when there Is a problem and help you decide whether the injured person should see his or her doctor.

In 1995, researchers at the Ottawa Health Research Institute created the Ottawa Knee Rules to aid primary care and emergency room physicians in clinical decision-making and reduce unnecessary radiographs (i.e., x-rays). Usually, knee x-rays were ordered solely because of the complaint that the "knee was injured." This resulted in excessive numbers of "normal" x-rays, thus unnecessarily utilizing a rather expensive diagnostic tool. The Ottowa Knee Rules have reduced the number of normal knee injuries x-rayed by as much as 28 percent. Since no rule is perfect, there will be a few missed abnormals. These injuries are usually picked up on x-rays ordered at a follow-up visit.

Using the Ottawa Knee Rules, an x-ray series is only required for knee-injury patients with any one of the following findings:

* The injured individual is age 55 or older (Pittsburgh decision rules would later add individuals under the age of 12);

* Isolated tenderness of the patella (i.e., knee cap) with no bone tenderness of the knee other than the patella;

* Tenderness of the head of the fibula;

* Inability to flex the knee joint to 90 degrees;

* Inability to bear weight both immediately after injury and 30 minutes to an hour afterwards for four steps (i.e., the patient is unable to transfer weight twice onto each leg, regardless of limping).

The Ottawa Knee Rules can also be used in an aerobics studio to determine the extent of an injury. Of course, an aerobics instructor should never give medical advice nor treat a client, besides administering first aid and maybe stabilizing a joint until trained medical help arrives. The Ottawa Knee Rules are a simple tool that will assist in encouraging clients to seek appropriate medical attention.

References

Bauer, S.J., et al. "A clinical decision rule in the evaluation of acute knee injuries." J. Emerg. Med., 13 (1995): 611-5.

Dr. James B. Bragman, Bragman Health. com: Sports Medicine and Injury' (Chapter 15-Aerobics), 23 July 2001, <http://bragmanhealth.com/books/sports/ch15.html> (23 February 2004).

Stiell, I.G. and Wells, G.A. "Methodologic standards for the development of clinical decision rules in emergency medicine." Ann. Emerg. Med., 33, no. 4 (April 1999): 437-47.

Stiell, I.G., et al. "Derivation oF a decision rule for the use of radiography in acute knee injuries." Ann. Emerg. Med., 25, no. 4 (October 1995): 405-13.

Stiell, I.G., et al. "Implementation of the Ottawa Knee Rules for the use of radiography in acute knee injuries." JAMA, 278, no. 23 (December 17 1997): 2075-9.

Stiell, I.G., et al. "Prospective validation of a decision rule for the use of radiography in acute knee injuries." JAMA, 275, no. 8 (February 28 1996): 611-15.

Stiell, I.G., et al. "Use of radiography in acute knee injuries: need for clinical decision rules." Acad. Emerg. Med., 2, no. 11 (November 1995): 966-73.

Tandeter, H.B., et al. "Acute Knee Injuries: Use of Decisions Rules for Selective Radiograph Ordering." Am. Faro. Physician, 60 (1999): 2599-608.

J.P. Saleeby, M.D., is medical director of the Saleeby Longevity Institute, specializing in sport enhancement medicine. He alto serves as assistant medical director to the Liberty Regional Medical Center Emergency Department in Hinesville, Georgia. Saleeby may be reached at jpsaleeby@aol.com or (912) 201-9464.

Need medical attention? The Ottawa Knee Rules can help you determine if a client should visit a doctor

American Fitness, May-June, 2004 by J. P. Saleeby

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