UNDERSTANDING KNEE RECOVERY

Surgeries that require knee extension physical therapy include ACL reconstruction, meniscectomy, total knee arthroplasty, and arthroscopic scar resection. 


Why physical therapy is important: 

  • Physical therapy can help restore full knee extension, flexibility, and strength. 
  • It can help reduce knee pain and improve function. 
  • It can help prevent knee stiffness and scar tissue. 
  • It can help patients return to normal activities. 

How physical therapy is provided:

  • Physical therapy can include targeted exercises, specialized tools, and a carefully structured rehabilitation plan. 
  • Physical therapy after knee replacement surgery can include in-hospital therapy, at-home therapy, and outpatient therapy. 

Other treatments:

  • For arthrofibrosis, treatment approaches can include surgical intervention, extension casting, and daily physical therapy. 
  • For ACL reconstruction, the goal is usually to achieve full knee extension within 8-12 weeks. 

 

The Three Phases of PT During Recovery

 

From a physical therapy standpoint, there are three phases of recovery:

 

In the hospital (1 to 3 days after surgery): Before you’re discharged, you’ll work with a physical therapist on activities you’ll need to do at home, including using a walker, getting into and out of bed and using the stairs (if needed). You’ll also start exercises to improve your knee’s range of motion, or ROM (that is, how far it can bend and extend). And you’ll do exercises to strengthen the quadriceps muscle in your thigh, which tends to be weak in people who need or have a knee replacement.

 

At home (2 or 3 weeks after surgery): As you keep doing your ROM and strength exercises, your knee will get stronger and more stable. You’ll be able to do more and more during rehab sessions and in everyday life. You’ll also learn how to walk with a cane and, eventually, without one.

 

Outpatient therapy (up to 4 months after surgery): This portion of recovery is incredibly important because it’s the one that takes you across the finish line. The exercises that follow will help you continue to strengthen your muscles and improve your flexibility and cardiovascular capacity as needed to get back to “normal” activity, whatever that means for you.

 

Long-Term Recovery from Knee Replacement

 

While outpatient therapy may end after about four months post-surgery, most doctors agree that patients should keep doing their prescribed exercise program two or three times a week until at least eight or 10 months post-op.  From months 10 to 12, continue the knee workouts once a week while adding in other types of activity.  By month three, patients are usually around 75% recovered, and can probably return to some form of a sport.  The last six to 12 months are when you really fully recover, so never settle and give up on the program too early.  Always follow your healthcare team’s guidance on the specific exercises and time frames that are best for you.

 

After knee replacement surgery or other knee procedures, many patients struggle with bending and straightening their knee, which can lead to frustration and hinder their return to daily activities. Restoring full knee extension through a carefully structured rehabilitation plan is vital for reducing knee pain and achieving better knee function. Physical therapy, targeted exercises, and specialized tools like Knee Extend are crucial in helping patients reach their mobility goals. With expert guidance from physical therapists, patients can regain optimal knee straightening, flexibility, and strength, accelerating their recovery and improving their quality of life.

 

The Importance of Restoring Full Knee Extension

 

Full knee extension is the ability to fully straighten the knee joint, aligning the operated leg to a neutral starting position. Achieving this position is crucial for knee joint health, reducing knee pain, and ensuring proper knee bending and knee flexion. When patients can straighten the operated knee fully, they reduce strain on surrounding structures, particularly the quadriceps and kneecap, and prevent compensatory movement patterns that could lead to further issues.

 

Limited knee straightening can cause several complications including:

 

Knee Pain and Gait Abnormalities: Inadequate knee extension may cause pain and lead to an abnormal gait due to uneven weight distribution.

 

Scar Tissue Buildup: Scar tissue can form at the back of the knee, limiting range of motion and leading to chronic stiffness.

 

Long-term Mobility Issues: Patients may experience reduced overall mobility, affecting their quality of life and leading to dysfunction in other joints.

The good news is that restoring full range of motion soon after total knee replacement (TKR) or other knee replacement surgery has significant benefits including:

 

Reduced Pain and Swelling: Engaging in an early exercise program reduces inflammation and helps relieve knee pain.

 

Improved Muscle Strength: Regular exercises like straight leg raises and quadriceps sets strengthen the quadriceps muscle, supporting the kneecap.

 

Faster Recovery: Achieving full knee extension promptly minimizes scar tissue buildup, allowing patients to regain normal function and return to daily activities sooner.

 

Common Obstacles in Achieving Full Knee Extension

 

Patients often encounter several obstacles when striving for full knee extension after knee replacement surgery.

 

Common issues experienced include:

 

Scar Tissue Formation: Post-surgical scar tissue can form around the operated knee joint, restricting movement and making knee straightening painful.

 

Knee Pain: Pain from the procedure or from existing conditions like arthritis and meniscus injuries can inhibit a patient's ability to perform knee extension exercises.

 

Muscle Weakness: Quadriceps and hamstring muscles weaken after surgery, reducing their ability to support and control the knee, impacting knee bending and knee flexion.

 

Inflammation: Swelling around the knee joint limits range of motion and causes discomfort, making it difficult for patients to perform full extension exercises.

 

Patient Compliance

Patient adherence to their post-operative exercise program is crucial, yet often face challenges,  including;  pain and discomfort, lack of motivation and fear of re-injury if pushing too hard through their recovery exercises.

 

Creating an Effective Treatment Plan

Assessment

 

Regular assessments by physical therapists and orthopaedic surgeons are vital for

monitoring patient progress after knee replacement surgery or other knee procedures. These evaluations provide a comprehensive picture of the operated knee's current state, measuring the range of motion, knee straightening capability, quadriceps muscle strength, and knee joint stability. Routine assessments help identify scar tissue buildup, muscle imbalances, and other complications that may hinder recovery. By closely tracking these factors, healthcare providers can tailor treatment strategies, adjust exercise programs, and incorporate specialized positioning tools to address each patient’s unique challenges.

 

Setting Goals

 

Setting clear, measurable goals ensures that patients have a structured pathway to follow and remain motivated throughout their rehabilitation. These goals should be realistic and based on the patient’s specific condition and operated knee status. For instance, a patient recovering from total knee replacement (TKR) might aim to achieve full extension by performing gentle stretching and controlled repetitions of straight leg raises within a set timeframe. Breaking down objectives into short-term and long-term goals provides patients with a manageable progression, enabling them to celebrate milestones as they achieve improved knee bending and knee flexion.

 

Effective goal-setting will help physical therapists identify which exercises are most beneficial at each stage, ensuring therapy remains focused on gradually enhancing knee straightening, range of motion, and functional strength.

 

Tools and Exercises to Support Knee Extension

 

Specialized Exercises

  1. Quad Sets with Knee Extend
    • Purpose: Engage the quadriceps muscle through isometric contractions, crucial for knee straightening and strength.
    • Execution: In a seated position with leg raised onto chair and Knee Extend device in position, tighten the quadriceps while keeping the knee fully extended. Hold for a few seconds, then release. Repeat for several repetitions.
  2. Heel Prop Stretch with Knee Extend Comfort Flex Cushion
    • Purpose: Encourage gentle stretching at the back of the knee for better knee straightening.
    • Execution: Lie flat and place a cushion under the ankle, allowing the back of the knee to stretch gently. This position promotes passive knee extension.
  3. Straight Leg Raises:
    • Purpose: Strengthen the thigh muscle and quadriceps without putting stress on the operated knee.
    • Execution: Lie down with the operated leg straight. Lift it slowly to a few inches off the ground, hold briefly, then lower. Perform several repetitions.
  4. Prone Hang with Knee Extend 
    • Purpose: Provide a gentle stretch to promote knee straightening and extension.
    • Execution: In a seated position with leg raised onto chair and Knee Extend device in position, allow gravity to gently pull the leg down for a passive stretch. Weight can be added as strength improves.
  5. Heel Slides:
    • Purpose: Improve range of motion in the operated leg through controlled knee flexion.
    • Execution: Lie flat and gently bend the knee by sliding the heel toward the body, then extend the leg back out. Repeat several times.
  6. Ankle Pumps:
    • Purpose: Work the calf and hamstring muscles to prevent blood clots and improve circulation.
    • Execution: Point and flex the foot up and down while lying down or seated, focusing on activating the calf muscles.

 

Knee Extend

Product Overview:

Knee Extend offers ergonomic support to the operated leg and kneecap. Our specialized design promotes knee extension in a safe, controlled manner.

 

How to Incorporate:

Physical therapists can integrate the Knee Extend into your therapy sessions. 

 

Benefits:

Knee Extend facilitates safer therapy, providing proper leg alignment and reducing unnecessary strain on the knee joint. This support encourages patient compliance and enhances therapy outcomes, leading to faster progress in knee straightening and improved range of motion.

 

Monitoring Progress and Adjusting the Plan

 

Regular evaluation is crucial to effective rehabilitation. Physical therapists should frequently assess the progress of knee extension by looking at improvements in range of motion, quadriceps strength, and adherence to the prescribed exercise program.

First, range of motion should be measured to determine how close the operated knee is to reaching full extension. This will provide valuable insights into the patient’s progress with knee straightening and bending.

 

Tracking repetitions of essential exercises like heel slides,  quad sets, and straight leg raises will also offer important data on a patient’s recovery progress and stamina. Additionally, understanding the patient’s pain levels by regularly asking them to rate discomfort during exercises will ensure that the therapy remains at a manageable level.

 

Functional performance should be observed to gauge improvements in daily activities like walking or bending. This will highlight practical gains in the patient's knee joint function.

 

Revising Goals

 

As patients advance through their rehabilitation program, it is important to adjust their goals based on their current capabilities and challenges.  If patients are consistently reaching their exercise targets, the intensity of the workouts should be increased. This could mean adding more repetitions, resistance, or different variations that challenge the quadriceps and hamstring muscles.

 

New knee straightening exercises or tools like Knee Extend can be introduced to address specific weaknesses or support the back of the knee more effectively.

It is crucial to align the patient's goals with practical functional milestones. Shifting objectives to focus on everyday activities like scooting forward from a seated position, climbing stairs, or walking longer distances will help them regain mobility.

If setbacks occur due to increased knee pain, swelling, or other issues, previous goals and exercises can be revisited. Gentle stretches that promote safe recovery may be reintroduced.

 

Amplify Your Recovery With Knee Extend

Physical therapists, physios, and healthcare providers, it's time to improve the outcomes of your patients' knee rehabilitation. By incorporating Knee Extend into your treatment plans, you can provide essential support for knee straightening and enhance mobility. This ergonomic tool will empower your patients to regain confidence in their knee function and return to their daily activities faster. Contact us at Knee Extend to explore how this simple but innovative solution can transform your practice and help patients achieve better mobility today.