Why Is Improving Knee Flexion After Surgery Important
Now first things first please listen to your orthopedic surgeons range of motion guidelines! Not every knee surgery is the same, as there may be different precautions you must follow after a meniscus repair vs. an isolated ACL reconstruction. After some surgeries, you may want to push the range of motion to what is tolerable, whereas in others, pushing the range of motion past a certain degree may actually be harmful! So again please listen to your physical therapist and orthopedic surgeon for guidelines on how to improve your knee flexion depending on your exercise parameters!
When it comes to starting to move so that you can actually improve knee flexion after surgery, it may not be all that comfortable.
Much of the lack of knee flexion immediately after surgery is not only due to pain, but also knee swelling or edema in response to the surgery. Inside of your knee is a joint capsule that surrounds the entire joint, imagine this joint capsule is shaped like a balloon. When there is increased swelling in the joint, the balloon gets bigger. It gets a lot harder to bend the knee with a bigger balloon inside of it! Thus, its important very early on to follow the P.O.L.I.C.E. principle ofprotection, optimal loading, icing, compression, and elevation to minimize as much swelling as possible as that will only limit our knee flexion gains after surgery!
After Stretching Take Care Of The Knee
The kne might be sore after working it and stretching but thats ok. That means that you did a good job working it. Some of the best ways to help with discomfort after prolonged stretching include using a hot pack, wearing a compression sleeve, or doing some light movements afterwards to pump out the swelling. Our favorite knee compression sleeves are the Crucial Compression Knee sleeves.
Ice Heat Massage And Bracing: The Complements Of A Successful Rehab Program
During your rehab program, your therapist will advise you to use other measures to enhance your ROM. Before completing your exercises, you’ll likely use heat to loosen up the joint and surrounding muscles. Heat and massage can also help you manage the pain that is part of your recovery.
Icing your knee also helps to manage pain, reduce swelling, and improve ROM.
Finally, your physical therapist or doctor might prescribe a brace to support your knee as you complete therapy and resume normal activities.
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Knee Flexion And Extension Range Of Motion Is Very Important For You To Perform Daily Activities Especially Activities That Require The Use Of Your Knees The Inability To Achieve Full Rom At The Knee Joint Can Be Challenging And Detrimental To The Function Of Your Lower Extremities
Knee injuries can reduce the range of motion of your knee joint and this may require instant treatment. Reduced knee ROM can be improved by performing certain physical exercises which can be a treatment method to the knee injury causing the decreased ROM in the knee joint. Exercising your knee will not only help you improve your ROM but also strengthen the muscles in your legs.
Knee range of motion describes how much you can move your knee joints. Although there is two main knee movement which is flexion and extension, our knees can also be rotated to a small extent. The range of motion of the knee can change based on the condition or properties of the surrounding knee tissues .
The range of motion of the knee is measured in degrees and is compared to the average degree most healthy people have. On average, most individuals have around 0 degrees of knee extension and 135 degrees of knee flexion. This can vary based on how tall you are and how big your muscles surrounding your knee are.
There are three main types of range of motion of a joint. These are:
Passive Knee ROM: Describes how much your knee joint can bend and straighten when an external aid or support is provided. The external aid is often from another person.
Active Knee ROM: Describes the degree to which your knee joint can bend and straighten without any external aid.
What Not To Do
- Do not let the back arch during the exercise.
- Do not jerk or bounce the leg or lift it above the knee on the bent leg.
- People who have osteoporosis or a back compression fracture should not perform this exercise.
Muscles involved: Hamstrings and gluteal muscles.
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Acl Rehab: Gain Early Full Extension:
One of the main aims of early rehabilitation is to gain full extension of the knee as quickly as possible post-operatively. Not gaining full extension now can have drastic implications later on in the rehab process. This is where stretching is really important.
I tend not to stretch the hamstrings too vigorously early as most ACL grafts are taken from strands of hamstring tendon of the same leg this needs some healing time too.
Hold The Stretches For Longer
There are a lot of stretches you can do. The Heel Slide is commonly recommended. While lying on your back, bend your knee as you slowly slide the heel of your operated knee towards your buttock.
You can also do the standing knee flexion stretch on a stair. From a standing position, put your affected knee on the first or second step and then lean forward causing the affected knee to bend. Hold this position as long as you can without causing severe discomfort.
Be sure to use a variety of stretches, and work up to holding them for longer periods of time. They should be held for at least 30 seconds, but you can slowly increase to to holding them longer. The longer you hold them the more tissue change that occurs.
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What Causes Limited Range Of Motion In The Knee After Surgery
Knee replacement surgery removes the inflamed and damaged joint. In doing so, it aims to relieve pain and swelling and improve ROM. In the days, weeks, and even months after surgery, though, you will continue to experience some degree of pain and swelling. Pain and swelling are the body’s response to the trauma of the surgery. With time and rehab, they will lessen.
Besides pain and swelling, another factor that limits knee range of motion after surgery is scar tissue. Scar tissue is also part of the body’s response to trauma. During knee replacement, the surgical incision must cut through skin, muscle, ligaments, tendons, and other soft tissues. As these tissues heal, they form scar tissue.
Scar tissue is thicker and more fibrous than healthy tissue. Thus, scar tissue is more inflexible as well. Some patients form more scar tissue than others. More invasive procedures also tend to cause more scar tissue.
Fortunately, you can work through the pain, swelling, and scar tissue of your surgery to improve your knee ROM. For most patients, this means completing sometimes intensive physical therapy. The most important factor to limit scar tissue formation is movement. The longer you remain immobile after surgery, the more likely scar tissue is to form.
Minimising Pain And Swelling:
Post-operatively the knee will be sore and swollen. To aid in rehab, regular pain relief is essential to allow the body to let the knee move generally speaking, pain is a protective mechanism, and the body will only work with so much pain getting this under control is essential to allow early rehab and allow for faster and better outcomes at the other end of the journey.
Crutches help to get around while the knee is sore and muscles are yet to fire efficiently. Using crutches correctly can aid in normalising your walking pattern, which in the end will help get you off the crutches faster.
Regular ice and compression is also beneficial icing 2 hourly to start with, and wearing compression bandaging/bracing to help get the post-operative swelling under control. Read about the RICE method
Manual therapy from a physiotherapist is highly beneficial in the early stages of rehab. Massage work of the leg can also aid in pain relief and help with lymphatic drainage to get the swelling under control. Hands-on patella mobilisation and knee mobilisation techniques aid in restoring knee mobility, and can also have a pain-relieving effect.
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Be More Aware Of Controlling How Your Knee Moves
The knee joint does a lot more than just bend and straighten the leg. It allows for rotation around the knee joint, translation back and forth, and adduction/abduction . What does that all mean? It means that your knee has to not only be able to perform these motions, but more importantly it needs to be able to resist these motions.
The inability to resist excessive motions in different planes is what can lead to increased stress on ligaments, cartilage, and other structures in the knee, and yes, injuries as well.
There is a reason we continue to see such high rates of ACL injuries, meniscus tears, and other knee related injuries. Failure to make the lower body more resilient to stress, especially when fatigue plays a factor, is what can make you more susceptible to injury. Try these simple exercises to give your routine some variety and help reduce the likelihood that your knee will give you trouble:
#5 Mini Band Alternating Knee Knockers
While the band is positioned around the knees, remember that we are actually working the hips into abduction/adduction, along with slight external rotation and internal rotation with this exercise.
#6 Bowler Squat
These have many different names, but no matter what you call the Bowler Squat, they are a highly effective way to train single leg squat mechanics, while placing an emphasis on lateral hip stability and control. A little loading goes a LONG way here so dont overdo the dumbbell weights.
Looking For Knee Rehab
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Great Exercises To Strengthen Your Knees
Check out these 5 great exercises to strengthen your knees so you can enjoy your day-to-day activities with less pain, popping and stopping.
One of the best ways to develop stronger knees and ward off future injuries is to build strong, fluid and solid muscles around the knees and in your legs and core.
Strength and flexibility go hand-in-hand: a fluid muscle is a happy muscle. Knee exercises and stretches that promote both power and flexibility are of the greatest benefit. Knee strengthening exercises develop the muscles around the knee, but they can also cause the muscles to get tight, if not stretched properly. A tight muscle will constrict the knee joint and be more prone to injury. Stretching after knee strengthening exercise will alleviate muscle soreness and keep the muscles long and elastic.
Before embarking on any kind of training regimen, consulting with a certified physical therapist is a small investment that can pay huge dividends down the road. The expert advice of a trained professional, with no referral needed, can save you time, allow you to work more efficiently and guide you toward the best exercises for your own unique situation.
Prone Flexion With A Strap
To perform this exercise you will need to attach a belt to the ankle of your involved leg. Next, lie face down on a table or flat surface. Your arms should be in front of you with your hands holding the end of the belt which will be stretched across your back. Gently pull on the belt to bring your ankle forward and bend your knee. Perform 20 reps with each session and repeat as often as prescribed. With continued sessions you should eventually be able to reach a greater degree of bend in your knee.
What Causes Restricted Knee Motion
Reduced knee movement is often due to a combination of:
- Muscle Tightness: Passive muscle tightness – due to shortening in muscle length, active muscle tightness – due to muscle spasms
- Joint Stiffness: restriction of joint movement
- Muscle Weakness: lack of strength, control and endurance
- Pain: knee pain can inhibit movement
- Injury: Damage to structures in and around the knee
- Swelling: Excess fluid in the knee restricts movement
Learn more about the Causes of Knee Stiffness >
How To Measure Knee Rom Without A Goniometer
If you dont have a goniometer, you can still assess yourROM. This can be really helpful for seeing what progress you are making withyour rehab after a knee injury. It wont be as accurate as using a goniometer,but it does give you somewhere to start.
If you are wanting toguestimate the range of movement at your knee, try this
Estimating Knee Extension:
- Lie on your back on a firm surface
- Push your knee down into the floor
- Slide your hand, palm down, underneath your knee. If you can:a. Just get a couple of your fingersunderneath with difficulty = 0o extensionb. Just slide all your fingers underneath = +5o degrees i.e. lacking 5o extensionc. Easily slide your whole hand underneath = +10o i.e. lacking 10o extensiond. Cant get any of your fingers underneath = -5o or more i.e. hyperextension
Estimating Knee Flexion:
- Lie on your back on a firm surface
- Slide your heel along the floor towards your bottom
- Measure the distance from the back of your heel to yourbottom
This doesnt give you an actual measurement of flexion, but it doesgive you a measurement to compare with when monitoring you progress when tryingto improve knee flexion.
There are also various apps that you can download that essentially turn your phone into a goniometer. They vary in quality but a study1 published in Physiotherapy Journal found that the “Knee Goniometer” App installed on an iphone was a reliable tool.
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Self Stretches For Knee Extension Range Of Motion
Two of the first stretches that I give patients following surgery are simple self stretches for knee extension. The basic version simply has the patient applying a stretch into extension by pushing their distal thigh. The second and slightly more advanced version has the patient press down on their distal thigh while using a towel around the foot to pull up and simultaneously stretch the hamstrings.
Similar to how we assess knee extension range of motion, you will want to use some sort of wedge under the heel to assure that you are restoring full motion.
What Does The Acl Do
The ACL is a ligament a body structure made of strong fibrous material that works to control excessive motion by being a limit to the mobility of a joint. It is located within the knee joint capsule.
ACL injury is often seen in all football codes, skiing, basketball, netball and any other sport involving change in direction running.
The ACL is the main restriction to forward motion of the tibia or shin bone. It stops the tibia sliding too far forward or when the foot is planted, the femur sliding back. The ACL also contributes to stabilising the amount of angulation and rotation at the knee joint. It is called a cruciate as anatomically it crosses with another ligament in the knee the posterior cruciate ligament.
There are a few people out there rupturing their ACLs in professional sports some studies have seen an annual incidence rate of 0.15-3.7% . Ruptures of the ACL are seen more frequently in professional sports then amateur sports. It is commonly injured when the athlete rapidly decelerates, followed by a sharp or sudden change in direction .
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Stair Knee Flexion Stretch
As the name implies, this stretch will require you to utilize stairs. Start by placing the foot of your involved knee on the first step. While standing straight up, gently lean your body towards the stairs as far as is comfortable. This movement will help with knee flexion. Next, rock your body away from the stairs in order to gain the added benefit of knee extension. Once you are able to perform this level of the exercise easily you can move your foot to the second step and repeat the movements above. Youll want to perform this exercise twice daily, spending about three to five minutes per session. If you dont have a step at home then an aerobic step works just as good and can be moved around the house.
Focus On Knee Extension First
Working on your knee extension will be your primary goal for the first 2 weeks following surgery. Full knee extension is required for normal walking mechanics, normal joint stability, and is the best predictor of good outcomes after surgery. By stretching into knec extension it will make your knee flexion range of motion much easier. Knee flexion is easier to get and something you can emphasize after the knee is straight. To get a knee to full extension after surgery see our favorite exercises which also includes the following. Sit on a chair, hold your leg out straight, and then bend it back down. You will want to do this at least twice a day to start. Initially, it may be hard to fully extend, and that is to be expected. Working up to a full range of movement is a work in progress. Once you can fully extend your leg and hold it for 30 seconds or more, you will know its time to add other stretches.
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