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Range Of Motion Of Knee

Severe Cases Of Knee Pain Or Injury

Active Range of Motion (Knee Joint)

In some cases, a knee injury can be a serious injury and are so severe that they require surgery to repair. Some of the most common surgical procedures include:

ACL reconstruction: This surgery is performed to repair a torn ACL. The surgeon will remove the damaged ligament and replace it with a healthy autograft or allograft.

Meniscus surgery: This surgery is performed to repair a damaged or torn meniscus. The surgeon will remove the damaged tissue and either sew the remaining tissue back together or replace it with an artificial disc.

Why Is Range Of Motion Important Following My Knee Replacement

Swelling, weakness, pain, and fear of movement are all common following your knee surgery and may all contribute to less motion in your knee. Your knee will likely feel stiff and be unable to move as much as your uninjured knee. Throughout your recovery, one of your main goals will be to regain as much of your flexion and extension range of motion as possible.

The amount of movement in your knee during your recovery will determine the types of activities you are able to do after surgery! While full knee flexion or bending is not required for all activities, a research study shows that a minimum of 110 degrees of active knee flexion is ideal for walking, climbing stairs, and getting up from sitting to standing.

If you are preparing for an upcoming knee replacement surgery, or have already begun your rehabilitation journey, check out our app available on Apple and Android devices specifically for knee replacement recovery. The Curovate app can assist in your recovery with a personalized rehabilitation protocol developed by a licensed physical therapist.

Stay tuned for our upcoming blogs in this series, which will investigate how to improve your knee movements, how to measure your range of motion using our app, and how accurate this measure is!

References

  • Magee, D. J. . Orthopedic Physical Assessment. St. Louis, MO: Elsevier Saunders.

    • 6 Jul 2022 8 min read

    • 10 Jun 2022 6 min read

    Loss Of Flexion / Extension:

    Even minor losses of knee motion may have adverse effects. It is common to lose both flexion and extension however, loss of extension is usually more debilitating.

    A loss of extension of more than 5 degrees may cause patellofemoral pain and a limp during walking, whereas restricted flexion does not severely affect gait as long as the knee can be flexed to at least 60 degrees.

    Diminished running speed is associated with loss of flexion of 10 degrees or more, whereas an extension deficit of more than 10 degrees is poorly tolerated by active people. A loss of more than 20 degrees of extension may cause a significant functional limb-length discrepancy.

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    Importance Of Range Of Motion For Chronic Knee Pain Sufferers

    Experiencing knee pain can hinder your ability to actively participate in typical daily functions. Regardless if the pain is just a minor flare up or if you suffer from chronic knee pain, there are things you can do to help improve your quality of life.By increasing your range motion in the knee, the amount of pain will lessen as the two are ultimately linked. It only takes a small portion of your day to better that range of motion and that is done through exercises that are geared to increase your flexibility all while building and strengthening your muscles.

    Knee Replacement Range Of Motion: My Timeline And Goals

    Range of Motion After Joint Replacement Surgery

    As youve read, I improved a lot in my first month after knee replacement surgery. This wouldnt have happened if I would have slacked off or not followed the therapy.

    Even when I didnt have my physical therapy sessions, I was doing them on my own 3 times per day. I had heard about scar tissue building up after surgery and making the joint less flexible.

    The more activity after knee replacement, the less chance scar tissue will be able to develop in and around the joint. Heres my range of motion timeline for knee replacement:

    • Week 1: Due to swelling your knees range of motion will be minimal and it will be frustrating
    • Week 2: If youre working hard there will be big gains with flexion
    • Week 3: Gains should continue, although smaller, in the 3rd week
    • Week 4: Gains in week 4 were less but I was still improving . As a result of the leg workouts, leg strength on your repaired knee should be improving and feel secure.

    Ive already achieved straightening my leg so my goal for flexion is currently 130 degrees. If I reach my goal Ill push to gain more flexion in the knee.

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    Position And Stabilize The Knee Joint Correctly

    • Move the body part through its appropriate knee range of motion .
    • Determine the knee joints end of the range of motion and end-feel as well.
    • Then, palpate the appropriate bony landmarks.
    • Align the goniometer with the knees landmarks.
    • Read the measuring instrument properly.
    • Record measurements correctly .
    • The range of motion of the knee joint should be measured in isolation, to avoid trick movements and muscle insufficiency which may alter the reading as well.

    Range Of Motion Basics You Should Know

    Impress your physical therapist and care team by knowing some of the basic terms and important measures surrounding your range of motion.

    Range of Motion The normal movement of your joint, measured in degrees from the center of your knee. Range of motion includes flexion , extension , adduction , abduction , rotations . ROM is measured using an instrument called a goniometer. For instance, a completely straight knee joint measure 0° while a fully bent knee clocks in at about 135° degrees of flexion.

    • Knee Flexion The measurable degree in which your leg is bent. Think about laying on your stomach and bending your leg toward your buttocks. This requires knee flexion.
    • Knee Extension The measurable degree in which your knee is extended. Think of standing on one leg and raising your surgical leg behind you like youre stepping backwards or karate kicking someone behind youhiya! This requires knee extension.
    • Active Range of Motion Moving your knee joint to its maximum potential without any assistance.
    • Passive Range of Motion When your therapist or a piece of equipment moves your knee through a range of motion without any effort from you.
    • Active Assistance Range of Motion Moving your knee through a range of motion exercise with some assistance from your therapist of a piece of equipment.
    • Extension Lag When you cannot extend to a completely straight position .
    • Flexion ContractureWhen you cannot extend your leg, with or without assistance.

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    Basic Range Of Motion Timeline For Recovery

    While everyones timeline differs a bit, heres a general timeline for where you should be regarding your range of motion.

    When your leg is fully extended it will measure 0°. When you pull your foot back toward your buttock the maximum flexion that can be achieved in a healthy non-surgical knee is around 140° however, even people in the best shape have a difficult time reaching 135°. If you can get your flexion to 125° then you are doing great! Keep up the hard work.

    0 2 Weeks

    Within the first 2 weeks, you should be at or around 65°-90° flexion.

    2 6 Weeks

    12 Weeks +

    Once you reach the 12-week point you should be able to do most routine tasks and care for yourself without much assistance. Dont be discouraged if you are not where you want to be at this point. Just keep working. A positive mindset will help more than anything.

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    Looking After Your New Knee

    Knee Passive Range of Motion (PROM)
    • continue to take any prescribed painkillers or anti-inflammatories to help manage any pain and swelling
    • use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger
    • keep up your exercises to help prevent stiffness, but do not force your knee
    • do not sit with your legs crossed for the first 6 weeks after your operation
    • do not put a pillow underneath your knee when sleeping as this can result in a permanently bent knee
    • avoid twisting at your knee
    • wear supportive shoes outdoors
    • do not kneel on your operated knee until your surgeon says you can
    • raise your leg when sitting and apply an ice pack wrapped in a tea towel for 20 minutes every 3 or 4 hours to reduce any swelling

    Page last reviewed: 02 August 2019 Next review due: 02 August 2022

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    Why Cant You Bend Your Knee Past 90 Degrees

    If youre struggling with bending your knee because of sharp pain, the most probable cause would be an underlying symptom of the below-mentioned diseases or conditions.

  • Locked knee condition This happens by a mechanical impairment in extending your knee like a bucket handle tear of the meniscus, or loose osteochondral fragments.
  • Patellofemoral syndrome This is also called runners knee syndrome because its a condition that grows with the overuse of the knee joint or injuring the knee. This condition is very popular among athletes but even if youre not one, that doesnt mean that youre out of the woods.
  • Patellar Tendonitis This too is a common athlete injury that causes inflammation of the tendon that attaches your kneecap to your shinbone. Your pain might differ from mild to severe when trying to bend your knee. A 2005 study revealed that roughly 40 to 50% of skilled volleyball players have gone through this injury.
  • Osteoarthritis This disorder mainly happens as you age. Its a specific tear on your joints as the cartilage that protects your joints start wearing out and making your bones rub against each other eventually causing inflammation in the joints. So, if you try to get past a 90-degree bend, you will feel it. This is not just limited to your knees, but can also affect your hips, wrists, ankles, and fingers.
  • Since most of the above-mentioned conditions are triggered by knee injuries, it is important to know at what point can a knee injury be risky.

    Knee Flexion Exercise Volume Is Key

    As our bodies are healing from surgery, our tissues are undergoing many changes. YOU are your bodys best healer! Early mobility has not only been deemed appropriate after surgery but also necessary in order to facilitate a healthy healing response. An article by Kaye et al discusses the positive outcomes related to early mobility after surgery, some of which include decreased hospital length of stay, improved patient satisfaction, and decreased postoperative complications! Later on, in the middle and late tissue healing phases specifically, we want to gently apply forces to the tissues inside of the knee to increase the range of motion. This will assist in tissue remodeling and the long-term success of tissue healing. A great overview of tissue healing phases from start to finish is well explained in a blog post we have recently written!

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    Second Week Progress After Tkr: Range Of Motion

    During the 3rd session my therapist added another set of 5 standing exercises to go along with the 5 that I was already doing on my bed. She complimented me about my ability to do the exercise and was impressed with the progress I was making and she made note of the reduction in swelling.

    At the end of the session, she measured my flexion at 95 degrees. The exercises and the measurements were both painful. The results were worth the pain.

    The two exercises that hurt the most but that did the most good were: the ankle slides on the bed using a robe rope to pull the foot as far as I could towards my butt and the foot slides sitting on a chair sliding my foot in a plastic bag on a tile floor as far back to the chair as possible.

    During the second-week post-surgery I continued to make progress with my flexion. The pain did not decrease during the workouts but the results motivated me to continue the workouts when I felt like cheating or skipping one.

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    During the 2nd week, the swelling went down so much that the surgical knee began to look like a knee instead of a swollen mass. Day 10 post-surgery, I had 98 degrees flexion. Day 12 after surgery, I had 100 degrees flexion, and Day 14 after surgery, I had 110 degrees flexion.

    Range Of Motion 4 Months After Tkr

    Va Rating For Knee Flexion

    As Ive mentioned in other articles, your range of motion will increase the most in the few weeks after knee replacement .

    However, you can still achieve some improvements in the 3rd and 4th months.

    I would encourage you to continue to do the range-of-motion exercises that were prescribed by your physical therapist. I use a fitness center to continue my workouts Use your Silver Sneakers free pass if you are over 65.

    Ive developed a routine with the physical therapy exercises, the stationary bike, and regular bicycle rides 6 to 10 miles. I believe they continue to help me maintain flexibility and help me to increase my range of motion, slowly, by a few degrees.

    I am not seeing the huge gains as I did early on, but I am increasing my range of motion little by little.

    I continue to massage my knee with Free Up before and sometimes after workouts. It helps to loosen the knee before activity and feels better when I begin my exercise.

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    What Will Happen In Physical Therapy

    The physical therapist will measure your range of motion both in the healthy leg and the leg with the loss of extension to take note of what is normal for your body. They will also check your kneecap mobility, knee joint movement, and soft tissue restrictions.

    Studies show that restrictions in the kneecap are correlated to a loss of knee extension. The scarred knee-tendon can prevent movement as well.

    Once measurements have been made, the PT will use manual therapy to mobilize the joint, apply tissue manipulation to remove any scarred tissue and apply some force to stretch the area.

    The physical therapist will also load a stretch on the patient, usually a low-load, long-duration stretch with weights that can comfortably allow for gaining in the range of motion a little bit at a time. Additionally, the patient has prescribed stretches they can do to actively apply pressure for extensions, and other strengthening exercises that support the knee.

    If you have a loss of range of motion in your knee after surgery, dont wait. Call your Physical Therapy New Hyde Park, NY and see what they can do for you.

    How To Measure Knee Rom Without A Goniometer

    If you dont have a goniometer, you can still assess your knee ROM. This can be really helpful for seeing what progress you are making with your 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 to guestimate the range of movement at your knee, try this:

    Estimating Knee Extension ROM

    • 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 fingers underneath 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 ROM

    • 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 your bottom

    This doesnt give you an actual measurement of flexion, but it does give you a measurement to compare with when monitoring you progress when trying to improve knee flexion.

    Measure Knee ROM With Your Phone

    There are also various apps that you can download that essentially turn your phone into a goniometer. They vary in quality but a study* published in Physiotherapy Journal found that the “Knee Goniometer” App installed on an iPhone was a reliable tool.

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    What Are The Signs Of Knee Replacement Failure

    The most common symptoms of a failed knee implant are pain, decrease in joint function, knee instability, and swelling or stiffness in the knee joint.

    Persistent pain and swelling can indicate loosening, wear or infection, and the location of the pain can be all over the knee or in one particular area . A decline in knee function may result in a limp, stiffness or instability. Patients who demonstrate these symptoms and signs may require revision joint surgery.

    Loss Of Knee Extension Range Of Motion And Physical Therapy

    Improving Knee Extension Range of Motion after Injury or Surgery (ACL, Meniscus, Knee Replacement)

    After knee surgery, there are times when the patient has not been informed of what happens if they do not engage in physical therapy during their optimal moments. Surely, it can be very painful right after the anesthesia wears off and the patient just wants to rest.

    Rest is important. However, its also important to get that leg moving right away. Usually, the patient loses their functional knee extension range of motion when they lose that time or when a patient declines the therapist to push them because of the pain, or refuses to do the exercise or the stretches. Either of these things could cause this.

    Is it too late? Maybe not. Depending on how long its been since the surgery, their age, and other underlying conditions, when a patient goes back to physical therapy fully committed to their program, one may have gains in range of motion.

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