Rehab, PT, Exercises Following Knee Surgery & Knee Injury

1. Early Rehab, PT and Exercises Following Knee Surgery-Partial or Complete Meniscectomy

   Following To Be Done in Phase-I (0-10 days) After Partial or Complete Menisectomy for Early Recovery:

   • Knee Braces- A compressive knee brace or knee support should be worn for protection and reduction in the swelling around knee joint following partial or complete menisectomy.¹
   • Exercises for Range of Motion of the Knee Joint Following Partial or Complete Menisectomy – Exercises like bending and straightening the knee should be done as tolerated to improve range of knee joint movement after partial or complete menisectomy to help with early recovery.
   • Quadriceps Strengthening Exercises – Initially perform rehab exercises like static contractions and then advance to straight leg raises.
   • Cycling- Cycling exercise can be done after Partial or Complete Menisectomy if the pain in the knee joint allows.
   • Partial Weightbearing following Partial or Complete Menisectomy- Preferable to start weight bearing with crutches followed by full weightbearing as soon as possible following partial or complete menisectomy.

   

   Rehab, PT and Exercises That Needs to be Done in Phase-II (10-21 days) Following Partial or Complete Menisectomy:

   • Compressive Knee Brace or Knee Support- Knee braces or knee supports are advised after knee surgery if necessary, otherwise, avoid knee joint restrictions in this phase following knee joint surgery.
   • Range of Motion PT Exercises Following Knee Surgery (Partial or Complete Menisectomy) – Patient having undergone knee surgery should be able to do full range of motion exercises for the knee by this stage.
   • Straight Leg Raise Exercise after Knee Surgery (Partial or Complete Menisectomy) – Exercise for the knees should be continued and leg weights may be added to increase resistance.
   • Advanced Strengthening Exercises for the Knee Joint Following Partial or Complete Menisectomy – Exercises such as squats should be started to strengthen the knees following knee menisectomy surgery.
   • Swimming- Swimming is advised if the wound from the knee surgery has healed.
   • Aerobic Exercises Following Knee Joint Surgery Like Menisectomy – Cycling or swimming should be done for 20 minutes a day as a part of rehab and PT for early recovery after knee surgery.

   

   Rehab, PT and Exercises To Be Done in Phase- III (week 3 onwards) Following Knee Joint Surgery like Partial or Complete Menisectomy:

   • The intensity of the exercises for the knee can be increased in phase 3 following knee menisectomy surgery.
   • New exercises should be added such as by increasing weights, increasing the distance covered in swimming and cycling to improve the strength and range of motion of the knee joint and promote early recovery following knee surgery like partial or complete menisectomy.

   If there is difficulty or pain while doing the knee exercises, then the exercises should be stopped and medical attention should be sought.

   

2. Early Rehab, PT and Exercises Following Meniscal Repair Knee Surgery

   Following Should be Done in Phase-I (0-21 days) Following Meniscal Repair to Promote Early Recovery

   • Knee Brace- Brace should be worn for protection and reduction in the swelling around knee joint after knee surgery (meniscal repair) and the permitted range of motion should be 30-80 degrees.
   • Exercise to Improve Knee Range of Movement after Meniscus Repair- The range of motion exercises after knee surgery (Meniscus Repair) should be done passively which means someone else should assist the patient to move the limb while it is in the brace to promote early recovery.
   • Exercising after Knee Surgery with Knee Braces- Mild exercises should be done while in the brace. Straight leg raises can be done, bent at 30 degrees – lift, hold for 10 seconds, down, rest for three seconds, repeat 10 times, 3 to 5 sets.
   • PT and Rehab after Knee Surgery: Electrical stimulation can be done to contract muscles surrounding the knee joint.
   • Crutches- Non-weightbearing crutches should be used as a part of rehab after knee surgery (meniscus repair).

   

   Rehab, PT and Exercises to be Done in Phase-II (3-6 weeks) Following Meniscal Repair Knee Surgery

   • Knee Range of Motion- Knee Joint movement and range of motion (as much as the brace allows) should be increased by 10 degrees each week in flexion and extension (bending and straightening).
   • Knee Exercise after Knee Surgery (Meniscal Repair)- Range of motion exercises for the knees (as much as the brace allows) should be done so that by week 6 there should be 0 degrees (straight) to 120 degrees (bent) movement of the knee joint.
   • Straight Leg Raise Exercise Following Meniscal Repair Surgery – Intensity of straight leg raises can be increased by adding weights to promote early recovery after knee surgery.
   • Leg Extension Exercises – After the 6th week following meniscal repair knee surgery, leg extensions and leg curls from 90 to 30 degrees can be started as a part of rehab.
   • Use of Crutches Following Meniscal Repair- Crutches for partial weight bearing should be used by this stage and progression to full weight bearing should be achieved by the 10th week following meniscal repair knee surgery.

   Rehab, PT and Exercises for Knees To Be Done in Phase-III (7th week onwards) Following Meniscal Repair

   • Intense Exercises- Intensity and time of exercises is increased in phase 3 after knee surgery. Patient should be able to do full range of motion exercises.
   • Braces- Braces for the knee joint in this phase following meniscal repair should only be used if needed.
   • Swimming and Cycling- The athlete should be able to do swimming and cycling in Phase 3 rehab stage after meniscal repair surgery for knee joint.

   Prognosis of Early Post-Op Rehabilitation For Menisectomy or Meniscal Repair-

   • The athlete should continue to train the quadriceps and hamstring muscles even after returning to sports activity, as it is vital to make sure that these muscles are strong enough to support the knee.
   • In some cases, there may be a growth of a new and weaker tissue after complete meniscectomy. This new tissue may also tear producing the same symptoms as previously.
   • There may be degeneration or wear and tear at the ends of the bones after some years in individuals who have had complete meniscectomy.

3. Early Rehab, PT and Exercises after Knee Injury -Lateral Meniscus Tear

   1. Knee Joint Flexion/Extension Exercises:

      Goal –

      • Improving mobility of the affected knee joint
      • Improve strength of quadriceps and hamstrings.
      • Reduce swelling.
      • Promote early recovery after knee injury (Lateral meniscus tear).

      How To Do Knee Joint Flexion/Extension Exercises Following Lateral Meniscus Tear:

      • Patient should sit on the edge of a chair.
      • Patient should try and sit on an elevated seat.
      • Feet should not touch the ground.
      • Knee joint is slowly bent and straightened as far as the pain allows.
      • The exercises should be progressed such that the leg can be held in place at the extreme of both flexion and extension. This helps facilitate muscle strengthening surrounding the knee joint.

      Exercise Program-

      • At least three sets of about 20 repetitions are performed of the above mentioned exercise.
      • Exercise repeated three times a day.

   2. Knee Joint Flexion Exercise for Knee Injury (Lateral meniscus tear):

      Goal of Rehab Exercise-

      • This exercise is aimed for the hamstring muscles which are the chief flexor of knee.
      • It also helps in stretching the quadriceps in front of thigh.

      How To Do Knee Joint Flexion Exercise?

      • The athlete should lie face down and bend the injured knee as much as possible.
      • The knee should be held at the extreme range for about 10 seconds.

      Exercise Program-

      • This exercise should be repeated 10 times.
      • This should be repeated at least three times throughout the day.

   3. Heel Slide Exercise for Lateral Meniscus Tear Injury

      Goal of Rehab Exercise

      • Improve mobility and function of both hamstrings and quadriceps.
      • Improves function of the flexor muscles of the hip joint.

      How to do Heel Slide Rehab Exercise for Knee Injury-

      • Exercise is performed while patient wearing socks in both feet.
      • Patient should lie on hard surface and avoid carpet.
      • Foot is slide along bare floor instead of a carpeted one.
      • Exercise is beneficial during early stages of following surgery
      • The athlete should lie on the back, bend one knee and slide the foot firmly on the floor.
      • The heel should be moved up as much as possible in the direction of the buttock.
      • In the early stages of recovery from knee injury(lateral meniscus tear injury), maximum flexion that can be obtained is not more than 30 degrees, although this increases with repetitions over time.
      • In case of inadequate muscle strength for bending of knee, then the exercise can be made easier by use of a towel in order to promote flexion.

      Exercise Program-

      • Heel slide rehab exercise should be repeated at least 10-20 times daily and the athlete should try increasing the range of motion as much as tolerated.
      • Low impact exercises like swimming can be done to help promote range of motion. However, these should be attempted only when adequate range of motion is achieved.

   4. Stretching Exercise to help Early Recovery from Knee Injury:

      Goal-

      • Stretches help increase the flexibility of the soft tissue structures adjoining the joint such as muscles, ligaments and the joint capsule and thus facilitates increased range of motion of the joint.
      • Stretching exercise is imperative during rehabilitation for knee injury and should be done along with strengthening program to avoid instability around the joint. These stretching exercises should be done as much as the pain allows.

   5. Leg Extension Exercise with the Use of a Rolled Towel

      Goal

      • This helps in achieving ultimate knee extension in the later stages of rehab program.

      How To Do Leg Extension Exercise for Rehabilitation of Knee Injury?

      • A medium sized towel should be taken and rolled into a ball and tied with a ribbon or string to keep it in shape.
      • This ball of towel should be placed on a stool in front of the chair.
      • The athlete should rest the heel of the affected leg on the towel when sitting so as to keep the leg straight as much as possible.
      • The leg should be allowed to remain straight as much as possible.

      Exercise Program

      • This position should be held for about 15 minutes and repeated every hour.

   6. Calf Stretch:

      Goal

      • This stretch promotes calf muscle and hamstring flexibility.

      Exercise

      • The affected leg should be placed one step behind the other leg.
      • The knee should be straight and the heel needs to be on the floor at the time of leaning forward.
      • The athlete may stand in front of the wall for balance when doing this exercise.
      • A stretching sense need to be felt at the back of the leg which is behind.

      Exercise Program

      • This stretch should be held for 10 seconds and then released gradually.
      • This stretch should be repeated at least three times daily and should be done with the knee a little bit bent.

4. Early Rehab, PT and Exercises after Lateral Meniscus Knee Injury

   Static Quadriceps Contractions PT Exercise for Lateral Meniscus Injury:

   Goal-

   • This rehab exercise helps in preventing quadriceps muscle degeneration and weakening in the acute stages of knee injury.
   • Weightbearing or difficult exercises are not advised or are too difficult to be done in this stage of knee injury or lateral meniscus injury.
   • This exercise should be started as soon as the knee pain has reduced and should be done daily.

   How to do Static Quadriceps Contraction Exercise?

   • The quadriceps muscles at the front of the thigh should be contracted while keeping the toes pointed to the ceiling.
   • This should be held for 10 seconds.
   • Relax and rest for a few seconds.
   • This exercise can be performed either flat on the floor or with a foam roller or rolled up towel placed under the knee.

   Exercise Program-

   • Repeat 10 to 20 times.
   • Exercise should be performed 3 to 4 times a day.

   Static Hamstring Hold PT Exercise for Lateral Meniscus Injury

   This PT exercise helps maintain the strength of hamstring muscles. It should be started as soon as the pain allows and should be done on a daily basis.

   • Athlete should first lie on one’s stomach.
   • The knee should be bent so that the foot rises up to about 45 degrees.
   • This should be held for a count of ten and lowered slowly.
   • This should be repeated 10 to 20 times.
   • This exercise can be advanced by increasing the length of hold or using ankle weights.

   Static Hamstring Contractions Exercise for Lateral Meniscus Injury

   Goal-

   • This PT exercise for knee injury facilitate and increases range of motion of the knee joint.
   • This exercise comprises of contracting the hamstring muscles without any movement that is by pushing against a static object.
   • Exercise is performed by bending the knee or extending the hip or both.
   • Exercise is performed by while partner is used to resist the joint movement
   • Exercise also performed while pushing the leg against a wall, chair or the floor.
   • Hold the joint in optimum position for 10 second then relax for 3 seconds.

   Exercise Program

   Repeat exercise 10 to 20 times.

References:  

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• Knee Joint Bruises: Causes, Symptoms, Treatment, Recovery, Prevention
• Knee Joint Pain: A Complete Treatment Guide- Conservative, Medications, PT, Surgery
• Knee Joint Abscess: Causes, Symptoms, Treatment, Prognosis
• Understanding Knee Joint, Its Structure, 6 Causes of Knee Joint Pain
• Knee Joint Tendonitis: Types, Symptoms, Treatment- Conservative, NSAIDs, PT, Surgery
• 5 Major Causes of Knee Joint Pain: Inflammation, Infection, Injury, Osteoporosis
• Knee Joint Anatomy: Bones, Cartilages, Muscles, Ligaments, Tendons-Quadriceps