PHYSIOTHERAPY

Physiotherapy can be beneficial before & after treatment

Physiotherapy will play an important part in the treatment of many knee conditions.

You may be surprised to know that physio can be beneficial before as well as after your knee surgery. This ‘prehab’ can help speed up recovery after your operation.

Please note that the rehabilitation methods given on this site are guidelines. Your physiotherapist may vary some or all of these.

Physiotherapy Following Keyhole Surgery

The specialist knee consultants at Yorkshire Knee Clinic commonly treat cartilage tears and several other knee conditions with keyhole (or arthroscopic) knee surgery.

Physio may not always be an essential part of your rehabilitation but we will usually recommend it as a way of speeding up the recovery process.

All physiotherapy should be carried out under the supervision of a chartered physiotherapist.

Knee injury physio treatment
Anatomy of the Knee - joints

Why Do I Need Physiotherapy After My Knee Operation?

  1. To decrease pain and swelling
  2. To restore normal range of movement (ROM)
  3. To restore normal muscle tone and strength
  4. To help you return to normal daily activities

Most keyhole surgery is carried out as day case surgery. After the surgery you will usually be able to fully bear weight without the use of crutches. You’ll probably experience some pain, but this is usually quite minor.

Swelling causes pressure on the surrounding structures of the knee. This can impair muscle function and restrict your range of movement. Early mobilisation of the knee helps to activate the muscles, increasing circulation to the knee. Performing exercises with your leg raised will also help reduce swelling whilst you begin to move the joint and strengthen the knee muscles.

Exercises

Use the exercises below as a guideline to aid in your recovery. Remember, there is no recipe for rehabilitation as every case is different.

It is important to follow the advice of your physiotherapist in this early phase and be guided by them.

1. Knee Flexion Using A Sling

Sit with your legs out in front of you, preferably resting your heels on a sliding surface. Put a sling (towel, sheet etc.) around your foot then bend your knee using the sling, as far as it will comfortably go.

Hold it there for a few seconds before straightening the leg. Repeat 20 times.

2. Static Quadriceps Contraction (Thigh Squeeze)

Sit with your legs straight out in front of you and pull your toes upwards. Tense the thigh muscles to try and push the back of your knee against the underlying surface.

Hold for 10 seconds and repeat 10 times.

If you find this difficult, try it first on the other leg as often a reminder of the feeling prompts a better response when you try it again on the injured leg.

3. Co-contractions of the Quadriceps & Hamstrings

Sitting with your legs out in front of you, place a rolled-up towel under your knee.

Push your knee down onto the towel whilst digging your heel into the surface below. You should feel the muscles at the front and back of the thigh working together.

Hold that position for 10 seconds and repeat 10 times.

To progress this, repeat the whole process over two, then three rolls to increase the degree of bend at the knee.

4. Knee Extensions In Sitting

Sit on a chair and straighten the injured knee, pulling your toes up towards you.

Tense your thigh, holding that position for 10 seconds and repeat 10 times.

5. Straight Leg Raise

Sit with your legs straight out in front of you and tense the thigh muscle. Turn your foot out slightly and then lift the straight leg up about 3 inches off the bed.

Hold for a few seconds before lowering – repeating the exercise 10 times.

As this gets easier to do you should not need to rest the leg down in between repetitions. If you are unable to keep the knee straight during the whole of the exercise it means you are not ready to do this one yet.

Please Note:

All of these exercises should be done in moderation (little and often) in the first few days after knee cartilage surgery.

Where possible, elevate the limb when sitting or when applying ice. Ice helps minimise swelling in your knee and is often good for pain relief (your physiotherapist will be able to give you all the correct information for this regarding application and timing).

After this initial stage, your exercise programme will be devised according to your individual needs. The aims are to encourage normal walking and to progress to a more functional strengthening programme. This may include exercises such as ski squats, lunges, knee dips, balance exercises and progression onto mini trampoline, mat work, weights etc.

Full recovery after simple keyhole knee surgery can take from 2 to 6 weeks.

These rehabilitation guidelines have been prepared with the help of Gill Cannon and Rachel Galley (Physio Action Ltd.) – at David Lloyd Centre, Leeds and Harrogate Gymnastics, Hornbeam Park, Harrogate).

Group of People Doing Knee Physio Exercises
ACL torn Anterior Cruciate Ligament

Physiotherapy Following ACL Reconstruction

Recovery following a routine anterior cruciate ligament (ACL) reconstruction at Yorkshire Knee Clinic will take place over a nine month period (approx.).

You may need active physiotherapy for the first six months or so, depending on your activity levels and other specific requirements.

The exercise stages may vary if you have had other treatments during knee surgery e.g. meniscal (cartilage) repair, microfracture or reconstruction of other ligaments.

After your ACL reconstruction, the hard work begins. It requires dedication and patience to work towards a good outcome. It is very important that you follow the advice you are given as the exercises are specifically related to the stage of healing.

Timescales are important. You should remember that even if your knee feels like you could push it harder, the graft may not be ready. In essence, you should try to avoid twisting the knee (this is probably how it tore in the first place) and putting a forward force on the tibia.

All quadriceps exercises are designed to reduce the load on the new graft for the first six months and are classified as ‘closed chain’ (or ‘weight-bearing’). This means that they are all performed with the foot placed on a surface throughout the exercise. This compresses the whole of the lower limb, minimising shear forces across the knee.

It’s best to avoid ‘open chain’ quadriceps exercises (i.e. those done without the foot resting on a surface, such as leg extensions) for up to four months. That’s because they allow the thigh muscle to pull the tibia forward on the femur without the ground forces on the foot. This causes a greater shear stress across the knee and the new graft.

Anatomy of the knee
Knee injury physio treatment

Some ideas about rehab after ACL reconstruction are contentious, so the following are guidelines only, but they are recommended by the orthopaedic consultants at Yorkshire Knee Clinic, and commonly accepted by a large number of knee surgeons.

Why Do I Need Physiotherapy After ACL Reconstruction?

  1. To decrease pain and swelling.
  2. To regain full range of motion.
  3. To regain a normal gait pattern (i.e. walking without a limp) as soon as possible.
  4. To maintain and improve muscle tone and strength.
  5. To return to all usual daily activities including work and sports.

Exercises

Day 1-14

ACL reconstruction surgery at Yorkshire Knee Clinic is usually carried out as a day case or overnight stay. You will usually be allowed to bear full weight on the knee, but you will need crutches for the first few days to help you walk. It is better to walk well with crutches than walk badly without, and your physiotherapist will tell you when you no longer require them. However, they should be discarded as soon as possible.

Following ACL surgery you will probably feel pain in the knee. The pain is not usually severe and can be managed with over the counter painkillers.

Most ACL surgery will include a ‘hamstring-graft’. With these grafts it is normal to feel discomfort and experience bruising at the back of the thigh and knee. Swelling causes pressure on the surrounding structures which can impair muscle function and restrict your range of motion. Exercises will reduce swelling, and having the leg raised will also aid in the reduction of swelling whilst you begin to move the joint and strengthen the knee muscles.

The exercises below are a small selection and should be used as a guideline to aid in your recovery. Remember, there is no recipe for rehabilitation as every case is different.

It is important to follow the advice of your physiotherapist in this early phase and be guided by them.

Initial Management: RICE

Relative rest: Keep the knee moving as well as having periods of rest.
Ice: To help with swelling, ice regularly for at least 20 mins four times a day. You may find cold compression devices are used during your hospital stay, and you can buy these for home use.
Compression: In the early days to minimise swelling.
Elevation: Especially when ice is applied as it helps reduce in swelling. Elevate the knee when sitting.

1. Knee Flexion Using A Sling

Sit with your legs out in front of you, preferably resting your heels on a sliding surface.

Put a sling (towel, sheet etc.) around your foot then bend your knee using the sling, as far as it will comfortably go.

Hold it there for a few seconds before straightening the leg.

Repeat 20 times.

2. Static Quadriceps Contraction (Thigh Squeeze)

Sit with your legs straight out in front of you and pull your toes upwards. Tense the thigh muscles to try and push the back of your knee against the underlying surface.

Hold for 10 seconds and repeat 10 times.

If you find this difficult, try it first on the other leg as often a reminder of the feeling prompts a better response when you try it again on the injured leg.

This is important as regaining full straightening (extension) of the knee is a crucial part of the early period.

3. Co-contractions of the Quadriceps & Hamstrings

Sitting with your legs out in front of you, place a rolled-up towel under your knee.

Push your knee down onto the towel whilst digging your heel into the surface below. You should feel the muscles at the front and back of the thigh working together.

Hold that position for 10 seconds and repeat 10 times.

To progress this, repeat the whole process over two, then three rolls to increase the degree of bend at the knee.

Week 2-6
  • 0-120 degrees flexion
  • Full weight bearing and normal gait pattern
  • Two leg squats, static foot lunge, small knee bends
  • Open chain hamstring exercises
  • Stationary bike
Weeks 6-12
  • You should achieve a full range of movement
  • Single leg squats, stepping lunges, dips
  • Balance exercises – these are on ongoing key part of ACL rehab
  • Leg press and hamstring curl progression
  • Step ups/downs
  • Cycling, cross-trainer, step, rower
  • Jogging on mini trampoline / mat / straight line jog
  • Exercises for hip, knee, foot of both legs
  • Swimming (Straight leg kick only)
Month 5 Onwards
  • Start open chain quadriceps exercises under supervision
  • Concentrate on plyometric and sports specific exercises
  • Return to usual training/ skills

Please Note:

Only return to playing contact or twisting sports once your physiotherapist and Yorkshire Knee Clinic surgeon have mutually agreed that you are ready and fit to do so.

These rehabilitation guidelines have been prepared with the help of Gill Cannon and Rachel Galley (Physio Action Ltd.) – at David Lloyd Centre, Leeds and Harrogate Gymnastics, Hornbeam Park, Harrogate).

Physiotherapy treatment

Physiotherapy Following Knee Replacement

Exercise forms an important part of the recovery process following knee replacement.

The specific programme will depend upon the type of operation you have had at Yorkshire Knee Clinic, but there are a few basic principles you can follow in the early stages of every operation.

Patient in Hospital After Knee Replacement Operation
Lady Having Physio After Knee Replacement

Why Do I Need Physiotherapy After Knee Replacement?

  1. To decrease pain
  2. To reduce swelling
  3. To restore normal range of movement
  4. To encourage normal muscle function and strength
  5. To return to normal function, within the aims and expectations of surgery discussed with your knee consultant

It’s important to control pain and swelling as soon as possible as both will affect the amount of knee movement you have. When resting, it is important to raise the leg with the knee supported to reduce swelling. You can improve this by intermittently moving your ankle up and down, squeezing your thigh muscle and tightening your buttock muscles whilst in this position.

Use ice to help reduce swelling in your knee and relieve pain. Ideally, you should apply this when your leg is elevated for a period up to 20 minutes, and repeat several times per day in the early stages.

During your stay in hospital, you may find an ice-compression device/cuff is used, which can be more efficient.

Exercise little and often with a good balance of rest in between. It’s important to get the joints and muscles moving early to try and achieve a good range of movement and to activate the muscles supporting your new knee.

Ice compression to the knee

Exercises

The exercises below will help you start this process.

1. Knee Flexion Using A Sling

Sit with your legs out in front of you, preferably resting your heels on a sliding surface.

Put a sling (towel, sheet etc.) around your foot then bend your knee using the sling, as far as it will comfortably go.

Hold it there for a few seconds before straightening the leg.

Repeat 20 times.

2. Static Quadriceps Contraction (Thigh Squeeze)

It is important to straighten your knee early, and this exercise is the basis for regaining a straight knee.

Sit with your legs straight out in front of you and pull your toes upwards. Tense the thigh muscles to try and push the back of your knee against the underlying surface.
Hold for 10 seconds and repeat 10 times.

If you find this difficult, try it first on the other leg as often a reminder of the feeling prompts a better response when you try it again on the injured leg.

3. Co-contractions of the Quadriceps & Hamstrings

Sitting with your legs out in front of you, place a rolled-up towel under your knee.

Push your knee down onto the towel whilst digging your heel into the surface below. You should feel the muscles at the front and back of the thigh working together.

Hold that position for 10 seconds and repeat 10 times.

To progress this, repeat the whole process over two, then three rolls to increase the degree of bend at the knee.

4. Knee Extensions In Sitting

Sit on a chair and straighten the injured knee, pulling your toes up towards you.

Tense your thigh holding that position for 10 seconds and repeat 10 times.

5. Straight Leg Raise

Sit with your legs straight out in front of you and tense the thigh muscle of the injured leg.

Turn your foot out slightly and then lift the straight leg up about 3 inches off the bed.

Hold for a few seconds before lowering – repeating the exercise 10 times.

As this gets easier to do you should not need to rest the leg down in between repetitions. If you are unable to keep the knee straight during the whole of the exercise it means you are not ready to do this one yet.

Please Note:

The exercises will progress on the advice of your physiotherapist according to individual need.

These rehabilitation guidelines have been prepared with the help of Gill Cannon and Rachel Galley (Physio Action Ltd.) – at David Lloyd Centre, Leeds and Harrogate Gymnastics, Hornbeam Park, Harrogate).

Physiotherapy knee exercises
Patellar mobilization treatment

Physiotherapy For Kneecap Problems

Patella (kneecap) problems, anterior knee pain, and patella tendinitis are complex areas which need specific assessment by your Yorkshire Knee Clinic surgeon and physiotherapist to formulate the correct rehabilitation programme.

Below are some general principles, which you should consider only as guidelines.

Anterior Knee Pain Syndrome (AKPS), & Patella Instability

In general, AKPS means pain at the front of the knee, in the region of the kneecap, without any other obvious cause such as arthritis. Physio for AKPS has standardised over the years, but there are still a variety of approaches.

Strengthening of the quadriceps muscles can help the smooth tracking of the kneecap.

Research has shown that working on the hamstrings, especially the inner hamstrings, appears to be more important than previously thought.

Assessment of hip and foot alignment may be important, and is part of the physiotherapy assessment.

Patella instability ranges in type and severity but many of the rehab exercises are the same as for AKPS. Your physio will design a specific programme for you.

If you suffer from recurrent instability, you may need surgery. Talk to your knee specialist about this.

Patella Tendinitis

Rehabilitation for patella tendinitis aims to reduce pain and swelling, so you can return to normal activities. In severe episodes RICE (rest, ice, compression, elevation) helps, along with anti-inflammatories.

The main principles involve stretching and strengthening.

‘Eccentric stretches’ form the mainstay of physio, as they have been shown to help with healing and reduction in symptoms. An ‘eccentric stretch’ lengthens the muscle fibres while the muscle body itself contracts (shortens). It is thought that this helps develop new healthy collagen in the patella tendon.

You can do this by placing both feet flat on the ground. Bend the knees slowly to a squat. Hold it for about 10 seconds. Put more weight through the good leg, and then stand up again. This can be repeated 10 times, 2 or 3 repetitions.
As symptoms improve, put more weight through the bad leg. Eventually you can do it with extra weights.

Use a decline board (a downwards-sloped board) at about 45 degrees to exaggerate the stretch. The most important part is the downward phase, which is the eccentric component.
Other strengthening and stretching work (quadriceps, hip flexors) are also important.

Later and if required, you can commence sports-specific plyometric exercises, using fast and powerful movements (e.g. standing jumps, skipping, bounding) to develop strength and speed.

Kneecap Arthritis

General knee strength work is key. Specific strength work on the VMO – the quad muscle arguably most responsible for knee stability – can help the kneecap tracking which may be poor (see above).

Your physiotherapist may mobilise the patella to overcome some of the tightness which is often present.

The aims are to maintain or improve function, and to reduce pain.

Your physio will give you a customised programme.

Talk to us about treatment for your knee cap problem

If You Are Experiencing Knee Swelling, Pain Or Locking, Or If You Have Suffered A Knee Injury

Talk to the knee consultants at Yorkshire Knee Clinic

You May Also Be Interested In

Specialist knee surgeons will help you to speed up your recovery

Sports Athletes

Early diagnosis & expertise to speed up your recovery

Nuffield Health Hospital Leeds

Anatomy of the Knee

What’s going on inside your knee? Take a tour of the joint’s bones, ligaments, tendons & cartilage

BMI Duchy Hospital Harrogate

Why YKC?

YKC surgeons perform more knee replacements than almost anyone else. Discover why that matters.