Rehabilitation after knee injury

Knee injury

The knee joint is the most complex organ in structure, but it also accounts for quite a lot of activity. It is worth noting that compared to other parts of the body, it does not have protection such as fat or muscle tissue.

For this reason, he is susceptible to various injuries. Most often, athletes suffer from this disease, however, in everyday life, situations often occur when the knee joint is injured, for example, due to a fall, impact or other incident.

Also, a knee joint injury can be a complication after a sprain or bruise, if during the rehabilitation period the patient did not follow the recommendations of the attending physician. Most patients treat the recovery process without due attention, and at the first improvements they begin to overload the damaged joint. This leads to serious complications.

Types of endoprosthetics

Knee replacement surgery is the main way to avoid being in a wheelchair. Surgical intervention is performed when complex pathology can no longer be eliminated. Depending on the extent of damage, the following types of endoprosthetics are distinguished:

Total – complete replacement of the knee joint with a prosthesis. The operation is performed in case of tissue damage of 70%.
Partial – replacement of a specific area with an implant. A gentle technique is used if the joint is less than 50% damaged.

Damage to the knee joint can be caused by a jump from a height, chronic arthrosis, arthritis, gonarthrosis, or a blow to the knee. Bone and cartilage tissue is destroyed due to impaired blood flow and trophism.

Purpose of the rehabilitation period

Any injury to the knee joint is serious, for this reason you should carefully consider the doctor’s advice and follow all his recommendations. It is also worth remembering that rehabilitation after a knee joint injury will take quite a long time and will require considerable effort from the patient to restore the functionality of the organ.

Regardless of the extent of the damage, the recovery period is extremely important, even if it takes place at home. Any injury manifests itself in the following symptoms:

pain occurs, which may be accompanied by the development of hematomas;
deformation occurs and the joint loses its mobility;
in the absence of mobility, tone disappears, muscle mass gradually decreases;
the person is no longer able to control the limb, and this, in turn, can lead to problems with the synovial membrane. Fluid will begin to accumulate in it and, if its concentration is high in the joint, various negative consequences will appear.

Important!
Even if correct and comprehensive treatment has been carried out, failure to comply with the rules of the rehabilitation period will lead to the limb being injured again. And, therefore, it will be necessary to carry out the treatment again, followed by a recovery period. Rehabilitation measures consist of various types of procedures, which, first of all, are aimed at eliminating swelling, relieving pain, and most importantly, preventing various diseases, for example, hemarthrosis.

In addition, rehabilitation is aimed at restoring tone. It also prevents mass loss in muscle tissue. It is important that a person who has undergone competent and comprehensive treatment, and also followed all the necessary rehabilitation recommendations, recovers much faster. Rehabilitation activities can take place both at home and in a hospital. However, if possible, it is better to choose the second option, since if any complications arise, it is possible to receive timely and qualified medical care. Regardless of the location of rehabilitation, it is aimed at restoring the following tissues:

muscular;
nervous;
bone

In addition, the complex of restoration measures includes various techniques that are applied in a certain sequence. This is due to the fact that it is necessary to achieve maximum efficiency in the rehabilitation of the joint.

Knee structure

Why is rehabilitation needed?

The basis of treatment for knee injuries is the fixation method, which ensures immobility of the limb. The duration of immobilization varies and depends on the nature of the injury, the age of the patient and other factors. The longer the leg is left without movement, the more disturbances occur in cells and tissues. Forced inactivity impairs blood circulation and metabolic processes, provokes lymphostasis and the development of contractures. Certain muscle groups are at rest and do not receive the usual load - this causes gradual weakening and partial atrophy.

As a result of rehabilitation measures, a targeted effect is exerted on the damaged area. This helps restore muscle tone, rapid tissue regeneration, and reduce pain. There is also a positive effect on the psychological and emotional state of the patient, which becomes the key to successful treatment.

Rehabilitation activities

It is important that a set of measures to restore joint mobility begins simultaneously with the treatment course, and it should be noted that the period itself is divided into several main stages:

At the very beginning, the immobilization stage occurs. It consists in the fact that the patient’s limb is fixed in a certain position; for this, tools such as an orthosis and a bandage can be used. Plaster application is also practiced. This is necessary for bones and ligaments to heal properly. And rehabilitation measures are aimed at improving blood circulation, reducing swelling and relieving pain. At this stage, the most important thing is to prevent the occurrence of adhesions and muscle tissue atrophy;
the next stage is called post-immobilization. During this period, the patient is removed from the plaster or bandage that fixed the organ. Restorative measures are aimed at eliminating soft tissue atrophy. At this point, it is extremely important to improve the structure of the bone muscles. In addition, it is necessary to restore muscle mass;
The final stage is the training stage, which is aimed at completely restoring all the functionality of the joint and returning coordination of movements. At this stage, gradual adaptation to everyday loads on the damaged joint occurs.

Let us consider in detail what methods can be used at the earliest stages of the recovery process:

Physiotherapy is used to reduce swelling and relieve pain in the joint. This can be UHF, magnetic, ultrasound or laser therapy;
massage procedures are also necessary that help improve blood supply to tissues, increase tone, and add elasticity to ligaments;
health-improving gymnastics, which consists of specially selected therapeutic exercises. It helps restore coordination and restore previous mobility to the joint;
in addition, thermal procedures are necessary for successful rehabilitation. This helps to warm up the muscle tissue, which greatly increases the ability to recover faster and return to your normal lifestyle.

If the patient was treated in a hospital, he may be offered to undergo a reinforcing course of rehabilitation in a sanatorium-resort setting.

It is worth noting that full recovery can occur only after 12 months. During this time, the limb will fully recover. She will be able to endure more intense physical activity again. The rehabilitation course can last about 6 months. This time completely depends on what type of injury was received, as well as on the individual structural features of the body.

Attention! If an operation such as arthroscopy was performed on the knee joint, the patient will need to undergo repeated rehabilitation 1 or 2 times a year throughout his life. This is due to the fact that the limb needs to be kept in good shape and also strengthened so that relapses do not occur.

Failure to comply with the described rules can lead to negative complications, for example, partial or complete loss of mobility of the knee joint.

Rehabilitation after a torn knee ligament (ACL)

Rehabilitation after anterior cruciate ligament (ACL) injury

, posterior cruciate ligament and collateral ligaments has a single rehabilitation scheme and can vary only in terms of recovery depending on the patient’s age, lifestyle, and rehabilitation goals (return to professional sports, amateur sports, return to pre-injury lifestyle).

Read more about recovery after knee ligament rupture

Rehabilitation terms (general)

conservative treatment: 1.5 - 3 months; after ligament plastic surgery (surgery): 4–6 months.

The body, whether it is an injury or surgery, reacts the same way - swelling, muscle spasm and pain. Due to long-term immobilization, atrophy of the thigh muscles occurs. In order to lose muscle volume, as experience shows, one to two weeks of inactivity is enough.

The condition of our joint depends on the condition of our muscles. Why? Because when walking or running, most of the load is taken on by the muscles, whereas in the absence of well-developed muscles, the entire load falls on the articular surfaces of the knee joint, which causes swelling, pain, stiffness, etc. Based on the above, we can outline goals passive (and then active) stage of rehabilitation of knee ligament rupture.

PASSIVE STAGE OF REHABILITATION

At this stage, all physical exercises are excluded, since it is still impossible to put an axial load on the joint.

Goals:

Relieve swelling through physiotherapy, compresses, cold and kinesio taping.
Reduce muscle spasm by performing lymphatic drainage massage.
Relieve pain (reducing swelling and spasm leads to decreased pain).
Regain control of your thigh muscles and strengthen them through electrical myostimulation.
Improve passive range of motion in the joint.
Achieve a state in which it will be possible to walk without crutches.
The general goal of the passive stage can be called preparing the joint and muscles for further rehabilitation in the exercise therapy room.

Example exercise:

We present to your attention one of the exercises that can be performed at this stage: “Isometric tension of the quadriceps femoris muscle.”

STARTING POSITION: sitting on the floor, legs straightened, back straight, hands on the floor, gaze directed at the kneecap.

DOING THE EXERCISE:

Contract the quadriceps muscle so that the kneecap is pulled up. If this does not happen, then you are doing the exercise incorrectly and you should try again and again until it works. Hold the position for 3–5 seconds. Relax. Perform the exercise 25 times, 3 sets, several times a day. Upon achieving the goals of the passive phase of rehabilitation, we begin its active phase, which can be divided into 4 stages, each of which has its own goal.

Isometric quadriceps tension

IP: sitting on the floor, straightening the working leg, the second leg straight or bent at the knee joint, hands behind the back, back straight.

1. Pulling the toe towards you, contract the quadriceps femoris muscle 2. Hold the position for 5 seconds.

2. IP (2 seconds). 4. Repeat the exercise 15 times.

I STAGE OF ACTIVE REHABILITATION

Duration: 4–8 weeks after surgery.

At this stage, all exercises are performed in a gentle manner in a lying or sitting position, with the exception of some exercises. In this case, rehabilitation after a ruptured knee ligament, despite the impressive time frame, does not pose serious discomfort for the patient.

Goals and objectives of stage I:

Regain control of the thigh muscles of the operated leg through strength training and more.
To promote the development of muscle strength and endurance to static loads, especially the inner head of the quadriceps femoris muscle, as well as the posterior group of muscles of the thigh and lower leg, which ensure the restoration of the support ability of the leg.
Help achieve full extension of the knee joint by performing flexibility exercises.
Achieve an angle of flexion in the knee joint of up to 90° by performing strength and flexibility exercises, as well as various massage techniques, which include mobilization of soft tissues around the knee joint, patella, etc.
Help restore the proprioceptive sensation needed for stability in the knee joint through balance exercises.
Formation of the correct gait, which is possible only after achieving the goals described above.

An example of exercises performed at this stage:

Lifting legs with weights while lying on your back.

STARTING POSITION (IP):

Lying on your back, arms at your sides, healthy leg bent at the knee joint, foot on the floor, second leg straight 5 cm from the floor, toes pointing towards you. On the sore leg, a weight of 1 or 2 kg, depending on the condition of the patient’s muscles.

DOING THE EXERCISE:

Slowly raise your leg up to an angle of 45? (we reproduce the tension of the quadriceps muscle, which we learned at the stage of passive rehabilitation - THIS IS IMPORTANT). Hold the position for 2-3 seconds. Accept IP. Perform the exercise 15 times for 3 sets.

The main thing to remember when performing this task is that the leg should be as straight as possible, we try to pull the kneecap up due to the tension of the quadriceps femoris muscle, the toe should always be pulled towards itself and the exercise should be performed slowly without jerking. By following all the principles of restorative medicine, rehabilitation of knee ligament damage will take place with maximum efficiency and without any problems.

Upon achieving the goals and objectives of STAGE I, we move to STAGE II of the active phase of rehabilitation.

II STAGE OF ACTIVE REHABILITATION

Duration: 8–12 weeks after surgery.

At this stage, we propose to perform more complex exercises, which are performed mainly while standing and are closest to such natural movement as walking, etc. Basically, the exercises are performed with a skier’s expander, on a BOSU (hemisphere) simulator or trampoline, with the addition of seemingly simple ones, but essentially complex coordination exercises like squats (without weight or light weight) or lunges, etc.

Goals and objectives of stage II:

Promote further development of strength, power and endurance of the thigh and calf muscles by performing more complex strength and coordination exercises. Achieve a flexion angle of 60° at the knee joint. Help improve the proprioceptive sensitivity of the knee joint by performing balance exercises on bare feet or a trampoline. Prepare the muscles for running exercises by performing training exercises (various lunges on bare feet, etc.).

An example of an exercise for this stage: “Forward swing with an expander”

First, you need to attach a skier’s expander to the bottom rail of the wall bars and put the loops of the expander on your legs (on the ankle area).

STARTING POSITION (IP):

Standing with your back to the wall bars, at the distance of a stretched expander, hands on your belt, back straight.

DOING THE EXERCISE:

Slowly perform a forward swing movement, pulling the toe towards you (we reproduce the tension of the quadriceps muscle, which we learned at the stage of passive rehabilitation - THIS IS IMPORTANT!). Hold the position for 2-3 seconds. Slowly return to the IP, but do not place your foot on the floor. Perform the exercise 15 times for 3 sets.

This exercise should be performed on both the sore and healthy leg. The fact is that the leg that remains on the floor gets just as tired as the working one (if not more), and for us it would not be superfluous to maintain balance on the sore leg.

At the end of the second stage, the rehabilitation doctor assesses the condition of the patient’s muscles (whether the inner head of the quadriceps femoris muscle is well developed, as well as the posterior group of muscles of the thigh and lower leg), the condition of the joint (is there swelling or not). If the examination results are satisfactory, the doctor recommends moving to STAGE III of active rehabilitation.

III STAGE OF ACTIVE REHABILITATION

Duration: 12–16 weeks after surgery.

At this stage, we begin to use strength training equipment for straightening and bending legs in stato-dynamic mode, inertial exercises on a trampoline or barefoot.

Goals and objectives of stage III:

Help increase muscle strength, power and endurance without pain. Promote a gradual return to sport-specific functional activities. Ability to run normally. Achieve full flexion and extension in the knee joint. Achieve the muscle volume of the diseased leg equal to the muscle volume of the healthy leg. The difference in volumes can be no more than 20%. To form the correct motor stereotype of landing after jumping by performing plyometric exercises with and without interference.

After two weeks of performing exercises on strength training machines, the patient undergoes a functional test to determine whether the operated limb is ready for running and jumping exercises.

An example of a stage III exercise aimed at developing the quadriceps femoris muscle in the static-dynamics mode “Leg extension while sitting in a machine.”

INITIAL POSITION:

Sitting, your back is straight, your lower back is pressed against the back of the machine, your shins are firmly resting on the bolsters, your knee joint has an angle of more than 90 degrees, your hips do not extend beyond the seat.

DOING THE EXERCISE:

Bend - straighten your legs at the knee joint for 30 seconds. During this time, you need to have time to do 20–24 repetitions. There should be 3 such approaches. Rest between sets for 30 seconds. The movement should be uniform (without jerking). A burning sensation in the muscle is an indicator of the correctness of the exercise.

Stato-dynamic training is performed twice a week, one training is tonic in nature, the second is developmental. After a few weeks, if the leg test is positive, we begin running and jumping exercises. The goal of following a running and jumping program is to prevent recurrence of the injury. Quite often, repeated injury occurs due to the inability to land correctly after a jump; an incorrect motor pattern in running can also lead to swelling and pain in the knee joint. Your rehabilitation therapist will tell you how to properly alternate strength and running training.

Health-improving gymnastic complex

Exercise is a fundamental element that allows you to fully recover from any type of knee and shoulder injury. However, the patient must remember that in the first weeks they are moderate in nature. In addition, these complexes must be fully agreed with the attending physician. The load during the rehabilitation period increases gradually so as not to harm the limb.

Therapeutic complex of physical exercises is recognized as one of the best ways to recover from injury. But it is worth remembering that classes must be regular.

In addition, daily exercise will help strengthen your immune system. As a rule, special simulators are needed for training. Race walking and dynamic exercises can be used. The most important thing is to ensure that all elements are performed correctly. It is extremely important that a moderate pace of performing a set of physical exercises be maintained throughout.

Rehabilitation after knee arthroscopy

It will be possible to develop the knee after surgery with arthroscopic intervention many times faster than with operations performed using a standard open approach. However, it will take more than one month for complete recovery. It is very important to follow the instructions of your doctor and rehabilitation doctor to quickly restore the functionality of ligaments, muscles and the conductivity of nerve endings.

Rehabilitation after knee arthroscopy can take several months, up to six months. The entire period of development and restoration of the joint can be divided into 2 parts - rehabilitation begins in the hospital (during the first 3 days), then the development of the joint can be done at home or in a specialized medical center under the supervision of a doctor. The second option, when the patient decides to develop the joint in a rehabilitation center, is preferable, since it allows you to combine exercise therapy with physiotherapy methods, drug treatment, massages, etc.

In total, the process of outpatient recovery after injuries and knee surgery is divided into 4 successive stages:

During the first month, all exercises and rehabilitation methods are aimed at preventing postoperative complications and atrophy of the ankle and thigh muscles. The exercises are gentle and the load is minimal.
Starting from the second month and until about the third month, the joint is developed very intensively, during which time it is necessary to ensure the patient has a confident gait without lameness. At this stage, it is advisable to include swimming.
From the third month until the end of the fourth, rehabilitators work on strengthening the leg muscles, so the emphasis is on strength exercises.
Starting from the fifth month, the so-called “post-rehabilitation” period begins - the person works out on his own in order to regain full range of motion in the joint. Knee development is carried out at home or in gyms, but under the supervision of a specialist.

Basic exercises

When performing exercises, you should monitor your well-being, since the load should not cause severe discomfort or pain.

Exercises:

At first it is best to start with simple squats (see the picture below), but so that there is no heavy load on the joint. For this reason, you need to rely on the surface. The duration should not exceed 10 minutes. If pain occurs, the exercise time can be reduced to 5 minutes;
you need to take a sitting position, it is best to do this on a hard surface. The legs should be stretched forward, while the torso should reach towards the limbs. There may be some minor pain and discomfort while performing this exercise. This is due to the fact that due to injury, the ligaments have lost their elasticity, as mobility has been significantly reduced. After all, when left without movement for a long time, ligaments tend to shorten, for this reason it is extremely important to perform stretching exercises. The number of approaches is 2 times, and the duration itself should not exceed 3 minutes. After completing the exercise, you should not make sudden movements; you need to rest for a while, and then you can slowly get up from the floor.

It is important to exercise every day, then there is every chance of restoring joint mobility in the shortest possible time. In addition, it is imperative to follow the doctor’s recommendations, perform all movements consistently, and ensure that they are performed correctly.

Gymnastic exercises to develop the knee joint

It is worth noting that the complex, which is aimed at the recovery process, differs from classes aimed at developing the limb. Their main difference is that they have completely different tasks and goals for rehabilitation. First of all, joint development exercises are aimed at increasing and improving motor functions. As a rule, this complex is compiled by an experienced trainer. However, there are general exercises that are included in the complex of all classes:

it is necessary to take a sitting or lying position, then with slow movements perform flexion and extension of the joint in turn on each limb, in total the exercise is performed 15 times;
you need to sit on a hard surface, straighten your legs forward and bend your torso towards your limbs. The number of approaches should not exceed 15 times;
you need to take a lying position, it is best if it is a hard surface. Place your legs at a right angle, stretch them up and perform actions as if riding a bicycle. Duration of execution – about 1 minute;
The following exercise is performed while sitting on a chair. The limbs are extended forward one by one and held in this position for about 5 seconds.

As mobility is restored, the duration of classes and the number of approaches can be increased. However, when performing these exercises, slight pain and fatigue may occur. This should not be allowed - it is better to reduce the load, because there should not be excessive impact on the joint.

How do joint problems occur?

Unfortunately, no one is immune from joint pain. Among the patients of the traumatologist there are people of all ages, well-developed physically and those who prefer to stay away from sports.

At a young age, the causes of injury are more often heavy physical work, sports, accidents or heredity. In older age, this is a consequence of a sedentary lifestyle, excess weight and degenerative changes in joint tissue. Injuries and microtraumas received sometime earlier can make themselves known.

Strengthening activities

Strengthening health exercises are performed to prevent re-injury of the knee joint. A gymnastics complex may include a variety of exercises. It is worth noting that they can be used in everyday life, because they strengthen muscle tissue well, improve blood circulation, and tone muscles.

Any activity must begin with a warm-up; this is necessary in order to warm up the muscles and prepare them for physical activity. For example, you can bend and straighten your limbs, then slide along the surface, and then do a pendulum exercise, in which you need to rock. Then you can move on to more complex exercises:

stretching of limb ligaments;
side steps;
squats; if it is difficult to do, then at first you can do it with support;
lunges forward on each leg.

Most people believe that if you have a knee injury, you should not do cardio exercises. For some reason it is believed that they can be harmful to health. However, this is not at all true. In most cases, they can not only strengthen the damaged joint, but also improve the patient’s physical condition.

Exercises in the pool help to completely relax the damaged organ. It is worth noting that when swimming, all parts of the body are trained, but there is no load on the knee joint. This type of exercise is suitable for injuries to the shoulder joint.

Pool exercises

At the final stage, you can use an exercise bike or a bicycle. They are great for strengthening the knee joint, and they cannot cause complications. In these classes, the patient independently regulates the intensity and duration of the approaches. But before you start exercising on the simulator, you need to consult with your doctor to be sure that such loads on the joint are advisable.

If the patient approaches the treatment of the injured joint with full responsibility, then recovery can occur much earlier. However, there are often cases that during rehabilitation problems arise with the accumulation of fluid in the joint. In some cases, it is necessary to resort to surgical intervention. The operation cannot completely guarantee that the disease will not reappear, but it can significantly reduce the risk of re-damage to the joint.

Physical therapy program for knee mobilization

The main tasks of exercise therapy after injuries and knee surgery are to restore ligaments and muscles weakened during immobilization. In addition, you must:

Prevent swelling by normalizing blood circulation in the injured limb.
Strengthen your leg muscles.
Restore the maximum range of motion of the joint.
Activate nutrition of limb tissues.

If the patient engages in physical therapy under the supervision of a specialist, this will give the following positive results:

The risk of blood clots will be reduced.
Blood circulation in the tissues of the damaged limb is normalized: wounds will heal faster and muscle atrophy will be eliminated.
The circulation of synovial fluid and local metabolism will improve.
Regeneration of cartilage tissue will occur faster.
The ligaments will recover faster. The more actively the ligamentous apparatus works, the thicker the ligaments become.
The risks of developing reactive arthritis and arthrosis in the future will be reduced.

At the same time, exercise therapy is also useful for the entire body as a whole: not only the flexor and extensor muscles of the knee are developed, but also the anterior and posterior groups of the femoral muscles. The functioning of the cardiovascular system improves, the blood is filled with oxygen and quickly distributes nutrients to the internal organs.

Thus, exercise therapy is the best way to rehabilitate the knee joint after injuries and operations, but the exercise program should be individually drawn up by the attending physician or rehabilitation specialist. Self-medication in this case is inappropriate.