In this blog, I review 5 key components of early knee rehab that you will can to implement right away following an injury or surgery.
Looking to improve your strength, range of motion, and power to enhance your function and performance? Check out our Knee Resilience program!
Disclaimer
Before showing these recommendations, there are 3 important things to know:
- You may need a couple of days of relative rest after more severe injuries. For example, if you tore your ACL, you may need to wait 1-3 days to allow for pain or swelling to subside before starting certain exercises.
- Talk to your surgeon before starting a new program since you may have surgical precautions to consider. For example, following a medial meniscus repair, there are often weight-bearing and range of motion restrictions early on.
- Knee range of motion will vary from person to person. For example, it might not be feasible, or necessary, to achieve full knee flexion following a total knee replacement.
#1. Restore Knee Extension Range of Motion
Getting your knee straight should be a top priority for a majority of cases. For some people, you may actually be able to achieve a few degrees of hyperextension, which is often normal and not a cause for concern.
You can also do a similar variation while seated at your desk, at the dinner table, on the couch, etc. Straighten your leg, squeeze your quads for 10 seconds, relax, and repeat.
If you want to increase the range of motion, use a strap and pull up on your foot to add a calf and hamstring stretch.
Once you achieve full knee extension, you can add external resistance, such as a small ball against a wall or a band anchored to an object, in order to build strength and control. Your goal is the same – squeeze your quads as you push the back of your knee into a ball or band. Hold for 10 seconds, relax, and repeat.
Which quad set variation you choose will be determined by your injury, surgery, available range of motion, symptoms, etc.
For example, if you recently had ACL surgery and lack 5-10° of extension, performing the quad set with a towel under your knee will likely be the most appropriate starting option. As your extension improves over the period of days to weeks, you may progress to using a heel prop and adding external resistance with a ball against the wall.
In contrast, if you sustained a mild MCL sprain, experience minimal symptoms, and have no major extension deficits, you may choose to only perform the band-resisted quad set in order to help improve your strength and control.
#2. Improve Quadriceps Function
Your primary goal related to quad function is being able to perform a straight leg raise with your knee completely straight.
Lie on your back with one knee bent. Straighten the other leg by squeezing your quad, and lift that leg until your thighs are in line with one another. Slowly control back down. Build up to 3 sets of 10-20 repetitions.
In addition to improving quad function, you can also target other muscles of your hip by eventually performing leg raises while lying on your side and stomach.
While the straight leg raise is an important milestone, to maximize your function during daily activities, I also recommend you eventually progress to squats and step-ups once tolerated.
For squats, gently tap your butt to a chair or box and stand back up. If you find this to be challenging or painful, you can reduce the range of motion or use your hands for assistance.
For step-ups, place all your weight through the front leg as you step up onto a stair or object. Try not to push off the back leg. If this is too challenging or painful, use your hands for assistance. To make this harder, increase the height of the step.
For both the squat and the step-up, your goal is to build up to 3 sets of 20 repetitions.
It is important to keep in mind that factors such as your injury, type of surgery, and symptoms can play a role in determining the exercises you do and when you perform them.
For example, as previously mentioned, a medial meniscus repair will likely have weight-bearing and range of motion restrictions. Therefore, it’s important to wait for clearance from your surgeon or physical therapist before performing exercises such as squats and step-ups.
In comparison, if you have knee osteoarthritis and want to improve your overall function, squats and step-ups can be beneficial options, provided you can perform them safely with tolerable symptoms.
Finally, another option for improving quad function that you can incorporate in the early stage of knee rehab is an isometric leg extension.
Although considered dangerous by some, leg extensions are not only safe but extremely valuable because “open-chain exercises are the only means to isolate the quadriceps”.
If you had an ACL reconstruction and you’re still concerned, you can perform the isometrics between 90° and 60° of knee flexion, as it places zero strain on the ACL.
You can do these on a machine, with a band, or using a ball against the wall. If a single-leg variation is too challenging or uncomfortable, start by using two legs. Perform daily for 3-5 sets of 30-45 second holds.
#3. Normalize Walking
In certain instances, using crutches or another assistive device might be necessary early on if walking without them is not tolerable. However, you eventually want to be able to walk unassisted without a limp.
Restoring your knee extension range of motion and improving your quad function will help you achieve this goal. Additionally, here are 3 more options.
1. Single Leg Balance. Stand on one leg on flat ground with hands across your chest. Keep your torso upright and don’t let your other leg touch the ground or your stance leg. Work up to 3 sets of 60 seconds. Once you can achieve this, you can make this harder by trying to balance with your eyes closed.
2. Retro Walking. This is just a fancy name for walking backward, and it can be a helpful drill for improving your knee extension range of motion and control during walking. Take a small step back, slowly drive your heel to the ground, and straighten your knee by squeezing your quads. You can do this in an open space or on a treadmill.
3. Walking Over Cones or Hurdles. This exercise is intended to teach you to bend your knee during walking as opposed to swinging your hip out to the side. Drive your knee straight up in front of you and focus on clearing the object with each step. You can start with smaller hurdles or cones, and increase the height over time.
#4. Restore Knee Flexion Range of Motion
Normal knee flexion is being able to bring your heel to your butt or very close to it. This is about 135°.
To improve your knee flexion, here are 3 options:
1. Stationary bike. Start with the seat at a higher level and perform partial revolutions, moving your knee in and out of as much flexion as comfortable. Once you can complete full revolutions, gradually lower the seat in order to expose the knee to more flexion. Do this daily for 5-25 minutes, gradually increasing the duration as tolerated.
2. Assisted Heel Slides. Lie on your back, and slide your heel as close to your butt as you can using a slider or a sock on hardwood. Pull on a towel or strap to help bend your knee further. Aim for 15-20 repetitions, multiple times a day.
3. Kneeling Progression
Level 1 – Quadruped. Start on your hands and knees and rock your butt back toward your heels.
Level 2 – Tall Kneeling. Move from a tall to a low kneeling position. You can use your hands for assistance if needed.
Level 3 – Half Kneeling. In order to bias one knee, start in half kneeling and sit your butt back to your heel.
For each level, hold the end position for a few seconds, before returning back to the start. Repeat this for 2-3 sets of 10-20 repetitions.
These three exercises are only some options that can help various knee issues. Your exercise selection and the amount of range of motion you regain will differ based on your injury, surgery, symptoms, goals, etc.
For example, if you had a knee replacement, you may incorporate biking and heel slides, but the kneeling progression and achieving 135° of knee flexion may not be realistic or necessary.
On the other hand, if you practice jiu-jitsu, you may want to eventually incorporate the kneeling progression or other advanced options, and aim to restore your full knee flexion in preparation for your sport.
#5. Manage and Monitor Symptoms
Following any knee injury or surgery, a key component of rehab is to minimize pain, swelling, and joint soreness.
This does not mean you rest entirely and do nothing but ice and watch Netflix for days to weeks. While you do want to protect the injured tissues, especially within the first 1-3 days, you do not necessarily need to avoid all movement. In fact, in order to help reduce symptoms and improve function, some activity and exercise are usually beneficial.
The key is finding the right dosage.
Let’s say you perform 3 sets of 15 reps of the squat exercise. If you notice a flare-up afterward, such as experiencing significantly more pain, swelling, or joint soreness, you need to scale back the difficulty or amount of exercise you are doing. In this case, you could drop down to 3 sets of 10 repetitions in your next training session.
Conversely, if your knee is feeling good, you can continue by making gradual and incremental progressions. Maybe in the next training session, you decide to increase to 3 sets of 20 repetitions.
Despite common belief, rehab rarely follows this perfect, linear progression. There will be times when you end up pushing yourself too hard and your knee becomes more painful, swollen, or sore. This happens. But your goal is to reduce these occurrences by following your surgical precautions, if necessary, and constantly monitoring your response to activity and exercise and adjusting accordingly.
Lastly, elevation and compression are other strategies you can use to help manage knee swelling if you find yourself lying around on the couch or in bed.
Programming
Putting all of this information together, this is what your programming might look like in the early stage of knee rehab.
To restore your knee extension and flexion range of motion, you could perform quad sets, heel slides, and ride a stationary bike several times each day. To improve quadriceps function, include straight leg raises and isometric knee extensions in your daily routine and gradually incorporate squats and step-ups, 2 to 3 times per week. These knee extension and quadriceps exercises will assist in normalizing your walking, but you should also consider practicing your single-leg balance on a regular basis and include other walking drills if needed.
As you perform these exercises and your other daily functional activities, such as walking, it is very important that you manage and monitor your knee pain, swelling, and joint soreness in order to help reduce the occurrence of flare-ups.
Who Will Benefit From This Information?
These 5 key components of early knee rehab can be used for an acute, or sudden, knee injury that does not require surgery, such as a ligament sprain (i.e. ACL, MCL, LCL, PCL) or meniscus tear. You can also use these for more chronic issues such as knee osteoarthritis if you are looking to improve your range of motion and/or overall function.
If you require surgery or had surgery (i.e. ACL, meniscus, knee replacement), these are also extremely valuable, however, you may have precautions to consider, so it is recommended you talk to your surgeon or physical therapist before beginning any new exercises.
What Should You Do After The Early Stage of Rehab?
Typically, the early stage is one of three overlapping stages of knee rehab. The next stages usually involve gradually increasing the difficulty, volume, and complexity of your training. This often includes more advanced strength and balance exercises and depending on your goals, may include plyometric and running drills to better prepare you for sport or more advanced activities.
As an example, if you had ACL reconstruction and want to return to playing soccer, you must progress to more advanced exercises, including heavy resistance training, dynamic balance, jumping, sport-specific drills, etc.
The specific needs for different knee injuries and conditions will vary, so I recommend checking out some of our other blogs for more information.
Do You Need to Perform These Exercises Forever?
No, but your timeline will vary depending on the severity of your injury, surgery, symptoms, goals, etc.
If you are recovering from a mild ligament sprain, you may only incorporate these suggestions for a couple of weeks before progressing to more advanced options. Alternatively, if you have a chronic condition like knee osteoarthritis, you may find it beneficial to perform some or all of these exercises indefinitely.
Summary
In summary, there are 5 key components you should focus on during the early stage of knee rehab:
- Restore Knee Extension Range of Motion
- Improve Quadriceps Function
- Normalize Walking
- Restore Knee Flexion Range of Motion
- Manage and Monitor Symptoms
Don’t forget to check out our Knee Resilience Program!
Want to learn more? Check out our other similar blogs:
ACL Reconstruction, MCL Sprain Rehab, Meniscus Tear Rehab
Thanks for reading. Check out the video and please leave any questions or comments below.
