In this phase of rehabilitation the focus is on regaining function and range of motion, while gradually increasing general strength and avoiding complications.
First published in 2016, and reviewed August 2023 by Dr Sheila Strover (Clinical Editor)
This is a stage when things can seem to be going right, and then they suddenly go wrong.
It is tempting to push the knee too far in the excitement of getting going again. But if you trigger inflammation you can push your progress backwards. You can also damage a ligament graft or a meniscus repair by not being careful at this stage.
You need to -
Maintain passive range of motion
During this intermediate phase of the Rehab Cycle, when you are getting back to tackling home and work chores again, it is easy to be a bit lax about knee rehab. But this phase is important to maintain and improve the range of motion (ROM) of the knee joint. Even if the muscles are not fully strong again, the ROM can be maintained with passive stretches including:
Increase active range of motion
The previous section discussed passive range of motion - ie achieving bending and straightening without muscle contraction, using the body weight to help gently stretch tight ligaments.
during this intermediate phase of the Rehab Cycle, passive range of motion exercises need to be accompanied by active range of motion exercises, building up the exercises as your muscles strengthen and the swelling reduces to take your knee through a greater and greater active range.
Exercises should include:
Start re-building lower limb strength
As range of motion increases during this intermediate phase of the Rehab cycle, gradually start to introduce strengthening exercises. Ankle weights can be used in progressive sizes to add challenge to the previous full arc extensions and straight leg raises. At this stage you can also add:
Start strengthening trunk and upper body
After injury or surgery the gait may become affected from a combination of limping, using canes or crutches, and favouring the stronger leg. As you start to rebuild strength in the lower limb it is also important to pay attention to the hips and upper body. Here are some simple exercises to do:
- hip exercises, eg hip abduction, hip extensions, hip external rotation and abduction
- crunch
Rebuild balance and spatial awareness
A big problem with knee injury or knee surgery is loss of proprioception - the ability of the person to know where the limb is in space. Balance loss is a consequence too. The knee needs to be re-educated using exercises such as:
Learn about potential complications
Because in this phase you are probably seeing the clinical team less often, it is important to be aware of potential complications that may surface now. In particular we feel you need to pay attention to range of motion - there may be an inability to achieve full extension or full flexion. This may be due to a number of reasons, but be particularly aware of arthrofibrosis.