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Knee rehabilitation- early stage

After an operation, injury or after developing age related changes such as osteoarthritis you may develop pain, swelling and stiffness in your knee joint.

The vast majority of knee pain does settle with time after an injury or operation and even if you have a degenerative condition pain levels at times can be very comfortable however it is normal for your knee to flare up from time to time. Managing these flare ups is key and this guide is devised to help you with this.  If you are experiencing consistent pain that is difficult to manage, especially at night and your knee feels unstable after a recent injury with associated locking and loss of movement you may need some help. Please do not hesitate to contact your physiotherapist or GP for advice.

How much weight can I put through my foot?


Following your injury or surgery it is important to keep moving but to do so in a safe way. You will be told how much weight you can put through the ankle.
 

  • Non-weight bearing (NWB) - NO weight should go through the affected leg when walking – you will need crutches or a Zimmer frame to help you to move about safely.
     
  • Touch weight bearing (TWB) - This is where a very small amount of weight is put through the toes of your affected limb as you place your foot to the ground. Pressure should be very light (10%) and the majority of your weight should be taken through your arms (using crutches or a Zimmer frame) and your non-affected leg.
     
  • Partial weight bearing (PWB) - Partial weight bearing means putting some weight through your affected limb with help of crutches/zimmer frames but not all of your weight. You can try to walk with a normal pattern but, when you have the affected foot on the ground, you need to have both crutches in contact with the floor; putting only 50% of your weight through your leg.
     
  • Full weight bearing (FWB) - You are able to put full weight through your affected leg (100%). This means the fracture has healed well enough now to bear your full body weight as you walk, enough so you can stand fully on one leg while holding on! You may still be experiencing some pain or discomfort. You can discuss this with your healthcare professional, as this may be due to other factors such as muscle weakness. During the transition to fully weight bearing, you may still need a crutch or zimmer frame initially.

How do I get up and down the stairs using my crutches?


Downstairs with elbow crutches

  1. Put your crutches onto the step below. 
  2. Lower your injured leg first onto the step.
  3. Take some weight through your arms and step down with your good leg so it is on the same step as your injured leg.
  4. Repeat, stepping down one at a time.
  5. If a handrail is available, use the rail and one crutch and follow the same instructions.


Upstairs with elbow crutches

  1. Keep the crutches on the same step as you are standing on.
  2. Step up with your good leg first (if not weight bearing then hop up with the good leg).
  3. Keep your crutches on the step below you while you bring your injured leg up so it is on the same step as your good leg.
  4. Finish by bringing your crutches up to the same step.
  5. If handrail is available, use the rail and one crutch and follow the same instructions.

Managing the swelling in your knee

If you have swelling in your knee it is important to try and manage this as best you can. Try and identify if there is something you are doing in your day to day life or exercise regime that could be making your knee swell. Your body may well be letting you know that at this time your knee is not quite ready that particular task. Ice can be useful for the first few days if an injury but after this we think regular elevation and compression is more beneficial throughout the day.

Elevation

Sit with your leg up supported with pillows which will help to drain the fluid out of your knee.
 

Compression

You can use a knee brace or similar compression device to help with the swelling in the knee. In the early stages of your rehabilitation it may help you regain the confidence back in your knee and help you to be more active. Only use it when you really need it, for example a longer walk and can you use it whilst you are elevating the knee to help with reducing the swelling in your knee.

How to get your knee straight

Improving the ability for your knee to straighten is very important for the functioning of your knee joint, we call this knee extension. It is quite hard to walk without a limp if your knee does not fully straighten. This may happen for a number of reasons; after surgery, after a knee injury or can just happen as your knee starts to develop age related changes such as osteoarthritis or a degenerative meniscal tear. It is important to work on the exercises as much as your symptoms allow. We recommend 5-10 minutes every waking hour.

Regaining knee extension

How to improve the bend in your knee

Improving your knee bend is important to allow you to get back to your daily activities and other interests such as cycling or gardening. Your knee can stiffen up after surgery or an injury due to natural development of scar tissue. It is important to work on the exercises as much as you symptoms allow. We recommend 5-10 minutes every waking hour.

Regaining knee flexion

Early stage knee strengthening exercises

The quadriceps (thigh) muscle can lose muscle bulk rapidly following an injury or operation which is unfortunate as this is a very important important muscle which stabilises you knee. Below are some early strengthening and range of movement exercises which help to start strengthening your muscles around your knee. You can start these as soon you feel able.

You may experience some discomfort whilst performing some of the exercises and this may persist for some time after finishing them. The pain you may experience after the exercises does not mean you are damaging anything. How much and how long the pain lasts for is something you will discuss with your physiotherapist, but usually if the pain and the length of the time the pain lasts for is acceptable to you, then it’s fine.

Early knee exercises 


Early weight bearing exercises