Physical therapy after knee surgery

Arthroscopy of the knee joint is a minimally invasive surgical procedure used to treat damage to the inside of the joint or diagnose diseases. During the operation, a complete opening of the joint does not occur; two incisions are made through which the arthroscope instrument and the surgical instrument are inserted. After the operation, there are no significant scars, a low degree of damage to the connective tissues.

In the Yusupov hospital, treatment of the knee joint is carried out, during the recovery period, rehabilitation specialists develop a program to restore joint function using physiotherapy exercises. The program is developed individually, depending on the degree of damage to the joint, the condition of the patient. Treatment with arthroscopy is performed for meniscus injuries, to restore the cruciate ligaments, cartilage destruction, which often happens in athletes.

When you can not do exercise therapy after surgery on the knee joint

The recovery period for each patient depends on the individual characteristics of the body. It also depends on the degree of joint damage, the volume of surgical intervention. Arthroscopy can cause hemorrhage in the surrounding tissue and joint edema, the development of complications: thrombosis, thrombophlebitis, infection, thromboembolism. The patient needs to remember that for the first time after surgery, you should not create stress on the joint, turn it around. At first, the knee joint will respond to increased load when moving with swelling and soreness. In this case, the load on the knee joint should be reduced, rest more often. It will be several months before the patient can again go in for sports, move a lot, do physical labor. You can not conduct exercise therapy in the following situations:

  • the knee joint turned red, swelling appeared;
  • body temperature increased, chills appeared;
  • severe, increasing pain;
  • shortness of breath, shortness of breath, chest pain.

If swelling occurs after exercise therapy and within a few days does not go away, you should consult a doctor. In the first week after surgery and during the period of deterioration, they reduce the load on the joint, bandage the foot from the foot to the third of the thigh with an elastic bandage, apply ice for 15 minutes to the knee joint. In the supine position, the leg should be at a level above the heart.

Types of physiotherapy exercises after arthroscopy

Daily exercise can speed up recovery of knee function. A few days after the operation, you can perform the following exercises:

  • lying on your back. Bend the legs at the knees as much as possible, exercise slowly and effortlessly, if pain occurs. Press the heels to the surface, strain the back of the thigh, count to five and relax. Repeat 10 times;
  • lying on your back. To bend a healthy leg in the knee, the leg with the operated knee lies straight. Tighten the front thigh muscle group on the operated leg and slowly raise the leg up 20-30 centimeters above the surface. Count to five and lower. Repeat 10 times;
  • lying on your back. Bend your knees, raise your hips up, resting on your feet. Tighten the gluteal muscles, count to five and go down. Repeat 10 times;
  • lie on your stomach. Put the feet on the roller, pressing on the roller to try to straighten the leg as much as possible. Count to five and relax. Repeat 10 times.

The complex of exercises is complicated after a few weeks from the start of postoperative rehabilitation. Exercise therapy includes more active exercises for flexion and extension of the joint, increased load on the joint. Depending on the condition of the patient, the instructor may schedule classes on an exercise bike, walking, running. Running classes can begin no earlier than one and a half to two months after the operation, the increase in load occurs gradually. Types of loads, duration and speed are calculated by a rehabilitation specialist. Individual lessons with an instructor help to avoid complications and quickly restore joint function.

Where can I get exercise therapy with an instructor In Moscow

Classes of exercise therapy with an instructor after arthroscopy of the knee joint are held in the Yusupov hospital. The rehabilitation clinic is recovering from various diseases and operations, including joints. For the patient, an individual exercise schedule is drawn up, rehabilitation classes are held under the supervision of specialists. Assistance is provided by a team of surgeons, orthopedists and other hospital specialists. You can make an appointment with a doctor by calling the Yusupov hospital.

Rehabilitation and exercises after knee surgery

Any surgical intervention on the joint, regardless of the volume and degree of complexity, necessarily requires rehabilitation. It is a big mistake to think that a successful operation has already solved all the problems. Without proper postoperative rehabilitation, the knee will not restore the full range of movements and sooner or later it will begin to hurt.

Rehabilitation plan

compiled for each patient individually by a rehabilitologist, taking into account many factors, such as:

  1. The complexity and scope of surgery.
  2. The degree of dysfunction of the joint.
  3. The presence or absence of complications.
  4. Accompanying illnesses.
  5. The degree of physical fitness.

It is important to understand that rehabilitation should be comprehensive, i.e. include the following:

  • A balanced diet with a sufficient content of polyunsaturated fatty acids, protein, zinc, calcium and selenium in foods.
  • An additional intake of chondroprotectors that help restore cartilage (glucosamine + chondroitin).
  • Special exercises, massage, dosed physical activity.
  • Physiotherapy

Rehabilitation Stages

The entire rehabilitation period can be divided into the following stages:

  1. Early recovery
  2. Feature Recovery
  3. Late recovery

The duration of each of them depends on the volume and complexity of the surgical intervention and the condition of the patient himself.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Early recovery phase

Its duration is up to 2 weeks after the intervention. At this time, they carry out antibacterial and analgesic therapy, apply ice, make sterile dressings, a bandage. After a day, under the supervision of a doctor, you can begin the first warm-up exercises. Exercises are gradually expanding, but for normal loads, the time has not come yet. Let’s say, climbing stairs must be done with an added step.

Joint function recovery

The stage lasts from 2 weeks to one and a half months.

During this period, a gradual and measured increase in the load on the operated joint is very important. Physical therapy is carried out several times a day. To fix the joint, it is necessary to use a knee pad. There is a psychological adaptation.

Late recovery phase

Lasts over 45 days. The operation will require not just temporary changes, but correction of the patient’s lifestyle. Even after complete restoration of the motor function of the joint, you will need to perform a set of daily exercises, eat right and regularly visit a doctor.

Physiotherapy exercises in different periods of recovery

The first movements in the joint begin no earlier than 12 hours after surgery. They must be done under the supervision of a rehabilitologist or therapeutic gymnastics instructor. As a rule, the initial complex consists of the following exercises.

  1. Lie on your back. Slowly perform foot movements toward you, then away from you. Heels should not be torn off the surface of the bed.
  2. Lie on your back. The operated leg is straight, healthy – bent at the knee. Under the heel is a roller made of a towel. For 5-7 seconds, press the heel on the roller, straining the ligaments and muscles under the knee, as if trying to bend the leg.
  3. Lie on your back. Healthy leg bend at the knee. Slowly raise the straight operated leg up to a distance of 15-20 cm. Hold for 5 seconds and carefully lower it.
  4. Lie on your back. Bend both legs at the knees with support on the heels. Tighten your thigh muscles for 10 seconds.

After a few days, the complex can be expanded with the following exercises.

  • Standing against a wall or chair (for safety). Gently lift the straight operated leg and fix it at an angle of 45 degrees for 5-7 seconds. Gently lower.
  • Standing position, leaning with both hands on the back of a chair. Gently lift the diseased leg to the side, lifting it slightly. Lock for 5 seconds and gently lower.

The feeling of a little discomfort in the knee is not a reason for refusing exercise. If the joint is not developed, then the risk of adhesions and contractures increases sharply (persistent restriction of joint mobility).

If swelling occurs when even light physical exertion is performed in the knee, a special drainage massage is prescribed to the patient.

In the second period of rehabilitation, the load can be gradually increased.

  1. Position – standing leaning both on the back of a chair. Perform squats at a slow pace. The angle of flexion in the knee joint should be less than 90 degrees. The back is straight. The number of squats gradually increase to 10 times.
  2. Lie on your back. Place a roller under the operated knee. Leaning on the roller, unbend the leg as much as possible and fix it for 5 seconds. Gently lower. Perform 10 times.
  3. Position – standing, leaning his hands behind the back of a chair. Bend the operated leg and grab the foot with the same hand. Gently pull the foot to the buttock and lock for 5 seconds. Gently lower your leg. Bring the number of repetitions to 10 times.
  4. Position – standing in front of a platform with a height of 15-20 cm. Take a step on the platform with your operated leg and smoothly transfer body weight to it. Straighten your back. Do 10 reps. You can use the stairs to complete this exercise.
  5. Position – sitting on a chair. Put the diseased leg on the second chair. On the thigh next to the knee, put a load (sand bag) weighing 1-2 kg. Fully straighten the leg in the knee and fix for 5-10 seconds. Relax smoothly. Repeat up to 10 times.
  6. Walking or walking on a treadmill. You need to start from 1-10 minutes a day at a slow pace, gradually increasing the pace and duration of the walk. After the load, there should be no swelling of the joint and increased pain!

In the late recovery period, it is recommended to regularly perform the following loads:

  • Classes on a stationary bike. The pedal mode is “light.” To start classes from 1-2 minutes a day with a gradual increase in duration to 20 minutes and pedal resistance to the level of “heavy”
  • Swimming in the pool and aqua-gymnastics.

Throughout the course of rehabilitation, the patient needs a mood to work with doctors, as the effectiveness of restoration of joint functions depends primarily on the responsibility and discipline of the person himself.

What exercises to choose for knee recovery after surgery

The vulnerability of the knee joint is due to its structure and location. Injuries, constant loads often end in operations. After arthroplasty, surgery to restore ligaments, a competent rehabilitation is necessary on the meniscus. Restoring the knee after any surgery will help exercises for the development of the knee joint, which should be included in the rehabilitation program.

General principles of knee repair

Knee joint movement should not be limited to pain or mechanical obstruction. However, free bending, extension of the knee is often impossible. After any injury with or without gypsum, rupture of ligaments, sprains, or with a damaged meniscus, with degenerative changes, the knee simply loses such abilities and needs to be restored. Motor rehabilitation is also necessary after any operation. Although after endoprosthetics, even after minimally invasive surgery in the form of arthroscopy, with which the meniscus is restored or removed, ligament plastic is performed.

The key points in the rehabilitation of the joint after any injury or surgery, endoprosthetics are:

  1. Regular gymnastics corresponding to the recovery phase after surgery and the complexity of the intervention.
  2. A phased increase in the load on the joint, in which the exercises of the previous stages are fully mastered by the patient.
  3. Carrying out a massage that helps improve blood flow, and accordingly strengthen the nutrition of all tissues, ligaments, menisci, cartilage.
  4. Adding to the complex of exercises to strengthen muscle tissue. Only thanks to strong muscles the knee is supported, which eliminates repeated injuries, sprains, tears of the meniscus.

For preventive purposes, the patient is advised not to leave the workout, but to continue it even when the knee is fully restored after a replacement or other operation.


Video – Early rehabilitation after knee surgery. Part 1

Joint development after injury, fracture

Knee recovery after removal of gypsum necessarily combines exercise therapy and massage. All actions are aimed primarily at stimulating blood flow. Therefore, the patient is recommended walking, training on special simulators, isometric exercises to reduce the femoral muscles. Stretching is also important at the first stages, since after prolonged immobilization of the tendon and ligament are reduced, which limits the range of motion. However, the training is carried out in a sparing mode without overloading the damaged joint.

  1. We tilt the body alternately to both legs, spaced shoulder w />
  2. Sitting on a chair, bend and unbend a leg in a sore joint. The amplitude should be up to acceptable painless parameters. 15 repetitions.
  3. Lying on your back, bend your knee, sliding your heel on the mat – 15 repetitions.
  4. We repeat the bends in the position lying on the stomach – 15 times.
  5. We sit on a chair, straighten the leg and hold it on the weight for 5-7 seconds.
  6. Lying on your back we perform an exercise bike. Bend a sore leg, avoiding pain.

If performing certain exercises is painful or difficult, first reduce the number of repetitions. Increase repetition and amplitude gradually.

Video – Early rehabilitation after knee surgery. Part 2

Gymnastics after surgery, arthroplasty

This complex can be started immediately after joint replacement or another operation.

  1. Without getting out of bed, bend a healthy limb. We tear off the operated leg from the surface and lifts it somewhere by 20–25 cm. We try to keep the sore leg for 5–8 counts and carefully lower it.
  2. Lying on your back, slightly bend both legs at the knees, do not tear off the heels from the surface. We strain the femoral muscles and hold the tension to 10 counts as much as possible and relax. Repeat voltage 10 times.
  3. We make a roller from the towel and place it under the feet. We press with our feet on the roller, tensing the muscles of the legs and popliteal ligaments. 10 repetitions.
  4. Without getting up, we bend our legs and rest on the floor with our feet. Perform isometric tension of the buttocks, holding it up to 5 accounts.

Such a lightweight complex is used not only after arthroplasty, but also any complex surgical intervention.

But after the first week after endoprosthetics, it’s worth moving on to more complex exercises:

  1. We stand against the wall so that the sore leg was outside. Raise a sore leg, slightly bending at the knee. We keep it on weight up to 5 – 7 accounts. Slowly put your foot on the floor.
  2. We hold our hands on the back of a chair. We transfer weight to a healthy leg. Bend your knees, crouching. In the semi-squat, we hold up to 6 accounts and go up.
  3. You will need a step or any height, a bench up to 20 cm. We become the operated foot on the step, transfer weight to it and rise, tearing off a healthy limb from the floor. We return the same foot to the floor. Make up to 10 lifts.

Training walking. Walking must begin already on the 7-14th day after surgery. In the beginning it will be a few steps. Bring walks to 10 minutes later. And after a half to two months, you can go on foot walks or light jogging on the street. It is necessary to regulate the load, depending on your own feelings. But in no case do not ignore gymnastics, even if the leg is very sore.

Stretching exercise

Without fail, any workout is supplemented by stretching exercises. Such movements will help relieve muscle tension and restore elasticity to tendons, ligaments, which are shortened after prolonged immobilization.

  1. We sit on the floor with outstretched legs. We stretch our socks from ourselves until a slight pain appears. We repeat the tension of the socks, but now on our own.
  2. Without getting up from the mat, tilt your torso to straight legs. Try to grab your socks with your hands and pull the torso to your legs.
  3. Sitting on the rug, spread your legs. Perform inclinations first to the right foot, between the legs, followed by the left. In each position, hold up to 8 accounts.
  4. Stand on one foot. Grab your foot with your foot bent at the knee. To maintain balance, use your other hand to hold onto a wall or chair.

Stretching exercises are mandatory included in any training, both at the initial stage of rehabilitation, and during preventive training.

Knee rehabilitation is considered successful when all joint functions are fully restored. It can take after injuries or surgery from a month to six months. The use of a competently designed set of exercises can significantly accelerate this process.

A set of exercises after arthroscopy of the knee

Exercise therapy after knee arthroscopy of the knee joint is an obligatory step in the process of postoperative restoration of limb performance. The complex of motor exercises after knee arthroscopy plays a paramount role.

Therapy goal

Home rehabilitation after arthroscopy is a key factor that allows patients to restore leg functionality and return to a full-fledged rhythm of life in the shortest possible time.

A set of correctly selected exercises will help to avoid stagnation in the muscles and accelerate the restoration of tissues and cartilage. It will protect against complications of the postoperative phase. Daily gymnastics will minimize the risk of processes such as:

  • inflammation;
  • infection;
  • fluid formation in the patella;
  • accumulation of blood after arthroscopy;
  • the appearance of synovitis;
  • scarring and adhesions;
  • compression of nerve endings and muscle tissue.

A serious attitude of the patient to recovery measures in the postoperative period will significantly reduce the rehabilitation period and achieve full recovery.

Features and rules of exercise therapy

Therapeutic gymnastics after arthroscopy of the knee joint differs from other similar complexes and has its own characteristics:

  • the emphasis is on flexion and extension of the knee;
  • the load on the joints and cartilage is strictly dosed;
  • special attention is paid to the development of muscles and tendons;
  • restorative, general strengthening and relaxing exercises are combined;
  • proper breathing is practiced.

Compliance with the rules is a guarantee of a positive result. The main conditions of the procedure are the individuality of the recovery program for each case and the start of classes in the early period after the operation.

It is possible to use only the complex of exercise therapy recommended by experts.

Phased rehabilitation

The period required for complete restoration of the knee joint after surgery depends on the type and severity of the operation. The rehabilitation period for arthroscopy of the knee joint is on average from 2 to 4 months. In the most difficult cases, an extension of up to 6 or 12 months is possible. The use of a set of exercises after arthroscopy of menisci and other interventions is aimed at solving the following problems:

  • joint stabilization;
  • prevention of the inflammatory process;
  • blood flow normalization;
  • reduced risk of contracture;
  • complete restoration of motor and supporting capabilities of the limb.

According to the complexity and degree of load on the joint, all gymnastic and exercise therapy classes are divided into several blocks:

  • Week 1. This block of the most light and simple loads on the contraction of the muscles of the thigh and buttocks.
  • Week 2,3. Recovery exercises are aimed at actively returning flexion and extensor functions and stretching the thigh muscles.
  • Week 4,5,6. Therapy is aimed at returning the ability to walk without support and limp, the formation of the correct gait.
  • Week 7,8. The stage of restructuring, accompanied by weakness of the knee ligaments. Excludes vigorous jumps, squats, jerks.
  • Week 9 onwards until recovery. Classes for coordination of movements, muscle stretching, walking at any distance. Allowed light jogging, exercise exercises without restrictions on the load.

An approximate set of exercises

To fully restore muscle strength in the legs and the motor-supporting functions of the knee after returning from the hospital, it is necessary to do physical rehabilitation at home. Training becomes more complicated gradually.

When signs of worsening, acute pain and swelling appear, it is necessary to reduce the load on the joint and return to simpler exercises.

  1. Heels pressed to the floor. Slowly pull your knees to your torso. Alternate tension and relaxation of the thigh muscles.
  2. Underneath the feet, lay a soft roller. Extend the limbs, tensing and relaxing the femoral muscles, press the roller.
  3. Bend a healthy leg at the knee. Raise and hold the second straight, at a distance of 30 cm from the floor, lower it slowly. The same exercise can be performed by unfolding the foot to the right and then to the left on the rise.
  4. Rest your heels on the floor, bend your limbs slightly. Compress and relax the muscles of the buttocks.
  5. Place a soft roller under the sore knee. Straighten and keep the leg extended with support on the roller, then relax.
  6. Bend a healthy limb at the knee, the second lies straight. Slowly raise the straightened operated leg to an angle of 45 degrees. After every few cm of lifting, fix on weight. Gently lower.

In a standing position:

  1. Lean on the back of the chair, squat until a right angle is formed with fixation in the lower position. Gently straighten up.
  2. Based on a healthy leg and back of the chair, only bend the sore leg in the knee. Using a hand, tighten the foot to the buttocks, fix, slowly lower.
  3. Holding the back of the chair, perform light half-squats on a sore leg to an angle of at least 100 degrees.
  4. Having taken a step with a sick foot to a step 15 or 20 cm high, straighten the knee and lower back.

For a longer period after arthroscopy surgery, classes are adjusted to increase the load with the addition of exercises:

  • for increased flexion and extension of the knee;
  • exercises on a stationary bike;
  • to strengthen the femoral muscles;
  • lifts on the steps;
  • unhurried walking;
  • body tilts in different directions in a rack with bent legs;
  • deep squats.

The whole range of recommended exercises can be successfully performed at home. Classes are held up to 3 times a day for half an hour. Exercises must be repeated up to 10 times, alternating 5-second tension, relaxation and fixation of the desired muscles.

To prevent repeated damage to the knee joint during physical therapy classes, it is necessary to use a special knee pad or fixing bandage.

Only daily training will allow you to restore the joint after arthroscopy in the optimal time, forget about pain and discomfort.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.