Your post-op rehabilitation can be more important in your recovery than the surgery itself.
This protocol is a guideline for your post-op rehab. Remember, everybody is different and this often has to be individualized based on how it goes or things specific for your surgery. If there are any problems or questions, look to Dr. Maffet for guidance.
General Postop Goals:
- Let inflammation settle down – that is, a decrease in the pain, stiffness, and swelling.
- Improve function – which is the quadriceps strength, hamstring flexibility, range of motion, gait pattern, and proprioception and coordination.
- Remember the Physical Therapy is “supervised rehab”. PT has a role in you recovery, but the rehab exercises need to be learned and done on your own as well.
First 7-10 days:
I don’t typically start any formal physical therapy before the first postoperative office visit. During this time I want you working on decreasing the inflammation by icing the knee at least 3 times per day for 15 minutes. You may have a cold therapy machine which makes this process easier. You will get the cold therapy machine if your insurance covers it. It is not critical to your recovery if it is not covered. I also want you backing off on your activity level as much as possible to help let knee inflammation settle down. If you start too much activity too soon, therapy or otherwise, you’re just going to make the knee angry and hurt more. It is okay for you to get up and around doing the things you need to do. Use crutches until you can walk without a limp. I’d rather you use them a day or 2 too long than get rid of them too quickly.
We’ll start Physical Therapy.
- Early quad work – ( quad sets, straight leg raises, electrical stim.) Advance to closed chain kinetic quad strengthening ( leg presses, squats, or equivalent
- Hamstring stretching
- Anti-inflammatory modalities ( ice )
- Gait training with ambulatory aids as needed ( weight-bearing as tolerated unless otherwise instructed)
- Ankle pumps / toe raises
- Stationary bike when 110 degrees of flexion reached
- Balance training advancing to sport specific activities as tolerated ( plyometrics, cutting / agility program, throwing program, running program)
I try to avoid open chain kinetic quad strengthening ( leg extensions) and active hamstring curls. Also avoid Stairmaster, step aerobics, and lunges. These activities can increase leg function but can stimulate patello-femoral syndrome.
Transition to a home program.
- Take your supervised rehab activities and start doing them on your own. It is important to understand that full rehabilitation is an ongoing process and needs to be continued far beyond the limits of supervised physical therapy.
- Get access to a gym if possible. I recommend for the first 6 months at least. Some PT places give gym memberships.
- If you can’t get access to a gym, your physical therapist can often show you things you can do at home with minimal equipment.
Mark W. Maffet, M.D.