Phase one:  The First Six Weeks after Injury

                     

Initially, the knee needs to be protected-use the knee immobilizer and/or crutches and avoid full weight bearing.  Apply ice and an elastic wrap to control swelling.  Elevate the leg and use elastic stockings if the leg is swollen. As the pain lessens and the swelling decreases, try to gradually regain knee motion.  Avoid pivoting or twisting the knee because it might be unstable and give out.

Do not place a pillow under the knee for comfort. This can lead to knee stiffness.

When walking, bear weight according to the doctor’s instructions. Use crutches to assist when walking.  You may gradually wean from 2 crutches to 1 crutch, held on the side opposite the injured knee.  Progress to no crutch(es) or brace when you can walk without a limp and there is no pain.

Ice the knee if there is pain and swelling.  Place a towel or cloth between the skin and the ice to prevent skin injury.  Ice for 20 minutes, three times a day.

At about three weeks following injury, the pain is usually subsiding and the swelling is lessened.  You can now try to stretch the knee to regain motion.

Stationary cycle, swimming (flutter kick only) and the following exercise program are recommended.

 

QUADRICEPS SETTING –

to maintain muscle tone in the thigh (quadriceps)muscles and  straighten the knee.

                                                                         

Lie on your back with the knee extended fully straight as in the figure.  Contract

nd hold the front thigh muscles (quadriceps) making the knee flat and straight.

f done correctly, the       kneecap will slide slightly upward toward the thigh muscles.

The tightening action of the quadriceps muscles should make your knee straighten

and be pushed flat against the bed or floor.  Hold five seconds for each contraction.

Do at least 20 repetitions three or four times a day until you can fully straighten your

knee equal to the uninjured side.  

 

HEEL PROP- to straighten (extend) the knee.

Lie on your back with a rolled up towel under your heel or sit in a chair with the heel on a stool as shown in the figure.  Let the knee relax into extension (straight).  If the knee will not straighten fully, you can place a weight (2 to 5 pounds) on the thigh, just above the kneecap.

Try to hold this position for 5 minutes, three times a day. While maintaining this extended position, practice quadriceps setting.

 

HEEL SLIDES - to regain the bend (flexion) of the knee.

 

While lying on your back (figure), actively slide your heel

backward to bend the knee.  Keep bending the knee until

you feel a stretch in the front of the knee.  Hold this bent

position for five seconds and then slowly relieve the stretch

and straighten the knee.  While the knee is straight, you may

repeat the quadriceps setting exercise.  Continue this exercise

until you can fully bend your knee equal to the unoperated side.

Also, as you start to gain flexion, you can assist your efforts

to gain flexion by assisting the heel slide with a towel.  See

illustration.  Repeat 20 times, three times a day.

 

STRAIGHT LEG LIFT  

                                 

The quality of the muscle contraction in this exercise is what counts the most, not just the ability to lift the leg!

1. Tighten the quadriceps (quadriceps setting) as much as you can, push the back of the knee against the floor.

2. Tighten this muscle harder!

3. Lift your heel 4 to 6 inches off the floor

4. Tighten the quadriceps harder again.

5. Lower your leg and heel back to the floor.  Keep the

     quadriceps as tight as possible.

6. Tighten this muscle harder again.

7. Relax and repeat .

 

If the knee bends when you attempt to lift the limb off of the bed, do not do this exercise.  Keep trying to do the quadriceps setting exercise until you can lift the limb without letting the knee bend.

                                     

 

You can advance to the following exercise program to help you regain knee motion and strength.  If the exercises can be performed easily after the first week, then an ankle weight may be used to increase the resistance of the exercise and to build strength.  Start with one pound and add one pound per week until you reach five pounds.

Do the exercises daily for the first week, then decrease to every other day when using ankle weights.

You may ride the stationary bicycle daily for 10 to 20 minutes.

Avoid using stair-stepper machines, doing deep knee bends and squats or any exercise that causes crunching, clicking or pain at the kneecap.