A Guide on Knee Rehabilitation With Physical Therapy 

Importance and Benefits of Physical Therapy in Knee Rehabilitation

Knee injuries and health issues can result from many causes, such as age-related degeneration, sports injuries, accidents, and sometimes chronic knee conditions. All these conditions require rehabilitation with physical therapy. Physical therapy for knee rehabilitation is most often used when someone is preparing for or after knee surgery. 

Whatever it may be, physical therapy is a cornerstone in the journey towards knee recovery. 

So, what is the primary role of physical therapy?

Physical therapy relieves pain, helps you move better, and strengthens weakened muscles. Its best positive outlook is to show you what you can do yourself to improve your health.

What are the therapies included in knee rehabilitation physical therapy (PT)?

• First and foremost, PT starts with guided, passive knee mobility exercises (the therapist helps you move), including applying pressure massages.
• Then, there are active knee-strengthening exercises that you can do by yourself without straining your knee joints.
• In addition to the above, physical stimulation-based treatments such as heat, cold, electrical currents, or ultrasounds can be used. These stimulate your joint-to-brain signals to enhance your knee joint functioning.

The Aim of Physical Therapy for Knee Rehabilitation

Are you curious to know how knee rehabilitation improves knee joint function? Well, let me tell you: it's all about restoring your knee function and making sure you can move like you used to. How?

• Physical therapy aims to improve your metabolism and circulation while reducing muscle and joint pain, whether you've had knee surgery or an injury.
• It also helps you improve your coordination, strength, and flexibility, which can be especially helpful when you are compensating for a physical disability. 
• It can also prevent chronic problems and further damage and assess your form and mechanics. 

You'll work with a physical therapist to create a structured plan that progresses at the right pace for you. This minimises your risk of re-injury and allows you to perform exercises at the perfect intensity. 

So, if you're ready to move again, physical therapy is what you need!

Physical Therapy Rehabilitation for Common Knee Issues

In an active individual, be it sports-related or age-related, knee injuries occur commonly due to the extensive usage of the joint. Some common issues that the knee joint faces are;

• Ligament tears - Especially ACL (Anterior cruciate ligament)
• Meniscus tears
• Patellofemoral pain syndrome
• Osteoarthritis 
• Iliotibial band syndrome
• Jumper's knee (patellar tendonitis)
• Bursitis
• Runner's knee (chondromalacia patella)

Let's check out how step-by-step physiotherapy rehabilitation training is carried out for common knee joint issues.

Anterior cruciate ligament (ACL) tears

The ACL is the ligament in the knee joint that prevents the knee from moving excessively forward. If the ligament is injured, the knee will lose its stability.  

What Physical Therapies Are Recommended?

• Early phase: Initially, therapy focuses on reducing the swelling and restoring the range of motion. 

Exercises involved - Heel slides, gentle knee extensions, stationary biking

• Intermediate phase: Exercises to increase strength and stability and rebuild the muscles around the knee.

Exercises involved - Lunges, step-ups, squats, and balance exercises to develop proprioception.

• Advanced phase: When the knee gains strength and stability, the exercise focuses on functional training to prepare for a return to activities.

Exercises involved - Agility drills and sports-specific movements. 

Meniscus Injury

The meniscus, a structure found in the knee joint, protects the lower part of the leg from the shock created by our body weight.

What Physical Therapies Are Recommended?

• Rehabilitation: Gradual increase in knee mobility is focused upon without aggravating the condition.

Exercises: Straight leg raises, calf raises, gentle stretching

• Strengthening: Regaining the strength of the quadriceps and hamstrings as healing progresses.

Exercises - Hamstring curls, mini squats, leg presses.

• Functional training: Activities that mimic real-life movements, which promote stability and flexibility, are introduced. Gradually, the intensity of movements is increased.

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a complex condition of the knee which mainly involves pain around the knee cap (patella) and front of the knee.

What Physical Therapies Are Recommended?

• Muscle strengthening: The quadriceps, hamstrings, and hips are strengthened. This improves the knee cap alignment and reduces pain.
• Flexibility: Quadriceps, hamstrings, and iliotibial band stretching are focused on. The exercises help relieve the tension around the knee joint and improve flexibility.
• Functional exercises: Activities focusing on body mechanics like squatting and jumping techniques are done to prevent future injuries and pain episodes.

Osteoarthritis 

Osteoarthritis is the degeneration of the joint.

What Physical Therapies Are Recommended?

• Low-impact activities: As degeneration of your bones and cartilage is more common here, low-impact exercises are preferred and recommended by your physiotherapists. The aim is to improve mobility without excessive stress on the knee joint.

Exercises: Swimming, stationary cycling, elliptical training

• Strength training: strengthening quadriceps, hamstrings, and hip muscles are essential to support the knees.
• Pain management: Added modalities to manage pain and inflammation, like ice therapy, heat therapy, ultrasound, and transcutaneous electrical nerve stimulation (TENS), are included.

Iliotibial Band Syndrome (ITBS)

Iliotibial band syndrome is where a tendon called the iliotibial band gets irritated or swollen from rubbing against your hip or knee bones.

What Physical Therapies Are Recommended?

• Stretching and strengthening: The muscles around the hip and knee are strengthened and stretched to reduce friction. 

Exercises: hip abduction, foam rolling, stretches targeting the IT band. 

• Biomechanical evaluation: A gait and running mechanics evaluation is done to identify the underlying issue contributing to the formation of ITBS. Then, corrective adjustments are incorporated.

Patellar Tendonitis (Jumper's Knee)

Patellar tendonitis is a condition characterised by inflammation of your patellar tendon. This tendon connects your kneecap (patella) to your shin bone (tibia). 

What Physical Therapies Are Recommended?

• Load management: activities that add to symptoms are reduced and gradually reintroduced as the tendon heals.
• Eccentric strengthening: Slow lengthening and contractions of the quadriceps, like eccentric squats and leg extensions, improve tendon resilience.

Ligament Sprain (MCL, LCL)

The two ligaments that protect and stabilise your knee from both sides are LCL(Lateral collateral ligament) and MCL (Medial collateral ligament).

MCL (Medial Collateral Ligament) and LCL (Lateral Collateral Ligament ) are less common ligament strains after ACL.

What Physical Therapies Are Recommended?

• Early Stage: The early stage focuses on swelling and pain reduction; gentle movements are introduced with ice application and compression modalities.
• Strengthening and stability: Gradually strengthen the muscles around the ligament, improving stability and joint support.

Bursitis 

Bursitis is a painful condition that affects the small, fluid-filled sacs called bursa that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed. 

What Physical Therapies Are Recommended?

• Pain management: Therapists focus on reducing pain and inflammation with the help of modalities like ice and ultrasound.
• Range of motion and strengthening: Improvement of range of motion by strengthening the surrounding muscles without aggravating the bursitis is added.

Exercises: Gentle knee bends and hip strengthening exercises.

Runner's Knee (Chondromalacia Patella )

Chondromalacia patellae, or "runner's knee," is caused by the softening of the kneecap cartilage. It is seen commonly among young athletes.

What Physical Therapies Are Recommended?

• Muscle balancing: The focus is correcting muscle imbalances by strengthening the quadriceps, hamstrings, and hip abductors.
• Activity modification: Changes in routine activities like footwear adjustments, running techniques, and cross-training activities to reduce overall knee stress.

In short, any physical therapy exercise involves conditional adjustments and modifications of strengthening, flexibility training and pain management techniques for a better functional outcome. 

The approach is always made according to individual needs, limitations and rehabilitation goals.

Rehabilitation of Target Muscles: Knee Strengthening and Mobilising

Let's find out what your physical therapists may teach you to strengthen your knee-supporting muscles.

Strengthening Quadriceps and Vastus Medialis Obliquus (VMO) Exercises

• Quadriceps strengthening sets
• Terminal knee extensions
• Leg press
• Step - Ups
• Lunges
• Wall sits

Knee Mobility and Flexibility Exercises

• Knee Circles
• Straight Leg Raises
• Hamstring Stretches
• Quadriceps Stretch
• Calf Stretches
• Heel Slides
• Foam Rolling

Knee Stability Exercises for Balance

• Single Leg Balance
• Bosu Ball balance
• Mini Squats
• Balance Board or Wobble Board Exercises
• Step-ups with balance
• Lateral band works

Strengthen Knees by Incorporating Resistance-Band-Training

Resistance bands are bands of different strengths that apply an opposite force on your knees when you move them. Then, work excellently on functional movement improvement.

Some exercises you can adopt with resistance bands are ;

• Clamshells
• Leg Press with Bands
• Terminal Knee Extensions
• Seated Leg Extensions
• Standing Leg Curls

Note : If you wish to learn how these exercises are performed, then you must visit a qualified physical therapist. Your needs according to your knee condition may not be the same as your friends'. So, always practise under supervision, lest you injure yourself.

Precautions for Safe Resistance Training

Begin with lighter force and pressure, gradually increasing and letting your muscles adapt to the strength.Different coloured bands have different strengths. Here's an easy guide for you to choose the right band-

• Light resistance - yellow or green
• Light to medium resistance - Red or blue
• Medium resistance - Green or black
• Heavy resistance - Purple or silver
• Extra heavy Resistance bands - Orange or Gray

However, always check with the manufacturer-given information in the packages.

• Focus on correct posture and movement patterns
• Avoid overextension and always listen to your body when it indicates discomfort.
• Keep practising regularly.

Essential Knee Rehabilitation Exercises at Home 

Some rehabilitation methods and knee pain exercises that target muscles that support your knee joint may be practised by yourself in the comfort of your home. Learn some easy ones with this step-by-step guide.

Straight Leg Raises

Straight leg raises help to decrease torque around your hip and knee and protect them from injury.

How to Perform?

• Lie on your back, one leg straight and the other bent.
• Lift your straight leg off the floor, about 10-12 inches.
• Hold for a few seconds and slowly lower down.
• Repeat and switch legs.

Muscles targeted - Quadriceps

Wall Squats

Wall squats strengthen all the muscles that support the knee joint. A wall squat can also improve mobility in the joint and increase flexibility.

How to Perform?

• Stand with your back against the wall and the legs shoulder-width apart.
• Slowly slide your back down the wall till your knees make an angle of about 45 degrees.
• Hold this position for a few seconds, then slowly slide back up the wall.
• Repeat it a few times.

Muscles targeted - Quadriceps. Hamstrings, Glutes

Hamstring Curls

Improves overall knee health by balancing strength in the quadriceps (front thigh muscles) and hamstrings.

How to Perform?

• Stand behind a stable surface like a chair, holding it for support.
• Bend your knee till the heel touches your buttocks.
• Hold for a moment, then slowly lower your leg.
• Alternate the legs and repeat.

Muscles targeted - Hamstrings

Step - Ups

The step-up with knee raise is a great cardio move that tones and sculpts your thighs and glutes, which helps support the knee.

How to Perform?

• Step up on a steady platform.
• Press the foot to straighten your hips and knees and stand on the platform.
• Step down and repeat.

Muscles targeted - Quadriceps. Hamstrings, Glutes

Clamshell Exercise

Clamshell Exercise is a great low-impact exercise to help strengthen and stabilise the knee.

How to Perform?

• Lie down on your lateral side.
• Keep your knees bent and ankles touching together.
• Lift the top of your knee towards the ceiling.
• Keep in the position for a few seconds (at least 5).
• Lower the knee back and repeat.

Muscles targeted - Gluteus medius (side hip muscle)

The above exercises target the most crucial groups of muscles that support your knees, giving you a good stretch to relieve knee pain and stiffness. If you are performing these exercises independently, always keep your movement within the pain range. It is best not to start your exercise rehabilitation routines if you are new to knee rehabilitation or have a condition that needs absolute medical attention, such as recent injuries. 

To Recapitulate,

Knee rehabilitation is nearly as complex as the knee joint itself. The general and specific specific programs and exercises presented are to be used eclectically. Rehabilitation must not be of a cookbook nature but rather individualised to fit the patient's needs. The emphasis on rehabilitation must be dictated by the individual's demands upon the knee. Rehabilitation must degenerate into function!