Guide to Post-operative Knee Care & Exercises

For those who suffer from knee pain, a knee orthotic or knee brace is an important tool to help you on the road to recovery. At MMAR, we specialize in supplying top-of-the-line information on knee brace technology.

Knee surgery is dreaded by every athlete and fitness enthusiast around the world. Often marked as a career killer, knee surgeries require constant dedication to recover. Although it takes some time to regain your strength and flexibility, recovery is possible. To do so, your doctor may suggest that you work with a physical therapist. Your doctor’s goal is to prevent you from trying to take on too much exercise too soon, all while trying to avoid any further muscle loss. It is important to have a workout routine that will enhance your recovery after ACL surgery and help you maintain knee mobility and strength.

Here at MMAR Medical, we took it upon ourselves to offer you a guide to post-operative knee care and exercise ideas to supplement the work you are already doing in physical therapy.

Common Knee Surgery Conditions

Knee pain, whether chronic or acute, is one of the most common complaints affecting the skeletal structure that doctors see and treat with regularity in an active society. The knee is taxed to bend and rotate and often manages to accommodate such movements when it shouldn't leading to strains, sprains and other injuries.

Conditions that can lead to surgery are:

• Ligament Injuries - most often the result of athletic activity affecting any of the four separate ligaments responsible for stabilizing the knee joint. They are the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL) and the lateral collateral ligament (LCL). Injury can occur from twisting the knee with the foot planted, hyper-extension, sudden stopping in the midst of running, shifting weight from one leg to the other, jumping, landing in a flexed position or direct impact to the knee.
• Dislocation of the Knee Cap - occurring after a sudden or unexpected changing of direction on a planted leg position or else from direct impact.
• Cartilage Injuries - having a wide range of causes from genetics, to meniscal or patella tendon injuries, to Osteochondral Defects, to arthritis, to instability from weaknesses, the result of repeated micro-traumas or a single impact.
• Condylar Fractures - affecting the lower end of the femur corrected with a groin-to-toe plaster for un-displaced fractures or surgery for displaced fractures.
• Tibial Plateau Fractures - involving the most critical area in the knee that accommodates load-bearing, the upper end of the tibia bone.
• High Tibial Osteotomy (HTO) - knee surgery to repair osteoarthritis.

The ability to perform myriad movements on a joint as complex as the knee presents the possibility of incapacity. The most frequent complaints of pain and injury come from those participating in such sports as basketball, football and skiing. Recognizing the potential for injury and the subsequent need for recovery that will support the joint during repair, there are a series of post-operative knee braces from which to choose to help in this process.

Post Surgery Exercises

The goal of exercise post-surgery is to slowly regain mobility. To the seasoned athlete, this might come as somewhat of a shock. Not being able to complete the exercises you once were able to do effortlessly is certainly a change of pace. However, it is important to be patient with your body while it’s in recovery. In due time, you’ll be back to hitting it hard at the gym. For now, try these exercises until you are fully finished healing.

Range of Motion (ROM) Exercises:

1. Straight leg raises - A straight leg raise is imperative in regaining full extension. To perform a straight leg raise, lay flat on your back and bend the uninjured leg at the knee while keeping the injured leg straight. Lift the straight leg up off the floor. Hold this position and then lower your leg back to the ground. Remember to do this exercise slowly during your first few weeks of recovery.
2. Hamstring Curls - Without the muscles in the back of the thigh, the knee muscles would lack support. You can do a hamstring curl in a standing or lying position. In order to do a standing hamstring curl, you should stand with your feet apart and slowly bend your knee to lift your foot off the floor towards the back of your thigh. This is a great balance exercise that also provides a fantastic stretch.
3. Hip flexion and extension - This is one of the best exercises after ACL surgery. It is a fantastic way to increase your mobility, especially if you need a rest from bending your knee. A hip flexion is when you keep your leg straight as you move it forward to the front and the extension is when you keep your leg straight as you move your leg to the back. This will also help your balance and flexibility.

Low Impact Exercises:

1. Light jogging and treadmills - If you’re ready for a more intense exercise, light jogging will help you warm up and get your blood circulating. Over time, you will see your endurance and mobility increasing.
2. Cycling - Biking will increase your heart rate and give your knee a work out. Whether you use a stationary bike or a fully mobile bike, make sure that you remain safe. The last thing you want to do is reinjure your knee.
3. Swimming - Unlike running or cycling, swimming will take a lot of pressure off of your knee. Swimming has been widely considered as a great therapeutic exercise for almost any injury. With the added resistance of the water, swimming will slowly help build the strength of your knee.

Training with a Knee Brace

One way to ensure safety during your post-operative exercise regimen is to use a knee brace. Having a knee brace should help, rather than hinder, your exercise or training regimen. Whether you are wearing a patella stabilizer, a soft support brace or a hinged knee brace, the brace serves as an fantastic aid during your recovery process. However, if you have never used a knee brace before, there are some tips you should be aware of before incorporating it into your daily routine.

• Wear your brace with care and check daily for imperfections. If your brace isn’t working properly, do not wear it. Wearing a warped brace is not only uncomfortable, but it could also cause further injury. Try not to exercise until you get a functional replacement brace.
• Make sure the brace is in the right place. When you are putting on your brace, use both hands to position the brace into place. Make sure it is secure and that all the straps are correctly positioned. Make sure the hinges are where the knee bends otherwise it will be very uncomfortable. Not only that but if your brace isn’t worn correctly it can do more harm to your knee.
• Wear your brace every day. Make sure you put on your knee brace early in the morning before the leg naturally swells up from activity. Even small exercises can strain your knee without the proper brace like walking up a stair or sitting, for example. So be sure to wear your brace every day during any and all activity.
• Be sure to warm up. It is extremely important to stretch and warm up before you work out. Not stretching will increase your risk of further injury to the knee. With proper stretching, you will have a safe workout and reduce further injury.
• Know your limits. If you are doing an exercise and you feel strain on your knee, do not continue with that exercise. Fight the temptation to push through the pain because doing so will only aggravate your current injuries.

Selecting a Post-Operative Knee Brace

Rehabilitation and recovery can occur very soon after surgery in most case, with the need to focus on mobility while strengthening the knee. This means being able to have a stabilized range of motion as the damaged knee and surrounding muscles are worked. Immobilizing the knee is necessary to prevent further injury while still allowing for a range of movement, depending upon the degree of injury. In some cases, complete immobilization is necessary to promote healing.

The post-op knee braces available today have features that allow for adjusting compression and range of flexibility through the use of rigid hinges and straps that can be fitted for comfort and adjusted for the best therapy while in use. They have been designed to allow for control of bending and straightening the knee joint along with the flexion and extension that normally occurs through movement. This can be achieved with the use of locking mechanisms that enable a patient to lock the brace out in full extension so as to prevent any flexing of the knee joint, or by degree, depending upon what has been prescribed by the surgeon.

Manufactured in either telescoping or pre-determined lengths for an individual's specific height, these braces are able to accommodate cold therapy wraps or dressings to aid in speedier recovery. Some of the braces have a limited 6 month warranty, in the case of Donjoy post-op braces, while others have a 30 day return policy. Among the manufacturers, there are brands made by Breg, New Option Sports, Ossur, Orthotic Rehab, Donjoy, Hely Weber, Deroyal, Neuroflex, Comfy, Thermoskin and RCAI. These brands represent only the highest quality post-operative knee braces available on the market today.