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Postoperative knee stiffness is a common complication following knee surgery, including total knee replacement (TKR), arthroscopic procedures, and fracture repair. It can significantly hinder the recovery process and limit the patient's ability to regain full function. Physiotherapy plays a crucial role in addressing and overcoming this stiffness.  

Causes of Postoperative Knee Stiffness:

• Scar Tissue Formation: The body's natural healing process involves the formation of scar tissue around the surgical site. Excessive or unmanaged scar tissue can restrict joint movement.  

• Inflammation and Swelling: Postoperative inflammation and swelling can contribute to pain and stiffness in the knee joint.

• Muscle Weakness: Weakness in the muscles surrounding the knee (quadriceps, hamstrings, calves) can make it difficult to move the joint through its full range of motion.  

• Pain: Postoperative pain can cause patients to limit their movement, leading to stiffness.  

• Prolonged Immobilization: While some immobilization may be necessary initially, prolonged periods can contribute to joint stiffness.  

• Underlying Conditions: Pre-existing conditions like osteoarthritis can sometimes contribute to increased stiffness after surgery.  

How Physiotherapy Helps Postoperative Knee Stiffness:

Physiotherapy interventions are tailored to the individual patient's needs and the specific cause of their stiffness. A comprehensive physiotherapy program will typically include the following:

• Thorough Assessment: A physiotherapist will evaluate your knee's range of motion, pain levels, swelling, muscle strength, and functional limitations to identify the underlying causes of stiffness.  

• Pain Management:

  • Modalities: Applying ice, heat, electrical stimulation (TENS), or ultrasound to reduce pain and inflammation.

  • Gentle Manual Therapy: A soft tissue massage around the knee and thigh can help reduce muscle guarding and improve circulation.  

• Range of Motion Exercises:

  • Passive Range of Motion (PROM): The therapist gently moves your leg to improve joint mobility.  

  • Active-Assisted Range of Motion (AAROM): You use your muscle power with some assistance from the therapist or an external aid to move your leg.

  • Active Range of Motion (AROM): You move your leg independently through its available range.

  • Specific exercises like heel slides, knee bends (within a comfortable range), and straight leg raises are commonly used.  

• Strengthening Exercises: Once pain and swelling are reduced and some range of motion is restored, exercises to strengthen the muscles around the knee are introduced. This helps to stabilize the joint and improve its ability to move. Examples include:

  • Quadriceps sets  

  • Hamstring curls  

  • Calf raises

  • Short arc quads  

  • Step-ups (as tolerated)

• Manual Therapy Techniques:

  • Joint Mobilization: Gentle, hands-on techniques to restore proper joint mechanics and improve range of motion. This may involve small, controlled movements to address stiffness within the knee joint itself.  

  • Scar Tissue Mobilization: Specific massage techniques to break down and improve the flexibility of scar tissue around the incision and within the deeper tissues.  

• Gait Training: As you regain strength and range of motion, the physiotherapist will help you improve your walking pattern, ensuring proper weight-bearing and mechanics.

• Balance and Proprioception Exercises: These exercises help improve your body's awareness of your knee's position in space and enhance stability, which is crucial for functional activities.

• Education and Home Exercise Program: Your physiotherapist will teach you exercises to continue at home to maintain and progress your recovery. They will also provide advice on activity modification and strategies to manage stiffness.

Key Principles of Physiotherapy for Postoperative Knee Stiffness:

• Early Intervention: Starting physiotherapy as soon as safely possible after surgery is crucial to preventing excessive stiffness.  

• Gradual Progression: Exercises are gradually progressed as your pain and stiffness decrease and your strength and range of motion improve.  

• Patient Compliance: Your active participation and adherence to the home exercise program are essential for successful outcomes.

• Individualized Treatment: The physiotherapy program is tailored to your specific needs, the type of surgery you had, and the severity of your stiffness.  

If you are experiencing significant knee stiffness after surgery, consulting with a physiotherapist is highly recommended. They can perform a thorough assessment and develop a personalized treatment plan to help you regain optimal knee function.