Knee Manipulation & Physical Therapy

Patients who have just undergone one of a variety of different knee-joint surgeries will typically be referred to a physical therapy treatment program, many times immediately following the procedure. The aim of knee manipulation within a therapeutic setting is to promote and maintain proper range of motion within the joint while also strengthening the large leg muscles surrounding the knee for continued stabilization.

Early Manipulation

• Physical therapists will typically begin working on a new patient 24 hours after a surgical procedure since the introduction of movement to the knee joint despite inflammation and muscle atrophy is critical to long-term healing. Early manipulation procedures include manual manipulation of the patella (knee-cap) to minimize inflammation within the patellar ligaments. According to Duke Orthopedics, therapists will also focus on assisted flexion and extension of the lower leg to help minimize joint capsule constriction, or "freezing." Early flexion will typically average 30 degrees of motion while extension is contingent upon the level of tissue inflammation. Patients may also be prescribed a continued passive movement (CPM) machine to help with manipulation while at home.

Mid-Treatment Manipulation

• According to Duke Orthopedics, patients with less than 80 degrees flexion after 11 weeks post-operative will continue to receive therapist-assisted manipulation from both a prone (face-down) and a supine (face-up) position. Patellar manipulation will be minimal at this time due to a lower level of inflammation and greater strengthening of ligaments responsible for the natural "gliding" motion of the patella within the joint. Patients will also begin working on increased strengthening exercises during this time to promote fine muscle toning which will aide in the joint manipulation process from a biofeedback perspective.

End-Treatment Manipulation

• Once a patient has reached a minimum of 140 degrees assisted flexion (typically 16 to 20 weeks post-operative, depending upon the procedure), joint manipulation and mobilization promoters will be decreased at the therapist's discretion. Lateral stability of the joint may be tested at this point in order to determine the fluidity of ligament movement should the patient need to quickly change direction while walking or running. The physical therapist will typically discharge the patient with a home-exercise program aimed at continuously strengthening the leg muscles in an effort to prevent future injury.