What Manual Therapy Techniques Are Beneficial for Post-Operative Knee Rehabilitation?
To uncover effective manual therapy techniques for post-operative knee rehabilitation, we asked physical therapists and senior rehabilitation specialists for their expert advice. From performing the Sweep Test to incorporating Muscle Energy Techniques, here are four techniques they recommend.
- Perform the Sweep Test
- Utilize Myofascial Release
- Apply Contract-Relax Technique
- Incorporate Muscle Energy Techniques
Perform the Sweep Test
In my experience, especially in the initial weeks after a total knee replacement, it would have to be the 'Sweep Test.' This manual technique is not therapy in and of itself, because in post-op rehab we really focus primarily on strengthening the knee as much as possible and restoring range of motion. The sweep test is quick and easy to perform on the knee, and it'll assess 'effusion' or fluid buildup in or around the knee joint. This can be a very common minor complication after knee replacement, but if left unchecked and persistent, can interfere with rehab.
Utilize Myofascial Release
One manual therapy technique I've found particularly beneficial for post-operative knee rehabilitation is myofascial release. This technique involves applying sustained pressure into the myofascial connective-tissue restrictions to eliminate pain and restore motion.
Benefits of Myofascial Release for Post-Operative Knee Rehabilitation
1. Reduction of Pain and Swelling: After knee surgery, patients often experience significant pain and swelling. Myofascial release helps to alleviate pain by reducing muscle tension and improving blood flow to the affected area, which can also help reduce swelling.
2. Improvement in Range of Motion: Scar tissue and adhesions can limit the range of motion in the knee joint post-surgery. By applying pressure to the fascia, myofascial release can help break down these adhesions, leading to improved flexibility and range of motion.
3. Enhanced Healing: Improved circulation resulting from myofascial release can enhance the delivery of oxygen and nutrients to the healing tissues. This can accelerate the recovery process and improve overall tissue health.
4. Reduction of Stiffness: Post-operative stiffness is a common issue that can hinder rehabilitation progress. Myofascial release helps to stretch and elongate the fascia, reducing stiffness and promoting smoother movement patterns.
The technique involves the therapist using their hands to feel for areas of tightness or tenderness in the fascia. Once identified, sustained pressure is applied to these areas with progression to movement in all directions while pressure is being held. The pressure can be adjusted based on the patient's comfort and tolerance levels. The goal is to stretch and loosen the fascia to improve movement and reduce discomfort.
Patients typically report a decrease in pain and an increase in mobility following myofascial release sessions. They often feel more relaxed and notice a reduction in the tightness around their knee joint. Over a series of treatments, many patients experience significant improvements in their functional abilities, which contributes to a more effective overall rehabilitation process.
Incorporating myofascial release into a comprehensive rehabilitation plan, including exercises and other therapeutic modalities, can greatly enhance the recovery outcomes for patients following knee surgery.
Apply Contract-Relax Technique
I find that when someone is struggling to improve their range of motion, using a technique called 'contract-relax' helps a lot. It involves having the patient contract and extend their knee by pushing against the therapist for a number of seconds. Then, they relax and the therapist mobilizes them into flexion by bending their knee. This tends to give patients a bit more motion when other methods are reaching their limits.
Incorporate Muscle Energy Techniques
As a Physical Rehabilitation Specialist, my post-surgical knee rehabilitation practice focuses on optimizing muscle activation and enhancing active range of motion. Building patient confidence and reducing movement apprehension are crucial for fostering self-reliance, especially in the early stages.
While manual therapy techniques are tailored to individual needs and the specifics of the surgical approach, employing scar-tissue mobilization and soft-tissue release can significantly improve tissue pliability, reduce adhesions, and facilitate functional movement. Muscle energy techniques, a form of manual therapy targeting the muscles, are particularly effective for reducing muscle tightness, increasing range of motion, and enhancing muscle control, while actively engaging patients in their rehabilitation process.
Additionally, when the surgery does not involve the patella, patellar mobilization—whether performed with or without knee movement—can significantly increase joint mobility and extend the functional range.
Each patient is unique. Hence, it is essential to assess thoroughly and apply clinical rationale to choose the best approach. Utilizing a range of manual therapy techniques tailored to their specific requirements accelerates recovery and improves patient outcomes.
