What to Expect From Rehab in the First Two Weeks After Knee Surgery

Our goal is to help patients use their injury as an opportunity to become fitter, faster, and stronger than they have been in years. Successful rehabilitation is marked by patients seeing themselves as athletes in training rather than as patients in rehab. This post describes a few of the steps we take as a rehabilitation team with the immediate post-operative patient to reduce their pain, swelling, and range of motion limitations while simultaneously building their total body fitness. We strive to addict all patients to fitness training and help them play forever.

Rehab After Knee Surgery

Early and effective rehabilitation is crucial for post-operative patients. Still, many people do not know what successful rehabilitation does or should look like. This uncertainty can leave patients anxious and under-prepared for what comes after their surgery. With that in mind, here is what we as rehabilitation specialists aspire to achieve, and what our patients can expect in the first two weeks following knee surgery.  

The general goals of all post-operative physical therapy (PT) are as follows: reduce pain and swelling, improve range of motion, increase functional capacity, and build strength. These general goals are further adapted to meet each patient’s personal goals—whether they be climbing Mount Everest or safely getting up and down off the floor to play with their grandchildren.

Pain Management and Patient Education

At The Stone Clinic, post-operative rehabilitation begins the first day following a patient’s surgical procedure. Our patient education and post-op preparation, however, begin before surgery. This includes a pre-consultation with a rehab specialist to mentally and physically prepare our patients for their role in their recovery. 

Though each individual case and recovery process is different, patients can expect to experience the most pain and discomfort during the first two weeks. We see these weeks as an opportunity to introduce safe ways to keep or enhance our patient's fitness while they recover from their procedure. 

Our rehab team manages post-operative pain with a variety of tools. These include hands-on manual therapy, ice/compression, and specific exercises. The manual therapy techniques are specific to each person (and their pain experience), but always include massage, stretching, joint mobilization, and techniques to facilitate proper muscle firing. Swelling slows healing and the inflammatory components of the swollen fluid irritate the joint. Manual therapy reduces swelling and decreases pain, speeding the healing process. Our hands-on technique improves the recovery experience by increasing muscle length, mobilizing stiff and painful tissue, and assisting in fluid reabsorption. 

In the pre-consultation and immediately after surgery, the StoneFit Physical Therapy team provides education on assistive-device use (which is most commonly crutches in our orthopaedic environment). Depending on their type of surgery, patients are allowed to put anywhere from full weight to no weight upon their surgical leg. A thorough rehabilitation program ensures that post-op patients feel confident navigating a variety of life’s day-to-day activities within their weight-bearing precautions. This includes flat surface navigation, curb navigation, sit-to-stand transfers, and even floor-to-stand transfers.

Swelling Reduction 

Post-operative swelling inhibits range of motion, impairs local muscles’ ability to activate, and causes pain. That’s why rehabilitation professionals live by the post-op mantra of “ice, elevation, compression, and motion.” All of these work in combination to reduce swelling and decrease scar formation

At The Stone Clinic, we use intermittent compression therapy combined with circulating cold water, rather than typical ice packs. This reduces both the pain and swelling. We advise our patients to apply ice compression to their elevated surgical limb for 15 minutes every two hours during their first two weeks of recovery, both at the clinic and at home. 

When not icing, a compression sleeve is used to maintain the support on the limb and to reduce the risk of blood clotting. The effective combination of ice, elevation, and compression assists in the recovery and improves a patient’s ability to participate in their physical therapy sessions. 

Building Strength, Functionality, & Range of Motion

We highly encourage patients to rehab their surgical limb every day for the first two weeks after surgery (and perform another hour of total body fitness conditioning daily). Different procedures dictate how much weight a patient can put on their surgical leg. Total and partial knee replacements are full weightbearing (as tolerated immediately after surgery), while other biologic cartilage repairs require more time to heal. Still, there are effective ways to safely condition and exercise each part of the body.

Early exercises typically include well-leg cycling, core/upper extremity exercises, and light table exercises. These are focused on muscle activation that slowly and safely takes the recovering limb through the full range of motion.  

All patients are taught specific exercises to address their current deficits. Although these may vary based on specific limitations and different surgical procedures, the general goal during the first few weeks is to improve muscle function of the involved joint, assist in the reduction of swelling, improve range of motion, and ensure safety in functional mobility. 

For the first six months after surgery, we suggest that PT continue 2-3 times a week. The specific surgery protocol and a successful return to full range of motion and strength will determine when a patient can transition into a more focused strength training/cross-training routine and be cleared for certain activities. Our rehab team performs StoneFit Tests at three months, six months, and one year to comprehensively assess the strength and functionality of the surgical leg. Using this data, we advise and adjust a patient’s program to address any remaining deficits and to help them achieve their personal activity goals. Overall, patients should dedicate six months to a year to a consistent strength, endurance, and proprioception routine to optimize their outcome. 

With any surgical procedure, patients should prepare not only physically, but mentally and emotionally as well. Recovery is not a linear process. There will be ups and downs and modification periods as they recover from their procedure. Though each recovery is different, one constant asset is our mindset, effort, and intentions. Setting short, attainable goals and more ambitious long-term goals with a clinician helps to maintain focus and make the recovery plan more achievable. 

The journey to full recovery will be unique to each person and reflect what they ultimately put into it. What post-op patients do beyond their 45-minute PT session is at least as important as the program that is completed with a clinician. Hard work and consistency are keys to a successful outcome.
 


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Medically authored by
Allison Dastugue PT DPT
Allison Dastugue PT DPT
Allison Dastugue PT DPT, Doctor of Physical Therapy for the StoneFit Rehab Team