I have seen most patients coming to me for outpatient total knee rehabilitation doing quite well after their initial stints in Acute Rehab or Home Health. I find that my biggest role is to make sure people understand what the next 12 months will be like and to help them manage independently. Here are my main guidelines:
1) Pain Science Education: Yes, you went through pretty severe trauma, so pain is ok, don’t be afraid of it, it definitely doesn’t indicate anything is wrong, you’re just healing from a surgery where someone took a saw and cut off the ends of two of your bones and hammered in metal parts (not to mention any soft tissue lacerations to see the bones). It’s ok to be in pain. Use meds as needed and remember the pain will get better.
2) When your knee is warm, it is moldable. I use a warm metal analogy. A blacksmith can mold metal if it is hot, and your knee can gain or lose range of motion if it is warm. This assessment is really easy, compare the temperature of your knees, the surgical one is probably warmer. Keep stretching every day until it cools down (this will probably be 4-6 months post op).
3) Don’t manually stretch knees. Get someone on a bike, have them start at a high seat where they can go around easily. Pedal there for a minute, then lower the seat level. Every minute you should lower it a little more. You’ll find flexion improves pretty quickly. For extension, elevate the leg on a block / cushion at the heel and put weight on the knee. Tell the person to stay there as long as they can tolerate it. Shoot for 5-10 minutes, 2x/day. Use any other pain modulating manual therapy techniques to ease these motions. But with both of these, the patient is in control and can have a successful outcome. I’ve seen a couple of nightmare joints where the patient clearly didn’t have control during stretching and the result was a knee that didn’t bend ideally and had long term residual spasm.
4) Strengthen the knee as much as possible with closed chain activities (this applies to everyone). Sit to stand, step ups, floor transfers. Then progress to more aggressive strengthening if they want to do it.