General Intervention Strategies for Non Operative Knee Conditions
|
Healing Stage |
Impairments |
Goals |
Interventions |
Examples |
|
Acute (0-2 or 3 weeks) Maximum Protection |
Swelling Pain Localized tenderness Weakness from muscle inhibition |
Control inflammation Reduce pain Protect structures Initiate gentle exercises; minimize atrophy
|
Ice Modalities for swelling and pain reduction NMES for muscle retraining Assistive devices and bracing for joint protection Submaximal and multidirectional isometrics Joint mobilization for pain reduction and increased joint motion Soft tissue mobilization
|
Hi-volt; IFC hinged or compression knee brace Quad sets, glut sets, hamstring sets Prone hip extension SAQ - no weight, SLR, heel slides (supine and sitting), hip abd/add Patellar and tibia mobilization Cross friction massage |
|
Subacute (3-6 or 8 weeks) Minimum to Moderate Protection Controlled motion with progression to function |
Minimal tenderness and swelling Instability Weakness Decreased functional mobility (bending, squatting) |
Gradual increase in joint loading activities Full AROM Normal joint motions Improve dynamic and weight bearing stability Normalize gait
|
AROM; aerobic exercise Joint mobilization Closed kinetic chain exercises - start in partial range Stretching for flexibility Open chain multi-direction strengthening Gait training for normal gait, moving from least-restrictive to no assistive device |
Stationary bike SLR Bridging Hip abduction adduction strengthing with light resistance (open and closed chain) Standing hamstring curls Step up-down (multidirection) Resisted walking Single leg progressive balance activities (weight shifting/toe raises) Partial squats (double and single limb)
|
|
Return to function (8+weeks) |
Decreased coordination Decreased agility Decreased endurance
|
Return to sport Return to work Regain highest functional level for individual |
Advanced flexibility and strengthening Therapeutic activities for return to sport Neuromuscular reeducation for return to sport Long-term bracing for return to sport |
Jumping Running Pivoting Bracing Power drills
|
Video Resource - ACL Injury Prevention - Approximately 4 minutes
Although listed as ACL prevention, these exercises are consistent with conditioning for controlled motion and dynamic stabilization at the hip and the knee during the initial loading and unloading phases of weight bearing. Educating patients who present with mild sprains in the lower quarter on exercises to prevent tears in the future is advised as an integrated part of a home exercise program
