The 5 Phases of Rehabilitation after Knee Injury or Surgery
INFO
Please note that the five rehabilitation phases described below may be applicable to many, but certainly not all cases. Every injury, every surgery, and every person is unique, which is why your rehabilitation must be tailored precisely to you. Some of the goals and interventions mentioned below may not fit your specific circumstances. Therefore, you must discuss the details of your individual treatment plan and the timeline for your recovery with your own medical team (doctor + therapist)!
This text cannot replace a medical consultation or physiotherapy. Trying to rehabilitate your knee on your own without direct professional guidance is not recommended under any circumstances, as you could seriously harm your knee. If you have already received a specific treatment plan from your doctor or therapist, I highly recommend that you adhere to it.
Phase 1 - Acute Phase after Injury or Surgery
In Phase 1, your knee is undergoing the particularly intense first stages of healing. These may cause pain, swelling, and warmth in the affected area. At this stage, you probably experience stiffness in your knee and you have difficulty contracting your upper thigh muscles - both of which is normal. Your medical team might recommend using crutches or a knee-brace after surgery in order to protect your knee from excessive load or movement. Right after surgery or injury you also need to receive further instructions on how to support healing processes, on how to optimize the mobility of your knee joint, and on how to safely start reconditioning your upper thigh muscles. Your therapist might also talk to you about options to train the uninjured leg and other parts of your body.
Following a clear and effective home exercise program is absolutely essential to get your knee through phase 1 successfully! Even during the first weeks of rehab, half-hearted and ineffective training can potentially prolong your recovery by weeks.
Typical Goals
Little to no swelling in the knee
Full knee extension
Adequate knee flexion (depending on your injury or surgery)
Good voluntary contraction of the upper thigh muscles
Phase 2 - Muscular Control, Early Load Tolerance and Foundational Strength
At the beginning of Phase 2, your knee has calmed down significantly and is now more tolerant to load. Nevertheless, it is likely still sensitive and probably slightly swollen. After clearance by your medical team, you may gradually wean off crutches and (if previously used) the knee brace at this point.
In physiotherapy, you initially focus on building back trust and on improving the load tolerance of your knee during everyday acitivities. Among other things, you work on your knee stability, your lower limb coordination, your gait pattern, your bodyweight squat and your ability to climb up and down the stairs. As Phase 2 progresses, your exercise program must continually adapt to your knee's improving capacity for load. If you are sporty, you will eventually need highly intense strength training, as high levels of strength and load tolerance are necessary in order to successfully participate in most sports. Furthermore, you and your therapist might also discuss ways to improve other aspects of your general fitness and health as well as your knee mobility.
A solid exercise program to perform at home or at the gym and discipline are, as expected, incredibly important during this phase of your recovery. Without a well-thought-out plan and good work ethic, you will not build the strength you need for a healthy and robust knee.
Typical goals
No to minimal swelling in the knee joint
Full to nearly full mobility of your knee joint
At least 70% - 80% strength of the upper thigh muscles when comparing sides and adequate absolute values compared to normative data
Excellent movement quality when performing relevant squat variations (depending on your fitness level)
Phase 3 - Running, Jumping, Agility and Peak Strength
Phase 3 largely focuses on developing sport-specific speed under relatively controlled conditions. Depending on your athletic goals, you might work on running, jumping, agile maneuvers, and explosive movements. Your therapist should assess your performance during these tasks both quantatively in terms of speed, power, distance or duration and qualitatively in terms of movement quality. In other words, he or she should carefully analyse how your knee can deal with high loads, high speeds and complex tasks. This process can be enhanced via slow-motion and motion capture video analysis. Once your knee can handle quick sport-specific movements well in isolation, exercises need to become more demanding by also having you react to your environment, by forcing you to make spontaneous decisions and by making you perform multiple tasks at once.
At the beginning of Phase 3, while you are working on sport-specific speed, your strength and endurance need to be enhanced further. If you are an athlete, your exercise program, therefore, has to cover many aspects of your physical development simultaneously. For this reason, there is a good chance that you need more than two days of training per week and quite a bit of determination to make optimal progress.
If your daily life or sport do not require running, jumping, or explosive movements, Phase 3 is less demanding. In this case, your therapy probably aims at improving muscle strength, general endurance, and basic functional movements.
Typical Goals
Solid trust in your knee
> 90% strength of your upper thigh muscles when comparing sides and adequate values compared to normative data
> 90% performance and good movement quality during single-leg horizontal jumps when comparing sides and adequate absolute values compared to normative data (sporty population)
> 80-90% performance and good movement quality during single-leg vertical jumps when comparing sides and adequate absolute values compared to normative data (sporty population)
Adequate performance and movement quality during running and sprinting (sporty population)
Adequate performance and movement quality when changing speed and direction (sporty population)
Adequate endurance and weekly workload
Phase 4 - Return to Sport
Phase 4 is all about gradually returning to your usual training routines. If you return to a team sport, this means that you are now ready to begin the process of re-entering regular team training. From now on, your sport, athletic skills, training load, and interactions with other players take center stage. Nevertheless, your hard-won coordination, strength, endurance, and speed still need further optimization throughout phase 4.
In case you want to participate in tournaments and competitions, you have to pass a “Return-to-Competition” test at the end of phase 4. This test must be tailored specifically to you and checks for any neuromuscular deficits which might put your knee at risk in a highly competetive scenario. Depending on your injury, surgery, sport, and athletic performance level, phase 4 can vary greatly from person to person.
Typical Goals
The goals in Phase 4 need to be highly individualized.
Phase 5 - Fun, Performance and Long-term Knee Health
The last phase of rehabilitation is finally about having fun and perfoming well at your sport. At the end of your rehab, your therapist will show you what to do in order to keep your knee fit in the long run and in order to prevent further injuries.