The knee is a complex joint. It consists of the shin bone (tibia), fibula, femur and patella. It is a hinge joint, which means that small rotational movements as well as stretching and bending movements are possible.
In addition to the bony structures, the ligament structures have an important stabilizing, proprioceptive, balancing and supporting function. These include inner and outer ligaments, menisci, cruciate ligaments, patellar tendon and the retinaculum, which extends on both sides of the patella to a protrusion at the tibia. Knees are muscles that encompass the knee: In total, a flexion of 140°, an extension of 5°, an internal rotation of 25° and an external rotation of 30° is possible in the knee when the leg is bent.
Due to certain accident mechanisms, the cruciate ligaments, collateral ligaments or menisci may tear. Depending on their severity, they can be trained by the following exercises. Carrying one’s own body weight and the normal degenerative changes can lead to knee arthrosis, which in the worst case can be improved by fitting a knee joint prosthesis.
- M. semimembranosus
- M. semitendinosus
- M.
biceps femoris
- M. popliteus
- M. gracilis
- M.
sartorius
- M. gastrocnemius
- M. tensor fascia latae
- M.
quadriceps femoris
If a complete joint replacement (TEP = total endoprosthesis) has been performed, the question of load release remains. Depending on the extent of the operation, the doctor decides what is important for further therapy planning. The biggest problem after a knee replacement operation is the lack of movement.
Many doctors only release patients from hospitals when a degree of movement of 90° has been reached. Directly after the operation, patients are prescribed a movement splint, which is used up to 4 times a day and mobilizes the knee passively in flexion and extension. Since patients usually have enormous pain immediately after the operation, the use of the mobility splint results in increased muscle tone due to the high pain.
This continues to interfere with the improvement of mobility. 1) Inpatient As a direct exercise in hospital, physiotherapy recommends the development of the extension and control of the M. Quadriceps by a complete extension of the knee in supine position. The patient should consciously push the back of the knee down to the pad and hold it for a few seconds.
If this is already successful, the exercise can be combined with a lifting of the extended leg. 2) Stationary To improve flexion, independent flexion is also possible in the supine position. Here the patient should only move as far as it is possible for him/her to do so, thus avoiding any protective tension.
3) stationary If the patient is sitting at the edge of the bed, he can put his foot on a cloth lying on the floor and pull his heel under the bed. Alternatively, a small ball can be used, which also takes away some of the workload. The patient can also consciously pay attention to his gait mechanism.
Deliberately rolling over the heel to the big toe ensures a proper movement in the knee and avoids an evasive movement. You can find information on this in the article Gait Training. 4) stationary Climbing stairs is also suitable for practicing a final movement (stair climbing) and as strength training when climbing stairs.
In most clinics patients are discharged after 10 days and rehabilitation follows. There the movement is further improved by intensive therapy and a start is made with strength training. When the operation wounds have healed well, water gymnastics is performed.
In the water all exercises can be completed more easily, because the water resistance reduces the weight of the patient. Different step sequences and easy moving through are particularly suitable. More information about training in the water can be found in the article Water gymnastics.
1) outpatient Riding a bicycle also proves to be good self-mobilization, especially if you ride on a low resistance to improve the movement. It is important that the pedals and seat are adjustable so that the knee has no basic tension before you start riding. 2) outpatient If the mobility is well achieved again, the strength training can be intensified.Free sitting on the wall for a limited time provides good quadriceps tension and can be performed at home without hesitation.
3) Outpatient knee bends can be performed up to 90° and can be reinforced with aids such as Thera bands or balls between the knees to achieve additional adduction or abduction tension. 4) outpatient Leg press is also possible, provided that the seat can be adjusted according to the movement possibilities. In general, however, post-treatment should be carried out in the company of a physiotherapist, as he or she can identify problems, movement restrictions, evasive movements and treat them in a targeted manner.
Further exercises can be found in the articles:
- Exercises with a knee TEP
- Physiotherapy for knee TEP
Depending on the severity of the surgery, the post-operative treatment varies. In general, however, the therapy depends on the symptoms of the patient. Thus, in the case of swelling, pain points and movement restrictions, pain-relieving and resorption-promoting measures as well as mobilization of the joint follow.
Directly after the operation, the same exercises are suitable as after a knee operation. If there are no major complaints, the gait pattern can already be improved after the acute phase has subsided, and the patient is instructed to pay attention to the rolling motion while walking to avoid gait errors. In the further course of the treatment, balance and coordination training can be started.
Exercises such as the one-legged stance are particularly effective because a large number of muscle groups are activated in this position to stabilize the knee. In addition, the exercise can be combined with different surfaces and can be strengthened by moving the arms or other leg. More detailed information and exercises can be found in the articles
- Exercises for a meniscus lesion.
- Torn meniscus – Physiotherapy
The knee is treated right from the start.
In the case of severe swelling, lymph drainage is suitable as a measure to promote resorption. The patient is instructed to position the leg high, to cool it and to get the lymph fluid moving by means of the calf pump. Depending on the permitted load, the gait is adjusted.
With a partial load, the patient learns how to use the supports correctly. With a full load, he is trained directly to roll correctly. 1.)
As first own exercise the patient can practice the stretching (see Knietep). 2.) In order to improve the supporting force for the support walking, a trick training in the upper arm with the Theraband is recommended, in which the patient pulls the Theraband from a bent elbow position into the extension.
Also suitable are holding positions (dips) on the edge of the bed or chair back. 3.) Together with a therapist, techniques from the PNF treatment scheme can be applied across muscles.
The leg remains in rest and the therapist works with the opposite arm. The patient pushes the arm outwards under resistance and looks at it, the tension flows over into the opposite leg. 4.)
Once the load is released, slight knee bends and the leg press can be used. 5.) Equally important for the proprioception and coordination of the knee muscles is balance training on uneven surfaces.
These exercises can be extended from a one-legged position to step variations and can be changed individually in many ways. It is only important that the knee is already stable in itself. You can find exercises for this in the article Balance Coordination Training.
6.) In the late phase, lunges and knee bends can be combined with uneven surfaces and coordination training. In general, the exercises should be performed with the help of a therapist and in consultation with the attending physician.
More exercises and information on this topic can be found in the article Exercises for cruciate ligament rupture. Similar topics that might interest you:
- Exercises against a patella luxation
- Physiotherapy for a patella luxation
- Physiotherapy after cruciate ligament rupture
Exercises for the ischiocrural musculature (back of thigh): Starting position seat (Alternatively also possible in prone position): Feet dangling in the air, Theraband on a railing and tie other side around the foot, under tension in the flexion of the knee pull Bridging: Supine position, legs turned on, wrap the Theraband around the knees from the outside so that tension can be felt, lift and lower pelvis Keep pelvis up and alternately stretch legs Keep leg stretched up and slowly lower pelvis and push it up again Exercises Ischiocrural muscles and front thigh muscles: Knee bend: Tie the Theraband around the knees from the outside Stay in low position Stay in low position and push the Theraband outwards Enlarge the straddle Stay in low position and move step by step to the side Exercises for the abductors You can find more exercises in the article Exercises with the Theraband.
- Starting position seat (alternatively also possible in prone position): Feet dangling in the air, attach Theraband to a railing and tie other side around the foot, pull under tension into the flexion of the knee
- Bridging: Supine position, legs turned on, wrap Theraband around the knees from the outside so that the tension can be felt, lift and lower the pelvisKeep the pelvis up and stretch the legs alternatelyKeep the legs stretched up and slowly lower the pelvis and push it up again
- Keep pelvis up and stretch legs alternately
- Keep leg stretched up and slowly lower pelvis and push it up again
- Stand: Fix the Theraband to the railing and tie it around the foot –> stretch the leg backwards
- Keep pelvis up and stretch legs alternately
- Keep leg stretched up and slowly lower pelvis and push it up again
- Knee bend: Tie Theraband around the knees from the outsideHold in low positionHold in low position and press Theraband outwardsEnlarge the straddleHold in low position and walk to the side step by step
- Stay in low position
- Stay in low position and press Theraband outwards
- Enlarge slide
- Stay in a low position and walk step by step to the side
- Supine position: Hold the Theraband around the foot and hold it with your hands at both ends, stretch the leg
- Stay in low position
- Stay in low position and press Theraband outwards
- Enlarge slide
- Stay in a low position and walk step by step to the side
- Bridging: see above
- Side position: tie Theraband around the feet and connect the legs together, lift up the upper leg sideways
- Stand: Fix Theraband to the railing and wrap around the foot, spread the leg to the side
The most important thing to do in case of existing cartilage damage or existing knee arthrosis is to enlarge the joint space in the knee or kneecap (chondropathy patellae) and thus stimulate the metabolism.
The cartilage cannot be rebuilt, but a worsening can be avoided and pain and movement can be improved. In addition to the relieving physiotherapy, in which the joint physiology can be improved by traction treatment and mobilization, some exercises are suitable to help yourself. To improve the movement, water gymnastics can be used.
As mentioned above, the water pressure reduces the patient’s weight and he can more easily perform the movements that cause many problems on land. Likewise, careful cycling ensures a continuous mobilization of the knee and thus a blood circulation effect. Strengthening exercises for the buttocks, front and back thigh in all variations provide better stabilization in the pelvis to turn the load away from the knee.
