Rehabilitation for Knee Flexibility: Is Forceful Bending Necessary? - Rehabilitation

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Rehabilitation after a knee injury, especially following a severe fracture like a comminuted tibial fracture, can be a challenging process. Your concerns about knee flexibility and the rehabilitation process are valid, and it's important to address them carefully to ensure optimal recovery.

1. Is Forceful Bending Necessary?
Forceful bending of the knee during rehabilitation can sometimes be necessary to regain range of motion, but it should be approached with caution. If you are experiencing inflammation and swelling as a result of aggressive bending, it may indicate that your knee is not ready for such intensity. Instead of forceful bending, a more gradual approach is often recommended. Gentle stretching and mobilization techniques can help improve flexibility without causing excessive pain or inflammation. It's crucial to communicate with your physical therapist about your pain levels and any swelling you experience, as they can adjust your rehabilitation program accordingly.

2. Progress Stalling at 85-90 Degrees
Reaching a flexion of 85-90 degrees is a significant milestone, but it is common for progress to stall at this stage. This plateau can occur due to various factors, including muscle tightness, joint stiffness, or even psychological barriers related to pain and fear of movement. Continuing with a consistent rehabilitation program that includes both passive and active range of motion exercises is essential. Your therapist may also incorporate modalities such as heat or ultrasound therapy to help reduce stiffness and promote healing.

3. Effective Exercises for Improvement
To improve knee flexion and extension, consider incorporating the following exercises into your rehabilitation program, always under the guidance of your therapist:
- Heel Slides: While lying on your back, slide your heel towards your buttocks, bending your knee as much as possible, then slide it back out. This can help improve flexion gradually.

- Quadriceps Sets: Tighten your thigh muscle while keeping your leg straight. Hold for a few seconds and release. This helps strengthen the quadriceps, which is crucial for knee stability.

- Straight Leg Raises: While lying down, keep one leg straight and lift the other leg to the height of the straight leg. This helps strengthen the muscles around the knee without putting too much strain on the joint.

- Wall Slides: Stand with your back against a wall and slide down into a squat position, then return to standing. This can help improve both flexion and strength.

4. Surgical Intervention for Adhesions
If conservative rehabilitation does not yield the desired results, surgical intervention may be considered. Procedures like arthroscopic surgery to remove adhesions or scar tissue can help restore range of motion. However, this decision should be made carefully, considering the potential risks and benefits. The idea of forcing the knee to bend to 120 degrees under anesthesia, known as manipulation under anesthesia (MUA), can be effective in some cases, but it carries risks such as further injury or complications. It's essential to have a thorough discussion with your orthopedic surgeon about your specific situation, the potential outcomes, and whether this approach is appropriate for you.

In conclusion, rehabilitation after a knee injury requires patience and a tailored approach. It's crucial to work closely with your healthcare team, including your orthopedic surgeon and physical therapist, to develop a rehabilitation plan that suits your needs and promotes healing. Always listen to your body and report any significant pain or swelling to your therapist, as they can adjust your program to ensure you are progressing safely. Wishing you a smooth recovery and improved knee function!