How to attain full knee mobilization in a patient who has undergone surgery and physiotherapy for multiple injuries in the leg?

Question

Hello doctor,

I am a 41-year-old male. I met with an accident about five years ago and injured my right leg. Due to its impact on the right knee, my femur bone broke off in two places and one injury near the knee, ligaments and knee cap are safe. I got operated and nailing has been done, both the fractures are fixed with a rod and nails. After a month I started physiotherapy and after four months the doctor advised me for full weight bearing. After six months some pain is still there near the right knee portion, hip, and thigh. The biggest problem is that my knee is not mobilized completely and I am not able to get the full range of motion. The knee bending is just about 70 degrees. I am regularly undergoing physiotherapy exercises like CPM, quadriceps, hamstring, knee mobilizer, IFT, ultrasound, etc. But I am still not able to walk properly and I use an elbow crutch for support. Currently, I am taking calcium and multivitamins. Please suggest me some treatment or rehabilitation procedures to get full knee mobilization and range of motion.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query.

I read your concern. In my opinion, your knee should be mobilized to gain range. You will get your knee range back and there is nothing to worry about. Choose a physiotherapist who can work a bit on your knee with manipulation and mobilize your knee, some soft tissue mobilization will help you. Moderate isometric exercise will help you to maintain and improve range along with manipulation. It is because of the long period of immobilization your knee lost its range and there is nothing to worry about. Kindly revert in case you need any further help.

I hope this has helped you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I saw your X-rays and treatment charts (attachment removed to protect the patient's identity). You had been through a complex surgery. I would like you to concentrate on gaining range and strength. You need to get your hip and knee joints mobilized as their movement is much less than what they are supposed to due to post-surgery muscle stiffness. This can easily be relieved with mild and gentle stretching exercises, isometric training, and joint mobilization. I suggest you to follow a program as mentioned below:

Keep icing on your joint, no matter if there is pain or not.
Gentle and mild kneading over the front thigh, back thigh, inner thigh, and side of your knee (very important). Calf muscle can be kneaded a bit more deeply.
A very mild gentle stretch of all the above-kneaded muscles and hold for 30 seconds or until you can tolerate it.
Squeeze the towel under your knee and hold it for 30 seconds.
Squeeze your knee with a towel between the knees.

Bridging exercises:

Clamshell with therapy band.
Knee extension in sitting.
Knee flexion in lying.
Squats.
Step ups.
Spine extension with legs placed in a figure of four position, foot of flexed knee to be tucked under opposite leg thigh.
Along with these exercises move your kneecap gently up and down and side to side.

Each exercise is to be done at least 20 times and three sets with body weight. Do these exercises for three weeks and let me know.

Mobilisation exercises:

Rolling the ball to and fro with your feet while lying on your back.
Rolling the ball against the wall lying on your back.

This should be done as often as possible following a gentle massage.

Kindly revert in case you have any further queries.

I hope this has helped you.

Thank you.