Suggested Program for Restricted Knee ROM

By Mike Mimken, P.T.

When pts are seen within 1-2 weeks after surgery, generally a limited program with the flexion or extension harness is all that is necessary to regain ROM.

- I generally begin with a warm-up program that includes an exercise bike. The pt is asked to rock the pedals forward and back within their pain-free ROM. Typically, the pts spend 2-5 minutes on the bike.

- Soft tissue mobilization and patella mobilization are typically helpful.

- Flexion or extension harness is applied to the knee. The pt is asked to pull for 20-30 seconds to the point of strain, but not pain. This is repeated for 10 reps or 5 minutes. Periodically, ganiometer readings are given to the patient for feedback. I generally expect to gain at least 2-5∫ /session. If the pt is unable to achieve this by pulling to the point of strain I will encourage them to pull to point of tolerance.

- After 5 minutes, the pt is started on AROM into the limited ROM using open chain exercises. Normally, the pt will do 2-3 exercises such as straight leg raise, short arc quads and graduated drills for 3 sets of 10 reps for extension. Eccentric and Concentric knee curls in prone and sitting.

- Close chain exercise for 15-20 minutes complete the porgram.

- Ice is used following the session.

When pts have had restricted ROM longer than 4 weeks:

- Soft tissue and patella mobilization are used to begin treatment.

- The extension or flexion harness is applied to the patient. The pt is asked to pull to the point of strain. A moist heat pack is applied over the knee with concentration of the heat given to the most apparently restricted tissue. The harness is locked at this range for 10 minutes.

- After 10 mintues, the mosit heat is removed and the pt is asked to pull again. My goal is to achieve 2- 5∫ more than the previous visit. The harness is locked at this range and ice is applied for 5 minutes.

- After 5 minutes the ice is removed. Typically, 30 seconds of grade I-II joint mobilization is helpuful in reducing discomfort.

- Patient then moves to the exercycle for 5-10 minutes.

- Open chain exercises follow completion of the exercise bike. Generally 2-3 exercises to increase AROM are utilized.

- Closed chain exercises follow the open chain program (6-8 exercise).

- For patients who have difficult tolerating the stretch, I will utilize TENS for pain control during the application of the harness.

- For patients with a large lag between active and passive ROM, I will use muscle stimulation following the harness. Biofeedback has also been beneficial with several difficult pts.

Patients who fail to achieve 2-5∫ per visit will benefit from home use of the harness for more frequent stretching sessions.

Mike Mimken is Director of Physical Therapy at Wilson Center, 800 Carter Street, Rochester, NY 14621.

He has been using Mechanical Advantage Harnesses since their introduction