Phases of Physical Therapy


Physical Therapy is the next step after surgery to help achieve a successful return to full, pain-free knee function. The rehabilitation program consists of different phases that are both progressive and sequential. The key to successful rehabilitation is identification of the tissues involved, communication with the surgeon regarding the type of surgery performed, the patient’s tissue quality, the quality of the repair, concomitant procedures performed, and patient understanding and compliance. The patient’s goals and lifestyle desires must also be taken into consideration.



THE FOUR PHASES OF PHYSICAL THERAPY ARE:

1. Acute Phase
2. Intermediate Phase
3. Advanced Strengthening
4. Return to Sports

Phase 1:

 Reduce pain and swelling Rehabilitation begins seven to ten days post-operatively. Passive range of motion, manual therapy, initiation of gentle rhythmic coordination exercises, quadriceps stabilization exercises and modalities are utilized as needed to reduce pain and increase range of motion. Instruction in the use of a brace and modification of activities of daily living are reinforced to maintain and/or protect the integrity of the repair.

Phase 2:

  Initiate active range of action and activity tolerance Exercises are introduced increase active motion while allowing for continued healing of soft tissue. Full passive range of motion is gradually restored during this phase. Manual therapy and modalities are used as needed to continue to reduce pain and inflammation. The use of a brace is gradually diminished, with instruction to not overstress the healing tissues.

Phase 3:

 Increase muscle strength and endurance The patient should have full passive and active range of motion. Knee exercises for strength and endurance are progressed here and more dynamic knee stabilization exercises are introduced. Exercises include eccentric contractions, proprioception and neuromuscular re-education, and multi-joint and multi-planar endurance exercises. Exercise selection is based on patient goals and activity/occupational demands. Manual therapy and modalities are used as needed.

Phase 4:

 Return to sport Advanced strengthening to increase muscle strength, power and endurance are performed so the patient can attempt to return to his or her previous level of sport participation. Maintenance of activities and sports-specific loads are applied to the knee. Plyometric exercises enhance dynamic stability and proprioception and should be chosen individually based on sport-specific demands.