Stretch limitation after knee surgery.

We often see a limitation in the extension of the knee after knee surgery. We can distinguish two reasons by which we can explain why a knee may be unable to extend after injury or surgery.

The least common reason is an intra-articular mechanical blockage. This means that there is something in the joint that is preventing the knee from stretching. This is rare because any loose fragments/tissues in the knee are basically removed naturally during surgery. The most significant reason for a post-operative extension limitation is found in the muscles around the knee and their control. 

Our body cannot distinguish between injury and surgery and thus cannot know that surgery is being performed for the purpose of restoring function and anatomy. So after surgery, the body signals tissue damage, so to speak, which causes it to take protective action. It does this in the case of the knee by switching off the quadriceps (knee extensors), so to speak. What actually happens is that the nerve stimulus sent from the brain to tighten these muscles is blocked. As a result, the stimuli needed to tighten the muscles do not arrive and no muscle contraction occurs. We also call this principle arthrogenic muscle inhibition (AMI). Thus, in addition to holding back tightening of the quadriceps, we also frequently see a kind of spasm of the hamstrings that causes the leg to remain precisely in a flexion.

Trochantor major syndrome

Unfortunately, there are still question marks surrounding the concept of AMI. Scientists believe that the underlying mechanism lies in swelling, pain and restlessness in the knee that stimulates certain receptors. This in turn overstimulates the knee's flexors (hamstrings) and inhibits the extensors. 

Regaining quality extension and activation of the quadriceps is one of the most important goals in the first phase of rehab. This is because failure to achieve these goals in the first few weeks of your rehabilitation is a predictor of problems such as a cyclops (scar tissue formation) in the knee.

Both post-operatively and pre-operatively, proper stretching has great value. In fact, research has shown that patients who undergo knee surgery and have good knee extension (and function) experience less pain and restriction after surgery. In addition, good pre-operative function also reduces the risk of cyclops post-operatively. 

Exercises that provide better coordination and stretching of the knee;

Team Fysio Fitaal focuses a lot on knee procedures both pre and postoperatively. If you would like to know how we work with knee cases, please contact us. info@fysiofitaal.nl

physio fitaal physiotherapy
Richie Brewer

Physical therapist, sports rehabilitation

Evidence-based and measurable physical therapy. That's how we make care as efficient and targeted as possible. By collecting data during your rehabilitation, we know what you do, and therefore how you improve over time. In this way, together we ensure that you will soon be able to sport and move again without any complaints!

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