Little and Often: Physical Therapy for the Stiff Knee

The goal is homeostasis, not forced range. Cranking the knee gives only elastic gains that bounce back and drives sensitization. Priorities are extension first, then patellar mobility, then flexion. Ice with compression 6 to 8 times a day for 20 minutes slows the overactive joint. Crutches are adjusted to how the knee reacts to walking. Patients do their program five times a day. It includes posterior chain stretches of 45 seconds with 15 seconds rest, and low-load prolonged stretch for extension with the heel on a stool for 20 minutes three times a day, adding load with a backpack. Pain behind the knee is acceptable, but pain at the front over the fat pad means stopping. Patellar mobilization in all directions applies to every post-op patient. Heel slides with a strap, 3 sets of 30 per session, and quadriceps stretching with the hip extended work on flexion. Temperature, stiffness and pain are rated daily. Cycling, the pool and other loading come only once the knee is calm, along with honest talks and emotional support for patients and families.