Physiotherapy is fundamental to addressing knee stiffness, regardless of its cause. The primary goals are to:
- Restore full, pain-free range of motion (ROM).
- Improve muscle strength and control around the knee.
- Reduce pain and swelling.
- Enhance overall function and quality of life.
Physiotherapy Approaches for Knee Stiffness:
- Manual Therapy:
- Joint Mobilization: Hands-on techniques where the therapist passively moves the knee joint in specific directions to glide the joint surfaces, stretch the joint capsule, and improve mobility. This can be gentle oscillations for pain relief or more sustained stretches for increasing range.
- Soft Tissue Mobilization/Massage: Addressing tightness in muscles (quadriceps, hamstrings, calf, IT band) and fascia surrounding the knee to release restrictions and improve flexibility.
- Patellar Mobilization: Specific techniques to ensure the kneecap moves freely, as its restricted movement can significantly limit flexion and extension.
- Exercise Therapy:
- Range of Motion Exercises: Both active (patient moves the joint) and passive (therapist or device moves the joint) exercises to gradually increase flexion and extension. Examples include heel slides, wall slides, prone hangs, and stationary bike pedaling.
- Stretching: Targeted stretches for tight muscles contributing to stiffness.
- Strengthening Exercises: As ROM improves, strengthening of quadriceps, hamstrings, glutes, and calf muscles is crucial for knee stability and function.
- Proprioception and Balance Exercises: To improve joint awareness and control, reducing the risk of re-injury.
- Modalities:
- Heat/Cold Therapy: Heat before exercises to warm up tissues, cold after to reduce inflammation.
- Electrotherapy (e.g., TENS, EMS): For pain relief or muscle activation.
- Ultrasound: May be used for deep tissue heating.
Advanced Physiotherapy Techniques for Knee Stiffness
“Advanced physiotherapy” for knee stiffness often involves more specialized techniques, technology, or a deeper, more aggressive approach to regain lost motion, particularly in stubborn or chronic cases.
- Continuous Passive Motion (CPM) Machines:
- Often used post-surgically (especially after TKR) to gently and continuously move the knee joint through a prescribed range of motion without active muscle effort from the patient. This helps reduce swelling, prevent scar tissue formation, and improve early ROM.
- Instrument-Assisted Soft Tissue Mobilization (IASTM):
- Uses specialized tools (e.g., Graston, ASTYM) to effectively detect and treat fascial restrictions and scar tissue that contribute to stiffness and pain. It’s more targeted and often more effective than manual massage for breaking down adhesions.
- Dry Needling:
- Inserting thin needles into myofascial trigger points or tight bands of muscle can help release muscle tension, reduce pain, and improve the ability to stretch and regain range of motion, especially if muscle guarding is contributing to stiffness.
- Blood Flow Restriction (BFR) Training:
- While primarily for strengthening, BFR can also indirectly help with stiffness by allowing patients to perform low-load exercises (like knee extensions or light cycling) with significant physiological benefits. This can improve muscle function around the stiff joint without excessive stress or pain.
- Targeted Neuromuscular Re-education:
- Focuses on improving the communication between the brain and muscles. Techniques include biofeedback (to help patients ‘feel’ and activate specific muscles), specific motor control exercises, and balance training that challenges the neuromuscular system. This is critical when stiffness has led to disuse and altered movement patterns
