Quick Guide: 6 Best Exercises After Knee Manipulation
1. Heel Slides
- Stretches the knee joint capsule and breaks up scar tissue
- Improves the flexion range of motion and bend of your knee
- Hold this stretch for 10 seconds and repeat 10 times
- Complete 2 sets and perform 5 times per day
- Best Stretching Strap in the link below
2. Prone Quad Stretch
- Stretches the quad muscle and patellar tendon of your knee
- Improves the bend of your knee
- Hold this stretch for 10 seconds and repeat 10 times
- Complete 1 set and perform 5 times per day
- Best Stretching Strap in the link below
3. Seated Knee Bend
- Stretches the knee joint capsule and front of your knee
- Improves the flexion range of motion and bend of your knee
- Hold this stretch for 45 seconds and repeat 5 times
- Complete 1 set and perform 5 times per day
- Best Stretching Strap in the link below
4. Knee Flexion on a Stair
- Stretches the knee joint capsule and breaks up scar tissue
- Improves knee flexion range of motion
- Hold this stretch for 10 seconds and repeat 10 times
- Complete 1 set and perform 5 times per day
5. Recumbent Bike
- Stretches the knee joint capsule and surrounding soft tissue
- Improves the bend of your knee
- Perform a rocking motion and hold the stretch for 5 seconds
- Complete 6 minutes of biking and perform 3 times per day
- Best Recumbent Bike in the link below
6. Heel Prop
- Stretches the capsule and soft tissue on the back of your knee
- Improves extension range of motion and straightening of your knee
- Let your knee hang straight with a weight on it for 10 minutes
- Perform the heel prop 3 times per day
- Best Weights in the link below
Other helpful equipment after knee manipulation: Ice and TENS
Other helpful equipment after knee manipulation: Compression
- Helps reduce swelling in the knee and leg
- Important for reducing pain and improving mobility
- Use for 10-20 minutes 2-3 times per day.
- Best Air Compression and Compression Garment in the links below
Disclaimers and Disclosures: All information in this article is for informational and educational purposes only and should not be taken as individual medical advice. Additionally, this article contains affiliate links, meaning when you make a purchase, we make a small commission at no additional cost to you. For more information, see our full Disclaimers and Disclosures.
Are you looking for the best exercises to get better after your knee manipulation?
If you recently went through knee surgery but ended up with a stiff knee that requires a manipulation, then you have come to the right place. The fact that you are having to go through a knee manipulation means that things did not go as planned after your knee surgery, and you need some help. It is my goal to be there for you, get you back on track, and give you the roadmap for your journey to recovery!
As a physical therapist, I have seen my fair share of patients after a knee manipulation. Because of this, I have created an exercise program specifically designed to address the deficits that are present after this procedure. I have included the most important exercises after knee manipulation that you need to be doing to improve your flexibility and heal your knee.
In this article I will cover some background information on knee manipulations and then we will dive in deep together with explanations of the best exercises after a knee manipulation, how to perform them, and what the best equipment is to help with these exercises.
And then be sure to stick around at the end of the article for our most frequently asked questions about recovering from knee manipulation surgery. If you’re looking to get started right away, then check out our quick guide to the best exercises after knee manipulation directly above, and then scroll later in the article for specifics on how to perform them.
What is a knee manipulation?
A knee manipulation is a non-invasive surgical procedure that is performed under general anesthesia. The purpose of a knee manipulation is to break up adhesions (scar tissue) in the capsule that surrounds the knee joint. The goal of breaking up the adhesions is to reduce stiffness in the knee and improve the range of motion.
There are two reasons the procedure is performed under general anesthesia. Primarily, it is very painful to stretch out the tissue around the knee and break up the adhesions. Secondly, the general anesthesia causes you to relax all of your muscles, so the surgeon is able to bend your knee and break up the adhesions, without your muscles resisting and fighting against the movement.
Why do I need a knee manipulation?
The main reason people need a knee manipulation is because they had surgery, often a knee replacement or an ACL reconstruction, but their knee became too stiff after the surgery. Stiffness following knee surgery is normal and part of the process, but it is when this stiffness becomes so severe that it limits your functional ability and is not getting better, that you need a knee manipulation.
It is not common to need a knee manipulation, they have a low prevalence rate of 1.3% and it is best to try and avoid the procedure. However, when knee manipulations are performed, they have a very high success rate with patients gaining an average of 30 degrees of motion. This increased motion will allow you to get back to the daily activities that are important to you.
What can I expect with a knee manipulation?
You might be nervous going into the knee manipulation surgery, but since it is typically performed under general anesthesia, it is the easy part and pain-free. Afterward however, you will be restarting the healing process and it is vitally important not to let your knee stiffen up again. Physical therapy exercises after knee manipulation should be started again once you are able to on the day of your procedure.
Additionally, you will need to do these exercises multiple times a day, every single day, for a few weeks after your knee manipulation. These exercises will be uncomfortable, if not downright painful, because you will consistently be breaking up the scar tissue that is trying to reform after the procedure. This discomfort during the exercises is very normal, you are not alone, and it will get better over time. I have helped hundreds of patients to recover after their knee manipulations and all of the hard work and discomfort will be worth it in the end.
What are the best at home physical therapy exercises after a knee manipulation?
The best physical therapy exercises after a knee manipulation are heel slides, prone quad stretch, seated knee bend, knee flexion on a stair, recumbent bike, and heel prop. These exercises should be completed 5 times per day following your knee manipulation.
1. Heel Slides
How to perform the heel slides with a strap exercise after knee manipulation.
Start lying on your back with the strap around the middle of your foot. Try to relax your leg and slowly pull on the handles of the strap so your knee bends and your heel slides up toward your butt. Keep pulling until you feel a stretch across your knee. Once you feel the stretch, pull just a little bit further and hold it there for 10 seconds then return to the start position and repeat 10 times. Take a short break and complete 2 sets.
Professional tips: I usually tell people this exercise is most people’s least favorite for the first couple of weeks due to the discomfort associated with it. So if you’re feeling this discomfort then you’re in good company. This is normal, but we want it to be tolerable and the pain should go away very quickly when you’re done with the exercise.
What is the best equipment for the heel slides with a strap exercise?
The Stretch Out Strap is the best option for several reasons. It is 6 feet long and has multiple loops and handles all along its length, so it is good for people of different sizes and allows you to get the most comfortable grip. It is also very durable and we have had thousands of patients use it in our clinic and most of them end up buying one for their own use at home. The Stretch Out Strap can be found in the link below.
We want your heel to slide with as little friction as possible. If you’re doing this exercise on your hardwood floors with socks on, then consider this pretty frictionless. However, if you’re exercising on a massage table, on a couch, or in your bed then using a slide board can be helpful to make this exercise nice and smooth. We use the slide board for our patients in the clinic when they’re on the mat tables and need a smooth surface. The Slide Board can be found in the link below.
2. Prone Quad Stretch
How to perform the prone quad stretch with a strap exercise after knee manipulation.
Start by lying on your stomach and loop the strap around your foot. Gently pull on the strap and bend your knee until you feel a stretch on the front of your thigh and knee. Once you feel the stretch, hold it there for 10 seconds and then relax your leg back to the start position. Perform 10 repetitions.
Professional Tip: Sometimes your knee can feel like it sticks to the massage table or bed, if this is the case you can just place a soft towel under your knee.
What is the best equipment for performing the prone quad stretch?
The Stretch Out Strap is also the best option for this stretch as well. It has great utility and can be used for over 20 different stretches that we commonly have patients perform. There is also a version of this strap that is about a foot longer, the Stretch Out Strap XL, and it works well for people taller than 5’10’’. The Stretch Out Strap can be found in the link below.
It’s also nice to have a firm but soft surface to perform this stretch on. Many of our patients will start their exercises in bed after a knee surgery but most people prefer a surface that is a little more firm. You can use a portable massage table, which is firm enough that you don’t sink into it but soft enough to make it quite comfortable. This massage table is collapsible and portable and allows you to perform your physical therapy routines at home like our patients do in the clinic. The Massage Table can be found in the link below.
3. Seated Knee Bend
How to perform the seated knee bend with a strap exercise after knee manipulation.
Start by sitting in a chair or on the side of the massage table and loop the strap around your foot. Feed the strap under the table or chair and pull it up from behind you. Gently pull on the strap and bend your knee until you feel a stretch on the front of your knee. Once you feel the stretch, hold it there for 45 seconds and then relax your leg back to the start position. Perform 5 repetitions.
Professional Tip: Once you gain enough range of motion, the back of your leg may start to hit the table or chair. If you scoot out a bit it will give you more room to bend your knee further, but do not fall off the chair or table!
What is the best equipment for performing the seated knee bend?
The Stretch Out Strap is also the best option for this stretch as well. It has great utility and can be used for over 20 different stretches that we commonly have patients perform. There is also a version of this strap that is about a foot longer, the Stretch Out Strap XL, and it works well for people taller than 5’10’’. The Stretch Out Strap can be found in the link below.
4. Knee Flexion on a Stair
How to perform the knee flexion on a stair exercise after knee manipulation.
Start by standing in front of your steps and placing the foot of the involved leg on the first step. Make sure to hold on to the railing or walls and gently lean forward to bend your knee until you feel a stretch. Once you feel the stretch, hold it there for 10 seconds and then relax back to the start position. Perform 10 repetitions.
Professional Tip: If you don’t feel enough of a stretch, then move your foot up to the second step. This will place your knee in a deeper angle of flexion and give you a bigger stretch.
5. Recumbent Bike
How to use a recumbent bike after a knee manipulation.
Start sitting in the bike with both feet on the pedals. Make sure the resistance is on the lowest setting and gently start to rotate the pedals forward. Once you feel a stretch on the front of your knee, hold it there for 5-10 seconds. Then rotate the pedals backward and keep going in reverse until you feel a stretch on the front of your knee again. Hold it in this position for 5-10 seconds and repeat this pattern of rocking back and forward to stretch out your knee for 6 minutes.
Professional tips: Over the days and weeks you should gain more motion and eventually begin to perform full revolutions. Many people are able to go in reverse before they can go forward, and this is ok. Start by rocking, then do full revolutions in reverse and then perform full revolutions forward and this turns into a great warm-up to do before your other exercises.
Why the recumbent bike is a good exercise after knee manipulation.
The recumbent bike is one of the best machines for rehabbing after a knee manipulation, so much so, that I have every patient of mine use it. One of the great features about the recumbent bike is that you can use your good leg to control the motion and gently rock back and forth to start bending your knee. This will help to restore flexibility and range of motion to your knee joint.
As you get better and have more motion, you can begin to perform full revolutions on the bike. At this point, you can use the bike as a warm-up for your exercises because it improves circulation and gets your tissues ready to be worked and stretched. Some people will use the continuous passive motion (CPM) machine after a knee manipulation, but I see even better results using the recumbent bike.
What is the best recumbent bike after a knee manipulation?
If you already have a stationary bike at home and it is upright, you may be able to use that as an alternative. However, if you don’t have a bike yet then I would suggest one that is recumbent. Recumbent bikes are easier to get on and off, especially with an injured knee. Also, the position the recumbent bike places you in allows you to have just a little more control over the motion, which is helpful in the initial phases of treatment. The Recumbent Bike can be found in the link below.
If you don’t have the room for a full-sized recumbent bike, then using a smaller version that you roll up to your couch or a chair can be a viable option. This one on Amazon is smaller and can be moved and stored much easier than a typical recumbent bike. Another benefit is the lower price, but it comes at the cost of less control and less versatility. This smaller, portable recumbent bike is best for gentler stretching and warming up, it can be found in the link below.
6. Heel Prop
How to perform the heel prop with an ankle weight exercise after knee manipulation.
Start lying on your back with your ankle/heel propped on a small towel roll so your knee is able to hang completely straight. Try to relax your leg, keep your toes pointed toward the ceiling, and let gravity pull your knee straight. Lie a small ankle weight just above your knee, which will add pressure to push your knee into more extension. You should feel a stretch in the back of your knee, try to relax and leave your knee in this position for 10 minutes.
Professional tips: This stretch generally doesn’t feel like much when you are starting out, but it can become quite uncomfortable as the minutes go by. In fact, there’s a chance you might think your 10-minute timer is broken, but I just tell my patients to find something distracting to put on the TV and try to go to their happy place!
What is the best equipment for the heel prop with an ankle weight exercise?
We have found that our patients prefer a weight that you can comfortably drape on your knee and that secures in place. This way you don’t have to worry about it sliding off and having to fiddle with it to keep it in place. Also, it is important that you can adjust the amount of weight that you place on your knee. These ankle weights meet all of these criteria, are highly rated, and are sold in pairs so you can use it for other exercises as well. The Ankle Weights can be found in the link below.
Other helpful equipment after knee manipulation: Ice and TENS
How to use ice and TENS after a knee manipulation.
I like to have my patients lie on their back with their leg propped up so the knee is above heart level, this will also help with getting rid of the swelling. Then I place the pads of the TENS unit on either side of the knee cap. I then wrap the knee in a pillowcase to place a barrier between the skin and the ice, and I’ll place one ice pack behind the knee and one on top of the knee so the whole joint is surrounded.
Professional tips: Turn up the TENS until you feel a comfortable tingling sensation. This isn’t one of those “the stronger the better” scenarios, so only increase the TENS until it is at a very comfortable level for you. Keeping the ice and TENS on for 10-15 minutes at a time seems to be the optimal timeframe for reducing pain and inflammation.
Why ice and TENS is helpful after a knee manipulation.
A knee manipulation is performed in order to break up the scar tissue that has formed around the knee joint. Breaking up this scar tissue tends to cause some amount of swelling and inflammation after the procedure. This swelling and inflammation increases pain and limits your range of motion.
Ice and TENS work well together to reduce your swelling and pain after a knee manipulation surgery. These modalities are most important immediately following the manipulation procedure for reducing your pain and inflammation. The ice and TENS can be used for 10-15 minutes after your exercise routine.
What is the best equipment for ice and TENS after knee manipulation surgery?
It’s pretty hard to beat the TENS units we have in the clinic. But considering those units are over $3,000, this portable unit with great reviews for under $50 is an excellent alternative. This unit comes in a travel case, with two channels allowing for 4 electrode placements, and runs on a 9 volt battery. Consider this simple but effective pain relief. The TENS Unit can be found in the link below.
These ice packs are exact replicas of the ones we use in the clinic, and our patients love them! I have had so many patients ask for a recommendation on where they can get the ice packs that we use. They are sick of hard ice packs that don’t conform, or using bags of peas from their freezer that just don’t work as well as they want them to.
These ice packs are large, reusable, and conform to various body parts so you can use them over and over again on any aching joints. I suggest you get a small and a medium so you can wrap your entire knee, front and back. Some people like to get a handful of the ice packs so they can keep one set in the freezer, nice and cold, while they’re using the other set. The Ice Pack can be found in the link below.
Other helpful equipment after knee manipulation: Air compression and compression stockings
Why compression is helpful after a knee manipulation.
Compression after a knee manipulation is beneficial for reducing swelling and improving circulation, which will help the healing process. Many patients find that compression garments can be cumbersome to wear and difficult to put on. But if you’re looking to expedite your recovery process and promote healing, then it can be worth it to wear compression stockings for a few weeks after surgery.
What is the best equipment for compression after knee manipulation?
Some patients don’t like to wear compression garments all day but still want the benefit that compression can provide for healing after their knee manipulation. For those patients, I recommend the Hyperice NormaTec 3 compression system. NormaTec is the number one name in the game for using compression as a recovery tool. The system is expensive but it provides a number of desirable features including 7 levels of compression and they are very highly reviewed. The Hyperice NormaTec 3 can be found in the link below.
We recommend a compression garment that starts on your foot and extends up to mid-thigh. Additionally, the pressure of the compression should be in the range of 15-30 mmHg and provide a gradient to promote proper blood flow. Always make sure the compression is not cutting off circulation with alterations in limb color or numbness/tingling. The compression garment below checks all of these boxes and receives positive reviews from patients following their knee replacement surgery.
Best Exercises After a Knee Manipulation Final Thoughts
I am sorry that you are one of the unfortunate few that needs to have a knee manipulation. It’s definitely unlucky and not what anyone plans for after going through a surgery that was supposed to get them better. But you are now fully prepared with all the skills and knowledge you need to make your knee manipulation a success. I feel confident these are the best exercises after a knee manipulation to restore your range of motion, flexibility, and to get you back to the activities that you love to do!
Frequently Asked Questions About Exercises Following a Knee Manipulation
Knee manipulation vs MUA vs MUGA?
A knee manipulation is a manipulation that is done to the knee joint. Manipulations can be performed on any joint, but most commonly they are done on the knee and the shoulder. In any case, they are done to increase the range of motion of the target joint. MUA is a medical abbreviation that stands for Manipulation Under Anesthesia. MUGA is also a medical term and stands for Manipulation Under General Anesthesia. You may see any of these terms in a medical chart and they all mean the same thing.
Do you need physical therapy after a knee manipulation?
Most people will start physical therapy the day after their knee manipulation and then do therapy every day after that for about a week. Then they will transition to a few times per week. However, what I tell my patients is that 90% of their recovery comes from what they are doing at home. The most important thing you can do to recover is a high-quality at home physical therapy exercise program after your knee manipulation.
How long does it take to walk after knee manipulation?
Most people will be on a walker or crutches for 2-3 days after a knee manipulation. After this, you should have enough strength in your leg to walk with a cane or no assistive device, based on what you were using before your manipulation. If you were not able to walk without a walker before your knee manipulation, then do not expect to walk without it for at least a few weeks after the manipulation.
When should I start physical therapy exercises after a knee manipulation?
You should begin your physical therapy exercises the day of your knee manipulation. Aim to perform these exercises two times on the day of your manipulation and then 5 times per day, every day after that. It is important to start range of motion and flexibility exercises as soon after your manipulation as possible because this will help to prevent scar tissue from forming.
What is the recovery time for a knee MUA?
The first week after the knee manipulation is the most painful. Using ice and TENS for pain relief and compression for the swelling can be beneficial during this time. The first 3-4 weeks after the procedure is when you have to be the most diligent with your exercise routine and see the greatest amount of progress. The total recovery time is typically 3-4 months.
What is the CPM protocol after knee manipulation?
Some doctors will prescribe a CPM or continuous passive motion machine after your knee manipulation. There isn’t much evidence that a CPM machine helps increase knee motion, and I have found that people have much more success with the exercise program instead.
If you are looking for a CPM protocol to supplement your exercise program, then the following is an option. Start the CPM at 80 degrees and use it for 30 minutes at a time and accumulate a total of 4 hours of use each day. Every 3 days increase the bend by 10 degrees and use it for 2-3 weeks.
How should I sleep after a knee manipulation?
The most important thing to keep in mind when sleeping after a knee manipulation, is to not put a pillow under your knee so it is able to remain perfectly straight. You can alternate between sleeping on your back and sleeping on your side. When you are sleeping on your back, your leg should be completely straight.
If you need to put a pillow under your leg, then place it under your calf and foot so there is nothing behind your knee and it remains totally straight. When you sleep on your side, you can place a pillow between your knees for comfort.
Can a knee be manipulated twice?
A knee can be manipulated more than once. However, each time you undergo a manipulation you are causing trauma to the knee and restarting the healing process. The single biggest modifiable risk factor to avoid a second knee manipulation is participating in and diligently performing a comprehensive physical therapy exercise program after your first knee manipulation.
Can I drive after knee manipulation?
Your doctor is responsible for releasing you back to driving after your knee manipulation. Typically, once you are off your assistive device you are allowed to return to driving. Most people are back to driving 1-2 weeks after a knee manipulation.
Can stretching and physical therapy break up scar tissue?
Physical therapy stretching exercises can break up the small adhesions (scar tissue) within the knee joint capsule. Occasionally, the stretching that you perform can break up one of the larger pieces of scar tissue, but this is not typically our goal because it can be painful. If this happens though, it will usually cause discomfort for about 24-48 hours and then your knee will be less painful and you will have more flexibility.
What is the best position to sit after knee manipulation?
It is most important to alternate positions of your knee when you are sitting after a manipulation. I like to have my patients sit with their knee extended and their heel propped on something for a few minutes. Then sit with your knee bent as far back as you can tolerate for a few minutes. Finally, sit in a comfortable position with your knee halfway between bent and straight. Where most people go wrong is to always sit in the most comfortable position, and then their knee begins to stiffen up into this position.
How do I prevent a knee manipulation?
The best way to prevent a knee manipulation after a knee replacement is to perform your knee replacement exercises two times a day, every single day. Being diligent with your exercises and pushing the stretches to an uncomfortable, but tolerable level will keep you on the path to improving your flexibility and avoiding a knee manipulation.
What is the best vitamin for tissue healing after knee manipulation?
Vitamin C has been scientifically proven to be beneficial for tissue healing. There is trauma and damage that occurs to the tissues around the knee after a manipulation and creating an environment that is optimized for healing is important. The recommended dietary allowance for vitamin C is 80mg and the upper tolerable intake level is 2,000mg. I take a single 500mg tablet once a day and this has been working well for me for years now.
What is the best mineral for tissue repair after knee manipulation?
Zinc plays a major role in all phases of the wound healing process. The tissues that surround the knee become damaged and inflamed after a knee manipulation. It is important to help repair this damaged tissue by optimizing your micronutrients. The recommended dietary allowance for zinc is 10mg and the upper tolerable intake level is 40mg. I take a 10mg supplement as part of my daily regimen.
Why trust Physical Therapy Simplified for exercises after knee manipulation?
At Physical Therapy Simplified, our mission is to provide an easily accessible and highly reputable source of physical therapy information that anyone can understand, follow, and benefit from. We want you to feel confident that you are getting the best content and information that will help to reduce your pain and restore you to your highest functional potential.
The author of this article, Andrew Harkins, DPT, has demonstrated expertise in the field of physical therapy and is certified by the American Board of Physical Therapy Specialities as an Orthopedic Clinical Specialist. He has over ten years experience as a licensed physical therapist and is an expert in treating conditions related to the knee.
Andrew has worked as a teaching assistant at the University of Pittsburgh in their Doctor of Physical Therapy Program. Specifically, due to his expertise in treating knee conditions, he assisted in musculoskeletal coursework and provided instruction on how to treat knee manipulations.
