"Frozen knee" is a common term used to describe arthrofibrosis in the knee joint. The most common causes are injury or surgery, which can lead to the formation of extensive, internal scar tissue. Lack of motion in the joint during the recovery period after an injury or surgical procedure can cause the knee capsule to contract and tighten, creating the stiff and frozen effect. Traditional treatment of the condition includes a program of physical therapy exercises.
Mobility
In the early stages of rehabilitation, passive range of motion exercises help to restore mobility without loading the knee joint. The wall slide exercise uses the unaffected knee and gravity to encourage greater flexion. Lie on your back close to a wall and raise your legs up to rest against it. Position your buttocks around 1 foot from the wall and raise your feet as high as possible. Cross your ankles to place the affected leg on top of the unaffected leg and allow both legs to slide down the wall. The unaffected leg can then assist the affected leg in returning to the starting position.
Stretching
Low load prolonged stretching has been shown to be effective in increasing the range of motion in the knee when combined with passive mobility exercises or stationary cycling without resistance. Holding a prolonged mild to moderate stretch in the affected knee can help to promote changes in the tissues that are restricting the movement. A flexion stretch can be achieved by sitting with your back against a wall and the unaffected leg positioned comfortably on the floor. Using your hands to assist, bend the affected knee and aim to slide your heel along the floor towards your buttocks. To achieve an extension stretch, sit with your back supported and the affected leg positioned straight out in front of you. Raise the leg slightly by placing a small pillow or similar under your ankle. Allow your leg to hang in this position to create the stretch. Both the flexion and extension stretches should be held for at least 10 minutes, aiming to build up to 30 minutes.
Strengthening
As the range of motion in the knee joint increases, low load resistance exercises help to regain the functional strength of the surrounding muscle groups. Suitable strengthening exercises include stationary cycling with light resistance or the use of an elastic resistance cord. The seated leg press helps to maintain mobility in the joint and strengthen the quadriceps muscles. Begin with a low resistance and aim for a high number of repetitions, progressively adding greater resistance over time.
Considerations
To regain full range of motion, it's recommended that passive range of motion exercises are performed 3 to 4 times daily for 15 to 20 minutes each time. However, it must be noted that excessive or overly aggressive exercising can generate an inflammatory response in the joint that can actually lead to even greater stiffening.
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