Knee Gel Injections: Exercise Guidelines, Recommended Activities, and What to Avoid

Can you exercise after gel injections in the knee?

Generally, yes, you can exercise after gel injections (viscosupplementation) in the knee, but a crucial period of initial rest is required, followed by a gradual and carefully managed return to activity under the guidance of your healthcare provider.

Understanding Gel Injections (Viscosupplementation)

Gel injections, medically known as viscosupplementation, typically involve injecting hyaluronic acid into the knee joint. Hyaluronic acid is a naturally occurring substance found in healthy joint fluid (synovial fluid) that acts as a lubricant and shock absorber. In conditions like osteoarthritis (OA), the natural hyaluronic acid in the joint can break down, reducing its protective qualities.

The purpose of these injections is to:

• Restore lubrication: Improve the gliding motion of the joint surfaces.
• Enhance shock absorption: Provide cushioning to reduce impact forces.
• Reduce pain and inflammation: Some formulations may have anti-inflammatory properties, and the improved joint mechanics can lessen irritation.

While not a cure for OA, viscosupplementation aims to alleviate symptoms, improve function, and potentially delay the need for more invasive interventions.

Immediate Post-Injection Period (First 24-48 Hours)

The period immediately following a gel injection is critical for allowing the injected substance to settle and for minimizing potential side effects.

• Rest is paramount: Avoid strenuous activities, heavy lifting, prolonged standing, or excessive walking for at least 24 to 48 hours. This allows the hyaluronic acid to distribute evenly within the joint space and minimizes mechanical stress that could cause discomfort or inflammation.
• Minimize swelling and discomfort: Some individuals may experience mild pain, swelling, or warmth at the injection site. Applying ice packs for 15-20 minutes at a time, several times a day, can help manage these symptoms. Over-the-counter pain relievers (like acetaminophen) may also be recommended by your doctor.
• Avoid high-impact or repetitive movements: Activities that place significant load or repetitive stress on the knee, such as running, jumping, or deep squatting, should be strictly avoided during this initial phase.

Resuming Exercise: General Guidelines

The return to exercise post-injection should always be a collaborative decision between you and your healthcare provider, which may include your orthopedic surgeon, general practitioner, or physical therapist.

• Consult your physician: Before resuming any exercise program, always get clearance from the doctor who performed the injection. They can provide specific recommendations based on your individual response to the injection, the severity of your condition, and your overall health.
• Gradual progression: Do not attempt to return to your previous activity levels immediately. A slow, progressive increase in activity intensity and duration is key to preventing re-injury or exacerbating symptoms.
• Listen to your body: Pain is a signal. If an exercise causes discomfort beyond mild fatigue, stop or modify the activity. Distinguish between muscle fatigue and joint pain.
• Focus on low-impact activities initially: These types of exercises minimize stress on the knee joint while still promoting movement and strengthening.

Recommended Exercises Post-Injection

Once cleared by your physician, the focus should be on exercises that support knee health without undue stress.

• Gentle Range of Motion (ROM) Exercises:
  • Knee Bends/Heel Slides: While lying down, gently slide your heel towards your buttocks, bending your knee as far as comfortable, then straighten.
  • Ankle Pumps: Simply move your foot up and down at the ankle to promote circulation.
• Isometric Exercises: These strengthen muscles without moving the joint.
  • Quad Sets: Tighten your thigh muscle (quadriceps) by pressing the back of your knee into the floor or bed, hold for 5-10 seconds, then relax.
  • Glute Sets: Squeeze your buttocks together, hold, then relax.
• Low-Impact Aerobic Activities: These improve cardiovascular health and joint lubrication without high impact.
  • Stationary Cycling: Begin with very low resistance and gradually increase duration.
  • Swimming/Aquatic Therapy: The buoyancy of water reduces joint load, making it an excellent option for early rehabilitation.
  • Elliptical Trainer: Provides a smooth, gliding motion with less impact than running.
  • Walking: Start with short, flat walks and gradually increase distance and pace as tolerated.
• Progressive Strengthening: Once initial discomfort subsides, incorporate exercises to strengthen the muscles supporting the knee.
  • Straight Leg Raises: Lying down, lift one leg straight up, keeping the knee extended.
  • Wall Slides/Partial Squats: Lean against a wall and slowly slide down as if sitting in a chair, keeping knees over ankles, then slide back up. Avoid deep squats initially.
  • Hamstring Curls (Seated or Standing): Focus on controlled movement.
  • Calf Raises: Stand and raise up onto the balls of your feet.
• Balance and Proprioception: These exercises improve joint stability and awareness.
  • Single-Leg Stands: Hold onto support initially, then progress to unsupported.
  • Tai Chi or Yoga (modified): Gentle movements and postures can improve flexibility and balance.

Exercises to Avoid or Modify

Certain activities can put excessive stress on the knee joint and should be avoided or significantly modified, especially in the early post-injection phase and potentially long-term for OA management.

• High-Impact Activities:
  • Running, jogging, sprinting.
  • Jumping, plyometrics.
  • High-impact aerobics.
• Activities with Sudden Twisting or Pivoting:
  • Sports like basketball, soccer, tennis, golf (unless modified).
• Deep Squats, Lunges, or Heavy Leg Presses: These can place significant compressive and shear forces on the knee joint. If performed, ensure proper form, limited range of motion, and appropriate weight.
• Activities that Cause Pain: Any exercise that elicits sharp, persistent, or increasing knee pain should be stopped immediately.

Importance of a Personalized Approach

Every individual's response to gel injections and their pre-existing knee condition will vary.

• Individual Variability: Factors such as the severity of your osteoarthritis, your overall fitness level, and how your body responds to the injection will influence your recovery and exercise plan.
• Role of a Physical Therapist: A physical therapist can be an invaluable resource. They can assess your knee function, design a tailored exercise program, teach proper form, and help you safely progress your activities. They can also provide manual therapy and other modalities to support your recovery.
• Long-Term Management: Viscosupplementation is often part of a broader management strategy for osteoarthritis. Regular, appropriate exercise, weight management (if applicable), and other lifestyle modifications are crucial for long-term knee health.

When to Seek Medical Attention

While mild discomfort is normal, certain symptoms warrant immediate medical review.

• Increased pain or swelling: Especially if it's worsening or not responding to rest and ice.
• Redness or warmth at the injection site: Could indicate an infection.
• Fever or chills: Also potential signs of infection.
• Persistent numbness or tingling: Around the knee or down the leg.
• Any new or unusual symptoms: That cause concern.

The Role of Exercise in Knee Health

Even with the benefit of gel injections, exercise remains a cornerstone of managing knee osteoarthritis and promoting overall joint health. It strengthens the muscles that support the knee, improves joint lubrication, enhances flexibility and balance, and can significantly reduce pain and improve quality of life. When combined with viscosupplementation, a well-structured and progressive exercise program can maximize the benefits of the injections and contribute to sustained knee function.