Knee Injections: Post-Injection Exercises, Recovery Phases, and Important Considerations

What exercises to do after a knee injection?

After a knee injection, a phased approach to exercise is crucial, beginning with gentle range-of-motion and isometric exercises, progressing to low-impact strengthening and stability work, all while prioritizing pain-free movement and adhering strictly to your healthcare provider's specific guidance.

Understanding Your Knee Injection and Recovery

Knee injections are common interventions for various conditions, including osteoarthritis, tendinitis, and bursitis. Common types include corticosteroid injections (to reduce inflammation), hyaluronic acid injections (to lubricate the joint), and regenerative medicine injections like Platelet-Rich Plasma (PRP) or stem cell therapies (to promote tissue healing). Regardless of the type, the immediate post-injection period typically involves a brief rest period (e.g., 24-48 hours) to allow the medication to settle and minimize irritation.

It is paramount to understand that the information provided here is general guidance. Always consult with your orthopedic surgeon, sports medicine physician, or physical therapist for a personalized exercise protocol tailored to your specific injection type, underlying condition, and individual recovery needs. Ignoring medical advice can compromise the injection's effectiveness or lead to further injury.

General Principles for Post-Injection Exercise

The overarching goal of post-injection exercise is to restore function, improve strength, and enhance stability around the knee joint without causing undue stress or pain. Adhere to these principles:

• Pain-Free Movement: Never push into pain. Discomfort is a signal to stop or modify the exercise.
• Gradual Progression: Start with minimal load and range of motion, slowly increasing intensity, duration, and complexity as your knee tolerates.
• Low-Impact Focus: Avoid activities that involve jumping, pivoting, or high-impact landings, especially in the early stages.
• Emphasis on Control: Perform all movements slowly and deliberately, focusing on proper form and muscle activation rather than momentum.
• Listen to Your Body: Pay close attention to how your knee responds. Swelling, increased pain, or warmth are signs to back off and consult your healthcare provider.

Early Post-Injection Exercises (Typically Days 1-7, or as advised)

The initial phase focuses on gentle range of motion, reducing stiffness, and activating muscles without significant joint loading. These are often performed multiple times a day.

• Ankle Pumps:
  • Lie on your back with your leg extended.
  • Gently pump your foot up and down, pointing your toes towards your head (dorsiflexion) and then away (plantarflexion).
  • Purpose: Promotes circulation, reduces swelling, and prevents stiffness.
• Quad Sets (Isometric Quadriceps Contraction):
  • Lie on your back with your leg extended.
  • Press the back of your knee down into the bed/floor by tightening the muscle on the front of your thigh (quadriceps). You should feel your kneecap pull slightly upwards.
  • Hold for 5-10 seconds, then relax.
  • Purpose: Activates and strengthens the quadriceps without knee movement, crucial for knee stability.
• Glute Sets (Isometric Gluteal Contraction):
  • Lie on your back with your legs extended.
  • Tighten your gluteal (buttock) muscles, squeezing them together.
  • Hold for 5-10 seconds, then relax.
  • Purpose: Activates the glutes, which are vital for hip and knee stability.
• Heel Slides:
  • Lie on your back with your legs extended.
  • Slowly slide your heel towards your buttocks, bending your knee as far as comfortable without pain.
  • Slowly slide your heel back to the starting position.
  • Purpose: Improves knee flexion (bending) range of motion.
• Gentle Knee Bends (Sitting or Supine):
  • While seated with feet on the floor, gently slide your foot back to bend your knee, then slide it forward to straighten.
  • Alternatively, while lying on your back, bend your knee with your foot flat, then slowly straighten.
  • Purpose: Restores comfortable knee flexion and extension.

Mid-Phase Strengthening and Stability (Typically Week 2 Onwards, or as advised)

Once initial pain and swelling subside, and basic range of motion is restored, you can gradually introduce more challenging bodyweight and stability exercises.

• Straight Leg Raises (SLR):
  • Lie on your back with one knee bent and foot flat on the floor.
  • Keep the injured leg straight, tighten your quadriceps, and slowly lift the entire leg off the floor by about 6-12 inches, keeping your knee straight.
  • Lower slowly with control.
  • Purpose: Strengthens quadriceps and hip flexors.
• Wall Slides / Mini-Squats:
  • Stand with your back against a wall, feet shoulder-width apart, about 6-12 inches from the wall.
  • Slowly slide down the wall, bending your knees to a shallow squat (e.g., 30-45 degrees), ensuring your knees do not go past your toes.
  • Hold briefly, then slowly slide back up.
  • Purpose: Strengthens quadriceps, glutes, and hamstrings in a controlled, weight-bearing manner.
• Calf Raises:
  • Stand holding onto a stable support.
  • Slowly raise up onto the balls of your feet, lifting your heels.
  • Lower slowly with control.
  • Purpose: Strengthens calf muscles, important for ankle and knee stability during walking.
• Hamstring Curls (Prone or Standing with Band):
  • Prone: Lie on your stomach and slowly bend your knee, bringing your heel towards your buttocks. Lower slowly.
  • Standing with Band: Loop a resistance band around your ankle and a stable object. Slowly bend your knee, pulling against the band.
  • Purpose: Strengthens hamstring muscles, which work synergistically with quadriceps for knee stability.
• Clamshells:
  • Lie on your side with knees bent and stacked, and hips stacked.
  • Keeping your feet together, slowly lift your top knee upwards, rotating your hip.
  • Lower slowly with control.
  • Purpose: Strengthens hip abductors (gluteus medius), crucial for pelvic stability and preventing knee valgus (collapsing inward).
• Bridging:
  • Lie on your back with knees bent, feet flat on the floor, hip-width apart.
  • Engage your glutes and core, then slowly lift your hips off the floor until your body forms a straight line from shoulders to knees.
  • Hold briefly, then lower slowly with control.
  • Purpose: Strengthens glutes, hamstrings, and core, improving hip and knee stability.

Advanced Strengthening and Functional Movement (Typically Weeks 4-6 Onwards, or as advised)

As strength and range of motion improve, the focus shifts to more dynamic and functional exercises, gradually preparing the knee for daily activities and potentially sport-specific movements. This phase often benefits from the guidance of a physical therapist.

• Shallow Lunges:
  • Step forward with one leg, keeping your torso upright. Bend both knees to a shallow lunge position (e.g., 45-60 degrees), ensuring your front knee stays behind your toes.
  • Push back to the starting position.
  • Purpose: Improves single-leg strength, balance, and functional movement patterns.
• Step-Ups (Low Step):
  • Stand in front of a low step (e.g., 4-6 inches).
  • Step up onto the step with one foot, pushing through your heel, bringing your other foot up.
  • Step down slowly with control.
  • Purpose: Strengthens quadriceps and glutes while improving balance and proprioception.
• Single Leg Balance:
  • Stand on one leg, maintaining balance. Start with holding onto support, then progress to unsupported.
  • Increase challenge by closing eyes or standing on an unstable surface (e.g., pillow).
  • Purpose: Enhances proprioception (body awareness) and strengthens stabilizing muscles around the knee and ankle.
• Light Stationary Cycling:
  • Start with very low resistance and a comfortable seat height.
  • Focus on smooth, controlled pedal strokes.
  • Purpose: Improves cardiovascular fitness and knee range of motion with minimal impact.
• Elliptical Trainer:
  • Begin with low resistance and a slow pace.
  • Purpose: Provides a low-impact cardiovascular workout that engages major leg muscles.

Important Considerations and Red Flags

• Consistency is Key: Regular, consistent exercise, even in short bouts, is more effective than infrequent, intense sessions.
• Warm-Up and Cool-Down: Always begin with a few minutes of light activity (e.g., marching in place) and end with gentle stretches.
• Hydration and Nutrition: Support your recovery with adequate fluid intake and a balanced diet.
• Avoid Pain: If an exercise causes sharp pain, increased swelling, or instability, stop immediately and consult your healthcare provider.
• Professional Guidance: A physical therapist can provide an individualized assessment, identify muscle imbalances, and design a progressive exercise program. They can also provide hands-on techniques and advanced modalities.
• Return to Activity: Do not rush back to high-impact sports or activities without explicit medical clearance. A gradual, supervised return is essential to prevent re-injury.

Conclusion

Exercising after a knee injection is an integral part of the recovery process, helping to maximize the benefits of the injection and restore knee function. By adhering to a progressive, pain-free exercise protocol, starting with gentle movements and gradually advancing to strengthening and functional exercises, you can effectively support your knee's healing and regain confidence in its capabilities. Always remember that your healthcare provider is your primary guide in this journey, and their specific instructions should take precedence.