In this early phase in bed after an injury or surgery the focus moves away from the wound and the management of critical function and towards minimising the damage that can occur from keeping the leg still for a long time in bed.
Attention is on preventing leg clots, minimising swelling and maintaining range of motion.
Limit inflammation and swelling
The RICE regime is the mainstay when it comes to limiting inflammation and swelling.
If you can tackle inflammation early, and keep swelling down, then the rest of the rehabilitation process becomes easier. The joint cavity is large, and can hold as much fluid as the volume of your two fists, and when it is tense with fluid it is very hard to keep the joint moving and the knee can soon become stiff and the muscles weak.
When the knee has been injured or after surgery, the most comfortable position for the joint seems to be slightly bent.
This can be a problem as it is easy to lose those few degrees of extension - the quads become inhibited and weak and the hamstrings tendons at the back of the knee can shorten. It can be difficult to regain that extension if it is lost. So it is easier if you can at this stage maintain extension with a simple passive extension stretch.
When the knee has been swollen with fluid inside the joint, and some of the fluid has been resorbed, there is the potential after a while for the remaining fluid to thicken into sticky strands called adhesions.
In the early stages adhesions can easily be broken by mobilising the joint - taking it through flexion and extension and keeping the patella and structures around it mobile. But if the knee is not kept mobile, the adhesions can eventually form into strands of scar tissue and lock the joint from moving. This can be a major problem.
To avoid this complication at this early stage while you are still in bed, relevant exercises include -
Prevent Deep Vein Thrombosis
When the leg is kept still the blood flows sluggishly through the veins back to the heart. Normally when one is walking the rhythmic contraction of the muscles behind the calf aid the circulation of blood, but this cannot happen in bed if the leg is kept still.
The problem with sluggish blood flow, especially after injury or surgery, is that clots can form in the veins. This is called deep vein thrombosis - DVT. It is a potentially serious problem because such clots can break off and shoot up to the heart and into the lungs, stopping the blood flow to the lung tissue.
A number of things are useful to prevent DVT while in bed:
- TED stockings - those very tight elasticated stockings
- A calf muscle pump (usually only available in hospital)
- foot pump exercises
- Anti-coagulant medications. In hospital these would be prescribed, but ordinary aspirin is quite good as an anti-coagulant.
Prevent Quads Inhibition
When the quadriceps muscle is inactive for a time it can rapidly waste, and it is extremely hard to rebuild it. In this early phase in bed, a few simple exercises will help to maintain tone in the quads muscle. They can all be done in the bed -