Phase 1 (First 2 Weeks): What to Expect
Phase 1 (First 2 Weeks) is about controlling pain, protecting the wound, managing swelling, and starting safe movement — all while the knee begins the healing process God has designed the body to carry out. This phase sets the foundation for everything that follows.
One day of diligence in Phase 1 (First 2 Weeks) can buy you one week of earlier return to walking and sport.
1. Pain Management
- Take your painkillers regularly, around the clock, at least for the first week. Don't wait for pain to build before taking them.
- No need to fear dependence on painkillers used this way for a short post-operative period.
- Apply cold packs every 3 hours to help with pain and swelling.
- Well-controlled pain keeps you able to do your exercises — pain control isn't just for comfort, it protects your recovery.
- Unexpected bouts of pain can happen and are normal.
2. Wound & Skin Care
- Wounds typically take about two weeks to heal.
- Do not scratch your wound, even if it feels itchy — this is the most important rule this phase.
- You'll be discharged with a compression tube grip to help with swelling. If it causes itchiness, it's safe to remove it.
- Itchy skin is common — let us know and we can prescribe antihistamines.
- Some patients may take longer than 2 weeks to heel. This is normal.
3. Bracing & Weight Bearing
- Brace on at all times, including sleep — the only exception is showering.
- The brace limits your range of motion to a safe zone. Within those limits, feel free to extend or flex the knee as needed — you don't need to stay rigid.
- Partial weight bearing (PWB) with crutches.
- Follow your physiotherapist's guidance on how much weight to place through the leg.
4. Get Your Knee Straight (Knee Extension)
Why the bent position feels comfortable
Post-op swelling fills the joint with fluid. The knee has more space and less pressure when bent — so it naturally wants to rest here. Resting or sleeping with the knee bent is fine.
But — never straightening it is a problem
Scar tissue forms during healing. If the knee is never fully straightened, scar tissue sets in a shortened position — progressively limiting extension. This leads to a stiff knee (arthrofibrosis), which is harder to treat than the original surgery.
Stretching pain is temporary. Stiffness can be permanent.
Your daily extension routine
- 15 minutes of full extension, 3 times a day, starting Day 1.
- Some discomfort is expected and normal.
Two techniques:
- Heel prop (lying): Lie flat, pillow under the heel — not the knee. Let gravity drop the knee straight.
- Progression from heel prop. Add a 4–5 kg weight above the kneecap. Hold 1 min, rest 10–15 sec. Do 5 reps.
- Heel hang (seated): Sit on a chair with your heel resting on another chair. Let gravity drop the knee straight.
Resting position: When resting in bed, keep the pillow under your ankle (foot of the bed), not under the knee, so the knee can drop into extension between sessions.
Goal: full extension within 2 weeks — the earlier, the better.
5. NMES (Neuromuscular Electrical Stimulation)
NMES uses electrical currents to stimulate your quadriceps muscle, helping counter the muscle weakness that's very common after knee surgery due to pain, immobilization, and neural inhibition. It's strongly recommended by international clinical guidelines to support recovery.
Why it matters after surgery:
- Reduces pain, swelling, and neural inhibition
- Facilitates faster return to walking and sports
- Home-based NMES is as effective as clinic-based therapy, with far greater convenience
How to use it:
- 15 minutes per session, 3 times a day, 5 days a week
- Continue for 6–8 weeks after surgery
- Sit with your leg straight out (long sitting), with a towel roll under the knee
- Contract your thigh muscle whenever you feel the stimulation — this is what makes it effective, not the machine alone
6. Physiotherapy 3 x Daily
Follow our Physiotherapists' instructions closely. You may be advised to do any of the following selected exercises, or other appropriate ones — you may not be prescribed all of them, based on your physiotherapist's assessment. It's important to do exactly what's taught specifically to you. Most exercises are done with your brace on. Do them 3 x a day
Quads Activation
Glutes Activation
Leg Extension
DVT Prevention - Repeat Throughout the Day
Key Takeaways for Phase 1 (First 2 Weeks)
- Painkillers around the clock, at least for the first week.
- Cold packs every 3 hours.
- Brace on 24/7 except showering — free to move within its set limits.
- Don't scratch the wound; compression can come off if itchy.
- Extension routine — 15 min, 3x daily, using heel prop or heel hang.
- Physiotherapy 3x daily per our Physiotherapists — only what's specifically taught to you: quads activation, glutes activation, leg extension, DVT prevention (ankle pumps) — all in brace.
- NMES 3x daily, separate from exercises.
- Partial weight bearing with crutches, per PT guidance.
- Full extension goal: within 2 weeks.
