Physiotherapy protocol until orthopaedic review

Safety rules

• Keep pain during exercise at 0-3/10. Stop an exercise if pain becomes sharp, causes catching/locking, or swelling is clearly worse later that day or the next morning.
• For now, avoid deep knee bending beyond 90 degrees, squatting, kneeling, sitting cross-legged, twisting/pivoting on the involved leg, running, jumping, stairs/hills in high volume, and heavy leg press.
• Avoid loaded flexion beyond roughly 60-70 degrees until individually cleared. Deep flexion can increase posterior extrusion forces in a medial root tear. Root-tear review
• Walk on level ground in short, tolerable bouts. Use a cane in the opposite hand temporarily if limping.
• Ice for 10-15 minutes after activity if the knee is swollen. Elevation and a compression sleeve may help mild effusion.

Phase 1: settle pain, swelling, and regain control

1. Ankle pumps
   20-30 repetitions, 3-5 times/day.
2. Quadriceps sets
   Lie with the leg straight, tighten the front thigh and gently press the knee downward.
   Hold 5-10 seconds x 10-15 repetitions, 2-3 sets/day.
3. Straight-leg raise
   Only if you can keep the knee fully straight without pain or lag.
   2-3 sets of 8-12 repetitions.
4. Heel slides, limited range
   Slide the heel toward the buttock only to a comfortable range, maximum about 90 degrees initially.
   2 sets of 10-15 repetitions.
5. Seated assisted knee extension
   Straighten the knee gently, do not force it if blocked or sharply painful.
   2 sets of 10-15 repetitions.
6. Hip strengthening
   • Side-lying hip abduction: 2-3 x 10-15
   • Glute bridge: 2-3 x 8-12
     Keep the knee bend shallow and comfortable.
7. Calf raises, holding support
   2 x 10-15 if comfortable.

Phase 2: strength, balance, and walking tolerance

1. Continue quadriceps, hip, and glute exercises. Progress gradually with ankle weights or resistance bands.
2. Sit-to-stand from a high chair
   Keep knees aligned over the second toe. Use a high seat so the knee does not bend deeply.
   2-3 x 8-12.
3. Mini-squat, only 0-30/45 degrees
   Hold a countertop, move hips back, keep weight equal through both feet.
   2 x 8-10.
   Do not progress into a deep squat.
4. Low step-ups
   Start with a 5-10 cm step. Slow and controlled.
   2 x 8-10 each side.
   Stop if medial joint-line pain increases.
5. Terminal knee extensions with a band
   2-3 x 10-15.
6. Single-leg balance near support
   3 x 20-30 seconds. Keep the knee slightly soft but avoid twisting.
7. Low-impact aerobic work
   • Stationary cycling with a high seat and very low resistance, 5-10 minutes initially
   • Pool walking or swimming can be useful
   • Increase by 2-5 minutes every few sessions if there is no swelling flare
     Avoid breaststroke kick if it provokes medial knee pain.

Phase 3: long-term joint protection

• Strength training 2-3 times weekly: quadriceps, hamstrings, gluteals, calves, and core.
• Build walking or cycling gradually, generally no more than about 10% more total time per week.
• Maintain body weight in a healthy range if relevant, as this reduces knee joint load.
• Continue avoiding deep loaded squats, pivoting sports, and impact activities unless your surgeon/physiotherapist clears them.

Baker's cyst

Seek urgent orthopaedic assessment sooner if you have

• True locking, meaning the knee cannot fully straighten or bend
• Repeated giving-way or inability to bear weight
• Rapidly increasing swelling, redness, fever, or severe pain
• New calf swelling/pain or shortness of breath
• No meaningful improvement after 4-6 weeks of appropriately modified physiotherapy