Provider Name & Treatment Location: Winback Clinical Case Study Series (provider and treatment location not specified in source documentation)
Key Words: Total knee arthroplasty; post-operative swelling; quadriceps inhibition; arthrogenic muscle inhibition; TECAR therapy; gait retraining
Summary (Abstract)
This case study describes the rehabilitation of a patient following right total knee replacement presenting with persistent swelling, restricted range of motion, quadriceps weakness, gait dysfunction, and reduced functional mobility. A comprehensive rehabilitation approach was implemented including joint mobilization, gait retraining, hip and lower extremity strengthening, stretching, neuromuscular re-education, and Winback TECAR therapy.
A major focus of treatment involved management of post-operative knee swelling and facilitation of progressive quadriceps loading during the early and intermediate rehabilitation phases. TECAR therapy was specifically utilized to reduce persistent knee swelling, improve local circulation, decrease soft tissue congestion, improve tolerance to knee mobility, and assist with initiation and progression of quadriceps activation and loading.
The patient demonstrated progressive improvements in gait, knee mobility, functional ambulation, and overall activity tolerance. What is unique about this case is the use of TECAR specifically as a swelling-management and quadriceps-activation tool in the post-surgical context, addressing arthrogenic muscle inhibition as a primary driver of delayed functional recovery.
Key take-away lessons:
- TECAR therapy was used as a swelling-management modality post-TKA, addressing arthrogenic muscle inhibition of the quadriceps that commonly results from persistent joint effusion.
- Active range of motion improved substantially over the course of care: flexion 84°→120° and extension -21°→0° (active), reflecting a combined effect of swelling reduction, mobilization, and progressive loading.
- TECAR was integrated early in sessions to improve tolerance to joint mobilization, gait training, and therapeutic exercise — and again during initiation of quadriceps loading to reduce pain-related inhibition.
- A multimodal approach combining TECAR with gait retraining, gluteal strengthening, mobility restoration, and stretching supported normalized gait and improved stair negotiation.
Introduction
Post-operative rehabilitation following total knee arthroplasty frequently involves management of joint swelling, pain, quadriceps inhibition, gait abnormalities, and restricted knee mobility. Persistent swelling following knee replacement can significantly contribute to arthrogenic muscle inhibition, reduced quadriceps activation, pain, stiffness, and impaired functional recovery.
Early restoration of quadriceps function is essential for gait normalization, stair negotiation, balance, and return to functional independence. This case highlights the use of TECAR therapy as an adjunctive intervention for post-operative swelling management, facilitation of quadriceps activation, and support of progressive loading during total knee replacement rehabilitation.
Patient Information / Diagnosis
Demographics: Sex and age not specified in source documentation.
Surgical Procedure: Right total knee replacement; date of surgery 12/04/2023; physical therapy commenced 12/15/2023.
Diagnosis / History of Present Condition: The patient initially developed right hip pain approximately two months prior to surgery; movement of the right lower extremity reproduced severe right knee pain during medical evaluation. Subsequent orthopedic evaluation and imaging revealed advanced degenerative changes with complete loss of knee cartilage, leading to right total knee replacement.
Relevant Medical/Family History: Not specified in source documentation.
Past Interventions and Outcomes: Initially required use of a walker for ambulation following surgery.
Clinical Findings
Subjective
| Location | Pain Description | Pain Severity | Aggravating Factors / Alleviating Factors | Functional Limitations |
| Right knee | Dull; aching; sore; tender; sharp; burning | 6/10 | Aggravated by walking, standing, sleeping; alleviated by ice, medication, rest | Walking long distances, stair negotiation, transfers, prolonged standing, and functional mobility activities |
The patient reported persistent right knee pain, swelling, stiffness, difficulty walking, impaired stair negotiation, and difficulty tolerating prolonged standing and activity. At follow-up, the patient reported increased walking activity during the week and a mild increase in knee swelling, but overall minimal discomfort.
Objective
Knee range of motion — Initial Evaluation:
| Motion | Active ROM | Passive ROM |
| Flexion | 84° | 90° |
| Extension | -21° | -18° |
Knee range of motion — Follow-Up Progress:
| Motion | Active ROM | Passive ROM |
| Flexion | 120° | 125° |
| Extension | 0° | 10° |
The patient continued to demonstrate mild restriction in full flexion tolerance.
Strength findings: significant right quadriceps weakness identified initially (knee extension 2/5), with additional weakness noted in the right gluteus medius, hip stabilizers, and lower extremity loading control.
Mobility findings: significant restrictions identified in tibiofemoral mobility, patellofemoral mobility, proximal tibiofibular mobility, and soft tissue extensibility around the hip and knee complex. Persistent swelling and stiffness appeared to contribute to restricted mobility, altered gait mechanics, and quadriceps inhibition.
Detailed Treatment, Timeline, and Outcome
1. Timeline
| Date | Event |
| 12/04/2023 | Right total knee replacement surgery. |
| 12/15/2023 | Physical therapy commenced. |
| Initial evaluation | ROM: flexion 84° (active) / 90° (passive); extension -21° (active) / -18° (passive); knee extension strength 2/5; walker required for ambulation. |
| Follow-up progress | ROM: flexion 120° (active) / 125° (passive); extension 0° (active) / 10° (passive); improved gait and ambulation tolerance. |
2. Diagnostic Assessment
Diagnostic methods: clinical examination including knee active and passive range of motion, lower extremity strength testing, soft tissue and joint mobility assessment, gait assessment, and pain characterization; surgical and imaging history (advanced degenerative changes with complete cartilage loss) obtained from prior orthopedic evaluation.
Diagnosis: post-operative total knee replacement dysfunction characterized by persistent swelling, reduced knee mobility, quadriceps weakness, impaired gait mechanics, and difficulty with functional loading activities. A major contributor to dysfunction involved persistent knee swelling and associated arthrogenic inhibition of the quadriceps musculature.
Prognostic characteristics: not specified beyond the progressive ROM and functional gains documented between initial evaluation and follow-up.
Therapeutic Intervention
1. Type of Intervention
The rehabilitation strategy focused on swelling management, restoration of knee mobility, progressive quadriceps loading, gait normalization, and functional strengthening. Treatment interventions included manual therapy, gait training, therapeutic exercise, stretching, neuromuscular re-education, and TECAR therapy.
2. Protocol Steps
- Manual therapy: proximal tibiofibular mobilization, patellofemoral mobilization, tibiofemoral mobilization, and hip joint mobilization techniques — to improve joint mobility, reduce mechanical stiffness, improve knee motion, and facilitate improved lower extremity loading mechanics.
- TECAR for swelling management: WINBACK TECAR therapy was incorporated primarily to address persistent post-operative swelling, quadriceps inhibition, stiffness, and reduced tolerance to functional loading — unlike Case Studies 1 and 2 (tissue healing and muscle spasm reduction respectively), the primary emphasis here was management of post-operative edema, facilitation of quadriceps activation, and support of progressive lower extremity loading. TECAR was used to improve local circulation, facilitate fluid exchange, reduce tissue congestion, improve soft tissue mobility, and decrease swelling-related stiffness, and was integrated early in treatment sessions to improve tolerance to joint mobilization, gait training, and therapeutic exercise.
- TECAR and quadriceps loading: because swelling and pain can contribute to reflexive inhibition of the quadriceps musculature following knee replacement surgery, TECAR therapy was also utilized during the initiation of quadriceps loading activities — improving neuromuscular activation, reducing pain-related inhibition, improving tolerance to weight-bearing, facilitating muscular recruitment, and improving movement confidence during strengthening exercises.
- Integration with functional rehabilitation: TECAR therapy was combined with gait retraining, gluteal strengthening, mobility restoration, stretching, and progressive lower extremity strengthening to restore knee mechanics, normalize gait, improve stair negotiation, and improve overall walking tolerance.
3. Changes in Therapeutic Intervention
TECAR application transitioned from a primarily swelling-management role early in treatment toward integration alongside early strengthening and gait activities, supporting transition from protective movement patterns toward normalized lower extremity loading as the patient progressed.
Treatment Protocol and Follow-Ups
Session Frequency / Techniques: Not specified in source documentation beyond the phased TECAR/manual therapy/exercise protocol described above.
Clinician- and patient-assessed outcomes: Knee active/passive ROM (flexion and extension), quadriceps strength, gait assessment, and patient-reported pain and swelling.
Important follow-up diagnostic and other test results: Follow-up ROM measurements (see Clinical Findings) documenting flexion and extension gains.
Intervention adherence and tolerability: Assessed via clinical observation and patient-reported comfort with increased walking activity; mild intermittent swelling noted following increased activity.
Adverse and unanticipated events: None reported.
Results after Treatment Completed
The patient demonstrated progressive improvements in knee mobility, gait mechanics, walking tolerance, quadriceps activation, and functional independence. Active flexion improved from 84° to 120° and active extension improved from -21° to 0° between initial evaluation and follow-up. At follow-up, the patient reported minimal discomfort, improved mobility, and improved walking ability despite mild intermittent swelling following increased activity.
Discussion
This case highlights the important role swelling management plays during post-operative total knee replacement rehabilitation. Persistent edema following knee arthroplasty may contribute significantly to quadriceps inhibition, pain, mobility restriction, and delayed functional recovery.
In this case, TECAR therapy was utilized primarily as a swelling management intervention, a circulation-enhancing modality, and a supportive tool during initiation and progression of quadriceps loading. The integration of TECAR therapy with mobility restoration, gait retraining, and strengthening interventions appeared clinically beneficial in improving the patient’s tolerance to rehabilitation and progression toward functional recovery.
Limitations include the absence of direct swelling/effusion measurements (e.g., circumferential or volumetric measures) and the single-patient design, which prevents isolation of TECAR’s independent contribution from the broader rehabilitation program. Take-away: a comprehensive rehabilitation program including manual therapy, gait retraining, therapeutic exercise, progressive strengthening, and Winback TECAR therapy played an important role in management of post-operative swelling, reduction of stiffness, facilitation of quadriceps activation, and support of progressive lower extremity loading and functional recovery following total knee replacement.
Patient Perspective
Not provided in the source documentation for this case.
Informed Consent
Not specified in source documentation. Patient consent for use of de-identified clinical data in this case report should be obtained and documentation made available on request.