Evaluation of the Success of Using a Manual Stretching Approach to    Promote Knee Extension Following Total Knee Replacement

Shayda Shekhmohammed Ismael; Mohd Ashraf Thoker

doi:10.15218/ejnm.2026.04

Authors

Shayda Shekhmohammed Ismael Department of Physiotherapy, Erbil Technical Health and Medical College, Erbil Polytechnic University, Erbil, Kurdistan Region, Iraq
Mohd Ashraf Thoker Department of Physiotherapy, Cihan University-Erbil, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.15218/ejnm.2026.04

Keywords:

Total knee arthroplasty, Manual stretching techniques, Knee extension

Abstract

Background and Objectives: Total knee arthroplasty is an advanced surgical method for patients with severe knee disorders, including osteoarthritis and rheumatoid arthritis. Knee arthroplasty is effective in managing pain and restoring extension for better function. This study focuses on manual stretching techniques, following total knee arthroplasty, to improve knee extension and the aim is to decrease back pain and improve the physical quality of life of patients by restoring maximum possible mobility.

Methods: A quasi-experimental study (pretest-posttest) design was conducted to evaluate the quality of life of 110 patients with an age range spanning from 40 to 75 years, who were recruited for the research between October 2024 and April 2025. The method for data collection was meticulous and multifaceted. Prior to the rehabilitation program, a thorough baseline assessment was carried out for each participant. This initial evaluation included precise measurement of the knee's extension range of motion using a standard goniometer and a quantitative assessment of pain intensity via the Visual Analogue Scale.

Result: The analysis of the collected data revealed overwhelmingly positive and statistically significant results, affirming the intervention's efficacy. The primary outcome, knee extension range of motion, showed a remarkable improvement, with the cohort's average measurement increasing from 156.1 degrees pre-intervention to a near-full extension of 172.2 degrees postintervention. This marked increase in joint mobility was strongly correlated with a significant decrease in patient-reported pain levels.

Conclusions: Manual stretches can be a significant technique for improving the rehabilitation of knee extension following surgery. However, manual stretching on its own is not a panacea for every patient, especially those with advanced knee osteoarthritis, obesity, or knee flexion contractures, which potentially would result in severe knee stiffness.

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