Table 2.

Rehabilitation protocols for KOA after regenerative medicine intervention(s).

	Immediately post intervention (day 0–3)	Day 3–14 post treatment	2–4 weeks post treatment	5–10 weeks post treatment:
Goals	Protect area treated and pain control when required Range of motion (ROM) to tolerance Promote healing Patient education about KOA and weight management Improve joint mobility	Increase local circulation Increase tissue tolerance through exercise or rehab Improve muscular strength and endurance Progress to full ROM. Avoid deconditioning Ongoing patient education weight management as needed Precautions: deep squatting, twisting, kneeling, closed chain deep knee flexion activities	Progress muscular strength and endurance training Open chain vs closed chain Initiate balance and proprioception training on stable surfaces Patient education about KOA and weight management Initiate aquatic therapy	Improve muscular strength and endurance Progress balance and proprioception to unstable surfaces Patient education about KOA and weight management Precautions: avoid impact activities Continue modalities PRN
Precautions	No activity that causes pain	Weight bearing and exercise as tolerable
Suggested therapeutic exercise(s) or modality	Passive joint and soft tissue mobilizations techniques Gentle active ROM exercises Address swelling (manual lymphatic drainage) Isometrics above and below treated area If joint ROM is restricted due to pain, taping and/or bracing may be warranted Electro modalities: LLLT (total dose equal to or greater than 27J); TENS//IFC as required for pain management Acupuncture to surrounding periarticular structures	Passive joint and soft tissue mobilizations techniques Graded load progression with active ROM exercises Gradually increase intensity of isometrics above and below treated area (core/hip/knee strengthening) Electro Modalities: LLLT (total dose equal to or greater than 27J); TENS/IFC as required for pain management Acupuncture to surrounding periarticular structures WBV therapy (frequency of 35–40 Hz, vibration 60 s, interval rest 60 s) in combination with squat Water exercise- Whole body movements, with warm up, stretching/flexibility component and cool down. Weight-assisted treadmill	Graded load progression with active ROM exercises + stretching exercises Continued strengthening exercises (core/hip/knee strengthening) + implement eccentric exercises Dynamic exercises with Thera Band resistance band Proprioceptive, neuromuscular and stability training LLLT (total dose equal to or greater than 27J) TENS/IFC as required for pain management Initiate static loading exercises- wall squat holds, leg press holds, mini squat holds etc. WBV therapy (frequency of 35–40 Hz, vibration 60 s, interval rest 60 s) in combination with squat BFRT- Perform 4 sets (30, 15, 15, 15 repetitions) at 15–30% of 1RM. Cuff placement as proximal as possible on involved limb Water exercise- increase intensity and/or duration of water-based exercises.	Graded load progression with active ROM exercises + stretching exercises Advance closed chain exercises- leg press, squats, step up/down etc Continued progressive strengthening exercises (core/hip/knee strengthening) High-intensity resistance exercise Good eccentric and concentric loads that are multi-planar LLLT (total dose equal to or greater than 27J) TENS/IFC as required for pain management WBV therapy (frequency of 35–40 Hz, vibration 60 s, interval rest 60 s) in combination with squat BFRT- Perform 4 sets (30, 15, 15, 15 repetitions) at 15–30% of 1RM. Cuff placement as proximal as possible on involved limb Water exercise- increase intensity and/or duration of water-based exercises. Progress static loading to greater degrees of knee flexion
Cardiovascular Exercises	None	Cycling, Swimming, walking- low impact Aerobic exercise. Can be accumulated in bouts of 10 min, aim for 150 min/week
Progression Criteria	Pain and swelling are controlled ROM is maintained	Pain and swelling are controlled ROM is maintained Gait is normalized	Pain and swelling are controlled ROM is maintained Pain free muscle testing	Pain and swelling are controlled ROM is maintained Good dynamic neuromuscular control with multi-plane activities and without pain

● If increased pain return to previous step until pain is controlled and full return to function required for that step.

● Abbreviations: knee osteoarthritis, KOA; range of motion, ROM; pro re nata, PRN (as circumstances require); low level laser therapy, LLLT; transcutaneous electric nerve stimulation, TENS; interferential current, IFC; whole body vibration, WBV; blood flow restriction therapy, BFRT.