10 Exercises To Perform After Knee Replacement Surgery

Article written by physiotherapist Alex Kagunda and edited by Dr. Samantha Smith PT, DPT

Completing strengthening exercises after a knee replacement surgery constitute a major part of the rehabilitation program. Performing the right exercises after your knee replacement helps to increase muscle strength, improve mobility, reduce swelling and allow a quick return to activity of daily living. Your physical therapist will guide you on the best exercises to perform after your knee replacement, how often you should do them and the period you need to do them. 

The intensity you perform these exercises after your knee surgery should increase as you are able to place more strain on your muscles and move your joint across a more range of motion. Once tolerated, you should perform these exercises for 20-30 minutes 2-3 times a day. Aside from completing strengthening exercises, walking after your knee surgery is highly recommended as it will help reduce complications associated with immobility and helps improve recovery. In this guide, you will learn the best 10 exercises to perform after knee surgery, how they should be performed and the period in which they should be performed. 

What is the importance of performing exercises after knee surgery?

Exercises after total knee replacement surgery (and rehabilitation as a whole) will improve your overall recovery and enable you to return to day-to-day activities faster. The other benefits of performing post-operative knee exercises include the following: 

• They prevent the formation of clots within the blood vessels by aiding blood flow.
• Reduces lower limb swelling.
• Restores the strength of the limb muscles to aid ambulation. 
• Allows early independence. 

Exercises to Perform

The following exercises can be performed during the early phases of rehabilitation under the supervision of the physical therapist. 

Ankle pumps 

Performing ankle pumps after a knee replacement is an excellent way to kick-start recovery. Ankle pumps help to activate and utilize the calf muscles, which are muscles behind the leg. These exercises help to reduce swelling and prevent the formation of clots or Deep Vein Thrombosis (DVT) in the lower limbs. 

The calf muscle contraction utilizes a calf muscle pump function to pump blood to the heart from the legs. Ankle pumps can be coupled with elevation of the foot above the levels of the heart, especially while lying down, to reduce swelling. 

To perform ankle pumps: 

• Lie down or be seated in a chair. 
• Pull the toes up towards the head and then down rhythmically. The contraction of the calf muscles aids this. 
• You should perform this 10 times every hour while in the recovery room.

Knee bend stretch 

Knee bends are vital in helping restore your knee range of motion. With the normal knee range of motion (ROM), you can walk normally and bend your knee easily without any discomfort. However, you should not be in a rush to bend your knee to more than 90 degrees in the first two weeks if you cannot tolerate it. Knee bends can be performed when seated or lying on the bed. 

Performing knee bends while lying down. 

• Bend your knee by sliding your foot towards your buttock to the maximal position you can. 
• Hold in this position for 5-10 seconds. 
• Repeat the exercise severally for about 2 minutes, around when your limb will start to feel fatigued. 
  
   

Performing knee beds while seated 

• Perform this exercise while sitting on a chair. 
• Place the non-operated leg on the operated one and use it to bend the operated leg to the maximum position it can get. 
• Also, you can bend the operated leg solely by sliding your heel back toward the chair. 

Hold the leg for 5-10 seconds in the maximal position and repeat this severally. 

Knee straightening stretch 

This exercise helps maintain the knee's range of motion and attain a full knee extension. By the second week after surgery, you should aim to extend or straighten your knee fully. This knee replacement exercise can be performed in various positions but is safest when lying down on the bed. 

To perform knee straightening: 

• Roll a towel and place it below the heel of your operated limb. 
• The heel should not be touching the bed. 
• Tighten the thigh muscles and straighten the knee such that the back of the knee presses on the bed or touches the bed. 
• Maintain the position for 5-10 seconds and repeat the exercises for as much as you can tolerate. This can take about three minutes. 

Quad sets 

Quad sets exercise for knee replacement will help achieve knee straightening and initiate isometric contraction of the quadriceps muscles (muscles at the front of the thigh). These exercises are a good way to prepare yourself for mobility and ambulation, as the quadriceps muscles are one of the main groups of muscles involved in walking. You can be long seated in a bed or lie down to perform this exercise. 

To perform these exercises: 

• Maintain a long seated position on a bed. 
• Put a rolled towel below your heel such that your heel isn't in contact with the bed surface. 
• Tighten your thigh muscles so your knee will straighten and push down the bed. 
• Maintain this position for 5-10 seconds.  

Straight leg raises

As the name suggests, you will actively raise your whole limb from the hip. When performed after knee surgery, this exercise will help strengthen the muscles that flex your hip (bring the hip up or in front based on your position) and the quadriceps muscles. Performing the exercise will help speed up recovery and independence while walking. Strong hip muscles will also help walk in the proper gait, helping prevent musculoskeletal abnormalities associated with poor gait and walking pattern. 

To perform this exercise

• Lie down on your back (supine position). This is better done on a bed. 
• Lift your whole limb so it is not resting on the bed, and maintain the position for 5-10 seconds.
• Ensure that your knee is straightened when performing this exercise.
• Repeat this for about 3 minutes until your thigh muscles are tired.

Short arc quads 

Performing short arc quads after knee replacement surgery help to recruit your quadriceps muscles to action and to improve one's ability to straighten their knee. This can also help prevent deformities of the knee after recovery and help achieve a full range of motion of the knee joint. You would need either a foam roller or a large towel to perform the short arc quad exercise at home. 

To perform the exercise:

Lie on your back on a bed or the floor. 

• Place the foam roller or the rolled towel under your knees so that they are no longer in contact with your lying surface.
• Lift your leg (below the knee) such that your heel evacuates the surface of the bed and your knee becomes straight. 
• You should not lift your hip during this motion as it's the part below your knee you are moving.  

Early activity- walking 

Walking begins soon after surgery and will start before one is discharged to go home. Learn about how much you can walk after knee surgery. Walking can be done over short distances in the hospital room during the hospital stay, which should be advanced more when discharged. In the initial stages, one uses a walking aid such as a walker or crutches to walk. These aids should be weaned off as one acquires more strength and recovers. 

While walking using a walking aid after knee surgery, it is crucial that one is taught the best way to use the walking aid to ensure weight distribution is correct on the operated and non-operated limbs. It is common for people to walk with a limp after knee surgery. To ensure that you walk with the right walking pattern, ensure you use the heel-to-toe pattern when advancing in your steps.  

Stair climbing and descending 

 If there are stairs around the home compound or inside the house, one might be concerned about whether or not they should go up the stairs unaided, how they should climb and descend the stairs using aids and the correct pattern of stair climbing after knee surgery.

Stair climbing and descending after knee surgery is one of the functional tasks that you might be required to perform during your daily activities. Stair climbing can also aid in strengthening the limb muscles and improving muscular endurance after knee replacement. Therefore, one must learn how to climb stairs and descend for optimal functional performance, reducing limitations and dependence. 

Some tips on how to advance through stairs after you have had a knee replacement surgery include: 

• Use a handrail for support
• While advancing up the stairs (climbing), the un-operated should lead up the first, followed by the crutches and the operated limb. 
• While descending the stairs, start with the ambulatory aid and the operated limb, followed by the un-operated limb as the last.  

Hip abduction and adduction 

Hip abduction and adduction exercises after knee replacement involve moving the limb away from the body and towards the body, respectively, strengthening your gluteal muscles and inner thigh muscles. Strengthening the gluteal muscles will help correct abnormal gait acquired when the pelvis remains unsupported on one side while walking. 

As you progress with rehabilitation, these exercises can be advanced by using therapeutic bands for stronger contractions. These exercises are better performed when lying on the floor or the bed. 

To perform the exercise: 

• Lie down on your back, either on the floor or bed.
• Move your operated limb away from your operated leg and back.
• Repeat this about 10 times in a set of three.

You can also perform the exercise while lying on your un-operated limb by lifting your operated leg from the other limb and back. 

Standing knee bends

You can advance to doing knee bends after knee surgery while standing once you have gained more strength and independence in mobility for short distances. Performing knee bends while standing challenges the hamstring muscles to contract against gravity and over more range of motion. Standing knee bends will help strengthen the hamstring muscles and increase the knee's range of motion. 

You ought to have a stable place to hold on to ensure you don't fall while performing the exercise since you will be standing on just one of your limbs at one point. Standing on one limb is the other best way to improve balance and proprioception, reducing your risk of falls. 

To perform the exercise: 

• Stand supporting yourself on a crutch or walker. 
• Bend the operated knee as if you want the heel of that limb to touch the buttock. 
• Bend the knee to the maximal position and maintain the potions for 5-10 seconds.
• Repeat the exercises several times for about two minutes. 

Conclusively, the benefits of exercises after knee surgery range from aiding recovery, attaining independence, overcoming limitations in daily activities, strengthening the muscles, preventing clots, and reducing swelling. The performance of these exercises ought to be started immediately after surgery to ensure optimal benefit from the performance of these exercises. Your physical therapist is in the best position to recommend the best exercises based on your individual needs during the rehabilitation period. 

Some of the best exercises to do after knee surgery include those that will help you regain your muscle strength, such as short and long arc quad and straight leg raise and those that help restore the preoperative range of motion of the knee, such as knee bends and knee straightening. Increasing evidence supports doing the exercises more often for you to gain maximally from them. An important concept is the progression of the exercises to more advanced ones after one has attained more independence and the functional capacity to perform most of the exercises prescribed in the initial stages of the rehabilitation including when kneeling and squatting are allowed. Learn about kneeling after knee surgery here.