Knee Replacement Therapy Exercises

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Introduction

Physical therapy exercises are the cornerstone of successful recovery after knee replacement surgery. While the surgical procedure itself replaces the damaged joint, it's the rehabilitation process that ultimately determines how well you'll function with your new knee. For patients in the UK recovering from knee replacement, understanding and committing to an appropriate exercise programme is essential for achieving optimal outcomes.

This guide explores the key exercises prescribed during different phases of knee replacement rehabilitation, explaining their importance, proper technique, and how they contribute to your recovery. By following a structured exercise programme under professional guidance, you can maximize the benefits of your knee replacement and return to an active, comfortable lifestyle.

Why Exercises Are Critical for Recovery

Before diving into specific exercises, it's important to understand their fundamental role in rehabilitation:

Primary Benefits of Rehabilitation Exercises

Consistent physical therapy provides:

Restoration of range of motion in the replaced joint
Rebuilding strength in supporting muscles
Reestablishing proper movement patterns
Reducing swelling and pain through improved circulation
Preventing complications like stiffness and scar tissue formation
Building confidence in using your new knee

The Consequences of Inadequate Exercise

Without proper rehabilitation:

Knee stiffness can become permanent
Muscles remain weakened, compromising stability
Walking patterns may remain abnormal
Functional limitations persist unnecessarily
Risk of falls increases due to poor balance and strength
Long-term satisfaction with the replacement decreases

Phase 1: Initial Recovery Exercises (Days 1-14)

The first phase focuses on gentle movement, basic strength activation, and managing swelling:

Range of Motion Exercises

Essential early movements include:

Ankle Pumps

Lie with leg extended
Point toes away from you, then pull them toward you
Repeat 10-15 times, every hour while awake
Promotes circulation and helps prevent blood clots

Supported Knee Bends

Sit with leg extended
Slide heel toward buttocks, bending knee as far as comfortable
Hold briefly, then slide back to starting position
Repeat 10 times, 3-4 times daily
Begins restoring knee flexion (bending)

Knee Extensions

Sit with towel roll under ankle
Tighten thigh muscle to straighten knee fully
Hold for 5-10 seconds
Repeat 10 times, every 1-2 hours
Essential for regaining complete straightening

Initial Strengthening

Basic muscle activation exercises:

Quadriceps Sets (Static Quads)

Lie with leg straight
Tighten thigh muscle while pushing knee down
Hold for 5-10 seconds while breathing normally
Repeat 10 times, 5-6 times daily
Activates the main knee supporting muscle

Gluteal Sets

Lie on back
Squeeze buttock muscles together
Hold for 5-10 seconds
Repeat 10 times, 3-4 times daily
Strengthens important hip stabilizers

Straight Leg Raises

Lie on back with non-operated leg bent
Tighten thigh of operated leg and lift it 15-30 cm
Hold briefly, then lower slowly
Repeat 10 times, 3 times daily
Builds quadriceps strength while protecting the new knee

Phase 2: Progressive Exercises (Weeks 2-6)

As initial surgical pain decreases, focus shifts to building function:

Advanced Range of Motion

Building on initial movements:

Seated Knee Flexion

Sit on chair, slide foot back under chair
Apply gentle pressure to increase knee bend
Hold for 10-20 seconds
Repeat 10 times, 3 times daily
Progressively improves bending capacity

Wall Slides

Lie with operated leg against wall
Slide foot down wall, allowing knee to bend
Hold briefly at maximum comfortable bend
Return to starting position
Repeat 10 times, 2-3 times daily
Uses gravity assistance for improved bending

Functional Strengthening

More challenging exercises include:

Sit to Stand

Sit in standard-height chair
Stand up using minimal hand support
Lower back to sitting slowly and controlled
Repeat 10 times, 2-3 times daily
Builds practical strength for daily activities

Step-Ups

Face a small step (15-20 cm height)
Place operated foot on step
Step up, focusing on controlled movement
Step down with non-operated leg first
Repeat 10-15 times, 2 times daily
Builds strength for stair management

Standing Knee Bends

Stand holding onto stable support
Bend operated knee, bringing heel toward buttock
Hold briefly, then return to standing
Repeat 10 times, 2 times daily
Increases knee flexion and quadriceps control

Phase 3: Advanced Rehabilitation (Weeks 6-12)

The focus shifts to more functional activities and building endurance:

Balance and Proprioception

Improving stability and position sense:

Single Leg Balance

Stand near support but try not to hold it
Balance on operated leg for 10-30 seconds
Progress to longer durations and less support
Repeat 3-5 times, twice daily
Essential for confidence and fall prevention

Weight Shifts

Stand with feet shoulder-width apart
Shift weight from one leg to another
Progress to smaller base of support
Repeat for 1-2 minutes, several times daily
Improves weight acceptance through the replaced knee

Endurance Building

Activities for stamina development:

Stationary Cycling

Adjust seat height appropriately (higher initially)
Begin with 5-10 minutes, minimal resistance
Gradually increase time before adding resistance
Aim for 15-20 minutes, 3-5 times weekly
Excellent for both range of motion and endurance

Walking Programme

Begin with short, frequent walks
Gradually increase distance by approximately 10% weekly
Focus on proper heel-to-toe gait pattern
Aim for 15-30 minutes of walking, at least 5 days weekly
Builds practical endurance for daily activities

Special Considerations for Different Patient Groups

Exercise requirements vary based on individual factors:

Exercises for Younger, Active Patients

Considerations for higher demand patients:

Often progress faster through basic protocols
May require more advanced strengthening
Greater focus on return to specific activities
Potential for more demanding balance exercises
May need sport-specific rehabilitation components

Adaptations for Elderly Patients

Modifications for older individuals:

Greater emphasis on safety and fall prevention
More gradual progression of difficulty
Additional focus on practical functional movements
Often require longer to achieve range of motion goals
May need simplified home exercise programmes

Exercise After Minimally Invasive Surgery

Considerations after less invasive approaches:

Often begin with more advanced exercises earlier
Typically experience faster initial progress
Still require complete rehabilitation process
May achieve range of motion milestones sooner
Home exercise compliance remains crucial

Common Questions About Knee Replacement Exercises

Basic exercises begin immediately—often on the same day as surgery. Initial exercises like ankle pumps, quadriceps sets, and gluteal squeezes start in the hospital, sometimes within hours after surgery. These first exercises are gentle but crucial for preventing complications and beginning the recovery process. More substantial exercises begin under the guidance of a physiotherapist, typically the day after surgery, including supported knee bends and assisted leg lifts.

During the first few weeks, high-frequency but shorter exercise sessions are recommended. Perform basic exercises (quad sets, ankle pumps) every 1-2 hours while awake. Formal exercise sessions typically occur 3 times daily, with each lasting 15-20 minutes. As you progress, sessions may become longer but less frequent. Consistency is crucial—regular daily exercise produces better results than occasional intense sessions.

Some discomfort during exercises is normal, but not severe pain. Follow the "2-hour rule": if pain is significantly worse 2 hours after exercising compared to before, you've likely done too much. Mild discomfort that subsides quickly after completing exercises is acceptable. Sharp pain, significant swelling, or pain that disrupts sleep after exercising suggests you should modify your approach. Discuss persistent exercise-related pain with your physiotherapist.

Most patients can begin stationary cycling at 2-4 weeks post-surgery, starting with the seat high and minimal resistance. Swimming and water exercises typically start once your incision is completely healed, usually around 4-6 weeks, though you should confirm timing with your surgeon. Both activities provide excellent low-impact exercise that promotes range of motion and builds endurance without excessive joint stress.

Conclusion

A committed approach to rehabilitation exercises is essential for successful recovery after knee replacement surgery. The exercises described in this guide represent the foundation of a typical rehabilitation programme, though your physiotherapist will tailor recommendations to your specific needs and progress.

Remember that recovery is not a race—progress happens at different rates for different people. Focus on consistent effort rather than comparing yourself to others or rushing through rehabilitation stages. Regular communication with your healthcare team about challenges and achievements will help ensure you receive appropriate guidance throughout your recovery journey.

By maintaining dedication to your exercise programme through each phase of rehabilitation, you can maximize the benefits of your knee replacement and achieve the best possible functional outcome. While the surgical procedure itself replaced your damaged joint, it's your commitment to rehabilitation that ultimately determines how well you'll function with your new knee.

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