Post-Operative Exercises

Activity Guidelines
Exercise is important to help you obtain the best possible results from your knee surgery. You will begin doing exercises with the therapist on the first day after your operation. You will perform many of these exercises in between your therapy sessions as well as during each session. Prior to discharge, you will receive thorough instructions as to the exercises you are to continue. Additional instruction will come from the Academy therapist, the home health therapist, or from the therapist that will follow you as an outpatient if deemed necessary.

The next few pages contain some guidelines for your post-operative activity and exercise program. Your therapist will personalize these for you if necessary.

Total Knee Replacement Post-Op Exercise Plan: Weeks 1-2

Three or four days after your surgery you will be ready for discharge from the hospital. Most joint patients go directly home. A few are referred for outpatient therapy, home health therapy or maybe to an Acute Rehab Unit. Regardless, you will need to continue activity and exercise.

During weeks one and two of your recovery you goals are to:

• Continue walking with a walker or two crutches unless otherwise instructed.
• Walk at least 200-400 feet with walker or crutches.
• Walk up and down curbs and ramps.
• Actively bend your knee to 90 degrees.
• Straighten your knee completely.
• Independently sponge bathe or shower (after staples are removed) and dress.
• Gradually resume light household tasks.
• Twice a day, do 20 minutes of home exercises from the program given you – with or without the therapist.

Total Knee Replacement Post-Op Exercise Plan Weeks 2-4

During weeks two through four you will find that your level of independence and general strength increases. Even if you are receiving outpatient therapy, it is still very important that you continue to work on your strength, endurance, and range of motion. This ensures the best outcome for you and your new knee.

Your goals for this period are to:

• Achieve all of the goals listed for week 1-2 if not yet accomplished.
• Wean from the walker or two crutches to a cane or a single crutch as instructed.
• Walk at least a quarter of a mile.
• Bend your knee to 90 degrees or more.
• Straighten your knee completely.
• Independently shower and dress.
• Resume household tasks.
• Twice a day, do 20 minutes of home exercise from the program given you.

Total Knee Replacement Post-Op Exercise Plan: Weeks 4-6

By this time you will be feeling very confident and comfortable with your new knee, but you are still recovering and maximum benefit is the goal. Continuing to be goal oriented and committed to your home exercise program is important.

Your goals for this time period are to:

• Achieve all prior goals.
• Walk with a single cane or crutch and no limp.
• Walk a quarter to half mile.
• Begin progressing on stairs from one foot at a time to regular stair climbing, but only for a few stairs at a time.
• Actively bend knee to 115 degrees.
• Drive a car.
• Continue with home exercise program twice a day.

Total Knee Replacement Post-Op Exercise Plan: Weeks 6-12

During weeks 6-12 you should be able to resume normal activity and perhaps even add some that you could not do prior to surgery.

Your goals for this time period are to:

• Achieve prior goals.
• Walk without cane or crutch and without a limp.
• Climb and descend stairs in normal fashion (foot over foot).
• Walk a half to full mile.
• Improve strength to 80%.
• Resume all activities including dancing, bowling, and golf (closer to week 12).

Home Exercises for After Your Total Knee Replacement

The exercises included in this group are for flexibility and strength. Both are important for your full recovery and return to normal activity. Many of these exercises you will recognize as being similar or the same as those you were instructed to do prior to your surgery. You will begin doing the exercises indicated immediately and others are not to be added until the instructions indicate. The program will be personalized for you by the therapist in the event that you have some additional limitations or special circumstances. Please pay close attention to the instructions and the recommended time for initiating them as this will lead to the best path to complete your recovery. Your therapist may supplement the exercises provided with others if your recovery is moving along at a faster rate than anticipated.

Range of Motion and Flexibility Exercises

Ankle Pumps – Ankle Pumps.eps

1. While lying in bed or sitting in a chair, bend your ankles (both feet) up and down 15-20 times.
2. Do thisexercise several times a day. Not just when you are formally “exercising.”
3. Make sure your leg does not twist or turn while doing this exercise.

Knee Flexion (bending) and Extension (straightening):

Sit in a straight back chair.  Put the foot of the operated leg flat on the floor. Slide the foot back, bending the knee as far as you can. (You may use the other leg to assist with the bending as pictured). Repeat as needed to get more and more bend. When you reach maximum bend, then slowly count to five (5) out loud. Then, straighten your knee as much as you can, including lifting the foot off of the floor. Slowly count to five (5) out loud. Relax and return to the starting position. Repeat 10 times.

Seated Hamstring Stretch

1. Sit on a couch or bed with your leg extended (straight).
2. You may choose to allow the other leg to hang off and touch the floor.
3. Lean forward (from the hips) reaching for your toes. Bend your ankle to bring your toes toward your hand. Do not bend your knee.
4. Hold that stretch/pull on the muscles on the back of your leg while you slowly count to five (5) out loud.
5. Relax and return to the starting position.
6. Repeat five (5) times.

Seated Knee Extension Stretch:

1. Sit in a straight back chair.
2. Prop foot of affected leg up on another chair.
3. Put five (5) to ten (10) pounds of weight on the top of the knee. (sack of potatoes or flour)
4. Sit with this in place for five (5) to fifteen (15) minutes.

Hamstring Sets:

1. Lie on your back on a bed or couch.
2. Bend the operated leg (knee).
3. Push the heel of that leg into the bed without bending the knee any further.
4. Slowly count to five (5) out loud.
5. Repeat 10 times.

Quad Sets: Knee Extension

1. Lie on your back in bed. Tighten the muscle on the top of your thigh and hold.
2. Slowly count to five (5) out loud.
3. Relax.
4. Repeat 10-20 times.

Heel Slides: Hip and Knee Flexion

1. Lie on your back on bed. Bend your knee and slide your heel toward your bottom.
2. Slowly count to five (5) out loud.
3. Relax and return to the starting position.
4. Repeat 10 times.

Strengthening your Knee and Hip: Straight Leg Raises

1. Lie on your back with your unaffected leg bent and foot flat on the bed/couch.
2. Keep the affected leg straight. Tighten the muscle on the top of your thigh and lift that leg up 12 inches off the bed/couch.
3. Keep your knee straight and toes pointed up.
4. Slowly count to five (5) out loud.
5. Relax and lower your leg.
6. Repeat 10 times.

Terminal Knee Extension: Short Arc Quads

Lie on your back in bed. Place a large can or rolled towel under your operated knee. Lift foot, straightening knee. Do not lift your entire leg off of the roll. Slowly count to five (5) out loud. Relax and return to the starting position. Repeat 10 times.

Strengthening Arms

1. Sit in armchair, remembering KNEE PRECAUTIONS. 
2. Place both hands on the arm rests.
3. Place the foot of the operated leg out slightly in front of the other foot on the floor.
4. Straighten your arms raising your bottom up as much as possible.
5. Return to the seated position.
6. Repeat 10 times.

Partial Knee Bends/Squats

1. Stand holding onto a stable object like the back of a chair or a counter top.
2. With feet shoulder width apart and hands holding onto support, slightly bend knees.
3. Slowly straighten and return to upright, erect position.
4. Repeat 10 times.