Physical Therapy After Knee Replacement

Physical Therapy After Knee Replacement


Medically reviewed by Misty Seidenburg

An astounding 780,000 total knee replacements are performed in the U.S. every year. These surgeries significantly enhance mobility and stability for patients who previously struggled with sitting, standing, or walking due to pain.

Physical therapy is not just a recommendation but a crucial part of post-surgery recovery. It’s a journey that you, as a patient, play an active role in. It aids in getting you back on your feet, building your strength, and restoring function in your new knee.

Learn what to expect from physical therapy after total knee replacement, along with safe and effective knee replacement therapy exercises your therapist may prescribe after surgery.

When to Start Physical Therapy After Knee Replacement

It’s crucial to move soon after surgery. A lack of movement will cause your muscles to tense up, putting added pressure on your knee and increasing your pain level. Tight muscles also make it difficult to bend and flex the knee, and if you don’t address that tension, you won’t achieve the most mobility possible from your new knee. So, let’s get moving and start your recovery journey right away!

Patients who undergo hip and knee replacement are also at risk of blood clots, also known as deep vein thrombosis (DVT). That’s why physical therapy is not just recommended; it’s a crucial part of your recovery plan. Starting as early as the first day after surgery and continuing for several months significantly lowers the risk of these complications.

What to Expect From Post-Operative Physical Therapy

Within a few hours of your knee replacement surgery, a healthcare provider or physical therapist will assist you with standing and walking on your new knee. Initially, you’ll start with a few brief walks, usually with the aid of a walker.

In the first few days, you’ll work with your physical therapist on the routine activities you do at home, like getting in and out of a chair and climbing steps. This gradual progression is designed to help you regain your mobility and independence.

As part of your physical therapy journey, you’ll gradually be introduced to strength and range of motion (ROM) exercises. These exercises are designed to strengthen and stabilize your knee.

As you progress, you’ll transition from using a walker or cane to walking without mobility aids. This gradual transition is a testament to your progress and the effectiveness of the therapy, giving you hope and optimism about your knee replacement recovery.

It’s important to use the walking aid until your physical therapist or physician tells you to discontinue it. Using the walking aid can help you prevent walking with a long-term limp and ensure that you have adequate strength and range of motion of your leg to support you.

Physical therapy may continue for up to three or four months after surgery. During this stage, the goals are to continue building muscle strength, improve flexibility, and increase cardiovascular capacity so you can return to your normal activities.

Balance training is also essential to help your muscles “relearn” how to respond to outside changes, keeping you stable and reducing falls. Activity-specific training may also be included to help you perform tasks unique to your habits and interests.

Common Knee Replacement Rehab Mistakes to Avoid

Your physical therapist is an invaluable source of support throughout knee replacement recovery. They help you stay on schedule with therapy to get the maximum results and guide you to avoid common missteps that can delay your progress.

Remember these tips during knee replacement physical therapy to rehab safely and effectively:

  • Avoid doing too much too soon, which can prolong the healing process and cause unnecessary pain.
  • Do not ignore severe pain that is difficult to manage with prescribed medication.
  • Don’t forget proper wound care to keep your incision clean and prevent infection.
  • Do not add excess pressure on the knee joint early in rehab by sitting in low chairs, sitting cross-legged, or placing a pillow under the knee when lying down.
  • Do not skip physical therapy even if you don’t feel like moving. It is a vital part of your healing journey that will help you get the best results from joint replacement surgery.

Now that we’ve covered the don’ts let’s mention a very important do. Walking as a complement to physical therapy is one of the most effective ways to promote rehabilitation after knee replacement. With your therapist’s approval, start out with brief walks, gradually working up to at least 30 minutes per day.

Physical Therapy Exercises for Knee Replacement

Your physical therapist may recommend the following exercises after total knee replacement to help increase circulation to the legs and feet and strengthen your leg muscles. These movements focus on the muscles in the knee, quadriceps, hamstrings, and hips.

Joint replacement physical therapy typically involves both active and passive exercises. Active exercise requires the patient to exert force to move their body. Physical activity not only helps to increase function and recovery and reduce swelling in the surgical area, but it also has many other benefits. It improves heart health, reduces pain and stiffness, and boosts moods.

With passive exercise, an outside force moves the muscles without the patient’s voluntary effort or muscle contraction. That outside force can come from another body part, a machine, or the physical therapist. These movements improve ROM and help stretch muscles and reduce stiffness.

Before starting knee replacement physical therapy exercises, check with your provider and physical therapist to ensure they are safe and appropriate for your condition.

1.   Ankle Pumps

  • Lie on your bed with your ankles hanging off the end.
  • Move your foot up and down by contracting your shin and calf muscles.
  • Do this for 2-3 minutes a few times each hour in the recovery room and then a few times a day after that.

2.   Heel Slides

  • Sit in a chair.
  • Slowly drag your foot backward to bend your knee as much as possible.
  • Repeat 2-3 times and switch to the other leg.

3.   Knee Straightening Exercises

  • Lie on your back on a bed, a couch, or the floor with your legs outstretched in front of you.
  • Place a small, rolled towel under your heel so your heel is not touching the surface beneath you.
  • Tighten your thigh muscle and gently straighten your knee toward the bed or ground beneath you. Hold for 5-10 seconds and release.
  • Repeat this exercise up to 10 times on one side. Rest for a minute and repeat until your thigh is fatigued.
  • Repeat on the other leg.

4.   Leg Lifts

  • This exercise is similar to the previous one, except you lift your leg several inches off the bed or ground while tightening your thigh muscles.
  • Hold the raised position for 5-10 seconds and slowly lower the leg.
  • Repeat until your thigh is fatigued and switch to the other leg.

5.   Hamstring Stretches

  • Lie flat on your back with your knees bent and feet on the floor.
  • Using your hands, clasp and hold your thigh just above the knee.
  • Raise that leg to the ceiling as you straighten it as much as possible, keeping your foot flexed.
  • Hold for a few seconds. Release and repeat 2-3 times before switching legs.

6.   Calf Stretches

  • Sit on a bed or couch with your legs stretched straight in front of you
  • Place a towel or strap around your foot
  • Gently pull the strap towards you, pulling your toes towards your head until a gentle stretch is felt in the back of the cal.
  • Hold for 15 seconds and release. Repeat 2-3 times and switch to the other leg.

7.   Passive Knee Extension Stretch

  • Sit in bed or on the edge of a sofa with your leg stretched straight in front of you.
  • Place a small, rolled towel under your heel.
  • Using slow and sustained pressure, push your hands downward on your thigh muscles above the incision.
  • Hold for 30 seconds and release. Repeat 10 times and switch sides.

8.   Passive Knee Bends

  • For this move, sit on a sofa, bed, or the floor with both legs outstretched in front of you.
  • Place a towel or strap around your foot.
  • Gently pull the strap toward you as your knee bends, moving your foot toward your buttocks.
  • Slide your heel back until your pain level is about 3/10 before slowly moving your leg back to the starting position.
  • Repeat this move for 3-5 minutes before switching to the other leg.

Remember, even if you have only had one knee replacement, you can do these exercises on both legs to reap all the benefits of these active and passive exercises. Your physical therapist will tell you what to expect during exercise, like minor pressure, tightness, or discomfort, and the signs it’s time to take a break and rest.

Joint replacement offers a new lease on life in many ways. While recovery requires dedication and determination, the rewards are worth it. As physical therapists, it is gratifying patients to help patients regain their mobility and become pain-free after surgery. Find a physical therapy clinic near you to schedule an evaluation for total joint replacement rehabilitation.



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Medically reviewed by

Misty Seidenburg

Vice President of Clinical Programs

Dr. Misty Seidenburg has been a practicing physical therapist since 2006 after obtaining her Doctor of Physical Therapy Degree from Gannon University. Dr. Seidenburg completed an Orthopedic Residency in 2009 and subsequent Spine Fellowship in 2010 where she discovered a passion for educating clinicians. Since 2019, she has developed and refined several post-professional residency and fellowship programs and currently serves as the Vice President of Clinical Programs for Upstream Rehab Institute. She serves on several APTA committees to help advance the profession, is adjunct faculty at Messiah University, and is also a senior instructor and course developer for the Institute of Advanced Musculoskeletal Treatments with a special interest in exercise integration. Outside of work, she enjoys challenging herself with new adventures and is currently competing as an endurance athlete.

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