The Most Important Exercise After Total Knee Replacement

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In this article, we will elucidate the most pivotal exercises that patients should prioritize after undergoing a total knee replacement, ensuring they return to their daily activities with strength and confidence.

With over four decades of experience in orthopedic physical therapy, I’ve come to realize the profound significance of rehabilitation post-total knee replacement. Among the constellation of exercises available, one reigns supreme in facilitating a swift and efficacious recovery. These exercises, the cornerstones of post-operative therapy, not only expedites recuperation but also ensures the longevity of the prosthetic joint.

As an orthopedic physical therapist with over four decades of experience, I’m well-versed in the rehabilitation journey following a total knee replacement. Effective postoperative exercise regimens are broken down into what I consider four pivotal categories, ensuring comprehensive recovery and functional outcomes. It’s critical to note that while emphasis may vary, it’s the cumulative impact of these four categories that foster optimal recovery.

The first category, blood clot prevention, is paramount immediately following surgery. Engage in ankle pumps, as these exercises promote venous return and reduce the risk of thromboembolic events.

Secondly, range of motion (ROM) exercises, such as heel slides and knee extensions, are vital. They help in restoring the joint’s mobility eroded by years of arthritic changes and surgical intervention.

Regaining knee extension within six weeks is critical to preventing the necessity of manipulation under anesthesia to break the scar tissue.

Read my article: Total Knee Replacement Manipulation: (When & Why To Consider)

Thirdly, strength training is crucial for supporting the replaced joint. Performing quadriceps sets and straight-leg raises strengthens the musculature around the knee, providing stability and improving movement efficiency.

Lastly, endurance and balance work, involving walking and utilizing equipment like stationary bikes, enhance cardiovascular health and proprioception, respectively. Such exercises aid in the resumption of normal gait patterns, thus fortifying one’s ability to perform daily activities confidently.

Incorporating these exercises into your daily routine isn’t just recommended; it’s essential for a successful recovery. Yet, doing it alone isn’t always easy. Partner with a healthcare professional to tailor a personalized strategy that aligns with your body’s unique healing process. Remember, dedication to your rehabilitation program is the linchpin to reclaiming your mobility and quality of life.

Ankle Pumps: To Prevent Blood Clots

Post-operative care following a total knee replacement encompasses a multifaceted approach aimed at preventing complications, one of the most common of which are blood clots. Surgeons typically take a three-pronged strategy to mitigate this risk.

Firstly, they’ll often prescribe blood thinner medications designed to reduce the likelihood of clot formation.

Secondly, they might recommend TED hose, or compression stockings, to promote circulation and minimize the risk of clots in the lower extremities.

Lastly, as an experienced orthopedic physical therapist with over four decades of practice, I’ll emphasize the importance of physical therapy in this trifecta. Specifically, I’ll teach patients how to perform ankle pumps regularly throughout their day.

Ankle pumps play a crucial role in venous return, promoting blood flow from the lower extremities back to the heart. The motion involved in ankle pumps is simple but effective; it entails dorsiflexion and plantarflexion of the foot. Patients are advised to carry out this exercise by flexing their foot up towards their knee and then pointing it downwards. This rhythmic action stimulates blood flow, thus working in concert with the blood thinners and TED hose to significantly diminish the risk of blood clots post-surgery.

I recommend my patients perform ankle pumps multiple times a day, ideally every hour, to ensure maximal benefit and enhance their recovery process after a total knee replacement.

Knee Extension Stretches: A Limited Time Window To Achieve

Throughout my extensive years as an orthopedic physical therapist, I’ve emphasized to patients that the single most crucial exercise following a total knee replacement isn’t one to be underestimated. The task at hand is to diligently work on knee extension stretches, which plays a pivotal role in regaining the optimal range of motion (ROM).

There’s a finite window post-surgery where these stretches will yield the greatest increase in ROM, particularly in achieving full extension of the knee joint. Adhering to a disciplined stretching routine not only facilitates a smoother rehabilitation process but also contributes significantly to the longevity of the total knee replacement.
Remember, knee extension stretches aren’t just a recommendation; they’re a necessity for full recovery.

Heel Hang TKR
Knee Extension Stretch

Leg Raises: The Top Strengthening Exercise After Knee Replacement

Following a total knee replacement, one of the paramount exercises to prioritize is the straight leg raise. This is not simply a matter of regaining lost strength in the quadriceps muscle; rather, it’s about re-educating the muscle.

After surgery, it’s common for the brain to suppress the muscle’s ability to activate as a protective response for the newly implanted joint. Thus, the straight leg raise is less about rebuilding strength—a misnomer since the quadriceps haven’t necessarily weakened—and more about reestablishing the neural pathways responsible for muscle recruitment. Consistently applying this exercise helps the patient regain confidence in mobilizing the knee and restores the quadriceps’ critical role in leg stabilization.

As an experienced orthopedic physical therapist, I can attest to the substantial benefits of walking as a fundamental component in recuperation post-total knee replacement. Walking adeptly merges both endurance and balance enhancement into a simple, yet powerfully effective rehabilitation exercise.

It’s crucial for patients to work towards ambulating independently, without reliance on walkers or canes, aiming to achieve a Low Fall Risk score, which signifies a reduced chance of falls and related injuries.

The therapeutic journey following knee replacement isn’t just about regaining function; it’s also linked to overall health. Studies show that a daily step count exceeding 2,000 steps starts to lower the risk of mortality in healthy adults, and this benefit progressively increases as one approaches 7,000 steps each day.
Read my articles:
Walking After A Total Knee Replacement: (When and How Much?)
Walking: The Perfect Exercise After Total Knee Replacement

While surpassing the 7,000-step mark continues to decrease mortality risk, the advantage tapers, indicating a pattern of diminishing returns for steps beyond this threshold. Nonetheless, each step contributes to a stronger, more resilient knee joint and body.

After a total knee replacement, exercise isn’t just a suggestion; it’s a critical component of your recovery. Through my decades of experience as an orthopedic physical therapist, I’ve witnessed firsthand the transformative effects of a dedicated exercise regimen post-surgery.

Knee motion improvement must be top of mind, as the journey back to optimal health hinges on exercise. Range of motion and strengthening exercises are important, indeed indispensable, for regaining strength and flexibility to return to normal activities of daily living.

For those who search for the single most important exercise, one must look at an array of exercises, each serving a unique purpose in the recovery process of range of motion, strength, blood clot prevention, and endurance.

Let’s start with knee extension stretches. These are crucial as there’s a limited time window postoperative to achieve full extension of your new knee. Without full extension, a patient’s gait and leg function can be compromised.

Heel Hang TKR
Knee Extension Stretch

Following these are leg raises, which reign as the top strengthening exercise after knee replacement to bolster the muscles supporting your leg and hip.

Then we mustn’t forget about ankle pumps. Perfect for early post-surgery, they not only aid in reducing swelling but also prevent blood clots, an essential aspect to check off your recovery list.

Walking, undoubtedly, is the key ingredient in knee replacement recovery—for it’s through walking that we improve our fitness and ensure our newfound knee motion translates to a complete return to function.

Walking Stick Rear view cropped and watermarked 1
Walking with a walking stick after total knee replacement
Never use a cane; it promotes abnormal gait patterns.

Often, home therapy, immediately after discharge from the hospital, is the stage where patients need to hold themselves accountable to continue their exercises prescribed by a physical therapist.

Always perform your exercises multiple times a day, and slowly increase the difficulty as you improve. Incorporate a variety of exercises into your recovery, as these will collectively contribute to your swift return to health.

Lastly, always check with your physical therapist before adding new exercises into your postoperative routine, and remember, your recovery journey is unique; listen to your body and adjust your exercises accordingly.

Read my other articles about Total Knee Replacement

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Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.

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