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Staying stationary after total knee replacement surgery can cause more problems, and painful ones at that. Here are some simple exercises to help keep you on the move for better recovery. To make sure you’re performing them correctly, it’s best to see a physical therapist.
When the medications and injections are no longer enough to manage the symptoms of knee osteoarthritis (OA), you might start looking into total knee replacement. Technically called total knee arthroplasty (TKA), it’s the gold standard treatment for end-stage OA and entails resurfacing the damaged knee joint with artificial components.
Surgery can replace a damaged joint, providing pain relief, improved mobility, and a better quality of life, but it is only one part of the solution. The real work begins after surgery.
Physical therapy (PT) begins almost immediately after surgery and is essential to regaining strength, range of motion, and mobility. Weakness, stiffness, balance deficits, and difficulty with walking or climbing stairs can persist for months if they are not properly addressed. From preparing the body before the procedure to rebuilding strength and confidence with balance afterward, the right exercises help improve recovery and maximize long-term outcomes.
Motion is the lotion: the more safely and consistently you move, the better your “new” knee will function.
Prehab: Strengthening Before Surgery
Recovery starts before you even enter the operating room. Prehab, or pre-operative PT, makes the recovery process smoother because you’re going into surgery with stronger muscles and better range of motion. It gives your body a head start.
Swimming and Cycling
Cycling promotes knee flexion and extension while strengthening the quadriceps, hamstrings, and calf muscles. Aquatic exercise has the added benefit of buoyancy, which reduces the effects of gravity and pressure on painful joints. Both are low-impact activities that keep the knees moving without placing excessive stress on the joint.
Heel Slides
Heel slides are performed with a belt or strap, and they help improve knee flexion, or the ability to bend the knee. While lying on your back, use a belt or strap around your foot to gently pull your heel toward your body.
Hamstring Stretch
Tight hamstrings, the muscles behind your thighs, can contribute to stiffness and limit knee motion. While lying on your back, loop a strap around your foot and gently raise your leg until you feel a stretch along the back of the thigh to make straightening the knee more comfortable and move more efficiently.
Quadriceps Stretch
Also known as the Thomas stretch, this targets the hip flexors and quadriceps at the front of the thigh, which tend to become tight in people with chronic knee pain. Improving flexibility here can reduce stress on the knee joint and promote better walking mechanics. Lying near the edge of the bed with the legs hanging off the side, bring one knee toward your chest while allowing the other leg to continue to hang off the side, and then switch legs. If you have difficulty doing this, you can also use a band or strap around your foot to help lift.
Side-Lying Hip Abduction
It strengthens the gluteus medius and activates the hip muscles responsible for pelvic stability while walking. Strong hip muscles help control the lower extremities and their alignment, and take away unnecessary stress on the knee. To perform it, lie on your side with the bottom knee bent and the top leg straight. Slowly lift the top leg toward the ceiling, then lower it slowly and with control.
Aim to perform these exercises three to five times per week as you get closer to surgery day, or as directed by your physical therapist. This isn’t intended to be an intense workout. Consistency is the name of the game, just so you can build strength, flexibility, and perhaps slightly more mobility to set the stage for easier recovery and reduce post-surgical complications.
Early Post-Op Exercises (0-2 weeks)
The first two weeks after surgery are about managing swelling, restoring range of motion, and waking up the muscles. It’s tempting to spend most of the day resting post-op, but gentle movement according to the surgical and physical therapy teams’ recommendations is the best way to get through recovery. Here are some of the exercises we suggest to patients.
Elevated Ankle Pumps
These are a great first go-to after surgery. While lying down with the surgical leg elevated, slowly point your toes away from you, then pull them back toward your shin. This simple movement activates the calf muscles, improves circulation, helps reduce swelling, and may decrease the risk of blood clots.
Quad Sets
It’s common for the quadriceps muscle on the front of the thigh to become significantly weaker after knee replacement surgery. To perform a quad set, lie on your back with the leg straight and tighten the muscles on the front of your thigh as if you’re trying to push the back of your knee into the bed. Hold briefly, then relax. Remember, these are not supposed to be intense exercises, so don’t overdo it.
Heel Slides
Yes, heel slides again. Take these with you throughout recovery to improve knee flexion and prevent excessive stiffness from developing.
Knee Extension Stretch
Being able to fully straighten the knee is just as important as bending it. Place a rolled towel under your ankle while sitting straight-legged or lying down and allow gravity to gently straighten the knee. Again, don’t overdo it here. You’re looking to restore full extension, not dramatically bend the joint in the opposite direction. This is going to help walking mechanics and reduce strain on surrounding tissues.
Weight Shifting and Gait Training
Walking is definitely awkward at first! Weight-shifting exercises will help with gradually becoming comfortable placing weight on the surgical leg. As confidence improves with doing that, gait training will help restore a normal walking pattern and reduce compensatory movements that can place stress on other joints.
The best thing to do is perform these movements throughout the day: during coffee breaks, before or after lunch, while waiting for the elevator, or whenever a free moment arises. It’s reasonable to expect some discomfort, but we don’t encourage pushing through significant pain. Small, consistent movements each day add up to improvements in the early stages of recovery that will help you avoid some painful consequences.
Intermediate Post-Op Exercises (2-8 WEEKS)
At around the two-week mark, in addition to basic activation and motion, you’ll start working more on rebuilding strength and improving functional movement. There might still be some swelling and discomfort, but most patients are relying less on assistive devices and walking more confidently. This phase focuses on endurance and symmetry in how the leg moves and supports the body.
Straight Leg Raises
Stronger quadriceps take stress off the knee, and these exercises will help activate the muscles needed for walking and stair climbing. While lying on your back with the surgical leg straight and the opposite knee bent for support, tighten the thigh muscle and lift the leg a few inches off the surface. Slowly lower it back down with control.
Side-Lying Hip Abduction
This one is repeated again because it helps in multiple phases. In this phase, it helps take additional stress off the knee and improve lower-body alignment as you aim for greater stability.
Sit-to-Stands
The intention here is to engage both the quadriceps and glutes and re-teach the body how to perform everyday tasks, like getting up from chairs, toilets, and cars. Sit in a sturdy chair, lean slightly forward at about 45 degrees, push through your legs to stand up, and then slowly sit back down; don’t plop back down, keep it a controlled sit.
Resisted Band Terminal Knee Extension
This one is back to knee extension. A resistance band is anchored behind the knee while the patient stands, slightly bends the knee, and then straightens it against the band’s pull. The aim here is to get rid of stiffness and build up stability during standing and walking.
Stationary Bike
This is coming up again because it’s a great exercise, before, during, and after recovery. Once you have fully recovered and can pedal harder, it’s also a great way to improve cardiovascular health. You can begin with partial rotations if needed and gradually progress to full revolutions as flexibility improves.
Intermediate exercises are typically performed daily or every other day, and depend on tolerance and the physical therapist’s guidance. The goal is steady progress in strength, movement patterns, and the knee’s ability to support your weight and activities.
Advanced Post-Op Exercises (8-16 Weeks)
At this point, most patients are transitioning away from basic strengthening and toward rebuilding full functional capacity. Walking should really be feeling more natural, and by the end of this phase, you should feel more confident with daily as well as light recreational activities.
Lateral and Forward Step-Ups
These are going to help with walking over uneven surfaces as well as stairs and curbs. Using a low step, step up with the surgical leg and slowly control the movement back down. Forward step-ups emphasize quadriceps strength, while lateral step-ups target hip stabilizers. Working multiple muscle groups in this exercise, like the quadriceps, gluteus medius, and hamstrings, supports knee alignment and reduces stress on the joint space during movement.
Squats
Squats are good for rebuilding strength through the thigh muscles while engaging the tendons around the knee that support stability. Start with shallow squats and progress gradually as comfort improves. Squats also need to be performed correctly to avoid knee injuries. Keep it controlled and slow, only dipping into what’s tolerable. You aren’t going for depth or speed. Learning proper squatting mechanics now will help with functional tasks such as sitting, lifting, and bending later on.
Tandem and Single-Leg Balance
This balancing exercise strengthens stabilizing muscles around the ankle, knee, and hip. At the same time, it also trains the nervous system. Tandem stance, where one foot is placed directly in front of the other, is used as a progression toward balancing on one leg. This improves proprioception, which is the body’s ability to sense joint position, and better balance helps reduce the risk of falls.
Crab Walks and Monster Walks
These are banded walking exercises in which a resistance band is used to restrict movement and strengthen the hip abductors and external rotators, especially the gluteus medius and gluteus maximus. It looks silly, but it helps with lower-extremity alignment and to reduce inward collapse of the knee during activity. Maintaining a slight bend in the knees, patients step side to side (crab walks) or diagonally forward and backward (monster walks) against resistance.
Walking Regimen
Nothing fancy, just walking regularly. It seems simple, but you’re normalizing your gait mechanics. Start slow, focus on even step length and upright posture, then gradually increase distance and speed. Even once the knee has fully recovered, there’s no reason to kick the habit – walking is great exercise for overall health.
Regular exercise and noticeable progress through each stage of recovery will help prevent complications that can be extremely limiting, such as stiffness, chronic pain, and restricted mobility. Inadequate rehabilitation can contribute to scar tissue formation (adhesions), persistent tightness, and prolonged recovery timelines. In some cases, patients may require a manipulation under anesthesia (MUA). This is where the surgeon forcefully breaks up the dense scar tissue (adhesions) that has locked the knee joint in place due to a lack of movement.
Got questions? Contact the team at Premier Orthopaedic & Trauma Specialists. From evaluation to surgery to physical therapy, it’s all in-house, and we’re ready to help you get back to your healthiest self.
