Nurse Teaching on Exercises to Help Rehab after Knee Replacement Surgery

Knee replacement surgery is usually performed in individuals with history of arthritis, such as, osteoarthritis, rheumatoid arthritis, and gouty arthritis involving the knee. Also, knee joint could be replaced in individuals with severe damage to the joint due to accident & other physical injuries. Thus, wear and tear from excessive use, chronic inflammation and injury to the joint could all contribute to worn out articular cartilages. As the cartilage at the ends of bones is worn out, the bones start rubbing against each other, resulting in friction with worsening pain & swelling. This leads to further damage to the joint. Knee replacement surgery involves resurfacing of the ends of the bones forming the knee joint.

Pain in the surgical joint can be a deterrent for participation in the physical therapy session after knee replacement surgery. Taking a pain medication 30 minutes before the exercise schedule can help with better pain control and improved compliance with therapy. Placing an ice pack on the knee joint for 30 minutes before and after the therapy session can add to control of pain and swelling in the joint.

This nurse or physical therapy teaching lists exercises to help rehab after knee replacement surgery. These sets of exercises to strengthen the knee are to be performed 3 – 4 times every day. Fix scheduled time slots during your day to perform your knee exercises.

Based on the condition of the surgical knee and other coexisting factors, limitations could be recommended on performance of some exercises in some individuals after the knee replacement surgery. Check with your physician and physical therapist for any limitations recommended before performing these exercises.

Exercises to Help Rehab after Knee Replacement Surgery

Quad set exercises:

  1. This exercise strengthens quadriceps muscle, the big muscle on the front of the thigh. This muscle helps with straightening the knee from bending position during walking, running, sitting to standing posture, climbing stairs, jumping, and squatting.
  2. You can sit in the bed or on any firm surface, legs stretched out in front of you on the bed, with the knee and toes pointing straight up. In this position, push your knee down so that the back of the knee touches the surface of the bed, tighten the muscle in front of the thigh, and hold it for a count of 5 seconds.
  3. After 5 seconds relax the muscle in front of the thigh for 5 seconds. Then you can repeat the task by pushing down the back of knee against the surface of bed, holding it for a count of 5 seconds, and then relaxing for 5 seconds.
  4. Repeat this pattern for 10 – 15 sets of quad exercises.

Heel slide exercises:

  1. This exercise strengthens the hamstring muscles on the back of the thigh and helps with increasing the bend of the knee, which is important for establishing the range of motion in the knee after the knee replacement surgery.
  2. You can sit in the bed or on any firm surface, legs stretched out in front of you on the bed, with the knee and toes pointing straight up.
  3. To perform this exercise, draw your leg against the surface of the bed closer to your hip, the goal being getting the heel of the leg as close as possible to the hip. This helps with bending the knee and establishing range of motion in the knee.
  4. Due to pain in the knee joint, some individuals might find it difficult to bend the knee and draw the heel closer. In such cases, it might help to use a stretch strap under the thigh, hold the strap tight with the hands, and support the drawing of leg closer.
  5. Even if you are using a stretch strap, the maximum work should be done by the leg to derive the intended result.
  6. Once the heel is closest to the hip, hold it for a count of 5, and relax by stretching the leg out. Then you can repeat the task by bringing the heel closer to hip, holding it for a count of 5, and then relaxing by stretching the leg out.
  7. Repeat this pattern for 10 – 15 sets of heel slide exercises.

Seated knee flexion:

  1. This exercise helps with increasing the bend of the knee, which is important for establishing the range of motion in the knee after the knee replacement surgery.
  2. You can sit in the chair with legs relaxed and stretched out in front of you and toes pointing straight forward.
  3. To perform this exercise, draw the leg to be exercised back against the floor closer to the chair to the extent possible.
  4. This helps bending the knee and promotes flexion of the knee joint. Once the leg is closest to the edge of the chair, hold it for a count of 5, stretch the leg out and relax.
  5. Then you can repeat the task by bringing the leg closer to edge of chair, holding it for a count of 5, and then stretching the leg out again.
  6. Repeat this pattern for 10 – 15 sets of seated knee flexion exercises.

Short arc quad exercises:

  1. This exercise strengthens quadriceps muscle, the big muscle on the front of the thigh. This muscle helps with straightening the knee from bending position during walking, running, sitting to standing posture, climbing stairs, jumping, and squatting.
  2. You can sit in the bed or on any firm surface, legs stretched out in front of you on the bed, with the knee and toes pointing straight up. Roll up 2 bedsheets into a bundle and place the bundle on the back of the knee. The knee now will be bent across the bundle of bedsheets.
  3. With the back of the knee on the bundle of bedsheets and knee bent over the bedsheet bundle, lift the lower leg up and straighten the knee. Once the knee is straight, hold the limb in the same position for a count of 5 seconds. After 5 seconds, you can bend the knee and relax for 5 seconds.
  4. Then you can repeat the task by lifting the lower leg up, straightening the knee over the bundle of bedsheets, and holding the limb in position for a count of 5 seconds, and then relaxing by bending the knee for 5 seconds.
  5. Repeat this pattern for 10 – 15 sets of short arc quad exercises.

Ankle pump exercises:

  1. In individuals with arthritis of the knee, pain and swelling limit the mobility and range of motion in the joint.
  2. Consequently, blood tends to pool in the deep veins of the limb and increase risk for clot formation. Ankle pump exercises are important to keep the blood moving up along the veins in lower extremities, prevent pooling of blood due to gravity, and thus prevent formation of clots.
  3. You can perform this exercise in either sitting up or laying down in bed. Pump the ankles up and down for 20 times every hour.
  4. Observe compliance with practicing the recommended number of ankle pumps every day to help keep the blood moving.

Straight leg raise exercises:

  1. This exercise strengthens quadriceps muscle, the big muscle on the front of the thigh. This muscle helps with straightening the knee from bending position during walking, running, sitting to standing posture, climbing stairs, jumping, and squatting.
  2. You can lay on your back in the bed or on any firm surface. You can have a pillow or two under the head for your comfort.  Fold the opposite leg to stabilize and support your back, while you work on the leg being exercised.
  3. Keep your knee straight by tightening the quadriceps muscle, the big muscle on the front of the thigh. Raise your leg straight, without any bending of the knee, for up to 10 inches from the surface you are laying on. Hold your leg in the elevated position for a count of 5 seconds and then bring the leg down slowly on to the surface. You can relax the muscle for 5 seconds.
  4. Then you can repeat the task by tightening the quadriceps muscle, lifting the leg up straight without any bending of the knee for up to 10 inches, holding the limb in the raised position for a count of 5 seconds, bringing the leg down slowly on to the surface, and relaxing the muscle for 5 seconds.
  5. Repeat this pattern for 10 – 15 sets of straight leg raise exercises.

Kicking back:

  1. To perform this exercise, you can lie in the bed on the abdomen with legs relaxed and stretched out behind. Draw the leg to be exercised up towards the ceiling to the extent possible.
  2. This exercise helps strengthen the hamstrings muscles on the back of the thigh, which helps with bending the knee and promotes flexion of the knee joint.
  3. Once the leg is drawn closest to the maximum possible, hold it for a count of 5, lower it down and relax.
  4. Repeat this pattern for 10 – 15 sets of kicking back exercises.

Seated knee extension:

  1. This exercise helps with straightening the knee, which is important for establishing the range of motion in the knee after the knee replacement surgery. You can sit in the chair with legs relaxed and stretched out in front of you and toes pointing straight forward.
  2. To perform this exercise, draw a foot stool or an ottoman closer and stretch the lower portion of leg to be exercised onto the foot stool or ottoman with the knee hanging between your chair and foot stool. Make sure the foot stool or ottoman is about the same height as the seat of your chair.
  3. Try reaching out to your toes to the extent possible and stretch the hamstring muscle on the back of your thigh.
  4. This exercise helps with straightening the knee and promotes extension of the knee joint. Once the leg is as straight as it can be, hold the leg in position for a count of 5, and relax by bending the knee.
  5. If you start experiencing some tension in the hamstring muscle any time during the exercise and is hurting, you can release the tension by gently bending the knee.
  6. You can have a 5 pounds cuff weights placed on the knee to help the weight straighten the knee and stretch the hamstring further.
  7. Repeat this pattern for 10 – 15 sets of seated knee extension exercises.

Clamshells exercises:

  1. This exercise helps with strengthening the hip muscles, which is important for weightbearing and balance after surgery.
  2. You can lie on your side with the leg to be exercised up and facing the ceiling. Maintain the legs slightly bent at the knees in front of you and toes pointing straight forward.
  3. Keeping both the heels together, and hips & shoulders tucked in, slowly lift the upper knee and lower it back to the start point to join the other.
  4. This exercise resembles opening and closing of a clamshell.
  5. Repeat this pattern for 10 – 15 sets of clamshell exercises.

Armchair pushup exercises:

  1. After having a knee replacement surgery, individuals will be recommended crutch or walker use. Use of crutch or walker needs upper body strength to offload weight from the bad knee on to the assistive device.
  2. Also, the patients need upper body strength to help themselves get in and out of bed and lifting themselves up from the toilet.
  3. Practicing armchair pushups strengthen your upper body and help prepare yourself for the knee replacement surgery.
  4. Chairs with too low seats can be hard on the knees and aggravate the pain. Make sure the seat of the chair is a little high up, to help an easy lift. The seat of the chair must be at least 2 inches higher than the back of the knee.
  5. You can use some firm blankets to elevate the chair seat to the desired level. To perform this exercise, sit in the chair, slide to edge of the chair, lean forward, and slowly lift your bottom up from the chair by pushing against the armrests.
  6. Upon reaching the maximum lift your arms can push for, slowly return to the seated position using your arms against the armrests as control.
  7. Repeat this pattern for 10 – 15 sets of armchair pushup exercises.

Long arc quad exercises:

  1. This exercise strengthens quadriceps muscle, the big muscle on the front of the thigh. This muscle helps with straightening the knee from bending position during walking, running, sitting to standing posture, climbing stairs, jumping, and squatting.
  2. You can sit on the edge of a bed or on any firm surface, with legs dangling down and the knees bent. In this position, lift the lower leg up and straighten the knee.
  3. Once the knee is straight, hold the limb in the same position for a count of 5 seconds. After 5 seconds, you can bend the knee and relax for 5 seconds.
  4. Then you can repeat the task by lifting the lower leg up, straightening the knee, holding the limb in position for a count of 5 seconds, and then relaxing by bending the knee for 5 seconds.
  5. Repeat this pattern for 10 – 15 sets of long arc quad exercises.

Standing knee flexion:

  1. This exercise helps with increasing the bend of the knee, which is important for establishing the range of motion in the knee.
  2. These exercises are better performed taking the support of some stable surfaces, such as, kitchen countertop or study table.
  3. To perform this exercise, you will stand up on your good leg and draw the surgical leg upward and backward, thus bending it at the knee. This bending of knee promotes flexion of the knee joint.
  4. Once the knee is bent close to the maximum you possibly can, hold it for a count of 5, and relax by bringing the leg back to rest on the ground with some weightbearing.
  5. Then you can repeat the task by drawing the surgical leg upward and backward bending it at the knee, holding it for a count of 5 at the maximum bent, and then relaxing by bringing the leg to rest on the ground.
  6. Repeat this pattern for 10 – 15 sets of standing knee flexion exercises.

Hip abduction and adduction:

  1. This exercise strengthens the bottom or hip muscles after the knee replacement surgery. You can sit in the bed or on any firm surface, legs stretched out together in front of you on the bed, with the knee and toes pointing straight up.
  2. Move your exercising hip away from the other leg, with your knee looking straight up. This movement is called abduction.
  3. After abducting the exercising hip to the farthest you possibly can, bring the hip back to the center and close to the other leg.
  4. This movement bringing the leg back to the center is called adduction.
  5. Repeat this pattern for 10 – 15 sets of abduction and adduction.

Standing single-leg balance exercise:

  1. Do not practice this exercise during the immediate phase after knee replacement surgery. Putting too much weight on the surgical knee immediately after the surgery can lead to damage to the prosthetic.
  2. Practicing this exercise after 4-6 weeks after surgery can help improve balance in the surgical limb.
  3. Seek recommendation from your therapist regarding participating in this exercise. Stand straight with your feet hip-width apart.
  4. Do not lean on to either side and distribute your weight equally on both legs. Place your hands on the hips. Supporting your weight on the surgical limb, lift the other lower limb off the floor by bending it at the knee or reach out with the other lower limb as far as possible by lifting it off the floor.
  5. Hold the position for a duration that your endurance allows. Return to the starting position, by bringing the other lower limb on to the ground and balancing your weight on both legs.
  6. After you become stable and ready, repeat the exercise. Try performing 10 repetitions of the exercise. In the initial post-surgical phase it could be difficult to hold the position longer, balancing the entire weight on the surgical limb.
  7. Try starting off with 5 seconds and work to progressively increase the duration of holding the position for 30 seconds. As the balance in the surgical lower limb progressively improves, you can slowly improve on the duration of holding the position and the number of repetitions.
  8. Have your caregivers or physical therapist available around for needed assistance and to prevent a fall or accident, at least in the immediate post-surgical phase.
  9. Standing close to a solid piece of furniture, such as, a sofa or a table, can also offer extra assistance in fall prevention while performing this exercise.
  10. Do not rely upon your assistive device for support during performance of this exercise, as they could be unstable, offer poor support, and contribute to a fall.

Weight shift exercise:

  1. Do not practice this exercise during the immediate phase after knee replacement surgery. Putting too much weight on the surgical knee immediately after the surgery can lead to damage to the prosthetic.
  2. Practicing this exercise after 4-6 weeks after surgery can help improve balance in the surgical limb.
  3. Seek recommendation from your therapist regarding participating in this exercise. Stand straight with your feet hip-width apart.
  4. Do not lean on to either side and distribute your weight equally on both legs. Lift the other lower limb off the floor and slowly tilt your weight on to the side of surgical limb.
  5. Hold the position for a duration that your endurance allows. Return to the starting position, by bringing the other lower limb on to the ground and balancing your weight on both legs equally.
  6. After you become stable and ready, repeat the exercise. Try performing 10 repetitions of the exercise. In the initial post-surgical phase it could be difficult to hold the position longer, tilting and balancing the entire weight on the surgical limb.
  7. Try starting off with 5 seconds and work to progressively increase the duration of holding the position for 30 seconds. As the balance in the surgical lower limb progressively improves, you can slowly improve on the duration of holding the position and the number of repetitions.
  8. Have your caregivers or physical therapist available around for needed assistance and to prevent a fall or accident, at least in the immediate post-surgical phase.
  9. Standing close to a solid piece of furniture, such as, a sofa or a table, can also offer extra assistance in fall prevention while performing this exercise.
  10. Do not rely upon your assistive device for support during performance of this exercise, as they could be unstable, offer poor support, and contribute to a fall.

Walking:

  1. Walking helps improve weightbearing and promote strength & balance in the surgical joint. Try walking around your house for at least 5 times a day to start off. Do not over do on the exercise and perform the task only as your endurance allows.
  2. Having a companion/caregiver during the walk can help extra assistance and fall prevention. In the initial post-surgical phase it could be difficult to walk longer.
  3. As the strength and balance in the surgical lower limb progressively improve, you can slowly improve on the duration of walk and the number of repetitions to 10 times around the house.
  4. Observe compliance with use of your recommended assistive device during the walk.
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