Physical Therapy before Knee Replacement

In the United States, more than 600,000 people undergo total knee replacement surgery each year. This number is expected to rise to over 1 million by the year 2025.  Success rates for knee replacement surgery are high.  Almost 90% of people report less pain and improved function.  Post surgical rehabilitation is considered an integral part of the recovery process.

Rehabilitation following surgery can make or break your long-term outcome.  With proper physical therapy, you can expect to performmost activities of daily living within 6 weeks.   You can expect to begin driving within 3 to 6 weeks depending on which leg is operated on.  Most people take 6 months to a year to fully recover.   However, new research is suggesting pre surgical rehabilitation can expedite your recovery.

Preoperative Exercise for Knee Replacement

In 2017, researchers in Spain investigated the effects of intensive strength training prior to knee replacement surgery.  One group of patients performed the exercise program and another group did not.   The exercise program was performed 3 days per week for 8 weeks and supervised by a physical therapist.  Outcome following surgery favored the group of patients who performed the exercise program.   Hospital stay was significantly shorter in those who performed preoperative exercise.  Pain levels were less in those who exercised.  Also, these patients recovered greater strength, range of motion, and function 3 months after surgery.

Prior to knee replacement surgery, you should focus on 3 goals.  The first goal is to restore as much knee range of motion as possible.  It is especially important to have a fully straight knee in order to walk with a normal pattern.  The second goal is to maximize strength of the quadriceps muscle.  This muscle is responsible for walking, climbing stairs, and getting up from a chair.  The quadriceps muscle becomes very weak immediately after surgery.  The third goal is to normalize your walking pattern.  The following 5 videos include exercises which physical therapists commonly prescribe prior to knee replacement surgery.

Quadriceps Isometrics

This exercise can minimize quadriceps muscle loss following surgery.   It also helps restore full knee straightening.  Begin with the knee extended with a small towel roll placed under the heel.  Push the back of the knee down towards the floor while simultaneously tightening the front of the thigh.  Hold the contraction for 10 seconds and perform 10 repetitions.

Knee Extension Stretch

This exercise also helps restore full knee straightening which is imperative to walk normally.  Begin with the knee extended with a small towel roll placed under the heel.  Place a long towel, belt, or strap around the foot.  Gently pull the toes towards the shin while maintaining the knee straight.  Hold the stretch for 10 seconds and perform 10 repetitions.

Heel Slides

The heel slide helps restore full knee bending which is important to sit comfortably and climb stairs.  Begin with the knee extended with a long towel, belt, or strap around the foot.  Gently slide the heel towards the hip until a mild stretch is felt in the knee.  Hold the stretch for 10 seconds and perform 10 repetitions.   The more the knee bends prior to surgery, the easier it will be to regain range of motion after surgery.

Sit to Stand

This exercise involves an activity which older adults perform frequently in their daily lives.  The ability to transfer from a chair without the assistance of the hands has been linked to fall risk in older adults.  It can be easily performed in the physical therapy clinic, any community exercise studio, or in the home.  The exercise is progressed by lowering the height of the chair or by holding weighted objects such as a medicine ball or kettle bell.

Single Leg Balance

The ability to balance on one leg is important to walk normally and negotiate a step or curb.  Use the assistance of a chair or a counter if needed.  As you improve, progress away from using assistance.  Aim for at least 10 seconds on each side.

Closing Thoughts

Preoperative physical therapy reduces pain and results in faster recovery of function following total knee replacement surgery.  The preoperative exercise program should be individualized based on your needs and goals.  Meet with your physical therapist to determine which exercises are best for you to perform prior to your surgery.