Knee Replacement: Quadriceps Weakness Slowing You Down?

Nearly 5 million people are living in the United States with a total knee replacement.  This number is rapidly growing.  Knee replacement surgery is helping many people lead active lives for many years.  However, only 1/3 are completely satisfied with their function 1 year after surgery.  Even worse, 30% are dissatisfied because of knee pain, weakness, difficulty climbing stairs, poor balance, and poor walking ability.  Many within the medical community believe a successful outcome is equally due to the surgery itself and from the rehabilitation process.

Physical therapy after knee replacement surgery requires patience and commitment.  There will always be ups and downs.  The recovery process is not linear.  Your physical therapist assesses your progress along the way and determines the best program for you.  Factors that are important include minimizing pain, decreasing swelling, restoring knee range motion, improving strength, and correcting your walking pattern.

Quadriceps Muscle Strength after Knee Replacement

Growing evidence from research studies are showing the importance of restoring quadriceps muscle strength after knee replacement surgery.  A 2009 study from the University of Delaware showed superior outcomes 1 year after surgery in patients who performed progressive quadriceps exercise compared to those who received standard physical therapy.   Other research shows patients who undergo knee replacement surgery move with different strategies when getting out of a chair, climbing stairs, and when walking.  Patients who develop these compensations often develop pain in the other knee, low back pain, or hip pain.

Performing quadriceps exercise before surgery and soon after surgery is important to achieve the best long-term outcome after knee replacement surgery.  Early exercises are performed within the patient’s pain tolerance and should not overstress the knee joint.  Controlling pain and swelling will assist with the return of the quadriceps muscle.  The following 5 exercises are performed within the first few days after surgery and are progressed based on the patient’s ability levels and goals.

Quadriceps Isometric Set

This exercise minimizes quadriceps muscle loss following surgery.   It also helps restore full knee straightening which is important to walk without a limp.  Begin with the knee extended and 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.  This can be performed multiple times per day.

Short-Arc Quadriceps

Lie on your back with a foam roll, pillow, or towel roll under your knee.  Fully extend the knee by kicking the foot up.  Hold this position for 3 to 5 seconds and lower back to the starting position.  Achieving a fully straight knee is very important during this exercise.  Perform 10 to 20 repetitions for 2 to 3 sets each day.  Weights can be added to the ankle as your strength improves.

Terminal Knee Extension in Prone

Lie on your stomach with the ankle bent so you are supported on your toes.  Fully straighten the knee to contract the quadriceps.  Hold this position for 3 to 5 seconds and lower back to the starting position.  Achieving a fully straight knee is very important during this exercise.  Perform 10 to 20 repetitions for 2 to 3 sets each day.  Weights can be added above the thigh as your strength improves.

Terminal Knee Extension with Band

Stand with a resistance band looped around your leg just above the knee.  Begin with the knee slightly bent.  Pull the knee straight by contracting the quadriceps on the front of the thigh.  Hold this position for 3 to 5 seconds then return to the starting position.  Achieving a fully straight knee is very important during this exercise.  Perform 10 to 20 repetitions for 2 to 3 sets each day.

Sit to Stand

Many people struggle with rising from a chair after knee replacement surgery.  The movement is often painful and limited by weakness.  Start with a higher chair or a chair with several pillows stacked on top.  Be sure to distribute weight equally between legs so you don’t develop compensations.  Perform 5 to 10 repetitions several times per day.

Get Started Today

Many people are plagued by persistent pain and limited walking ability long after knee replacement surgery.  However, progressive strengthening exercise targeting the quadriceps is a proven treatment approach.  These 5 exercises are only a small sample of an effective physical therapy program.  Your physical therapist will perform an individual assessment and design an exercise program based on your deficiencies and goals.  Contact us today if you have questions about which exercises are right for you.


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