The best exercises after knee replacement depend on where you are in recovery, how your knee is responding, and what you want to get back to doing.
A good rehabilitation plan is not just a list of exercises. It should help you understand what you are trying to achieve at each stage: knee movement, muscle activation, walking, strength, balance, fitness and confidence.
If your pain, swelling or walking is getting worse, or if you have fever, redness, marked warmth, calf pain or feel unwell, seek medical advice.
What are the best exercises after knee replacement?
In the first 6 weeks, the most important exercises usually focus on bending and straightening the knee, activating the thigh muscles, and developing a normal walking pattern.
From 6 – 12 weeks, rehabilitation often shifts towards walking distance, balance, reducing gait aids and gradually building strength.
After 12 weeks, the best exercises depend more on your goals, such as gardening, golf, longer walks, gym exercise or getting back to enjoyable activities.
The first six weeks
During the first 6 weeks, you are trying to achieve 3 main things:
- Bending and straightening your knee
- Activating your muscles normally
- Developing a normal walking pattern
Swelling and pain make it hard to bend the knee – reducing both is therefore critical to achieving a good bend.
Your hamstring muscles (at the back of your thigh) do the bending.
When you try to bend your knee, feel your hamstrings working with your hand to make sure they are activating.
Watch your quadricep muscles (quads on the front of our thigh) when you are trying to bend your knee – they should be relaxed and not activating. They often do activate after a knee replacemnt as a protective action for the knee.
Focus on correctly activating and relaxing these muscle groups and your knee bend will improve.
A lot of people with knee arthritis develop a limp and this tends to continue after knee replacement.
Aim to develop a normal walking pattern, even with a frame or crutches. My preference is for people to walk normally with a gait aid rather than continuing to limp and protect their knee as this speeds up recovery.
Six to twelve weeks
Pain and swelling should both be settling, knee range of motion and muscle activation improving.
If these are improving, focus can shift to walking – in studies people on average are walking better at 8 weeks than they were before surgery.
This includes:
- reducing the use of your gait aid (or progressing from frame to crutch or stick)
- balance exercises to improve balance
- walking distances – trying to improve the time that you are walking each week
Still in the first 12 weeks and worried pain is holding you back?
Start by checking in with your treating team. If you want to better understand why pain can limit recovery after knee replacement, Free Kneed is a good place to begin.
After twelve weeks
The focus is on walking to improve fitness and turning to focus on your goals – like returning to gardening, golf or exercise.
A training program should include aerobic fitness, strengthening, balance and progressively doing more of the activities you like.
What if recovery is slower than expected?
If you are in the first 12 weeks after surgery and pain is limiting your recovery, speak with your doctor, surgeon or physiotherapist. It is important to make sure there is not a medical or surgical reason your recovery is not progressing.
If serious problems have been excluded, you may also find it helpful to start with Free Kneed, our short educational email series about pain after knee replacement.
If you are more than 12 weeks after surgery and pain is still limiting walking, sleep, stairs or confidence, Kneed may help you understand why pain can persist and how self-management can begin.
