Total Knee Replacement Exercise Booklet - Thunder Bay Regional ...

Total Knee Replacement
Exercise Book
Patient’s Name: ___________________________________________
Surgeon’s Name: ___________________________________________
Date of Surgery: ___________________________________________
Physiotherapist’s Name: ___________________________________________

Immediate Postoperative Exercises
You may begin the following exercises immediately aer your surgery, as they are important for:
• Helping to prevent complications with your breathing.
• Helping to prevent blood clots in your legs.
• Increasing your circulation.
1. Deep Breathing and Coughing Exercises
Until you are up and moving well take at least 10 deep breaths, followed by a cough, every hour that you are awake.
2. Ankle Pumping
Move your feet up, down and in circles.
Repeat 50 times every hour that you are awake.
3. Buock Contractions
Tighten your buock muscle and hold for a count of 5 seconds.
Repeat five to ten times, three to four times each day.
4. Static Quadriceps Strengthening
Tighten the muscle on the front of your operated thigh
by pressing your operated knee into the bed.
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Learning to Move
Aer surgery, plan ahead. Take pain medication ahead of time.
Exercise is a critical component of your recovery, particularly during the first few weeks aer surgery. These exercises and
walking will help to restore movement and strengthen your knee. The goal is for you to be able to resume activities.
Weight Bearing:
Weight bearing is the amount of weight that the doctor wants you to put on your new knee. There are three different
amounts. Usually your doctor will want you to fully weight bear.
• Feather or touch weight- Your operated leg touches the floor enough to help you balance. Do not put any weight on it.
• Partial weight bearing- Only a certain amount of weight can be put on your operated leg. Your physiotherapist will help
you learn how much.
• Full weight bearing- You can put full weight, or as much as you can tolerate when standing or walking.
Using a Walker or Crutches:
Stand up tall and look ahead while you walk.
1. Move the walker or crutches forward first, followed by your operated leg. Then
move your unaffected leg forward.
2. Put your weight on the walker or crutches to take the weight off your operated leg
when you step onto it. Follow your own weight bearing instructions when using a
walker or crutches.
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How to Manage Stairs
While you are in hospital, your physiotherapist will teach you how to climb stairs.
1. A handrail will make things easier and safer for you. Simply place one hand on the railing, and hold both crutches
on the other side of your body.
2. If no handrail is available, use one crutch on each side of your body. Follow the same sequence as above.
3. As your knee range of motion and strength improves you will eventually be able to resume “normal” stair climbing
To go up the stairs:
• Keep the cane/crutches with the operated leg.
• Start close to the boom step, and push down through your hands.
• Step up to first step, the non-operated leg goes up first.
• Step up to the same step with the operated leg and crutches, puing only
the advised amount of weight through your operated leg.
To go down stairs:
• Start at the edge of the step.
• Bring the cane/crutches and your operated leg down to the next step.
• Use upper body strength to support your weight and keep your balance.
• Step down to the same step with the non-operated leg, puing only the
advised amount of weight through your operated leg.
Check your balance each time before proceeding to the next step.
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Beginner Exercises
These exercises begin during your hospital stay and continue on aer discharge.
1. Static Quadriceps Strengthening:
• Pull your foot towards your nose.
Repeat sets of each exercise 2 to 3 times a day.
• Tighten the muscle on the front of your operated thigh by
pressing your operated knee into the bed.
• Hold _____ seconds.
• Repeat _____ times.
2. Static Gluteal/Hamstring Strengthening:
Total Knee Replacement: Exercise Booklet
• Press the heel of your operated leg into the bed.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
Repeat sets of each exercise 2 to 3 times a day.
3. Static Hamstring Strengthening:
• Sit as shown with the operated knee slightly bent.
• Tighten the muscle on the back of the thigh by pressing
the heel of the operated leg into the bed.
• Hold _____ seconds.
• Repeat _____ times.
4. Knee Bend with a Towel:
• Lying as shown put a towel or sheet under your operated knee.
• Pull on the towel to bend your operated knee.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
5. Knee Bend (progression):
Repeat sets of each exercise 2 to 3 times a day.
• Bend your operated knee by sliding your heel towards your buocks.
• Hold _____ seconds.
• Repeat _____ times.
6. Straight Leg Raise:
• Pull your foot towards your nose.
• Tighten the muscles on the front of your operated thigh by pressing your
operated knee into the bed. Keep your knee as straight as possible and
raise your leg about 6 inches off the bed.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
Repeat sets of each exercise 2 to 3 times a day.
7. Quadriceps Strengthening Over a Roll
• Place a roll under your operated knee.
• Raise your heel off of the bed.
• Straighten your knee as much as possible.
• Ensure you keep the back of your knee on the roll.
• Hold _____ seconds.
• Repeat _____ times.
8. Extension Stretch:
• Place the heel of your operated leg on a small roll.
• Press your operated knee down toward the bed using your
front thigh muscles.
• Place your hands above the knee (as shown) and press down
to help maximize the hamstring stretch behind your knee.
• Do not bounce with your hand, rather hold the stretch.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
Repeat sets of each exercise 2 to 3 times a day.
9. Knee Bend:
• Lying as shown, bend your operated leg as far as possible.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
Repeat sets of each exercise 2 to 3 times a day.
These 3 different exercises can be used to improve your knee bend.
10 a) Siing on the bed or chair, slide your heel under the seat to bend your operated knee as much as possible.
• Hold _____ seconds. Repeat _____ times.
10 b) Cross the non-operated ankle over the operated ankle, and use it to help bend the operated knee.
• Hold _____ seconds. Repeat _____ times.
10 c) With your operated knee bent and your foot planted on the floor, slide your buocks forward in the
chair to help bend your knee and feel a stretch.
• Hold _____ seconds. Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
11. Siing Knee Extension
Repeat sets of each exercise 2 to 3 times a day.
• Siing on a chair, tighten the muscles on the front of your thigh (quadriceps) to
straighten your operated knee. Lower your leg
slowly and controlled.
• Hold _____ seconds.
• Repeat _____ times.
12. Siing Knee Straightening
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• Stretch your operated leg out with the heel on the floor. Push with your hands
above the knee to straighten your knee as much as possible.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
Repeat sets of each exercise 2 to 3 times a day.
13. Standing Hamstring Curl
• Holding on to a support, bring the heel of the operated leg towards your buock.
• Remain standing up tall.
• Hold _____ seconds.
• Repeat _____ times.
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Beginner Exercises Continued
These exercises begin during your hospital stay and continue on aer discharge.
14. Chair Rise:
• Find a chair with armrests. You should be seated
at a comfortable height with your feet resting on
the floor.
• Sit at the edge of the chair, gradually standup to
a count of 5 seconds, using your legs as much as
possible.
• You may require assistance from the armrests to
begin with. Gradually lower yourself back into
the chair, using your legs as much as possible.
• Repeat _____ times.
Repeat sets of each exercise 2 to 3 times a day.
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Exercises with a Physiotherapist
Your physiotherapist may decide to do these 2 exercises with you to help increase your range of motion
Repeat sets of each exercise 2 to 3 times a day.
15 Physio Assisted Knee Extension Stretch:
• The physiotherapist will stretch your operated knee to help
straighten it further.
16. Physio Assisted Knee Bending:
• The physiotherapist will stretch your operated knee to help you bend it further.
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More Challenging Exercises
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
17. Knee Bend with Leg Press:
a) Place a sheet around the foot of your operated leg.
• Use it to help bend the operated knee up as shown.
• Hold_____seconds.
• Repeat_____times.
b) Start with you knee bent as in 17a.
Repeat sets of each exercise 2 to 3 times a day.
• Slowly straighten your operated leg against the resistance of the sheet.
• Keep your heel on the bed.
• Repeat_____times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
18. Hamstring Strengthening with Theraband:
• Siing in a chair place a _________ coloured Theraband around
the ankle of your operated leg.
• Slide your foot under the chair as far back as you can against the
resistance of the Theraband.
• Slowly allow your leg to return to the starting position.
• Hold _____ seconds.
• Repeat _____ times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
19. Forward Knee Lunge:
• Place the foot of your operated leg on a step.
Repeat sets of each exercise 2 to 3 times a day.
• Lunge forward to bend the operated knee so that you feel a stretch.
• Hold on to support if needed.
• Hold_____seconds.
• Repeat_____times.
20. Calf Stretch:
• Holding onto support, place the operated leg back.
• Keep your operated leg straight and the heel
on the ground.
• Be sure to keep your chest up tall.
Feel a stretch in the calf.
• Hold_____seconds.
• Repeat_____times.
Helpful Tip:
You can begin on a
lower step and progress
as able to a higher step.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
21. Single Leg Balance
• Aempt to balance on your operated leg. Begin by using a support.
Progression exercises:
1. Increase the amount of time you are balancing while using support.
e.g. aim to balance for 20- 30 seconds.
2. Carefully try to balance without the use of a support.
3. Gradually increase the amount of time on one leg while NOT using support.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
22. Step Exercise:
Repeat sets of each exercise 2 to 3 times a day.
This exercise is used to strengthen your operated leg so that
in time you will be able to do stairs “normally” (e.g. one leg
aer the other).
• Step up onto a _____ inch step with your operated leg.
• Step back down to the floor with your non-operated leg.
Use support as needed.
• Keep your body up tall and do NOT lean your chest
forward.
• Repeat _____ times.
Total Knee Replacement: Exercise Booklet
• Helpful Tip: Start with a lower step, and increase the step height as able.
e.g. Begin with a 2-4 inch step. Progress to a 6 inch step, and then to a standard step height of 7-8 inches.
• Remember: This exercise is done the opposite way you were taught to do stairs. In the “how to manage stairs” section,
we instructed you to use your non-operated leg to lead up the stairs and your operated leg to go down the stairs.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
23. Lateral Step Up:
• Stand facing sideways with your operated foot on the step.
• Hold on to support as needed. Step up by straightening the operated knee.
• Repeat _____ times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
24. Quarter Squat with a Pillow:
Repeat sets of each exercise 2 to 3 times a day.
• Place your feet shoulder width apart, about 6-12 inches from the wall.
• Keep your toes pointing straight ahead and your back and shoulders against the wall.
• Lower yourself about one quarter to one third of the way down the wall while squeezing a pillow folded in half between
your knees.
• Hold_____seconds.
• Repeat_____times.
25. Quarter Squat (progression):
• Place your feet shoulder width apart, about
6- 12 inches from the wall.
• Keep your toes pointing straight ahead and your
back and shoulders against the wall.
• With the weight back on your heels, slowly bend
your knees. Lower yourself about one quarter to one
third of the way down the wall. Ensure you
slide straight—do NOT lean to one side.
• Hold_____seconds.
• Repeat_____times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
26. Quadriceps Strengthening with a Theraband:
• Loop a Theraband around your operated leg at the level of your knee.
• Straighten your knee against the resistance of the Theraband (as shown).
• Remember to isolate the movement to your knee only.
(i.e. your trunk should not be shiing).
• Hold_____seconds.
• Repeat_____times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
27. Weighted Knee Extension in Siing
• Siing as shown, place a ____ weight in a bag and tie it around
your operated leg above the kneecap.
• Ensure the weight is NOT directly on your knee.
• Allow your knee to sink towards the floor.
• You should feel a stretch behind your knee.
• Hold_____seconds.
• Repeat_____times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
28. Chair Progression:
• As the strength in your thigh muscles improves you will gradually
be able to stand and sit without using the armrests.
• Repeat_____times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
29. Balance Exercise:
Repeat sets of each exercise 2 to 3 times a day.
• Practice your ability to balance on your operated leg, using a wobble board if one is available.
• If you do not have access to a wobble board you may aempt this exercise using a pillow instead.
• Begin by holding on to a support. Gradually try to discontinue the use of a support and increase
the amount of time you are able to balance on your operated leg
• Hold _____ seconds.
• Repeat _____ times.
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More Challenging Exercises Continued
When the beginner exercises become relatively easy you may start to progress to these more challenging
exercises as tolerated.
Repeat sets of each exercise 2 to 3 times a day.
30. Stationary Cycling:
• To start, adjust the height of the seat so that it is as high as possible when cycling.
You should still be able to pedal safely. As your knee gets stronger you may gradually
increase the resistance up to a moderate level and gradually increase the speed of cycling
to make the exercise more challenging. Cycling can help you to improve range of motion,
strength and overall fitness level.
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Resuming an Active Lifestyle
Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance aer you leave
hospital. Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and
slippery.
At 6 Weeks At 12 Weeks Not Recommended Never
Driving Bowling Downhill skiing Singles tennis
Stationary bicycling
Outdoor cycling
(not mountain biking)
Cross country skiing
(skate style)
Jogging/running
Swimming Tennis (doubles) Ice and inline skating Squash/ racquetball
Golf
( start at driving range)
Gardening
(use a pad under knee)
Golf
(on the course- suggest golf cart)
Cross country skiing
(classic only)
Mountain biking
Sailing
Kayaking
Basketball
High impact aerobics
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Canoeing
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We hope this booklet has helped to give you the information you need on
the exercises you will be doing aer your total knee replacement.
The information comes from the knowledge and experience of your
health professionals.
Special acknowledgment to Sunnybrook Holland Orthopaedic and
Arthritic Centre for sharing their exercise booklets.
Thunder Bay Regional Health Sciences Centre
Total Joint Clinical Pathway Team
No part of this publication may be reproduced or transmied by any
means, including photocopying and recording, or stored in a retrieval
system of any nature without the wrien permission of the
Thunder Bay Health Sciences Centre:
980 Oliver Road, Thunder Bay Ontario, P7B 6V4, (807) 684-6000
CS-PTED-SURG-80-A
Total Knee Replacement - Exercise Booklet
copyright© 2007 Thunder Bay Regional Health Sciences Centre
All rights reserved by Thunder Bay Regional Health Sciences Centre with
permission from Sunnybrook Health Sciences Centre.
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