Smart Exercising After Knee Replacement
Nearly 500,000 knee replacements are performed every year in the United States to treat severe knee osteoarthritis, according to the American Academy of Orthopedic Surgeons. And while you may be anticipating lots of bed rest after this operation, experts say the best way to get back on your feet is to get moving.
“In order to return to regular fitness and walking, exercising must be done during the recovery stages,” says Robert G. Marx, MD, professor of orthopedic surgery and of public health at the Weill Medical College of Cornell University in New York City.
So when should you start? By three months after surgery, a majority of people should be able to resume most of their pre-surgery exercise routine, though individual cases may vary. Check with your doctor first before beginning any activity.
Post-Surgery Exercise Planning
Although you should always follow the course of action outlined by your own treatment team before trying anything new, exercise after knee replacement surgery can generally be divided into the following stages:
- During the hospital stay. Patients may remain in the hospital anywhere from three to seven days, depending on the rate of recovery. Especially for people with osteoarthritis who may not have been working out much before the surgery due to pain, exercising in the hospital is important to increase quadriceps strength. This can begin as soon as the day following surgery.
“Deep breathing exercises, proper elevation and positioning of the involved lower extremity, active assistive knee flexion and extension (using the uninvolved leg to bend or straighten the operated leg), ankle pumps, quadriceps sets (to tighten up the quads), gluteal sets (to tighten up the buttocks), and heel slides are all possibilities,” says Keith Chan, MPT, clinical director of Wall Street Physical Therapy in New York City. “All of the above exercises should be repeated 10 times every waking hour.”
- At home. In general, knee replacement patients can be discharged once they can bend the knee about 90 degrees as well as extend it fully, get in and out of bed on their own, walk with crutches or a walker, and go up and down two or three stairs.
Once at home, a whole new set of exercises will apply. Specific exercises should be prescribed by your doctor and/or physical therapist and followed religiously. “Over time, exercises should focus more on increased weight bearing; correction of abnormal gait; neuromuscular re-education, which includes balance and quick changes in direction; and endurance activities such as a 30- to 60-minute walking program,” says Chan.
After Knee Replacement: Exercise Dos and Don’ts
As far as aerobic exercises go, good choices three to six weeks after surgery include stationary cycling and swimming or another water therapy (once the wound has healed in the case of water activities). Dancing and playing golf (using a cart and wearing shoes without spikes) are two other possibilities. Tennis, contact sports, jogging, squats, skiing, and jumping should all be avoided.
Strength training can also often be started in the three to six week post-operative timeframe. Weight bearing exercises may include partial lunges, leg presses, bilateral heel raises, and wall slides (squatting with the back against the wall). Do not do weight lifting or general lifting of weights or objects over 40 pounds.
Stretching can also be important in recovery. “During the outpatient rehabilitation, a basic flexibility program is introduced, which includes stretches of the muscle groups that cross the knee joint, in particular the hamstrings, gastrocnemius, and quadriceps,” says Chan.
While there is work involved in rehabilitation after knee replacement, ultimately all your efforts will help to determine the success of the surgery in overcoming the effects of your arthritis.
MATT REYNOLDS: Strength training after knee replacement
By MATT REYNOLDS Fitness columnist
After many years of wear and tear from our daily activities and/or our athletic pursuits, we have to pay more attention to our joints. There are some basic procedures we can do to take care of our joints, most notably warming up properly before any intense activity and taking omega-3 and glucosamine supplements.
Although in some cases, either from severe arthritis or a total loss of cartilage or even severe injury, someone may have to decide to have a knee replacement. After the surgery, someone’s quality of life will be dramatically improved, but will ask if they can still be as active as they were and can they continue or even start a strength training program.
The most important step to recovery from a knee replacement surgery is a strength training program, with the approval of your surgeon and doctor. This is the best way to strengthen the muscles around the new knee and speed the healing process after the surgery.
The strength training program will start shortly after surgery and will be classified as physical therapy. This will last for generally 6-8 weeks. A physical therapist should be in charge of the exercise at this stage and will gradually take the patient from little or no strength in the new knee to possibly normal strength by the time the physical therapy is over, assuming the patient exerts the physical and mental effort required. The only activities that will be excluded are those that require high impact and/or agility, such as football, basketball, running and jogging. Biking and swimming are excellent options for aerobic activity.
After someone has been released from their physical therapy, it is important to continue the strength training program. At this stage, the program can start to look very similar to how it looked before the surgery. It is possible for a knee replacement patient to do all of the strength training exercises with free weights and machines, including squats, leg presses, and lunges. The standard set and rep scheme can still apply at two working sets in the 8-12 rep range to begin with.
It is always important to perform all types of strength training exercises utilizing proper biomechanics, in other words proper form and technique. This becomes even more essential for someone with an artificial knee.
Proper biomechanics are essential so that the stresses are distributed appropriately between the various joints and muscles that are involved in each exercise. It is strongly advisable to find a personal trainer who is knowledgeable in biomechanics.
Furthermore, a good personal trainer will chart and evaluate their progress as well as provide encouragement. I have a client, who had her knee replaced in 2004, that has responded very well to the strength and conditioning program. Everyone is different, so each person should listen to how their knee is responding to the exercises and the personal trainer should listen to their client.
Remember that strength training should be a regular part of everyone’s weekly schedule, so your first goal should be to adhere to your program. Start conservatively and set small attainable goals to build up your new knee and your overall body strength to always improve your health.
Matt Reynolds is a certified personal trainer with sixteen years of experience. Matt works in the Humble/Kingwood area and in the central Houston area. He can be reached at [email protected] or at 713-542-3885.
Leg Presses and Squats After a Total Knee Replacement
When reviewing my email first thing in the morning one of the most frequent questions I get from current bodybuilders or weight training enthusiasts like myself is questions regarding using the leg press and /or squatting after knee replacement surgery.
In fact, this is a question I see from older adults as well who are more inclined to use a leg press than squatting weight on their back with a barbell.
Of course in the body of the email is the infamous, ” my surgeon said to either swim or get into a pool to exercise my legs” well if you were like me that didn’t go over too well.
I was not about to give up my entire leg exercise routine and pretend I was 75 years old now and never saw the inside of a gym in my life, just because I had total knee replacement surgery.
But, I also was well aware now that some changes and modifications were in order when it came to weight training and my legs. I was never one in the first place who loaded up 500-600 pounds and did deep squats so, powerlifting was not something I excelled at or would have missed.
I did work on both the leg press and squats with moderate weights however and of course, that’s relative in a sense. After my surgery, though, I didn’t completely give up on either exercise.
Today nearly 19 years after knee replacement surgery, I still use both, though I favor the leg press as I find the leg press is excellent in balancing the weight and taking the strain off other parts of my body.
As you age and wear and tear sets in, it’s a smart move. For you younger lifters that feel the leg press is for sissies, you will also in time make the adjustments I assure you.
I presently use lightweight and work on a HIIT program with it to maximize a pump in the muscles and spur on new strength and growth as well.
You just need to understand after knee surgery that the days of loading up on heavy iron will have to stop but, you still can get in an effective workout without damaging the prosthesis.
I am a big believer in pre-fatiguing the quadriceps group before I get on the leg press for instance.
I may knock out two or three sets of leg extensions for 15-20 repetitions and then immediately go to either the leg press or the smith machine to knock out leg presses or light squats.
Air squats are one of my favorites now as I get a good leg workout along with continued cardiovascular conditioning. Try for instance 10 rounds of air squats for 30 seconds work sets, 15 seconds rest between sets
The weight I tend to use is between 200 and 250 pounds and you can do that for high reps. I will use 135 pounds as well at the end of my workout as fatigue sets in and just knock out high repetitions to get the blood flowing through my quads and hamstrings’ as well.
If you are looking to go heavy as you did before or cannot face the fact you have to use lighter weight, then I recommend you do not have the knee replacement surgery done in the first place. That, however, will also depend on the level of pain you are in and how it has affected your quality of life.
Knock out a set of 20 repetitions with 225 pounds on the leg press then immediately follow that up with 20 bodyweight or air squats, in other words, going as deep as your new knee will allow and tell me if your legs are not on fire after that.
You can use your imagination when it comes to working legs after knee surgery, just use some common sense, you want to be in it for the long haul.
And I realize that there is medical personnel right now that would think this may be a bit extreme, just work within your limits and understand what your boundaries are in the first place, everyone is different and will have different starting weights, etc….
I have been doing this now close to 18 years without incident. By the way, I continue to work my calves and hamstrings no different than I did before surgery with the same amount of weight, etc…
It’s the forces you put through the prosthesis with the heavy pressing movements that can damage and prematurely wear it out.
But for heaven’s sake do not quit working your legs altogether or think you are doomed to a skinny or nonfunctional pair of legs.
Where there is a will there is a way.
If I can be of more help in regards to this subject matter feel free to either email me at [email protected] or, leave a comment below.
Also, please share what you may be doing to increase your leg strength after total knee replacement surgery and share it in the comment section below.
Richard Haynes PTA, CPT
Total Joint Fitness LLC
Richard Haynes is a Physical Therapist Assistant and Personal Trainer for Older Adults Through the American Council on Exercise.
Richard lives and practices in Bradenton, Florida.
Home exercise program
Your leg muscles may feel weak after surgery because you did not use them much with your knee problems. Surgery corrected the knee problem. Your home exercise program will include activities to help reduce swelling and increase your knee motion and strength. This will help you move easier and get back to doing the activities you enjoy.
Your success with rehabilitation largely depends on your commitment to follow the home exercise program on these web pages and as developed by your therapists.
You can track how often you do your exercises on the home exercise program tracking sheet.
It is important to try to keep your swelling down after surgery. You will be able to do this by:
- lying flat with your leg at the level of your heart
- putting a cold pack on your knee
- actively pumping your muscles through ankle pumps
- balancing activity with rest
- Go to activities that will help with swelling.
Range of motion
It is important to work on your knee motion (bending and straightening) after knee replacement surgery. This will help you walk without a limp and get up and down easier from a chair, toilet or bed.
You will be able to do this by:
- doing knee bending and straightening stretches as directed by your therapist
- sitting with your knees bent during meal times
- not resting with your knee bent over a pillow
- Go to activities that will help with range of motion.
It is important to work on regaining strength after knee surgery. This will help you get back to doing the things you enjoy.
You will be able to do this by doing leg strengthening exercises as instructed by your physical therapist.
Go to activities that will help with strengthening.
It is important to walk often throughout the day. This will help you get back to walking outside and in the community.
You will be able to do this by:
- walking around your home using a front-wheel walker, crutches or a cane (assistive walking device) your therapist instructed you to use
- walking with the “heel-toe” pattern that your therapist taught you (to help keep you from walking with a limp)
- gradually increasing the distance you walk
Get additional instructions on how often to walk.
Follow any additional instructions given to you by your healthcare provider or therapist.
Do these activities to help reduce the amount of swelling and improve circulation after surgery.
How often: At least 3 times a day
You will have swelling in your leg and foot after surgery. Your swelling may increase after you leave the hospital. This is common and should gradually go away. It is important to try to keep your swelling down. The activities below will help you with managing swelling and pain.