After many forms of knee surgery, including ACL or meniscus repair, total knee replacement or arthroscopic knee surgery, post-operative exercises are required—some just hours after surgery. There is little time spent convalescing; the goal of surgery is to repair damage and to have you return to a pain-free, mobile lifestyle. Through physical therapy and your prescribed home exercise protocol, exercise will help speed up recovery and lessen post-operative pain.
Edema, or swelling, occurs routinely after surgery, and gravity and position cause the swelling to pool in the lower leg and ankles. When your muscles contract, they apply pressure to the veins in the lower legs to pump blood and lymph fluid out of an area. Ankle pumps are recommended right after surgery. Your physician or nurse will instruct you to start this exercise in the recovery room. Move your foot up and down (like you’re pumping the gas pedal) by contracting the calf and shin muscles for 2 to 3 minutes. You will do ankle pumps during your entire course of physical therapy, until you are fully recovered and all the swelling in your ankle and lower leg is gone.
Heel slides are done to regain knee flexion. After surgery, some muscles are more atrophied than others. Heel slides are done using your own muscle strength and with the assistance of a stretch cord, towel, belt or even a dog leash. Place the foot of the involved leg in the middle of the cord, or in the loop, if there is one, and hold one end of the cord in each hand. Slowly pull the cord while bending your knee until you feel a stretch. Don’t go to the point of pain—take care not to undo any repairs or grafts done in the surgery. Hold for 10 seconds and then release. Repeat 10 times.
The quadriceps muscles are important for strength and the stability of the knee. After surgery, it is important to regain strength and function of your quadriceps so you can return to daily life activities. While seated or lying supine (face up), tighten your quadriceps and try to straighten your knee. Early on, your knee may not straighten all the way, but you should be able to see and/or feel the muscle contract. Hold the contraction for 5 seconds and then relax the muscle completely. Do 3 sets of 10, eventually working up to 5 sets of 10. You will be able to raise your heel off the table when you do a quad set as you get stronger.
Straight Leg Raise
The quadriceps muscle crosses both the knee and hip joint. Doing a straight leg raise targets the entire muscle because of the knee extension and hip flexion. Lie on your back with your involved leg extended. Keep the other leg bent, with you foot flat on the floor. Start by flexing the foot of your involved leg and performing a quad set to straighten the knee, and then slowly lift your leg about 6 inches off the floor. Lift for 4 counts and lower the leg for 4 counts. About 3 to 4 days after surgery, perform 3 sets of 6 to 10 repetitions. As your strength increases, perform more reps or, if your physician or physical therapist recommends it, use an ankle weight.