Following a home exercise routine is an important and integral step in recovering from a total knee replacement. A program of carefully chosen exercises helps the patient to increase flexibility and muscle strength, restore proper mobility, and improve gait pattern. Under the guidance of an orthopedic surgeon or a physical therapist, an exercise program can help to hasten recovery time and return the patient to daily activities with increased mobility.
Strengthening
Strengthening exercises are included as part of a rehabilitation program in order to increase lower extremity strength and prevent further muscle atrophy (loss of muscle mass) that is often seen following surgery. Strengthening the muscles allows the total knee replacement patient to develop and maintain strength that assists with walking, toileting, housework, and other daily activities.
The quad set is often one of the most used exercises following a total knee replacement. This exercise assists with initialing a quadriceps contraction, while limiting movement of the knee joint. This exercise is also useful to promote knee extension. This exercise is performed by pushing the back of the knee into the bed and holding the contraction for five to 10 seconds. This should be repeated for three sets of 10.
A second exercise that is often used to strengthen the leg is straight leg raises. This exercise is also important for increasing strength to the quadriceps, as well as the hip flexors. This exercise can be performed by lying flat on a bed, with the uninvolved leg bent and the involved leg straight. Lift the involved leg to the height of the other knee, keeping the leg as straight as possible, and slowly lower. Repeat for three sets of 10 repetitions.
Range of Motion
Following a knee replacement surgery, the knee joint is stiff, and the range of motion is greatly decreased. Restoring range of motion early in the rehab process is important to allow the patient to have greater overall mobility as well as a normalized gait pattern. Range of motion exercises help to increase the amount that the knee bends and straightens.
Heel slides are performed by lying on a bed and sliding the heel of the involved leg until a mild stretch is felt through the knee. Hold this position for 10 seconds, and return to start position. Repeat 10 times.
Prone knee extension is performed to encourage full knee extension. This exercise is performed by lying on the stomach with the legs off the side of the bed (edge of bed should be above the knee joint). Gravity assists with straightening the leg in this position. The patient remains in this position for two minutes, gradually increasing time as tolerance increases.
Flexibility
Flexibility, or normal muscle length, is also important to restoring full motion to the knee and improving gait pattern. This can be achieved through simple exercises such as a hamstring stretch and calve stretch.
A hamstring stretch can be performed by lying flat on the back and lifting the involved leg until a mild stretch is felt down the back of the thigh. Hands can be placed around the back of the knee, or a strap can be placed over the instep of the foot to assist with this stretch.
The calves can be stretched with the patient sitting with legs straight on the bed with strap placed over the instep of the involved leg. The patient then pulls the toes toward the head to feel a mild stretch down the back of the lower leg.
Stretches should be held for a minimum of 20 seconds and repeated two to three times each.
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