Total Knee Replacement Exercise Booklet

7/30/2019 Total Knee Replacement Exercise Booklet

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Total Knee Replacement

Exercise BookPatients Name: ___________________________________________

Surgeons Name: ___________________________________________

Date of Surgery: ___________________________________________

Physiotherapists Name: ___________________________________________


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T H U N D E R B A Y R E G I O N A L H E A L T H S C I E N C E S C E N T R E2

Immediate Postoperative ExercisesYou 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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3T O TA L K N E E R E P L A C E M E N T E x e r c i s e B o o k l e t w w w . t b r h s c . n e t

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Learning to MoveAer 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 awalker or crutches.


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How to Manage StairsWhile 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 onlythe 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 ExercisesThese exercises begin during your hospital stay and continue on aer discharge.

Repeat sets of each exercise 2 to 3 times a day.

1. Static Quadriceps Strengthening:

Pull your foot towards your nose.

Tighten the muscle on the front of your operated thigh bypressing your operated knee into the bed.

Hold _____ seconds.

Repeat _____ times.

2. Static Gluteal/Hamstring Strengthening:

Press the heel of your operated leg into the bed.

Hold _____ seconds.

Repeat _____ times.


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Beginner Exercises ContinuedThese exercises begin during your hospital stay and continue on aer discharge.


3. Static Hamstring Strengthening:

Sit as shown with the operated knee slightly bent.

Tighten the muscle on the back of the thigh by pressingthe 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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5. Knee Bend (progression):

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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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 yourfront thigh muscles.

Place your hands above the knee (as shown) and press downto 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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9. Knee Bend:

Lying as shown, bend your operated leg as far as possible.

Hold _____ seconds.

Repeat _____ times.


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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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11. Siing Knee Extension

Siing on a chair, tighten the muscles on the front of your thigh (quadriceps) tostraighten your operated knee. Lower your leg

slowly and controlled.

Hold _____ seconds.

Repeat _____ times.

12. Siing Knee Straightening

Stretch your operated leg out with the heel on the floor. Push with your handsabove the knee to straighten your knee as much as possible.

Hold _____ seconds.

Repeat _____ times.


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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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14. Chair Rise:

Find a chair with armrests. You should be seatedat 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 aspossible.

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.


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Exercises with a PhysiotherapistYour physiotherapist may decide to do these 2 exercises with you to help increase your range of motion


15 Physio Assisted Knee Extension Stretch:

The physiotherapist will stretch your operated knee to helpstraighten 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 ExercisesWhen 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.

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 ContinuedWhen the beginner exercises become relatively easy you may start to progress to these more challenging



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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19. Forward Knee Lunge:

Place the foot of your operated leg on a step.

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 heelon 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 alower step and progress

as able to a higher step.


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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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22. Step Exercise:

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.

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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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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24. Quarter Squat with a Pillow:

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 bendyour knees. Lower yourself about one quarter to one

third of the way down the wall. Ensure you

slide straightdo NOT lean to one side.

Hold_____seconds.

Repeat_____times.


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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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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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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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29. Balance Exercise:

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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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 LifestyleWalking 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 andslippery.

At 6 Weeks At 12 Weeks Not Recommended Never

Driving Bowling Downhill skiing Singles tennis

Stationary bicyclingOutdoor 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)

Golf(on the course- suggest golf cart)

Mountain biking Basketball

Gardening(use a pad under knee)

Cross country skiing(classic only)

Sailing High impact aerobics

Kayaking

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 CentreTotal Joint Clinical Pathway Team

No part of this publication may be reproduced or transmied by anymeans, 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 withpermission from Sunnybrook Health Sciences Centre.

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Total Knee Replacement Exercise Booklet