Overview
After hip or knee replacement surgery, the primary goal during the first two weeks is to allow your body to heal while regaining your range of motion. It’s essential to keep your activity level low during this period, focusing on reducing swelling and giving your body the time it needs to recover.
Activity After Knee Replacement
First Two Weeks: Low Activity Focus
For many patients, formal physical therapy is not necessary in the recovery phase. This is especially true in the first two weeks after surgery. Instead, a simple, consistent routine of light activities at home is recommended:
- Walking: Take a short walk to a different room in your house and back once every hour. This light activity helps maintain circulation without overloading your healing knee.
- Knee Extension Stretching: After each walk, spend 3-5 minutes stretching your knee into full extension. This helps prevent stiffness and improves your range of motion.
- Knee Flexion Stretching: Follow the extension stretching with 3-5 minutes of knee flexion stretches, gradually bending your knee as much as is comfortable.
- Leg Elevation: After your stretching routine, elevate your leg for 20-30 minutes every hour. Elevation helps reduce swelling and discomfort, the foot should be raised above your shoulder for best effect. You may apply ice as needed. When at rest you may perform your ISOMETRIC exercises.
How to Perform Isometric Exercises
Isometric exercises are a type of exercise where you contract your muscles without moving the joints. Here’s how to do them step by step:
- Toe Extension & Ankle Dorsiflexion:
- Keep your legs straight, and point your toes up toward your shins, trying to bring your foot closer to your leg.
- Hold this position for 5-10 seconds, then relax. Repeat 5 times.
- Hamstring Flexion:
- Bend your knee slightly while keeping your heel on the ground.
- Try to pull your heel back toward your butt without actually moving it.
- Tighten the muscles at the back of your thigh (hamstrings) and hold for 5-10 seconds, then relax. Repeat 5 times
- Combined Ankle Pump & Quadriceps Contraction::
- Sit or lie down with your legs straight.
- Straighten your leg fully and point your toes down like you’re pressing a gas pedal.
- Tighten the muscles at the front of your thigh (quadriceps) and back of your lower leg (calves).
- It should feel as though you are pushing the back of your knee down into the floor or bed.
- Tighten the muscles in your calf and hold for 5-10 seconds, then relax. Repeat 5 times
These exercises can help strengthen your muscles without putting too much stress on your joints. Remember to breathe normally and relax between each exercise.
Leg Elevation: After your walking and when at rest, elevate your leg as you are able. Elevation helps reduce swelling and discomfort, the foot should be raised above your shoulder for best effect. You may apply ice as needed.
During the first 2 weeks, you will likely use a walker to assist with mobility. As you feel more stable and confident, you can transition to using a cane and eventually move to walking without any assistance.
The following video reviews exercises you can be working on at home after surgery. The last two exercises, the “heel prop” and the “tail hook”, should be performed every hour when you are awake for the first two weeks. The other exercises can be performed 2 times per day (morning & afternoon).
After your 2 week appointment you can increase your exercising as tolerated.
Dr. Montgomery recommends you do not do your exercises right before bed as they may cause discomfort and sleep disturbance.
By focusing on gentle movements, stretching, and elevation, you can support your body’s healing process. Remember, your recovery is unique, most activity is limited by swelling and most swelling is made worse with forceful activity. A smooth and steady recovery will win in the end. Physical therapy may be prescribed at any time if you feel you are not able to complete exercises on your own. If you are requiring pain medication to complete physical therapy you are pushing too hard.
After your 6 week visit
After the 6 week visit you should typically be cleared for activity as tolerated and encouraged to discontinue canes and walkers if you have not already done so. That does not mean you will be fully recovered! There is still work to do but strengthening takes time and this increases as we age. Please review the following video for exercises you can do to build your strength back into your operative leg.
Remember, the surgery is only a small part in the healing process and your recovery depends on your active participation. Stay consistent and be happy with steady progress big or small, everyone has a different experience.
Our goals:
2 weeks:
- minimum range of motion from almost fully straight to 90 degrees
- no longer taking, or using very little narcotic pain medicine
- transitioning to a cane or no assistive device
- You may return to driving if you have met these criteria
6 weeks:
- Range of motion from fully straight to 110 degrees
- No longer taking pain medicines (other than tylenol and anti-inflammatories)
- No longer using assistive devices
- You may return to all activity as tolerated if you have met these criteria
If you are not reaching your goals we will discuss options and schedule a 12 week follow up.
Activity after knee replacement surgery
The American Association of Hip and Knee Surgeons website is an excellent resource for additional information and can be found here:
