Exercises to Do BEFORE Total Knee Replacement Surgery

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Exercise Program to Prepare for Knee Replacement Surgery

Photo of a physical therapist examining a woman's knee.
Your physical therapist can help you develop an exercise program to prep for your total knee replacement. Banks Photos/Getty Images

If you have knee osteoarthritis, you may benefit from physical therapy to help you improve your knee range of motion (ROM) and strength to maintain your functional mobility.  Sometimes, the arthritis damage to your knee joint is too great, and your doctor may recommend a total knee replacement (TKR) surgery to correct your problems.

If you are scheduled for a total knee replacement surgery, you still may benefit from a course of physical therapy prior to surgery to learn exercises to do.  These exercises are designed to help you maximize your mobility and strength before surgery which can help you have a positive outcome after your knee surgery.

The following step-by-step exercise program is one that your PT may prescribe for patients who are scheduled to undergo a total knee or partial knee replacement surgery.  Remember, exercises that are specific to your condition are best, so it is a good idea to check in with your doctor or physical therapist before starting this, or any other, exercise program.  Your doctor can also check to be sure that exercise is safe for you to do.

The pre-op knee replacement exercise program starts with simple range of motion exercises and progress through specific strengthening exercises to help prepare your muscles and knee for the joint replacement surgery.  You may benefit from physical therapy after your total knee replacement surgery to help you return to optimal function and activities.

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Heel Slides

Performing heel slides is a great way to help you improve your knee flexion ROM when preparing for knee replacement surgery.  The exercise is simple to do, and it can help your knee bend and straighten better.

To perform the heel slide exercise, lie on your back with your leg out in front of you.  Slowly bend your knee and slide your heel up towards your buttocks.  Bend your knee as far as possible and hold it in the fully bent position for a few seconds.

You can add some overpressure to the heel slide exercise by pressing the heel of your opposite foot against the toes of the foot of the knee that is bent.  This exercise is one that can also be done in the immediate post-operative period to help restore normal ROM to your knee.

Perform about 10 to 15 repetitions of the heel slide exercise, and then move on to the next exercise.

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The Prone Hang Exercise to Improve Knee Extension

Use prone hanging to increase knee extension range of motion.
The prone hang exercise is used to improve extension range of motion in your knee. Brett Sears, PT, 2013

When prepping for knee replacement surgery, the prone hang exercise is a simple thing to do to increase knee extension ROM.  To do the exercise, simply lie face down on a bed with your leg hanging over the edge.  Your thigh should be supported, but everything from your kneecap down should be hanging over the edge of the bed.

In the prone hang position, you should feel a slight stretch in the back of your knee or calf.  Remain in the face down position for 30 to 60 seconds, and then relax the stretch by bending your knee.  Repeat the exercise 3 to 5 times.

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Quad Sets

Restoring normal strength to your quadriceps muscles on the top of your thigh is important to regain normal function after your total knee surgery.  Preparing your quads for surgery can help you get back to normal strength quickly after your procedure.  The quad set is a great exercise to practice working your quads.

To perform the exercise, lie on your back with your leg straight out in front of you.  Place a small rolled up towel underneath your knee, and then gently press the back of your knee into the towel.  Your quadriceps muscles should tighten as you do this.

Hold your quad tight for 5 seconds, and then slowly release the tension in your thigh.  Repeat the quad set for 10 - 15 reps, and then move on to the next exercise.

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Short Arc Quad Exercises

The short arc quad exercise is a great exercise to do to strengthen the way your quadriceps muscle works in preparation for your total knee replacement surgery.  To do the exercise, place a basketball, coffee can, or paper towel roll underneath your knee.  Then, straighten your knee out all the way and tighten your quad muscle.

Hold your knee in the straightened position for a few seconds, and then slowly allow it to return to the starting position.  Repeat the exercise for 10 to 15 repetitions.

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Straight Leg Raises

Straight leg raise with an cuff weight around the ankle.
Place a cuff weight around your ankle to add resistance to your straight leg raising exercise. Brett Sears, PT, 2013

Straight leg raises are a great way to strengthen the muscles around your hips and knees in preparation for your knee replacement surgery.  The exercises allow you to contract and work your leg and thigh muscles while placing minimal stress through your knee joint.

You can perform straight leg raises on your back, your side or on your stomach to work your hip and thigh muscles in various directions. Perform 10 to 15 reps of straight leg raises in each position to prepare for your TKR surgery.

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Long Arc Quads

The long arc quad exercise is a great way to work on the active range of motion in your quads and to improve the way your quad works. To do the exercise, simply sit in a chair and straighten your knee as far as possible.  Hold your leg straight for a few seconds and slowly release.  Repeat the exercise 10 to 15 reps.

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Seated Hamstring Exercises

Your hamstring muscles are located in the back of your thigh and they function to bend your knee.  They are active during walking, bending, and climbing stairs.

To improve the strength and function of your hamstrings you can perform the seated hamstring exercise.  To do it, you must obtain an elastic resistance band from your physical therapist.  Attach one end of the band to a door knob, or you can have a friend hold the band.  Loop the other end of the band around your ankle.

Sit in a chair and bend your knee against the resistance of the band.  When your knee is fully bent, hold the position for a few seconds.  You should feel your hamstring behind your thigh contract.  Slowly return to the starting position, and repeat the exercise for 10 to 15 repetitions.

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Advanced Hip Strengthening Exercises

Photo of the ball bridge with knee flexion.
Advanced hip exercises can help you prepare for your total knee replacment surgery. Brett Sears, PT, 2011

Many studies indicate the having good hip strength and control can help with knee pain, since your hips control the position of your knees when walking, biking, or climbing stairs and jumping.

Working to improve your hip strength is a great way to prepare for your total knee replacement surgery.  Advanced hip strengthening exercises such as the ball bridge or the pelvic drop are great ways to improve your hip strength in preparation for your total knee replacement surgery.

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Balance Exercises

Photo of a wobble board.
A wobble board can provide an unsteady surface on which to perform balance exercises. Rollover/Getty Images

Working to improve your balance before your total knee replacement surgery can help you maximize function and mobility after your surgery.  To improve your balance, you can perform the single leg stance exercise, the T-stance, or more advanced balance exercises.

Check in with your PT before performing balance exercises to ensure that you remain safe and you do the exercises correctly.

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Riding a Bicycle

Many people wonder if they will be able to ride a bicycle after their total knee replacement surgery. The answer for many people is yes.  And riding a bike can help keep your knee moving properly before undergoing total knee replacement surgery.  Talk to your doctor or PT to ensure that biking is safe for you to do while awaiting your total knee surgery.

If you are planning on having a total knee replacement surgery, you may benefit from physical therapy to help you prepare for the procedure. The exercises in this step-by-step program may be included in your PT program and can help you maximize your mobility before, and after, your total knee replacement.

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