Training for Knee Replacement Surgery

By Dirk Smith, MSc, SDL (He/Him). 

I received a message from somebody who asked, “Coach Dirk, what can I do to strengthen my legs in preparation for knee replacement surgery?” The first step of course, is receiving clearance from your doctor to begin an exercise program. While major lifting exercises might not be the best option in this circumstance, there are many exercises you can do to help you strengthen your legs and knees to improve functionality in preparation for surgery and recovery following surgery. 
 
These exercises are beneficial for post-surgery recovery per your doctor’s recommendations, they are also important to prepare for the surgery so as to help you improve your recovery from surgery and better prepare you for the surgery by increasing blood circulation, increase strength and muscle density and help you maintain mobility. 

Make sure you follow all your doctors’ recommendations in terms of permitted range of motion and load limits on the legs. For each exercise, we will be training for endurance which means light weight and high repetitions. Perform each exercise for 2-4 sets of 15-20 repetitions and select a weight that you can lift up to 20 reps by the last round with challenge but without breaking form. Remember to listen to your body and know the difference between the pain of burning muscles and pain that would be a signal to stop. If you feel any kind of uncomfortable pain, stop the exercise and consult with your doctor. 

​Mobility

• Leg Extensions- Sitting in a chair, sit upright with your back supporter, your hips and knees resting at 90 degrees. Lift your feet off the ground to extend the knees while squeezing the quadriceps muscle tight. Relax and lower the legs back to the starting position. 

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• Ankle Pumps- Starting in the same position as the Leg Extensions, extend the legs again, but this time hold them out. With one foot, push your toes out like you’re point your foot. At the same time with the other foot, pull the toes in toward the knee. Alternate this Push/Pull with each foot on a rhythm while squeezing the muscles of the calf tight on each contraction. 

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• Straight Leg Raise Supine & Prone- Laying flat on your back with one extended and the other foot flat on the ground., Flex your ankle to 90 degrees and lift the leg up from the hip and return to the starting position. After finished with both legs, flip over onto your stomach and point your toes. Lift your leg from your butt off the ground again and return to the starting position.

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Stability

• Standing Knee Bends w/ Support- Using the assistance of a rail, walker or crutches. Stand upright, lift one foot off the round and bend the knee as much as you are able, bring your foot toward the butt while balancing on the other foot. Hold for a few seconds before returning to the starting position. 

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Strength

• Leg Extensions with Weight- Using a leg extension weight machine (can be found at most gyms) adjust the machine appropriately so the pad is resting on the front of your ankles and the ankle is within a comfortable parameter. Select an appropriate weight and proceed with the exercise as described in the Mobility version. Make sure to select a weight that allows you to complete the last rep with challenge while maintaining proper form. 

• Lying Hip Abduction- Laying on your side, with one leg resting on the other and fully extended. Lift one leg up like a pair of scissors, taking care to keep your toes pointed directly at the wall in front of you. Slowly return to starting position. For an extra challenge, put a resistance band around your legs just above your knees.

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Conditioning

• Cycling- Using a stationary or recumbent bike, set the bike to have a proper fit, keeping the knees slightly bent at the furthest pedal position while not allowing the knee to come to close in the closest pedal position. Start with a light resistance and adjust as necessary. Ride for at least 15 minutes, but 30-45 minutes is ideal.
• Walking- Find a level, scenic route with minimal obstacles that you can walk as suitable to your conditioning level. Minimize any kind of large steps or high impact movements and try to get at least 15-30 minutes of walking in per day. 

I did not include any flexibility exercises due to restrictions of knee range of motion and other factors that influence the need for knee replacement surgery. Stretching and flexibility exercises should be consulted with your doctor and qualified physical therapist based on their recommendations for your specific circumstance, After your surgery, be sure to consult with your doctor and physical therapist on your limitations and schedule for return to exercise. Recovery is a slow process, so be patient and stay focused on the improvements you make every day. 
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By Dirk Smith