A Patient's Guide to Total Knee Replacement Exercise Pack

No matter what your age or health condition you can have the ability to build & maintain strength.

A strength exercise is any activity that makes your muscles work harder than usual. These activities involve using your body weight or working against a resistance.

Cardiovascular activity, sometimes called aerobic activity, increases breathing rate and makes the heart and muscles work harder.

You will need to be moving quick enough to raise your heart rate, breathe faster and feel warmer. This level of effort is called moderate intensity activity.

You will need to be moving quick enough to raise your heart rate, breathe faster and feel warmer. This level of effort is called moderate intensity activity.

Pain following knee surgery is very common and can be managed by a variety of ways including pain relief, ice, rest and exercises. If you are unable to complete your rehab exercise or complete your daily activities due to high levels of pain you may want to consider liaising with your GP to discuss possible adjustments to your pain medication.

  Static Quad
• Lie on your back with your operated leg straight.
• Press the back of your knee down into the bed and hold for 5 seconds.
• To make this harder place a rolled up towel under your heel.

  Hanging knee extension
• Sit on a chair with your operated leg out on a stool.
• Let the knee relax then push the knee down and hold for 5 seconds.

   Prone extension
• Lying face down with your feet of the edge of the bed.
• Allow gravity to straighten your knee and hold for 5 seconds.

Standing Knee extension with band
• Stand in front of a table with exercise band attached to the table as shown.
• Bend your operated knee slightly and then slowly straight the knee against the resistance band. Hold for 5 seconds.
• Please ask therapist if you require an exercise band.

  Standing knee extension with ball
• Stand against a wall with a ball between the back of your operated knee and the wall.
• Gently press the ball with your knee and hold for 5 seconds.
• Try not to allow the ball to drop.
• If you do not have a ball try a rolled up towel instead.

  Seated Flexion
• Sit upright on chair.
• Slide your foot backwards on the floor and bend your operated leg as much as possible.

   Prone Hamstring Curl
• Start my lying on your front.
• Bend your operated knee to your bottom.
• To make this exercise harder use a therapy band.

  Standing Knee Flexion
• Stand behind a chair or table.
• Bend your operated knee bringing your heel to your bottom. Hold for 5 seconds.

  Bridge
• Lie on your back, with your knees bent. Lift your bottom off the bend and hold for 5 seconds.

Sit to Stand
• Sit towards the edge of the seat.
• Bend your knees, squeeze through your bottom, to drive you up to standing.
• Try and keep your knees aligned over your big toe as you stand up.

Offset Sit to Stand
• Place your affected leg* further back.
• Squeeze your bottom as you bend your knees in order to stand up.
• Try not to use any upper limb support.
• *This will bias your affected/operated leg when standing up.

 Mini squat/Air squat
• Stand tall with feet hip width apart.
• Squat down by sitting your bottom back and bending your knees.
• Return to the starting position.

 Offset squat
 • Stand tall holding onto counter.
• Step non operated leg back.
• Squat down with your feet offset bending at your knees.
• Return to stand.
• Repeat slowly and with control.
 (Keep weight through the heel of the operated leg)

    Static Lunge
• Take one long step forward and bend both knees, lowering yourself towards the floor.
• The front heel stays on the floor and the back heel can lift off the floor.
• Only bend as far as you can, to stand up push through your front heel to straighten the front knee.
Note:
 Aim to keep the knee in line with your big toe.

 Single leg squat
• Stand on your affected leg – take upper limb support if needed. • Slowly bend the knee.
• Slowly straighten the knee again

Deadlift
• Stand in the middle of band with both feet and hold on to the end of the band.
• Squat down and then return to an upright position against the tension of the band while extending your hips.

 Double leg heel raise
 • Stand in front of the bar/chair and hold gently to balance yourself.
• Lift both heels up for the count of 3s, Hold for 3s and then slowly lower yourself.

 Double leg heel raise on step
 • Stand with heels over the edge of a step, holding gently onto a wall/railing to steady yourself.
• Lift both heels up for the count of 3s, Hold for 3s and then slowly lower yourself.

 Single Leg Heel raise
 • Stand in front of the bar/chair and hold gently to balance yourself. Stand on to your operated leg, Lift heel up for the count of 3s, hold for 3s and then slowly lower yourself.
• Add in a step to increase difficulty.

The functional station is goal specific.

Think about any goals you may want to achieve over the next 6 weeks.

Your therapist can then help you to choose a suitable activity that may help work towards permanent improvements of this activity or task.

Some examples include:
• Getting on and off the floor
• Kneeling
• Pilates/core strength
• Sport specific movements
• Unstable surfaces
​​​​​​​• Gait re-education/walking without aids

Tandem Stance
• Standing next to a chair for support, place your non-operated leg in front of your operated leg.
• Imagine you are on a tightrope.
• Try to take your hands off the support and maintain your balance for 30-60 seconds.

  Single leg stand
• Standing next to a chair/wall for support, stand on your affected leg.
• Try to take your hands off the support and maintain your balance for 30-60 seconds.
• Repeat on the other side if indicated. *For more core activation have leg bent in front of torso*

*For more glute and hamstring engagement, have the leg bent behind torso, keeping your knees aligned*

  Star Excursion
• Place markers at different points on the floor.
• Stand on your affected leg and take your opposite leg towards the markers.
• Try and maintain balance on your affected leg by using the muscles in your thigh and lower leg.

 Balance – Unstable surface
 **Do this exercise with a therapist for the first time**

• Stand on the Airex Cushion /BOSU /Wobble Board.
 • Hold on to a chair or surface for support with both hands.
• Squeeze and engage your core and glute muscles.
• Try to stand on your operated leg and maintain balance. If able and safe, release hand from support.
• *Hold for as long as you can.

 Alternate leg stepping
• Place your foot onto the step and allow weight acceptance through that foot.
• Take leg off the step and put the other foot onto the step.
• Repeat.
• Hold onto something if you need to maintain balance.
*You can also put the foot on the step and bend the knee without moving up the steps. This will aim to increase knee flexion/range of movement

  Step up
• Stand in front of the step.
• Using upper limb support as needed on the hand rail.
• Step up onto the bottom step.
• Continue to climb up further steps if you are able to.

Eccentric step down
• Stand on the step
• Take one leg in front of you and lower the heel towards the floor by bending the opposite knee.
• Gently step down on to the floor.

Note:
• Try to keep hip, knee and 2nd toe aligned.
• Try to keep your pelvis level.

 Lunge
 • Place the operated leg on the step in front of you.
• Push the knee forward until you feel a stretch.
 • Hold for a minimum 30 seconds.
• Repeat minimum of 3 times.

 This can be any activity that raises your heart rate:
 • Marching/Jogging on the spot.
• Upright bike or recumbent bike.
• Fast paced stairs.
• Shuttle running.
• Step jacks/Star jumps.
• Heel flicks or high knee drives.  

Try and complete to a certain length of time or try counting to 20 before resting and then repeating the movement when you have recovered.

 Quad Stretch
 • Stand tall.
• Bend the operated leg as far as possible keeping your knees next to each other.
• If you can’t hold your leg use a towel.
• Repeat on the other leg.
• Use the back of a sturdy chair for support.

  Seated Hamstring Stretch
• Sit in the middle of the chair and extend one leg forwards.
• Lift your toe up.
• Lean forwards.
• Repeat on the other leg.

Calf Stretch
• Stand with your operated leg back and straight.
• Bend your front leg.
• Keep both feet facing forward and heel on the floor.
• Repeat on the other leg.
• Use the back of a sturdy chair for support.

Try and complete 2-3 of stretches at the end of your exercises.
Hold each stretch for 15-30 seconds.
 Ask your therapist if you are unsure of which ones to perform.