Exercise Guide

for Knee Replacement Surgery

Name: _________________________
Surgery date: ___________________

Please bring this guide to the hospital

and to all physiotherapy appointments
Please refer to the Before During and After Hip and Knee Replacement
Surgery – A Patient’s Guide for further information.

The guide is available on the Fraser Health Patient Education Catalogue

website: patienteduc.fraserhealth.ca

Acknowledgments
This guide was originally developed in 2005 through the efforts of the Provincial Rehab Advisory Group (PRAG) and physiotherapists from
the Mary Pack Arthritis Program, Sunshine Coast, Powell River, Vancouver General Hospital and Richmond Hospital. A second version was
created in 2010 through collaboration with therapists from UBC Hospital, Vancouver General Hospital and the Mary Pack Arthritis and OASIS
Programs, Vancouver Coastal Health and all BC health authorities reviewed and provided feedback. This latest version has been updated by
the Mary Pack Arthritis Program in collaboration with therapists from the OASIS program and UBC Hospital.

Fraser Health gratefully acknowledges this work and uses this resource with permission

Mary Pack
Arthritis Program
Working Together for Healthy Joints

We also thank the patients who underwent knee replacement surgery, orthopaedic surgeons, and other health care professionals who provided
feedback on this version.
Contents
Before Surgery ..................................................................... 3
General guidelines ................................................................... 3
What to expect ......................................................................... 4
Exercises to do before surgery ................................................ 4

Weeks 0 to 6 After Surgery

In the Hospital After Surgery ............................................ 10
General guidelines after surgery ............................................ 10
Tips to manage your pain and swelling .................................. 10
What to expect ....................................................................... 12

Exercises to Do for Weeks 0 to 6...................................... 13

Exercises to do in the hospital................................................ 13

At Home ............................................................................... 19
What to expect ....................................................................... 19

Exercise Progressions Weeks 0 to 6................................ 21

Core muscle exercise progressions ....................................... 21
Exercises to improve knee range of motion ........................... 23
Exercises to improve flexibility................................................ 26
Exercises to improve strength ................................................ 29

Weeks 7 to 12 After Surgery

Exercises to Do for Weeks 7 to 12 .................................... 33
Exercises to improve strength ................................................ 34
Exercises to improve balance and daily activities .................. 37

Staying Active After Joint Replacement .......................... 43

Helpful Resources .............................................................. 44

You are about to have knee replacement surgery. Patients who prepare for
surgery and actively take part in their care can recover quicker and with
less pain. This guide has general information along with tips and goals for
exercising before and after surgery.
The goals and exercises in this guide are to help you along the path to
recovery. You may receive different instructions from your surgeon, doctor or
physiotherapist. Always follow the directions of your care team.
Before starting any exercise program check with your physiotherapist
or doctor.

Caution:
• If you have too much pain in your knee to exercise, or if any of the
exercises cause more pain or swelling in your knee, stop
• Talk to your physiotherapist or doctor about how to modify the
exercise and manage your pain

2
Before Surgery
General Guidelines
Doing exercise before surgery can help you to have a faster and easier
recovery. Exercise helps to:
• Maintain the movement in your knee
• Make your muscles strong
• Control your pain
• Reduce/control your body weight
• Improve your sleep
• Increase your knowledge of how to exercise after surgery

To stay active before surgery, do activities that put less stress on your
knee.
• Swimming, water walking, water aerobics, water running
• Cycling (stationary or bicycle)
• Seated stepper (eg. Nustep)
• Elliptical machine
• Walking with poles on level ground
• Knee movement and strengthening exercises (pages 5-8)

Always warm up before exercising. Your physiotherapist may tell you to

try gentle range of motion, walking or stationary cycling before starting
more vigorous exercise.
If you have increased pain or swelling after exercise…
• Put ice or cold gel pack on your knee for 10–15 minutes
• Rest your joint
• Pace yourself (e.g., do exercises one day and errands the next)
• Use a walking aid such as a cane, walking poles, crutches or walker
• Talk to your doctor or pharmacist about pain medicine

Before Surgery 3
What to Expect
Before surgery, you will be offered education in person or through a video or
online program to help you prepare for your knee replacement. Some people
also see a physiotherapist to learn specific exercises to do before surgery.
These exercises will help you to stay active and prevent further decline in
day-to-day activities as you wait for surgery. Do the recommended exercises
for at least 8 weeks to allow for the muscles to get stronger. If you do not see
a therapist for advice before surgery, try doing the exercises on the next few
pages to help you prepare.
Some of the exercises are designed to help you turn on or “activate” muscles.
You need to practice this skill several times a day. Other exercises are to help
you strengthen your muscles and these are suggested 2 to 3 times per week.
Follow the instructions in the booklet or from your therapist on how often to do
each exercise.

Exercises to do before surgery

Core Muscles
Your core muscles protect your low back and give support to your knee and
hip. These muscles are your pelvic floor (muscles that control your bowel and
bladder) and your lower abdominals (muscles deep in your belly). They often
work poorly due to arthritis or pain, such as after surgery. An important goal
is to learn to ‘turn them on’ when doing all of your exercises. The more you
practice turning them on, the more automatic it will become.

4 Before Surgery
1. Core Muscle Activation
a. Pelvic floor muscles
• Imagine you are trying to stop the stream of urine
Hold 6 seconds, then slowly relax
Repeat 6 times, several times per day in different positions

b. Deep lower abdominal muscles

• Pull your lower belly (below your belly button) toward your spine (imagine
zipping up a tight pair of pants)
• Take 6 quiet breaths in and out through your nose, into the sides of your
ribs
• Slowly relax your belly (imagine unzipping the pants)
Repeat 6 times, several times per day in different positions

Before Surgery 5
2. Knee Straightening
• Place large rolled towel under
both knees and smaller roll or ball
between thighs
• Squeeze small roll between thighs
and lift one foot to straighten knee
Hold 5–10 seconds and keep
squeezing rolled towel while lowering foot down
Repeat 8–15 times, 3–4 days per week

3. Lower Buttock Squeeze

• Lie on your back with legs straight
(if you have back pain, this can be
done with pillow under your knees)
• Squeeze lower buttocks together gently, as if holding a pencil between
your buttocks
Hold 5–10 seconds
Repeat 6 times, several times per day

4. Knee Bend (Heel Slides)

• Use towel behind thigh to help
bend your knee and slide your heel
towards buttocks
Hold 5–10 seconds
Repeat 10 times, 2–3 times per day

6 Before Surgery
5. Sitting Knee Bend and Straighten
a. Bend and straighten
• Sit on the edge of firm seat with feet on floor
• Slide heel back to bend your knee
• Slide heel forward to straighten your knee

b. Knee cap movement exercise

• Sit on edge of firm seat with knee straight, rest heel on floor
• Use lower thigh muscle to slide knee cap towards you and straighten
knee (tighten knee cap towards your hand)
• Keep knee straight and slowly relax knee cap
Hold 5–10 seconds
Repeat 10 times, 2–3 times per day

Before Surgery 7
6. Hamstring Stretch
• Sit up tall on edge of firm seat and straighten leg with heel on floor or stool
• Pull lower belly into your spine and bend forward from your hips, until
gentle stretch is felt on back of thigh
Hold 30 seconds
Repeat 2–3 times, once per day

7. Arm Chair Push-Ups

You need strong triceps to use your walker or
crutches, help you get out of bed, and stand up
from chairs.
Triceps are the muscles on the back of your arm.
• Sit on chair with armrests
• Place hands on armrests with elbows bent
• Push through hands to straighten elbows
and lift your body up
Hold 5–10 seconds and slowly lower yourself
Repeat 8–15 times, once per day

8 Before Surgery
Use this space to note any other pre-operative
exercises suggested by your physiotherapist.

Before Surgery 9
In the Hospital After Surgery
General Guidelines after Surgery
In the hospital, you will be seen by a physiotherapist shortly after your surgery.
The therapist will talk to you about managing your pain and swelling and
review your in-hospital exercises with you. You will be helped to move from your
bed to a chair and to stand and walk within a few hours after surgery. This ‘early
mobilization’ helps to reduce the risk of blood clots.
When walking, most people are allowed to put as much weight on the operated
leg as they can tolerate. Your healthcare team will let you know if your surgeon
wants to limit the amount of weight you can put on the operated leg.
The goal is to do these exercises independently 3 times a day while in
hospital in order to improve the range of motion of your knee. It is normal
to experience some discomfort with these exercises. Timing your pain
medication beforehand and icing afterwards can help.

Tips to manage your pain and swelling in the hospital

and at home.
Rest Your Joint
• Lie down 3 times a day for 30 minutes on your bed or sofa. Put your leg up
and support it with a wedge, arm rest of couch, or pillows (as shown). Keep
knee straight on the pillows with foot and ankle higher than your heart
• Change positions often (every 20–30 minutes) when you are awake.
Try sitting, standing, and walking
• Pace yourself. Rest the knee after exercise or after a busy day

10 In the Hospital After Surgery

Foot and Ankle Pump
• This helps to reduce swelling and risk of blood clots
• You may do this lying down or sitting on the edge of a chair
• Pump your whole foot up and down
Repeat 10 times every hour

Use Ice (Cold Therapy)

• Ask for ice or a cold gel pack in the hospital and talk to your therapist if
you are not sure how to apply it
• Follow these steps:
• If your incision is not healed, cover it with a clean bandage and a sheet
of clean plastic wrap
• Put a damp tea towel over your knee
• Put a flexible gel pack or plastic bag with crushed ice on your knee
• Leave the ice ON for a maximum of 10–15 minutes
Repeat several times a day as needed
Tip: If using a cold compression device, follow the manufacturer’s instructions
for use or ask your therapist to help you.

In the Hospital After Surgery 11

DO NOT use ice if:
• You are very sensitive to cold (e.g. fingers and toes turn white or blue
when you are cold)
• You cannot tell if something is too hot or too cold on the skin around your knee
• Your doctor has told you that the circulation in your legs is poor and that
you should avoid using ice

Use pain medicine

Use your pain pills as prescribed by your doctor or surgeon. Tell your doctor or
surgeon if the pain is too much or not improving.

Use walking aids

Use the walking aid that your physiotherapist has measured for your height
and recommended. Check with your therpist or doctor before you stop using
your aid, or if you plan to switch to a different aid to progress your recovery.
Walkers, crutches and canes help to:
• Reduce the stress on your knee
• Reduce pain
• Improve your walking
• Improve your balance and reduce falls
If you need to use stairs at home, your therapist will teach you how to safely
use crutches or cane going up and down stairs before you leave the hospital.

What to Expect
By the time you are ready to leave the hospital, you should be able to...
• Move safely from your bed to a chair and to the toilet
• Walk safely with crutches or walker
• Dress yourself
• Do your exercises on your own so you can continue them at home
Your healthcare team checks your ability to do these activities and recommends
when you should go home and what community services you may need at home.

12 In the Hospital After Surgery

Exercises to Do for Weeks 0 to 6
Exercises to do in the hospital
You will have better range of motion if you do these exercises at least
3 times a day in the hospital and continue doing them at home. They will get
easier over time. Your next physiotherapist, in the community or outpatient
rehab, will gradually make your exercises more challenging.

1. Core Muscles
• Remember the core muscle training you did before surgery?
• Pelvic floor muscles: imagine you are trying to stop the stream of urine
• Deep lower abdominal muscles: pull your lower belly (below your belly
button) towards your spine (imagine you are zipping up a tight pair of pants)
• Take 6 quiet breaths through your nose, then slowly relax the muscles
(unzip your pants)
• Repeat 6 times, several times per day
• Turn on these core muscles before you turn over in bed, go from lying to
sitting, or from sitting to standing

Exercises to Do for Weeks 0 to 6 13

2. Breathing
• Sit with shoulders relaxed, hands
holding sides of chair
• Pull your lower belly to your spine
• Breathe in slowly through your nose,
feel your ribs expand sideways
• Breathe out slowly through your nose,
feel your ribs drop down
Take 5–10 deep quiet breaths every hour

3. Knee Bends (Heel Slides)

• Use towel or strap behind thigh for
support to bend your knee by sliding
heel towards buttocks
• Slide heel away to straighten knee
Repeat 10 times
Tip: If needed, put a plastic bag under your foot

4. Knee Straightening
a. Assisted (using strap)
• Place pillow under knee
• Loop a long strap around ankle to
support leg
• Tighten thigh muscles above knee
cap and inner thigh to straighten knee
• Use thigh muscles to keep knee straight, reduce support from the
strap as much as possible
• Slowly relax knee cap and lower leg down
Hold 5–10 seconds
Repeat 8–15 times

14 Exercises to Do for Weeks 0 to 6

b. Knee cap movement exercise
Place small rolled towel under mid-calf
• Keep knee cap and toes facing ceiling
• Use lower thigh muscles to slide knee cap towards you and straighten
knee
• Keep back of knee straight while gently relaxing knee cap, letting it
slide away from you
Hold 5–10 seconds, then slowly relax knee cap
Repeat 6 times, several times a day

5. Lower Buttock Squeezes

• Lie on your back with legs straight (if you have back pain, this can be
done with pillow under your knees)
• Squeeze lower buttocks together gently, as if you are holding a pencil
between your buttocks
Hold 5–10 seconds
Repeat 6 times, several times per day

Exercises to Do for Weeks 0 to 6 15

6. Seated Knee Bend and Straighten
Sit on edge of bed or chair with feet
on the floor. Repeat the following
3 exercises 5–10 times each.
a. Knee Bend
• Slide heel backward to bend your
knee until you feel a stretch
Some discomfort is expected
• Hold 5–10 seconds, slide back to
comfortable position and relax
b. Knee Straightening
• Slide heel forward to straighten knee
• Hold 5–10 seconds, slide back to
comfortable position and relax
c. Knee cap movement exercise
• Sit on edge of firm seat with knee
straight, rest heel on floor
• Use lower thigh muscle to slide knee
cap towards you and straighten knee (tighten knee cap towards your
hand)
• Keep knee straight and slowly relax knee cap

16 Exercises to Do for Weeks 0 to 6

7. Drop and Dangle
Sit on high surface/edge of bed with feet
supported on stool
• Take operated leg off stool support.
Relax muscles on front of thigh;
allow your knee to bend and foot to
dangle
Some discomfort is expected
Place operated leg back on stool
for support to relieve pain
Hold 5–10 seconds
Repeat 5–10 times
Progression:
• Place a rolled towel or ball under
thigh and allow lower leg to dangle
for more bend
OR
• Place heel of non-operated leg on
the shin of your operated leg, gently
push the leg back to increase the
bend in your operated knee

Exercises to Do for Weeks 0 to 6 17

Use this space to note any other in-hospital
exercises suggested by your physiotherapist.

18 Exercises to Do for Weeks 0 to 6

At Home
What to Expect
During the initial weeks after discharge from hospital it is important to keep
your knee pain and swelling under control. Continue to follow the tips on
pages 10-12.

Weeks O to 6 after surgery

In this early stage, your therapist will give you exercises to help you bend and
straighten your knee and introduce exercises to improve your strength. If you
find the in-hospital exercises (#1-7) are easy, you can progress to the next
set of exercises. If you aren’t sure how to do them or if they cause too much
pain, continue to do the exercises you were doing in the hospital until you see
your physiotherapist at home, in a clinic or an outpatient hospital department.
The exercises are organized from ‘easy’, to ‘moderate’ to ‘advanced’. Track your
effort and let your therapist know when you are ready to move to the next level.
Tip: To avoid losing range, mind your leg position at rest when not
exercising. Aim to rest it fully straight or bent to 90° with foot resting on
the floor under knee. If the position gets uncomfortable, you can perform
repeated bending and straightening to relieve pain.

Goals by end of Week 6:

• Bend your knee at least 110°
• Straighten your knee so that no more than 3 finger widths can fit behind
the knee and floor/bed (about 5° of bend) when lying
• Walk short distances outside (4 to 6 blocks) using cane or walker
• Go up and down stairs safely leading with the non-operated leg up and the
operated leg down
• What are your personal goals? __________________________________
__________________________________________________________

At Home 19
To measure knee bend (flexion)
• Sit on chair with feet flat and toes touching a wall
• Bend your knee by easing forward on the chair
• Measure the gap between the wall and your knee (as shown below) and
record it. Use the same chair each time
Measure it Your Goal

Measure the Gap

To measure knee straight (extension)

• Lie on your back on a firm surface
• Keep your foot relaxed and press your knee down
• Have someone measure the gap under your knee (as shown below)
Measure it Your Goal

20 At Home
Exercise Progressions Weeks 0 to 6
Core muscle exercise progressions
8. Bent Leg Turn Out
• Lie with legs bent, feet in line with
hips
• Turn on core muscles to keep
back and pelvis still
• Turn one leg out 30–45° at the
hip, depending on your ability to
keep your pelvis from rolling side
to side
• Use core muscles to hold the opposite hip down
• Re-set or keep core muscles on, pull leg back to starting position
Do 6 times, repeat with other leg
Do several times a day

9. Bent Leg Float

Do this exercise only if you can bend your knee comfortably more
than 90° (typically after weeks 4–6)
• Lie with legs bent, feet in line with hips
• Turn on core muscles, especially pelvic floor
(refer to page 13)
• Float one bent leg up to 90°
toward belly button, lower it down
without releasing core muscles
Do 6 times, repeat with other leg
Do several times a day

Exercise Progressions Weeks 0 to 6 21

10. Hip Turn Out With Resistance Band
Lie on your back with legs bent, feet hip
width apart
• Bring thighs together and tie a light/medium
resistance band firmly around upper thighs,
then bring thighs back in line with hips
Do not tie band around your knees
• Turn on core muscles to keep
body and hips still while doing
the following exercises
a. Double leg turn out
• Turn out both thighs against resistance
band through your hips equally
• Bring thighs back in line with hips
b. Single leg turn out
• Turn out one thigh only; keep the other
thigh still
Do not hold
Repeat 6 times each, daily

22 Exercise Progressions Weeks 0 to 6

Exercises to Improve Knee Range of Motion
(Bending & Straightening)
You need about 90°
Do these exercises 3 times a day unless
bend to go up the stairs
your therapist gives you different instructions. and 110° bend to go
11. Passive Knee Bend down the stairs.

a. Lying down
• Use a towel or strap behind your
thigh to provide support and help
bend your knee
• Pull thigh towards chest and relax
knee to increase bend
Hold 5–10 seconds
Repeat 5–10 times
b. Sitting upright
Sit on chair or large therapy ball with
feet on floor (if using ball, make sure
there is sturdy furniture next to you to
rest arms for support)
• Keep feet fixed on floor and slide
bottom forwards on chair or roll
yourself forward on the ball to
bend operated knee
Hold 5–10 seconds
Repeat 5–10 times

Exercise Progressions Weeks 0 to 6 23

12. Assisted Knee Bend and Straightening with Therapy Ball
• Lie on your back, resting heel of
operated leg on therapy ball
• Keep knee cap pointing to ceiling
• Roll ball towards you to bend knee
• Roll ball away to straighten knee
Repeat 10 times
Progression:
• Do exercise with both heels on the ball, keep feet hip-width apart
Do not do this if you are experiencing back pain

13. Active Knee Bend and Straightening

• Lie on your stomach with feet just
off end of bed
• Gently squeeze lower buttock
muscles
• Bend knee, bringing heel
towards bottom
• Straighten leg and leave foot hanging over edge of bed
• Let gravity help to straighten knee (if lower leg is unable to touch bed,
support gap with a folded towel, making sure you still feel a stretch)
• To increase knee straightening, tighten muscles on front of thigh to pull
knee cap towards you
Hold each position for 5–10 seconds
Repeat 5–10 times
Progression: Add folded towel under thigh
• For bending:
Wrap lbs weight around ankle
• For straightening: Increase length of time resting knee straight for as
long as you feel comfortable

24 Exercise Progressions Weeks 0 to 6

14. Heel Slide on Wall
To increase bending:
• Lie on back with surgical leg resting on
wall
• Bend operated knee by sliding heel
down wall
Hold for 5–10 seconds
Repeat 5–10 times
Tip: Use the weight of non-operated leg
to bend leg more by resting it on the shin
of operated leg
To increase straightening:
• Slide heel up the wall
• Tighten front of thigh muscles to pull knee cap towards you
• You can straighten knee further by pulling foot towards you
Hold 5–10 seconds
Repeat 5–10 times

15. Knee Bend on Step

Place operated leg on the 2nd step
• Hold rail for balance
• Lean forward through the hip to
bend knee until stretch is felt at
front of knee, maintain upright
posture
Hold 5–10 seconds
Repeat 5–10 times
Progression:
• Move foot of operated leg to higher step as able

Exercise Progressions Weeks 0 to 6 25

Exercises to Improve Flexibility
If you had tight muscles before surgery it may take longer after joint
replacement to get the movement back in your joint. Stretches can be done
in many different ways. Ask your physiotherapist how to change a stretch to
make it work for you.
Guidelines:
• Stretch when you have done your exercises, after a walk or when your
muscles are warmed up. Warm muscles are easier to stretch.
• Hold the end of the stretch for 30 seconds and up to 1 minute.
Relax and breathe slowly. Repeat 3–4 times.
• Ensure that you feel a gentle stretch in the muscle or tissue being stretched.
If you don’t feel a stretch you won’t improve your flexibility.
• Stretch daily, several times a day.
• Tip: Heat can help with stretching. Put your leg in the stretched position and
apply heat on the tight muscles (where the stretch is felt) for 1–5 minutes.

16. Hamstring Stretch (Back of thigh)

Sit tall on edge of seat with one leg bent, other leg straight (rest heel on floor
or raised stool)
• Turn on core muscles
• Bend forward at the hips until a stretch is felt at the back of straight leg
Hold 30 seconds up to 1 minute
Repeat 3–4 times, several times a day on each leg

26 Exercise Progressions Weeks 0 to 6

17. Calf Stretch
• Stand facing wall with one leg ahead of
the other
• Keep back leg straight with heel on floor
and toes pointing forward
a. Upper calf
• Lean into the wall by bending the
knee of the front leg until stretch is
felt in the calf of back leg
b. Lower calf
• Bend the knee on the back leg,
keeping heel on the floor
OR
• Stand with support, feet side by side
• Place a book under the forefoot of one
leg to feel a stretch at the back of calf
• Pull your lower belly in, squeeze
your lower buttock and bring
hips forward to feel more stretch
• Keep the knee straight
Hold 30 seconds up to 1 minute
Repeat 3–4 times
Do several times a day on each leg
Remember to pull your lower belly to support
body posture during stretch

Exercise Progressions Weeks 0 to 6 27

18. Psoas Stretch (Front of Groin)
Sit on chair without arm rests, hold on to seat or furniture for support
• Sit up tall and turn on core muscles
• Let operated leg hang off side of chair
• Slide operated leg back on your toes until you
feel a stretch at the front of your thigh
Hold 30 seconds up to 1 minute
Repeat 3–4 times
Do several times a day on each side
OR
• Stand up tall and turn on core muscles
• Hold on to rail or back of chair
• Slide leg back on your toes until you feel a
stretch on the front of your thigh
Hold 30 seconds up to 1 minute
Repeat 3–4 times
Do several times a day on each side

19. Quadriceps Stretch (Front of thigh)

• Turn on core muscles
• Bend the knee and rest ball of foot on low
step or stool.
• Feel stretch along front of thigh and
surgical scar
Hold 30 seconds up to 1 minute
Repeat 3–4 times
Do several times a day on each side
Progression:
• For more stretch place toes on higher steps
• Loop a belt or towel around ankle and pull foot towards your buttock to
help further bend your knee (keep body straight)
28 Exercise Progressions Weeks 0 to 6
Exercises to Improve Strength
It is important to do strengthening exercises for several months after surgery
to help you regain strength, improve day-to-day activities and protect your
new joint. Your operated leg will take up to a year or more to regain normal
strength.
Guidelines:
• Do 8–15 repetitions of an exercise. To build strength, your muscle should
feel very tired by the last repetition.
• If you can’t do 8 repetitions of an exercise, you need to make the
exercise easier.
• If you can complete 1 set of 15 repetitions for 2 strengthening sessions in
a row you can progress the exercise (make it harder) by:
• Adding more weight (e.g. 2-3 lbs) or changing colour of exercise band.
• Doing a bigger movement (open or close your joint more).
• Switching to a more advanced version of the exercise.
• To maintain your current strength, train 2 days a week.
• To increase your strength, train 3–4 days per week.
• Always rest the day after doing strengthening exercises to let your
muscles recover.
• Remember to keep your core muscles turned on throughout your
strengthening exercises.

Exercise Progressions Weeks 0 to 6 29

20. Active Leg Straightening
Lie on stomach with knees bent and toes
tucked under or resting over rolled towel
• Squeeze lower buttocks
• Use one lower buttock to straighten
hip by lifting thigh, press into the ball
of your foot
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week

21. Seated Knee Straightening

• Sit tall on firm chair
• Keep thighs fully supported on chair,
non-operated leg supported on book/floor
• Squeeze a rolled towel between thighs
and straighten operated leg
• Keep squeezing rolled towel while
lowering leg down
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week
Progression:
Wrap lbs ankle weight above ankle

22. Heel Lifts in Sitting (Calf Exercise)

Sit on edge of seat with feet on floor, placed
under knees
• Raise heel (tip toe) and hold 5–10 seconds
(up to 45 seconds)
• Repeat 5 times with 1 minute rest between
repetitions, do daily
Progression:
Wrap lbs ankle weight above ankle
30 Exercise Progressions Weeks 0 to 6
23. Resisted Knee Straightening
Attach resistance band to a secure object
and to ankle of operated leg in figure of 8
as shown
• Sit tall on chair, squeeze a rolled towel
between thighs and straighten knee
• Slowly relax knee into bent position
until you feel a stretch on front of knee
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week
Progression:
• Use stronger resistance bands

24. Resisted Knee Bending

Attach resistance band to a secure
object and around ankle of operated
leg as shown above
• Sit tall on chair, squeeze a rolled towel
between thighs and bend knee as
much as you can
• Keep squeeze on towel as you slowly
relax band to start position
• Pull knee cap towards you to straighten
knee with the help of the band relaxing
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week
Progression:
• Use stronger resistance bands

Exercise Progressions Weeks 0 to 6 31

25. Upright bike
Using a stationary bike or seated stepper (e.g. the Nustep) can assist you in
getting your range of movement, and do light to moderate intensity exercise
after knee replacement.
Some tips on choosing the type of bike:
• Use an upright bike if your knee has less
than 110°, during the early stage
• Use a recumbent bike to encourage more
bending >110°, most likely during the later
stage
• Cycle forwards and backwards
• Adjust bike seat to maximum distance
and cycle backward if you are having
trouble straightening your knee
• Adjust seat closer to challenge knee bend
• As your knee range improves, you should
adjust your seat to get maximum benefit Upright bike
• Add resistance/tension slowly after you
knee feels comfortable with the range

Recumbent bike

32 Exercise Progressions Weeks 0 to 6

Weeks 7 to 12 After Surgery
By 7 to 12 weeks after surgery you will feel more confident with day- to-day
activities and getting back to work or some of your social and leisure activities
in your community. In this later stage of rehab, your therapist will give you more
challenging exercises to help you bend and straighten your knee, improve your
overall strength, balance and daily function.
Remember to keep your core muscles turned on throughout your
strengthening exercises.
Track your effort and let your therapist know when you are ready to move to
the next level.

Goals by end of Week 12:

• Bend your knee to 120° or more
• Fully straighten your knee
• Go up and down stairs normally with rail assistance
• Ride a stationary bike
• Sit and stand from an average chair height
• Walk longer distances without a limp using 1 cane or no walking aid
• What are your personal goals? __________________________________
__________________________________________________________
__________________________________________________________

Remember:
You may find that pain and swelling increase as you begin new exercises,
spend more time on your feet, become more active or return to work.
Continue to manage your pain and swelling with the tips on pages 5-7.
Each person heals differently and the time it takes to meet goals may differ
from person to person. Talk to your surgeon and your physiotherapist if you
feel that you are not reaching your goals.

Exercises Weeks 7 to 12 33
Exercises Weeks 7 to 12
Do the strengthening exercises 3–4 times per week to allow your muscles
time to recover in between sessions.

26. Bridging
Lie on your back, thighs hip-width apart,
squeeze large rolled towel firmly between
your thighs
• Use your lower buttock muscles to lift
hips off the bed
• Keep squeezing towel and slowly lower
hips down
Tips: 1. Use thin pillow under head, or none at all, if possible
2. Press arms down into bed to assist the lift
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week
Progression:
• Maintain squeeze on towel between thighs, lower hips a little and lift
back up in small movements (pulses), using your lower buttocks to press
into your feet

34 Exercises Weeks 7 to 12
27. Leg Lift in Side Lying
Lie on non-operated side, bottom leg bent,
top (operated) leg straight resting on a pillow
• Turn on core muscles to keep body
and hips still
• Squeeze your lower buttock and push
into heel to straighten operated leg, lift
leg up
• Slowly lower down
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week
Progression:
Hold leg up for 5–10 seconds

28. Active Straight Leg Hold

Lie on stomach with feet hanging off bed
• Turn on core muscles and squeeze
lower buttocks together
• Straighten leg and raise leg slightly
off bed
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week

Exercises Weeks 7 to 12 35
29. Heel Lifts in Standing (Calf Exercise)
(Only do this exercise if your knee can straighten fully)
Hold counter or table for support
Keep knees straight, do not lean forward
Static hold exercise:
• Rise up onto toes and hold 5–10
seconds (up to 45 seconds)
• Repeat 5 times with 1 minute
rest between repetitions
Controlled movement exercise:
• Rise up onto toes, then lower heel down
slowly (2 seconds up, 3 seconds down)
• Repeat 8–15 times, do 3–4 times a week
Progression:
• Stand on one leg, rest other heel on step or ledge under sink cabinet,
repeat heel lift exercise with the standing leg as above
• Take other leg off support and perform single leg heel lift

30. Standing Knee Bend

Stand holding chair or counter for support
• Place operated leg behind, resting on
ball of foot
• Squeeze lower buttocks and bend knee
to bring heel towards buttocks
Hold 5–10 seconds, repeat 8–15 times
Do 3–4 times a week

36 Exercises Weeks 7 to 12
Exercises to improve balance and daily activities
31. Sit to Stand
Sit on edge of a higher chair, squeezing a
large rolled towel between knees
• Bend forward with back straight, bring
shoulders over the knees
• Press feet into the floor and use
lower buttock muscles to lift you up to
standing. Do not use your arms
• Bend hips and knees to slowly sit back
down on chair
Alternatively, if you find your knees tend
to knock together, tie a resistance band
around your upper thighs and press thighs
against the band to keep hip-width apart
Repeat 8–15 times
Do 3–4 times a week
Progression:
• Use a lower chair
• Stagger legs by placing one leg back and other leg forward to make the
hind leg work harder. Keep both knees and feet pointing forward. Switch
sides

Exercises Weeks 7 to 12 37
32. Wall Slides
Stand with back against wall
• Place feet hip-width apart and 1 - 1½ feet
from the wall
• Bend hips and knees to slide down wall, as
low as you feel comfortable. Keep tailbone
against wall, knees over ankles and toes
pointing forward
• Use lower buttocks to slide back up the wall
Repeat 8–15 times, do 3–4 times a week
Tips:
• Hold a rolled towel between thighs to make core muscles and inner
thigh work harder
• If knees knock together as you lower, tie a resistance band around
mid-thighs and press thighs against the band to hold thighs hip-
width apart

33. Step Up
Stand facing step, one foot on higher step
• Hold counter or railing for balance
• Step up by first raising heel of
bottom leg, then lift up from lower
buttock muscle of the other leg to
straighten knee
• Step down backwards onto toes,
keep buttock squeezed, roll rest of
foot down
Repeat 8–15 times, switch sides, do 3–4 times a week
Tips:
• Avoid leaning forward or pulling on railing
• Keep your pelvis level at all times, and knee over second toe
38 Exercises Weeks 7 to 12
34. Side Step Ups
Stand sideways next to step
• Hold counter or railing for balance
• Place one foot on top step beside
the lower leg
• Step up sideways by first raising
heel of bottom leg, then lift up
from lower buttock muscle of the
other leg to straighten knee
• Step down onto your toes then roll
rest of foot down (keep lower buttock squeezed)
Repeat 8–15 times, switch sides
Do 3–4 times a week
Tips:
• Keep knee over second toe at all times
• Keep your pelvis level at all times

35. Split Squat (Lunge)

Hold counter for support
• Place one leg in front, other leg
behind resting on ball of foot
• Lower body toward the floor,
bending from hip and knee
• Use buttock muscles to lift you up
to starting position
Repeat 8–15 times, switch sides
Do 3–4 times a week

Exercises Weeks 7 to 12 39
Exercises to Improve Balance
Training your balance after total knee replacement will lower your risk of falling
and help you feel more confident when walking outside. Always have a firm
counter or railing within reach when doing balance exercises. For better control,
turn on core and lower buttock muscles when doing balance exercises.

36. Side to Side Weight Transfers

Stand facing kitchen sink or railing
• Place feet hip-width apart
• Shift your weight fully side to side
onto each leg
Hold each position for 5–10 seconds
Repeat several times daily
Progression:
• March on the spot

37. One Leg Balance

Stand facing stair or kitchen sink with a chair behind you for safety
• Practice placing one foot up and down on a step (or place the foot on
ledge under sink cabinet) while balancing on one leg, keeping pelvis
level and posture straight
• Start with using hand support on same side as
moving leg, then remove hand support
Hold up to 45 seconds
Repeat on other leg
Repeat several times daily
Progressions:
• Stand on one leg
• Slowly turn head side to side while balancing on
one leg
• Stand on small cushion

40 Exercises Weeks 7 to 12
38. Forward and Back Weight Transfers (Rocking Horse)
Stand beside counter or table
• Place one foot in front of the other,
resting on the heel (opposite leg to
the hand support)
• Shift your weight forward by lifting up
from the heel of the back leg, rocking
through the ball of your foot forward
then roll backwards
• Switch foot position and repeat
Repeat 8–15 times
Do several times a day
Progression:
• Take a full step forward and backward without holding on to support
• Walk placing your feet on a straight line. Start with small steps,
progressing to bigger steps

39. Balance Exercise

a) Side to side
• Step onto firm cushion/pillow or
balance board (place board to
rock side to side). Keep body still
and hips level
• Press down into cushion/pillow
down (or tip board down on
one side) through straight leg,
bending other knee
• Repeat movement from side
to side

Exercises Weeks 7 to 12 41
 b) Heels and toes
Step onto firm cushion/pillow or balance
board (turn board to rock forwards
and backwards)
• Keep body and hips still, move
through the ankles
• Press forward into cushion/pillow
(tip board forward) to stand on
toes
• Press backwards into cushion/
pillow (tip board backward) to
stand on heels

Some other ways to challenge your balance:

• Walking in water (forwards, backwards, sideways)
• Stand with feet close together, slowly turn your head from side to side, then
try this standing on a pillow
• Stand with feet staggered one in front of the other, slowly turn your head
side to side
• Take a few steps and stop mid-step to balance on one foot, repeat stopping
to balance on other foot
• Try Tai Chi exercises

42 Exercises Weeks 7 to 12
Staying Active after Joint Replacement
About 3 months after your knee replacement surgery, you will be
encouraged to become more active and return to some of your favourite
leisure and sporting activities.
Staying active will help to:
• Increase your fitness level and endurance
• Prevent or help you manage other chronic health conditions
• Increase your muscle strength and power (moving speed)
• Improve your bone quality and life of your joint replacement
• Keep your weight under control (extra weight on your body also places
extra stress on your replaced joint)
• Improve your mood and help you sleep better
Talk to your surgeon, family doctor or physiotherapist about what activities are
right for you. In general, choose activities that:
• are low impact
• build on your previous skills and experience
• have low risk of injury
• you enjoy!
For helpful information and guidance on how to get started and finding the
right activity for you, check out these resources:
Get Moving: Maximizing Your Activity After Hip or Knee Replacement
whenithurtstomove.org/wp-content/uploads/Get-Moving-Booklet_2015-
EN-1.pdf
Physical Activity Services at HealthLinkBC
healthlinkbc.ca/physical-activity-services or call 8-1-1
Contact your local recreation centre to see if a joint replacement exercise
program is available in your community!

43
Helpful Resources
Internet Resources:
Mary Pack Arthritis Program: mpap.vch.ca
Osteoarthritis Service Integration System (OASIS): oasis.vch.ca
The Arthritis Society: arthritis.ca
Physiotherapy Association of British Columbia (PABC): bcphysio.org
(to find a physiotherapist in your community).
Canadian Orthopedic Foundation: whenithurtstomove.org
American Academy of Orthopaedic Surgeons: orthoinfo.aaos.org
Please note: When looking for information on the internet, visit government
(.gov), university (.edu) and professional association web sites. Not all
information found on the internet is credible, reliable or correct. Always
check with your healthcare professional.

Booklet:
Before During & After Hip and Knee Replacement Surgery
(shared resource with Vancouver Coastal Health)
Ask your surgeon for a copy or access online at:
vch.eduhealth.ca/PDFs/FB/FB.130.B393.pdf

Videos to help prepare for surgery:

Fraser Health
• Preparing for Surgery www.youtube.com/watch?v=9Iloy-viriM
• A journey through the hospital www.youtube.com/watch?v=RYwtArC4GMk
• Getting back on your feet www.youtube.com/watch?v=nsXddDmtZic
• Pain management www.youtube.com/watch?v=YtVesexuhj4
OASIS oasis.vch.ca/surgery/classes-to-prepare-for-surgery
Hip and Knee Replacement (YouTube) by Dr. Mike Evans
www.youtube.com/watch?v=xAL_TrQdtTY

44
 Adopted FB.873.EX.372 with permission Vancouver Coastal Health

www.fraserhealth.ca
The information in this document is intended solely for the person to whom it was given by the health care team.

Catalogue #266645 (September 2019)

To order: patienteduc.fraserhealth.ca