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Total knee replacement surgery is not something you take lightly. It comes as a result of knowing your body, talking with medical professionals, and deciding it’s the best option to ensure your long-term health.
Ideally the surgery shouldn’t be carried out at the spur of the moment. More than likely, it will come after months of preparation. If your preparation is similar to mine, you’ll make adjustments to your lifestyle first to see if your knee pain diminishes.
My lifestyle changes began years ago in order to take pressure off my bad joint. They included losing weight, exercising more, and stretching – and yes, it helped me continue doing things I enjoyed outdoors.
I knew eventually I would need surgery so when that time came I wanted to be prepared. In this article we’ll look at the best exercises to do before having knee replacement surgery. These are easy exercises that most people should be able to do.
I encourage you to speak with your doctor for personalized exercises as knee health, structure, and pain differs from one person to the next. I started off slow and gradually built muscle strength up with more repetitions.
Understanding the Knee, Ligaments, Muscles, and Stability
The knee joint is the largest and arguably the most important joint in the body. It connects the femur (bone of the thigh) to the lower leg (tibia and fibula). The kneecap (patella) is also a floating bone that helps protect the joint.
Large tendons connect the muscles of the legs to the joint and assist with movement while ligaments are smaller connectors that provide stability to the joint. There are 4 main ligaments that support the knee joint.
They are the medial and lateral collateral ligaments, the posterior cruciate ligament, and the anterior cruciate ligament. These ligaments are often injured in athletic events or competition and take time to rehabilitate – since you’re having knee replacement surgery you may have prior injuries to your ligaments.
If you’re like me, your knee replacement could be as a result of losing cartilage in the knee. The medial and lateral menisci act as padding between the large femur and the smaller tibia.
When my menisci were removed during surgery 40 years ago I remained active. Over the years the little menisci that remained wore down until it was bone-on-bone. The pain increased each year and limited my activity.
As we age, our joint support structure tends to slowly degrade. Muscles, tendons, and ligament naturally weaken – even if we are active.
As the muscles and stabilizers weaken our joints, especially ones we stand on, they bear the brunt of our weight. Reducing pressure on my joint is one of the reasons I’ve focused on keeping my weight down – it really does help.
If you’re a senior like me, muscle strength is essential for more than just knee replacement surgery. Muscle mass will help with posture, immune health, and balance.
When I decided to have knee replacement surgery I adjusted my workouts to target the muscles in my legs. I believe it helped me recover more quickly after knee surgery. Below are the exercises that helped me. I hope some of them can be useful to you as well.
Total Body Strength
Sure, you’ll want to focus on specific exercises to strengthen your legs, however, total body strength can help your entire body prepare and gain strength. A total body workout will also improve your endurance, circulation, and help your body bounce back quickly.
These workouts will also improve your cardiovascular health, which will be important since you won’t be as active in the 1-2 weeks following surgery.
No. 1 Swimming
Swimming is my personal favorite. Over the past 20 years, I’ve enjoyed swimming. It puts very little pressure on my joint while allowing me to gain strength. It also allows me to exercise for long periods of time without worrying about damage or swelling.
I gain muscle strength, cardiovascular exercise, and it doesn’t tighten my muscles like weight training. The workout is more therapeutic and has stretching components to the movements. Ever notice how long swimmer’s muscles are?
If you have access to a pool, consider swimming in the months leading up to your surgery. If the pool is small, you can hold onto the side of the pool and gently kick your legs for 10 minutes and build to longer, more intense periods of time.
If you have access to a large lap pool (YMCA or club), you can swim laps in the pool or hold onto a kickboard while using only your legs to propel yourself in the water.
No. 2 Walking
Walking is the easiest exercise on our list. Depending on the severity of your knee, walking should be considered. Of course you walk around the house on a daily basis, but walking around the neighborhood as an evening routine will help get you into shape for knee replacement surgery.
Walking works particularly well if you’re also trying to reduce your weight before surgery. 1-2 miles or more, based on your comfort level, will help keep your legs strong and ligaments and tendons flexible. Start slow and build up your strength a few months prior to surgery.
If you encounter swelling in the knee after your walks, be sure to use ice, compression, and elevation to limit inflammation after exercise. Also speak with your doctor to know whether walking is best for you.
No. 3 Cycling
Cycling is a great low-impact activity for your knee. Of course, if you’re using a bike that is too small or not adjusted properly, it could cause your knee pain.
Riding a bike will increase blood flow in the legs and help with circulation. It also provides a great quadriceps workout – if you bike for 10-20 miles at a time you’ll feel the burn in your legs.
I bike 2-3 times per week and it causes me no pain or inflammation. It has become one of my go-to activities in the last 20 years since I’ve experienced more pain.
Riding on a flat, paved road will provide a smooth ride. There are more and more designated bike paths being developed.
Rides that include small hills enhance the muscle workout and the cardio benefit even more. If you’re sharing the road with vehicles make sure to wear a helmet and bright colors (or a light at night).
Stationary bikes can be a good substitute when the weather does not cooperate. For me, getting out and experiencing nature on a road bike makes the exercise more fun and rewarding.
Isolated Leg Strength For Knee Replacement
No. 4 Quadriceps and Hamstring Exercises
If you’re looking for specific exercises you can do to target the muscles around your knee, then read below. These exercises can be done inside the house – anywhere there’s space to lie down or sit.
Unlike the above-mentioned exercises, these won’t work your whole body but they will definitely strengthen the knee ligaments, tendons, and localized muscles.
In good practice, it’s wise to do these exercises on both legs, even if you’re only having surgery on one knee. Exercising both legs will ensure that one leg doesn’t become stronger than the other and should help with balance as well.
No. 5 Lying Leg Raises
This exercise can be done laying on the floor, on your back. You can also sit up at an angle, resting your upper body on your elbows.
One leg will be exercised at a time. The other leg can lay straight, or bent with the knee in the air and foot on the ground (decide what’s comfortable for you).
With your knee joint locked in the straight position, lying straight in front of you, raise your leg off the ground to a 45 degree angle from your hip. You should feel your thigh muscle (quadriceps) flex as it supports your leg.
Slowly raise and lower your leg from the ground to a 45 degree angle. Take a break and rotate legs.
2 Sets x 10 repetitions each (each leg)
No. 6 Side-lying External Leg Raises
Lie on your side with your legs together. Engaging your lateral quadriceps and hip flexor muscles, raise your leg into the air at a 45 degree angle from the ground.
Return to rest on your other leg and repeat raising your leg. You should feel your outer hip and lateral thigh muscles flex as they support your outstretched leg. Turn to your other side and repeat with the other leg.
2 Sets x 10 repetitions (each leg)
No. 7 Side-lying Internal Leg Raises
Stay in the same side-lying position but this time you’ll be raising the lower leg. Reposition your upper leg behind the lower leg so you can raise the lower leg.
This exercise might be challenging but you’ll gain strength and muscle memory within a few days.
The internal leg raises will engage your inner thigh and groin. You won’t be able to raise your leg to a 45 degree angle, but focus on raising your leg a few inches off the ground and slowly return to the ground. Repeat by turning to your other side.
2 Sets x 10 repetitions (each leg)
No. 8 Leg Raise Circles (clockwise and counter)
Using the same position as the straight leg raises, keep your legs straight and bring one leg off the ground. Hold the position in the air and make a small circular motion with your foot.
Make circles in a clockwise, then counterclockwise motion and return to resting position on the ground. Repeat with your other leg. Alternative motions can include figure eights or writing the alphabet in the air with your foot.
2 Sets x 10 circles each direction (each leg)
No. 9 Dual Leg Raises with Cross-over
Although this is still a beginner exercise it may be challenging initially. Lying on your back with legs straight out, raise both legs 2-3 inches off the ground.
Raise one leg slightly higher than the other leg, cross your legs, uncross, then repeat with the same leg under the other. Your legs will be crossing each other but shouldn’t hit each other.
You should feel your quadriceps and hip flexors engaged in this exercise and you may also feel flex in your lower abdominals. This is a great add-on exercise once you’ve mastered the other exercises above.
Depending on your repetitions, you should feel a burning sensation in your muscles – don’t worry, a burn is a good thing while sharp pain is bad.
2 Sets x 10 cross-overs
No. 10 Leg Raises on Stomach
This exercise differs from the others as it focuses on the back of your knee and your hamstrings and gluts (bum). Lying on your stomach you will do a similar movement by raising your straight leg off the ground 3-4 inches. In this position it’s not always easy to keep your leg straight, so a slight bend is okay.
Focus on flexing the muscles on the back of your thigh and bum and repeat with other leg.
2 Sets x 10 leg raises (each leg)
Upper Body Strength
Why is upper body strength important for knee replacement surgery? Upper body strength may seem unnecessary but it’s essential to be strong enough to move around after knee replacement surgery.
It’s even more important if you’re having 2 knees replaced as you’ll rely heavily on the strength of your arms to move around. Standing up from a meal, getting off the couch after watching a movie, getting up from the toilet and getting out of bed in the morning will require some form of upper body strength.
You’ll also need strength to hold yourself up with crutches, a cane, or a walker.
No. 11 Push-Ups (strength for getting up)
Push-ups are a functional exercise that will help you get out of bed in the morning. Any time you might need to push off, which includes getting up, push-ups will help. They engage the chest, anterior shoulders, and triceps.
If it’s been awhile since you did push-ups, start by doing them with your knees resting on the ground.
With your knees on the ground you’re lifting less body weight and you’ll be able to do more repetitions.
You can also modify push-ups by using a kitchen counter. With your feet apart, about 3 to 4 feet back from the counter you can do modified push-ups without getting down on the floor.
Once you’re strong enough to do several kitchen counter or knee push-ups, transition to full-length push-ups with the weight on your feet.
No. 12 Dips (strength for crutches)
Dips engage your triceps and lower chest. They are a great exercise for getting off the couch and up out of chairs. They will also help get you out of bed in the morning.
Dips can be done while sitting in a chair and using the armrests to push down and elevate yourself.
Dips can also be done using the couch. Sitting on the edge of the couch place your hands on edge of the couch.
With your legs together and straight, slide your hips off the couch with your hands/arms supporting your bodyweight. Allow your arms to bend and extend while your hips move in a vertical direction (toward the floor and up to the couch).
Balance For Knee Replacement Preparation
Balance will also be a key factor in your recovery and will help you avoid falls while you recover from knee replacement surgery. In the few weeks following your surgery, your body will be relearning how to move.
Early on, your new knee might be sensitive to pressure from the weight of your body. Having good balance will help your body handle the new knee. With relatively simple balance exercises you can improve a lot in a short amount of time.
No. 13 One Leg Stand (1 minute each)
We’ve all done this exercise since we were children. With your arms out to the side, lift one leg in front of you and balance on one leg. It helps to focus on something in your line of sight. Hold the pose for a minute and change legs.
No. 14 Eyes Closed One Leg Stand (30 seconds each)
Closing your eyes makes balancing slightly more difficult. Using the same form as above, close your eyes after you’ve raised one leg. Hold it for 30 seconds or longer and switch legs
No. 15 Line Walk (20 feet)
If you’ve ever been pulled over and tested for drunk driving, you’ll know this one. Most people don’t have a balance beam so a line on the ground must suffice.
Put one leg in front of the other and walk forward, staying on the line. If it’s a challenge, do it more often or try doing it while walking backward. If it’s easy, do it once a day to stay sharp.
Although motivation may be tough to find, exercising before knee replacement surgery is important for short-term recovery and long term health. If you’re in poor health going into your surgery, you can count on the recovery process being a challenge. If you’re in good health, it doesn’t mean you can skip your exercise preparations.
There are many simple exercises you can do to prepare. In this article I shared the most basic exercises for your whole body strength, leg strength, upper body strength, and balance.
I feel it’s wise to incorporate these into your daily routine 3-4 months before surgery. While leg muscle strength is key for joint recovery, don’t overlook the importance of cardiovascular health and stamina.
Once you’ve mastered the basics, check in with us for more advanced exercises to prepare for knee replacement surgery. We hope this article assists you as you prepare for TKR surgery.
Visit us for more articles about my experience and the helpful products I’ve used. Thanks for reading.
Note: During these exercises, if you feel pressure in your lower back you can put a towel under your back for support. A burning sensation in your muscles is generally a good thing while exercising. A sharp pain in your body, whether your back, leg, or knee, is not good. If you experience a sharp pain stop these exercises immediately. Talk to your doctor before trying these activities.