Week 3: Advanced Physical Therapy After Knee Replacement Surgery

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I was excited to transition from two weeks of in-home physical therapy to my first week of off site physical therapy. It was an unexpected convenience to have my first two weeks of therapy at my home but it was time to get out and about and begin socializing.

As I mentioned in earlier articles therapy started out tough but was rewarding. After two weeks of a daily routine on my bed, a chair and standing up, I was looking forward to something new outside my home.

I hoped to get some new exercises that included machines like a stationary bike, and leg press. I wasn’t disappointed.

After taking measurements of both legs and recording the data the physical therapist put me on a stationary bike.

Exercises After Knee Replacement With My Physical Therapist

  1. Bike Warm Up

stationary bike - advanced physical therapy after TKRThe physical therapist put me on a stationary bike for my first exercise. He adjusted the seat according to my height and made sure I could make a complete revolution with my surgical knee.

The resistance was set at level 2 which – in other words almost no resistance.

The first few revolutions were slow but once I warmed up I was able to complete 5 minutes on the stationary bike with little or no pain.  The exercise was meant as a warm up but also to gently bend my knee.

I was surprised that I could peddle a bike as well as I did.

  1. Leg Press

Next I moved to the Total Gym Machine (photo is slightly different machine). The machine was made famous in the 1990’s by Chuck Norris and his former wife Christy Brinkley.  The machine has stood the test of time because my physical therapist is still using it!

The physical therapist made adjustments for my height and assigned 30 leg presses with very little resistance. I was instructed to align my feet towards the top of the machine.

Make sure you’re using good cushion shoes for this exercise with good grip (also read my article on the best shoes after knee replacement)

With my feet higher on the press I’d put more pressure on my muscles and hips (if my feet were positioned lower there would be more pressure on my joint).

I started out with my legs almost but not quite straight and went down to about 90 degrees flexion. I was able to complete this exercise with no pain at all.  Once again, this helped with range of motion and I could control how much my leg bent.  The exercise was also for the muscles around my knee.

  1. Ankle Weights – Straight Leg Raises

    ankle weights - advanced physical therapy exerciseJPG

I moved from the Total Gym Machine to a low-lying table. The therapist put 3-pound ankle weights on my ankle.

He asked me to bend my good knee and position my foot down on the table (for support). He instructed me to keep my surgically repaired knee straight and flex my thigh muscles before raising the leg about 45 degrees off the table (check price for ankle weights on amazon).

This was a similar exercise that I was doing at home without weight. The increased weight made a difference but I had no problem doing the 30 leg lifts.

This exercise wasn’t for range of motion, instead it focused on the muscles around my knee, specifically the quadriceps muscles on my thigh.

  1. Ankle Slides – Straight Leg to Bending

knee replacement advanced exercise - ankle slideI remained on the table and the therapist instructed me to do “ankle slides”. From a straight leg position I kept my foot on the table and slid my heel back toward my butt as far as I could. Here is an article with more specific information on ankle slide exercises.

Each time I straightened my leg and relaxed before doing the next slide. I’ve been doing these at home but the ankle slid much better on the slick surface of the therapy workout table.

Bending the leg always caused some pain (5-7 on a 10 point scale). I did 30 ankle slides trying to get closer to my butt each time.

After the ankle slides I went to an elevated table and he had me do a few more ankle slides. He measured my flexion and extension. While measuring, he used his hands to help increase the flexion.

This was a bit painful. I measured 105 degrees flexion and -5 degrees extension.

He then massaged my knee with Free Up Lotion for 10 minutes. I did a few more ankle slides with his assistance then he remeasured my range of motion. This time I measured 113 degrees flexion and 0 degrees extension.

He suggested that a family member massage the knee before workouts at home. The massages made a difference in my ability to increase my range of motion while doing the flexion exercises.

  1. Leg Extensions with Hand Resistance

I moved to a higher table and the therapist had me dangle my legs over the side of the table. He had me extend my leg while he put a slight amount of resistance on the front my ankle with his hand.

I did 30 of these as he slightly increased the amount of resistance. I felt no pain.

  1. Leg Curls with Hand Resistance

Next I did leg curls off the side of the table while he again used his hand to create resistance with his hand on the back of the ankle for this exercise.

I did 30 repetitions while he slightly increased the resistance. I felt no pain

  1. Leg Hanging Off Table – Hip and Thigh Stretch

Next I let my surgical leg dangle straight off the side of the table. First the therapist pulled slightly down on my leg stretching the quads.

After ten repetitions he pulled up on my leg stretching the hamstrings with 10 repetitions. I felt no pain.

  1. Knee Massage

As I mentioned above the knee massage made it much easier to flex my surgical knee. The therapist made short strokes cupping his hand on both sides of my knee to begin with (5 minutes).

Then he began to make larger strokes from below my knee (distal to proximal) going along alternate sides of my knee all the way up to the middle of my thigh (5 minutes).

This loosened things up and I think it helped break up the scar tissue in the joint and on the scar area that is still healing.  Check out my article on the best massager in “things you need after knee replacement surgery“.

  1. Icing My Knee

ice pack after advanced knee replacement physical therapyAfter the exercises were completed the therapist elevated my knee on the table and applied an ice wrap to my knee for 10 minutes.  The physical therapist shared the best ice pack options for knee replacement and I bought one.

The ice felt very good after the workout. I went home and went for a mile walk and iced the knee again.

Ice as much as possible in between your exercise and workouts.  Icing pays off because it reduces inflammation and swelling and jump-starts the healing process.


During the first week of off-site therapy I made three visits to my therapist’s office. He repeated the same workouts all 3 days. He did not increase the time on machines, the weight I lifted or the number of repetitions I did.

The home therapist was very effective but it was nice to get a new workout to do 3 days a week. The therapist also said it was okay to go to my fitness center and do the same exercises on the days I did not see him.

I began going to the fitness center the next day and I continued doing my home workouts at least once a day. I enjoyed being able to use the stationary bike and the leg press.

At my fitness center I was able to do leg curls and leg extensions on machines using no resistance. I really felt like I had reached another milestone and looked forward to going to therapy.