Total Knee Replacement Exercise Book

Patients Name: ___________________________________________ Surgeons Name: ___________________________________________ Date of Surgery: ___________________________________________ Physiotherapists Name: ___________________________________________

Immediate Postoperative Exercises

You may begin the following exercises immediately aer your surgery, as they are important for: Helping to prevent complications with your breathing. Helping to prevent blood clots in your legs. Increasing your circulation.

1. Deep Breathing and Coughing Exercises

Until you are up and moving well take at least 10 deep breaths, followed by a cough, every hour that you are awake.

2. Ankle Pumping
Move your feet up, down and in circles. Repeat 50 times every hour that you are awake.

3. Buock Contractions
Tighten your buock muscle and hold for a count of 5 seconds. Repeat ve to ten times, three to four times each day.

4. Static Quadriceps Strengthening

Tighten the muscle on the front of your operated thigh by pressing your operated knee into the bed.

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Learning to Move
Aer surgery, plan ahead. Take pain medication ahead of time. Exercise is a critical component of your recovery, particularly during the rst few weeks aer surgery. These exercises and walking will help to restore movement and strengthen your knee. The goal is for you to be able to resume activities.

Total Knee Replacement: Exercise Booklet

Weight Bearing:
Weight bearing is the amount of weight that the doctor wants you to put on your new knee. There are three dierent amounts. Usually your doctor will want you to fully weight bear. Feather or touch weight- Your operated leg touches the oor enough to help you balance. Do not put any weight on it. Partial weight bearing- Only a certain amount of weight can be put on your operated leg. Your physiotherapist will help you learn how much. Full weight bearing- You can put full weight, or as much as you can tolerate when standing or walking.

Using a Walker or Crutches:

Stand up tall and look ahead while you walk. 1. Move the walker or crutches forward rst, followed by your operated leg. Then move your unaected leg forward. 2. Put your weight on the walker or crutches to take the weight o your operated leg when you step onto it. Follow your own weight bearing instructions when using a walker or crutches.

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How to Manage Stairs

While you are in hospital, your physiotherapist will teach you how to climb stairs. 1. A handrail will make things easier and safer for you. Simply place one hand on the railing, and hold both crutches on the other side of your body. 2. If no handrail is available, use one crutch on each side of your body. Follow the same sequence as above. 3. As your knee range of motion and strength improves you will eventually be able to resume normal stair climbing

To go up the stairs:
Keep the cane/crutches with the operated leg. Start close to the boom step, and push down through your hands. Step up to rst step, the non-operated leg goes up rst. Step up to the same step with the operated leg and crutches, puing only the advised amount of weight through your operated leg.

To go down stairs:
Start at the edge of the step. Bring the cane/crutches and your operated leg down to the next step. Use upper body strength to support your weight and keep your balance. Step down to the same step with the non-operated leg, puing only the advised amount of weight through your operated leg.

Check your balance each time before proceeding to the next step.

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Beginner Exercises
These exercises begin during your hospital stay and continue on aer discharge.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

1. Static Quadriceps Strengthening:

Pull your foot towards your nose. Tighten the muscle on the front of your operated thigh by pressing your operated knee into the bed. Hold _____ seconds. Repeat _____ times.

2. Static Gluteal/Hamstring Strengthening:

Press the heel of your operated leg into the bed. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Repeat sets of each exercise 2 to 3 times a day.

3. Static Hamstring Strengthening:

Sit as shown with the operated knee slightly bent. Tighten the muscle on the back of the thigh by pressing the heel of the operated leg into the bed. Hold _____ seconds. Repeat _____ times.

4. Knee Bend with a Towel:

Lying as shown put a towel or sheet under your operated knee. Pull on the towel to bend your operated knee. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

5. Knee Bend (progression):

Bend your operated knee by sliding your heel towards your buocks. Hold _____ seconds. Repeat _____ times.

6. Straight Leg Raise:

Pull your foot towards your nose. Tighten the muscles on the front of your operated thigh by pressing your operated knee into the bed. Keep your knee as straight as possible and raise your leg about 6 inches o the bed. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Repeat sets of each exercise 2 to 3 times a day.

7. Quadriceps Strengthening Over a Roll

Place a roll under your operated knee. Raise your heel o of the bed. Straighten your knee as much as possible. Ensure you keep the back of your knee on the roll. Hold _____ seconds. Repeat _____ times.

8. Extension Stretch:
Place the heel of your operated leg on a small roll. Press your operated knee down toward the bed using your front thigh muscles. Place your hands above the knee (as shown) and press down to help maximize the hamstring stretch behind your knee. Do not bounce with your hand, rather hold the stretch. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

9. Knee Bend:
Lying as shown, bend your operated leg as far as possible. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Repeat sets of each exercise 2 to 3 times a day. These 3 dierent exercises can be used to improve your knee bend.
10 a) Siing on the bed or chair, slide your heel under the seat to bend your operated knee as much as possible. Hold _____ seconds. Repeat _____ times. 10 b) Cross the non-operated ankle over the operated ankle, and use it to help bend the operated knee. Hold _____ seconds. Repeat _____ times. 10 c) With your operated knee bent and your foot planted on the oor, slide your buocks forward in the chair to help bend your knee and feel a stretch. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

11. Siing Knee Extension

Siing on a chair, tighten the muscles on the front of your thigh (quadriceps) to straighten your operated knee. Lower your leg slowly and controlled. Hold _____ seconds. Repeat _____ times.

12. Siing Knee Straightening

Stretch your operated leg out with the heel on the oor. Push with your hands above the knee to straighten your knee as much as possible. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Repeat sets of each exercise 2 to 3 times a day.

13. Standing Hamstring Curl

Holding on to a support, bring the heel of the operated leg towards your buock. Remain standing up tall. Hold _____ seconds. Repeat _____ times.

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Beginner Exercises Continued

These exercises begin during your hospital stay and continue on aer discharge.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

14. Chair Rise:

Find a chair with armrests. You should be seated at a comfortable height with your feet resting on the oor. Sit at the edge of the chair, gradually standup to a count of 5 seconds, using your legs as much as possible. You may require assistance from the armrests to begin with. Gradually lower yourself back into the chair, using your legs as much as possible. Repeat _____ times.

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Exercises with a Physiotherapist

Your physiotherapist may decide to do these 2 exercises with you to help increase your range of motion

Repeat sets of each exercise 2 to 3 times a day.

15 Physio Assisted Knee Extension Stretch:

The physiotherapist will stretch your operated knee to help straighten it further.

16. Physio Assisted Knee Bending:

The physiotherapist will stretch your operated knee to help you bend it further.

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More Challenging Exercises

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

17. Knee Bend with Leg Press:

a) Place a sheet around the foot of your operated leg. Use it to help bend the operated knee up as shown. Hold_____seconds. Repeat_____times.

b) Start with you knee bent as in 17a. Slowly straighten your operated leg against the resistance of the sheet. Keep your heel on the bed. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day.

18. Hamstring Strengthening with Theraband:

Siing in a chair place a _________ coloured Theraband around the ankle of your operated leg. Slide your foot under the chair as far back as you can against the resistance of the Theraband. Slowly allow your leg to return to the starting position. Hold _____ seconds. Repeat _____ times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

19. Forward Knee Lunge:

Place the foot of your operated leg on a step. Lunge forward to bend the operated knee so that you feel a stretch. Hold on to support if needed. Hold_____seconds. Repeat_____times.

Helpful Tip: You can begin on a lower step and progress as able to a higher step.

20. Calf Stretch:

Holding onto support, place the operated leg back. Keep your operated leg straight and the heel on the ground. Be sure to keep your chest up tall. Feel a stretch in the calf. Hold_____seconds. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day.

21. Single Leg Balance

Aempt to balance on your operated leg. Begin by using a support.

Progression exercises:
1. Increase the amount of time you are balancing while using support. e.g. aim to balance for 20- 30 seconds. 2. Carefully try to balance without the use of a support. 3. Gradually increase the amount of time on one leg while NOT using support.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

22. Step Exercise:

This exercise is used to strengthen your operated leg so that in time you will be able to do stairs normally (e.g. one leg aer the other). Step up onto a _____ inch step with your operated leg. Step back down to the oor with your non-operated leg. Use support as needed. Keep your body up tall and do NOT lean your chest forward. Repeat _____ times.

Helpful Tip: Start with a lower step, and increase the step height as able. e.g. Begin with a 2-4 inch step. Progress to a 6 inch step, and then to a standard step height of 7-8 inches. Remember: This exercise is done the opposite way you were taught to do stairs. In the how to manage stairs section, we instructed you to use your non-operated leg to lead up the stairs and your operated leg to go down the stairs.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day.

23. Lateral Step Up:

Stand facing sideways with your operated foot on the step. Hold on to support as needed. Step up by straightening the operated knee. Repeat _____ times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

24. Quarter Squat with a Pillow:

Place your feet shoulder width apart, about 6-12 inches from the wall. Keep your toes pointing straight ahead and your back and shoulders against the wall. Lower yourself about one quarter to one third of the way down the wall while squeezing a pillow folded in half between your knees. Hold_____seconds. Repeat_____times.

25. Quarter Squat (progression):

Place your feet shoulder width apart, about 6- 12 inches from the wall. Keep your toes pointing straight ahead and your back and shoulders against the wall. With the weight back on your heels, slowly bend your knees. Lower yourself about one quarter to one third of the way down the wall. Ensure you slide straightdo NOT lean to one side. Hold_____seconds. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day.

26. Quadriceps Strengthening with a Theraband:

Loop a Theraband around your operated leg at the level of your knee. Straighten your knee against the resistance of the Theraband (as shown). Remember to isolate the movement to your knee only. (i.e. your trunk should not be shiing). Hold_____seconds. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

27. Weighted Knee Extension in Siing

Siing as shown, place a ____ weight in a bag and tie it around your operated leg above the kneecap. Ensure the weight is NOT directly on your knee. Allow your knee to sink towards the oor. You should feel a stretch behind your knee. Hold_____seconds. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day. 28. Chair Progression:

As the strength in your thigh muscles improves you will gradually be able to stand and sit without using the armrests. Repeat_____times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Total Knee Replacement: Exercise Booklet

Repeat sets of each exercise 2 to 3 times a day.

29. Balance Exercise:

Practice your ability to balance on your operated leg, using a wobble board if one is available. If you do not have access to a wobble board you may aempt this exercise using a pillow instead. Begin by holding on to a support. Gradually try to discontinue the use of a support and increase the amount of time you are able to balance on your operated leg Hold _____ seconds. Repeat _____ times.

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More Challenging Exercises Continued

When the beginner exercises become relatively easy you may start to progress to these more challenging exercises as tolerated.

Repeat sets of each exercise 2 to 3 times a day.

30. Stationary Cycling:

To start, adjust the height of the seat so that it is as high as possible when cycling. You should still be able to pedal safely. As your knee gets stronger you may gradually increase the resistance up to a moderate level and gradually increase the speed of cycling to make the exercise more challenging. Cycling can help you to improve range of motion, strength and overall tness level.

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Resuming an Active Lifestyle

Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance aer you leave hospital. Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.

Total Knee Replacement: Exercise Booklet

At 6 Weeks

At 12 Weeks

Not Recommended

Never

Driving

Bowling Outdoor cycling (not mountain biking) Tennis (doubles) Golf (on the course- suggest golf cart) Cross country skiing (classic only)

Downhill skiing Cross country skiing (skate style) Ice and inline skating

Singles tennis

Stationary bicycling

Jogging/running

Swimming Golf ( start at driving range) Gardening (use a pad under knee)

Squash/ racquetball

Mountain biking

Basketball

Sailing

High impact aerobics

Kayaking

Canoeing

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We hope this booklet has helped to give you the information you need on the exercises you will be doing aer your total knee replacement. The information comes from the knowledge and experience of your health professionals. Special acknowledgment to Sunnybrook Holland Orthopaedic and Arthritic Centre for sharing their exercise booklets.

Thunder Bay Regional Health Sciences Centre Total Joint Clinical Pathway Team
No part of this publication may be reproduced or transmied by any means, including photocopying and recording, or stored in a retrieval system of any nature without the wrien permission of the Thunder Bay Health Sciences Centre: 980 Oliver Road, Thunder Bay Ontario, P7B 6V4, (807) 684-6000 CS-PTED-SURG-80-A Total Knee Replacement - Exercise Booklet copyright 2007 Thunder Bay Regional Health Sciences Centre All rights reserved by Thunder Bay Regional Health Sciences Centre with permission from Sunnybrook Health Sciences Centre.

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