Exercise Rehabilitation for Knee Replacements

Written by: Tom Eaton (Accredited Exercise Physiologist)

Knee replacements, also known as total knee arthroplasty, are increasingly common surgical interventions for individuals with severe knee osteoarthritis or other knee-related conditions. While this procedure can significantly improve pain, function, and overall quality of life, a proper exercise program is crucial for achieving optimal outcomes.
In this article, we will discuss the importance of exercise in the rehabilitation process after knee replacements to help restore optimal function and improve quality of life.


Exercise plays a vital role in knee replacement rehabilitation, helping patients regain strength, flexibility, and mobility.

Appropriate exercise programs can improve postoperative outcomes including strength, range of motion and activities of daily living, while decreasing pain and disability¹. Furthermore, exercise has been shown to enhance lower limb muscle strength, balance, and gait mechanics, ultimately increasing patients’ independence and reducing the risk of further joint deterioration and future surgeries².

Following knee replacement surgery, early stage exercises primarily focus on regaining range of motion and improving muscle activation.
Ankle pumps, quadriceps isometrics, and straight leg raises are frequently prescribed during the initial postoperative period to prevent complications such as deep vein thrombosis and muscle atrophy³. These exercises, performed under the guidance of a physical therapist, help stimulate circulation, reduce swelling, and initiate muscle activation without placing excessive stress on the healing joint.

Strengthening and Range of Motion
As patients progress in their rehabilitation, exercises shift towards strengthening and improving range of motion around the knee joint. Exercises such as leg press, squats, step-ups and hamstring bridges are commonly prescribed to rebuild quadriceps and hamstring strength4. These exercises can be modified to accommodate individuals with varying levels of fitness, knee function and pain. Additionally, incorporating closed kinetic chain exercises, such as wall sits and lunges, can provide functional strength gains and improve joint stability4.

Flexibility and Stretching
Maintaining or improving flexibility is crucial for optimizing knee replacement outcomes. Gentle stretching exercises targeting the quadriceps, hamstrings, calves, and hip flexors can help minimize joint stiffness, increase range of motion, and improve functional movement patterns5,6. Static stretching, where a muscle is stretched and held in a lengthened position for a specific duration, is commonly recommended during the rehabilitation period6.

Cardiovascular Exercise
Engaging in cardiovascular exercise is essential for overall health and well-being. In the context of knee replacements, low-impact activities, such as stationary cycling, swimming, and water aerobics, are recommended during the early stages of rehabilitation7. These activities provide cardiovascular benefits while minimizing stress on the healing joint. As patients progress, walking, elliptical training, and low-impact group fitness classes can be added to their exercise routine8. It is crucial to gradually increase exercise intensity and duration while monitoring pain levels and joint stiffness.

Balance and Proprioception
Balance and proprioceptive training should be incorporated into the exercise program after knee replacements. Exercises such as single-leg stance or tandem walking challenge the neuromuscular system, helping patients improve joint stability and reduce the risk of falls9. Proprioception exercises involving activities on unstable surfaces or balance boards, can further enhance joint position sense and dynamic stability9.

Exercise plays a vital role in the rehabilitation process following knee replacements, contributing to improved strength, function, and overall quality of life. Early stage exercises primarily focus on range of motion and muscle activation, gradually progressing towards strengthening, flexibility, cardiovascular fitness, balance, and proprioception. It is important for patients to consult with their healthcare providers to design an individualized exercise program considering their specific needs, abilities, and recovery progress. By adhering to evidence-based exercise protocols, individuals can enhance their recovery, restore knee function, and regain an active and fulfilling lifestyle. If you are interested in developing a post or pre-operative exercise program, please make an appointment with one of our Exercise Physiologists today.

1. de Groot IB. et al. Invesigating Subgroups of Patients with Knee Osteoarthritis: A Systematic Review of Within- and Between-Day Reliability of Physical Function Performance Measures. OARSI World Congress on Osteoarthritis. Paris: Osteoarthritis and Cartilage 2009.
2. Zeni JA. et al. Alterations in Quadriceps and Hamstrings Coordination in Persons with Medial Compartment Knee Osteoarthritis. J Electromyogr Kinesiol. 2010;20(1):148–54.
3. Rooks DS. et al. Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis Rheum. 2006;55(5):700–8.
4. Henriksson M. et al. Individualized Quadriceps Resistance Training to Improve Functional Ability and Decrease Impairment After Knee Arthroplasty. J Orthop Sports Phys Ther. 2012;42(12):1060–9.
5. Paoloni M. et al. Preoperative Functional Status is Associated with Return to Sport and Overall Physical Activity After Total Knee Arthroplasty: A Multicenter Cohort Study. Phys Ther Sport. 2017;29:24–31.
6. Crossley KM. et al. Targeted Physiotherapy for Patellofemoral Joint Osteoarthritis: A Protocol for a Randomised, Single-Blind Controlled Trial. BMC Musculoskelet Disord. 2008;9(1):122.
7. Roos EM. Et. al. Muscle Weakness, Afferent Activity and Therapeutic Exercise in Knee Osteoarthritis. Nat Rev Rheumatol. 2011;7(1):57–63.
8. Myers CA. et. al. Strength, Power and Implications for Functional Tasks Among Older Adults in Assisted-Living Facilities. J Strength Cond Res. 2013;27(3):719–25.
9. Rössler R. et. al. Motor Control of the Ankle during Point-to-Point Movements remains robust during Visuomotor and Somatosensory Disturbances. Neuroscience. 2016;312:174–88.