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The goal of physical therapy is to help you regain your strength, movement and improve your overall function after your knee replacement surgery. Regaining this strength and motion is crucial for your everyday tasks such as walking and getting out of bed. Physical therapy should start before your surgery, this is called prehabilitation, you can read more about prehabilitation here. You should continue to attend your physical therapy sessions until you have regained your function. This blog will address what you can expect from your physical therapy sessions.

Before Your Surgery

Two things you can expect before your surgery are: 1) Pre-surgery education and 2) Pre-surgery exercises.[1]

Pre-surgery education provides you with some baseline knowledge on what you can expect over the course of the surgery and can include topics such as:
1) The resources available to you to help you recover after surgery, for example, the rehabilitation programs in your area.
2) How to safely navigate your home environment
3) How to prevent falls and use assistive devices (To learn more about the importance of assistive devices check out this blog here).

Pre-surgery exercises have been shown to improve your recovery outcomes following surgery. One study that involved 44 people who underwent knee replacement surgery showed that those who received pre-surgery exercise programming had better outcomes after surgery.[2] The people were split into two groups of 22, where one group received a pre-surgery exercise program and one group did not. The people in the pre-surgery exercise group showed better knee strength, better knee range of motion, and better self-reported function after surgery. Range of motion describes the knees ability to bend and straighten.

After Your Surgery

Three things you can expect at your physical therapy sessions after your knee replacement include: 1) Targeted exercises, 2) Education, and 3) Modalities.[1]

Targeted Exercises

Prescribed exercises play a crucial role in strengthening the muscles around your knee and improving your ability to move your knee. At your first few sessions you can expect less demanding exercises, with the difficulty of the exercises gradually progressing throughout the weeks.

Examples of some early exercises include:

1) Knee extensions, as shown in the image directly below, to strengthen the muscles that surround your knee and help you regain range of motion at the knee.

Gathered from the Curovate App Knee Replacement Protocol Stage 1

2) Ankle pumps, as shown directly below, to help with circulation and prevent blood clots.

Gathered from the Curovate App Knee Replacement Protocol Stage 3

Examples of some advanced exercises include:
1) Bridge with alternating leg lifts (shown directly below)

Gathered from the Curovate App Knee Replacement Protocol Stage 16

2) Retraining your ability to perform functional activities such as walking. Retraining is done through a graduated walking program that builds your strength and mobility, progressing from in your home to outside. [3]

Education
After your knee replacement, you can expect further education at your physical therapy sessions.

Topics will likely include:
1) Knee replacement recovery timeline, to learn more click here.
2) What activities you can do, and what activities to avoid. To learn more click here.

Modalities
Modalities can be understood as tools used by physical therapists to help you optimize your recovery journey.

Examples include:
1) Cryotherapy
2) Neuromuscular electrical stimulation (NMES)

Cryotherapy is the practice of using low temperature, ranging from ice packs to colder alternatives, to help you with your pain management. One study looked at 306 people who underwent knee replacement surgery. Half received cryotherapy and the other half did not. [4] The people who received cryotherapy reported lower pain on a visual analog scale, a self-reported measure used to quantify pain.

NMES is a portable electrical device that is attached to your skin and is designed to send electrical impulses to your nerves and cause your muscles to contract. NMES is used to improve the strength of your muscles. One study separated 66 people into three groups.[5] Two groups received NMES, with each group receiving a different type of NMES, and one group receiving no NMES. Both groups that received NMES showed stronger quadriceps and improved performance on functional tests 4 weeks after surgery. An example of a functional test used was the 2-minute walk test, which measures a person's walking distance over 2 minutes.

Conclusion

Physical therapy plays a crucial role in helping you regain your strength and mobility after your knee replacement surgery. Physical therapy starts before your surgery. At these sessions you can expect education and exercise prescription. After your knee replacement surgery you can expect physical therapy for as long as it takes you to recover your functioning. At these sessions you can expect targeted exercises to regain your strength and mobility as well as modalities to help optimize this recovery journey.

Curious to learn more about knee replacements? In need of an effective guide to your recovery? Try the Curovate app, an evidence-based app that will provide you with a physical therapy plan, guided daily video exercises, and more to assist you along your journey to recovery! Download Curovate today by clicking the links below!

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Additional links

  • How does ice contribute to my recovery and should I use it?
  • Is it normal to still have pain after a knee replacement surgery?
  • What is a total knee replacement?
  • What is the Recovery Timeline for a Total Knee Replacement

    • References

    1. Jette DU, Hunter SJ, Burkett L, et al. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther. 2020;100(9):1603-1631. doi:10.1093/ptj/pzaa099

    2. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2864-2872. doi:10.1007/s00167-016-3985-5

    3. Dávila Castrodad IM, Recai TM, Abraham MM, et al. Rehabilitation protocols following total knee arthroplasty: a review of study designs and outcome measures. Ann Transl Med. 2019;7(Suppl 7):S255. doi:10.21037/atm.2019.08.15

    4. Rui W, Long G, Li G, Yang Y, Hengjin L, Zhenhu W. Effects of ethyl chloride spray on early recovery after total knee arthroplasty: A prospective study. J Orthop Sci. 2017;22(1):89-93. doi:10.1016/j.jos.2016.10.005

    5. Yoshida Y, Ikuno K, Shomoto K. Comparison of the Effect of Sensory-Level and Conventional Motor-Level Neuromuscular Electrical Stimulations on Quadriceps Strength After Total Knee Arthroplasty: A Prospective Randomized Single-Blind Trial. Archives of Physical Medicine and Rehabilitation. 2017;98(12):2364-2370. doi:10.1016/j.apmr.2017.05.005