Preparing for a knee replacement is key to a successful recovery. Research shows those who prepare their muscles have a better post surgery experience, which means less pain, more function and overall a better experience. Preparing for a surgery is called “prehab” or “prehabilitation”. Not only should you prepare your leg muscles before a knee replacement surgery, but you should strengthen your arm muscles and core muscles. A knee replacement is a tough surgery with a long recovery. It is always better to start preparing now than never!
Why does it matter?
Building strength before a knee replacement surgery can make the recovery easier. You will already have some muscle strength going into surgery, which can help make your daily routine much easier when you are in pain, using a walker, not sleeping well and relying on one good leg (maybe). Most patients before a knee replacement surgery have pain with exercise so it is very challenging to find an exercise routine that is doable. You will want to find a few exercises that do not cause significant pain when completing. We will cover specific exercises later in this article.
Stretching prior to a knee replacement surgery can also improve your overall range of motion. After a knee replacement, your recovery will have a large focus on regaining your knee bending and knee straightening. If you can improve your flexibility some before your surgery, that can make stretching much easier after surgery. Research shows that your pre-surgery range of motion (knee bending and knee straightening) can predict your post-surgery range of motion. However, at succeedcourses.com, we have seen many, many clients increase their range of motion way past their pre-surgery numbers in our Knee Bending Course and Knee Straightening Course.
Keeping active before a knee replacement surgery can also increase necessary blood flow to your affected knee. Increasing blood flow can help reduce pain, reduce swelling and improve your post surgery outcomes. Increasing blood flow to your muscles can also help speed up healing after your knee replacement surgery. Biking is a great activity to do before surgery, especially since this is a non-weight bearing activity that usually does not cause increased knee pain. Choose a recumbent bike over an upright bike if you have problems with your balance. If you need a space saving option, the DeskCycle under the desk bike is another great option. More information about this on the equipment page.
Practicing exercises prior to surgery can also boost your overall confidence post surgery. The more comfortable you are with your exercises, the better your posture surgery experience will be. There are a lot of unexpected variables that come after surgery including pain, lack of sleep, depression, lack of appetite and loss of independence, to name a few.
What muscles are most important?
The quads (the muscles in the front of the thigh) are by far the most important muscle group to strengthen and stretch prior to knee replacement surgery. The quads become severely weakened (research says 60% weaker) after a knee replacement surgery due to the traumatic nature of the surgery. During a knee replacement surgery, the surgeon has to separate the quads, flip the quad over so the surgeon can remove the bone and then sew the quad back together. Although there is no detachment of the quad muscle or cutting the quad muscle, the separation and moving of the muscles causes extensive damage, which results in significant muscle weakness. Focusing on quad strengthening prior to a knee replacement surgery can allow for better post surgery strength.
The quads are also very important for so many of our daily activities:
- Standing up from a chair
- Walking long distances
- Going up and down stairs
- Getting in and out of bed
- Getting on and off the floor
- Standing for long periods of time
- Getting on and off of toilets
After your knee replacement surgery, these common activities will be very difficult and often very painful. Strengthening your quad muscles prior to surgery can make these activities a little bit easier.
The hamstring muscles are also important to strengthen as well. While the hamstring muscles are not separated, flipped over and sewn together like the quads, they become severely disturbed after surgery. Often times, patients will experience back of the knee pain, limping and difficulty with straightening the knee due to hamstring weakness and dysfunction.
Some signs of hamstring dysfunction:
- Walking with a limp
- Difficulty with knee bending
- Back of the knee pain
- Back pain
Always make sure to address both muscle groups (quads and hamstrings) when planning your pre surgery exercise routine. Completing movements that strengthen both muscle groups can be more efficient and effective.
Knee exercises prior to replacement:
- Quad sets: Laying on your back, place a rolled up towel under your knee. Kick your foot up to the ceiling until the knee is straight. Lower foot back down to floor.
- Straight leg raise: Laying on your back, lift whole leg up towards ceiling with a straight knee. Lower back down to floor.
- Bridges: Laying on your back, bend both your knees and place feet on the floor or bed. Lift up your hips as far as you can then lower back down to the floor or bed.
- Standing kicks forward: Standing at the kitchen counter or back of a chair for balance support, kick your leg forward with your knee straight.
- Stand up sit down: Sitting at the edge of your chair, stand up fully and then sit back down.
Important Tip
It’s always better to do something rather than nothing. However, if you want to truly strengthen your leg muscles prior to surgery and truly make your post surgery experience better, less pain and have a quicker return to function, completing a variety of exercises that are challenging, yet doable is key. If you are doing the same exercises over and over, you may see a slight difference in your moblity and strength, but you cannot make key differences to change your post surgery experience.
As a knee replacement physical therapist, I have helped many clients prepare for their knee replacement with my online 6 Week Pre Surgery Exercise Class. If you need a thorough program to strengthen all the right muscles (legs, arms and even core), join the online class and get started right away!
