Physical Therapy - Knee

Exercise Program

Guidelines
Unless instructed otherwise by your therapist:

• Do these exercises 5 times each, 1 to 3 times a day.
• Increase to 10 to 15 repetitions of each exercise, 3 times a day, as tolerated.
• Do not hold your breath or bounce your leg while doing the exercises.

Exercises: Lying on Your Back
You may lie on your bed for these exercises.

• Ankle Pumps (Both Legs)
  
  Move your foot up and down.
• Quad Sets
  
  Push the back of your knee down against the bed and tighten the muscle on the front of your thigh. Hold for 5 seconds and relax.
• Gluteal Sets
  
  Tighten your buttock muscles. Hold for 5 seconds and relax.
• Hamstring Sets
  
  Bend your knee slightly. Pull your heel down into the mattress to tighten the muscles at the back of your thigh. Hold for 5 seconds and relax.
• Heel Slides
  
  Slide your foot along the bed and bend your knee. Slowly slide your foot down until your leg is straight again.
• Straight Leg Raises
  
  Keeping your knee straight, raise your surgical leg off the bed 1 to 2 feet, and slowly lower it. Brace yourself by bending your other knee and placing your foot flat on the bed. Remember not to hold your breath.
• Quadricep Set with a Stretch
  
  Place a small towel roll or pillow under your heel. Tighten the muscle of the top of your thigh by trying to press the back of your knee toward the bed. You should feel mild tension/stretch behind your knee. Hold for 10 to 20 seconds.
• Short Arc Quad
  
  Raise your leg and place a blanket roll or bolster under your knee. Lower your heel to the bed. Raise and lower your heel, leaving your thigh on the roll or bolster. When raising the heel, straighten your knee as much as possible. Repeat. Modify this exercise by using various sizes of rolls.
• Hip Abduction and Adduction
  
  Keep your knee straight and toes pointed upward. Bring leg out to the side and then back to the center.

Sitting Exercises

• Knee Extension/Flexion
  
  Raise your foot off the floor and straighten your knee as much as possible. Lower your leg to the floor slowly, then bend your knee as far back as you can.
• Larrick’s Exercise: Extension
  
  Cross your ankles, keeping your stronger leg beneath your surgical leg. Try to raise that leg to a straight position using your other leg to help. You should feel mild tension/stretch behind your knee. Hold for 10 to 20 seconds.
• Larrick’s Exercise: Flexion
  
  Cross your ankles, keeping your surgical leg beneath your stronger leg. Try to bend your surgical knee using your other leg to help. You should feel mild tension/ stretch in the front of your knee. Hold for 10 to 20 seconds.

Exercise and Activity Weekly Plan

The following pages are an outline of the exercises and goals for your recovery for the next 6 weeks. Share this with your therapist, and follow your therapist’s instructions.

• Do not stop using your walking aids until told to do so by your doctor.
• Do not use leg weights for 1 year after surgery.
• Avoid reclining in a recliner.

Follow the activity guidelines. Limit walking to 1 mile a day.

Week 1: Exercises

Do the following exercises. Your therapist will show you how. Check your own progress.

Exercises to do while lying down:

• Ankle pumps
• Quad sets
• Gluteal sets
• Heel slides
• Straight leg raises
• Short arc quads
• Abduction and adduction

Exercises to do while sitting in a chair:

• Active knee flexion and extension
• Active assisted flexion in chair (Larrick’s flexion)
• Active assisted extension in chair (Larrick’s extension)

Activity:

• Use walker or crutches as tolerated.
• Limit stairs to one round trip per day.

Week 1: Goals for Therapy

• Extend knee until it is straight with your heel supported.
• Flex knee as tolerated (at least 90°).
• Perform each exercise in your routine 10 times each, 3 times a day.
• Moderate swelling of your knee is acceptable.
• Goals for functioning independently — you should be able to:
  • transfer independently to and from your bed, chair, and commode.
  • do your home exercise program.
  • independently use ice and elevate your knee to reduce swelling as directed.
  • get in and out of a motor vehicle with minimal assistance.

Weeks 1 – 3: Exercises

Consult your therapist if you have any questions about your exercises.

Exercises to do while lying down:

• Ankle pumps
• Quad sets
• Passive knee extension
• Straight leg raises
• Heel slides
• Straight leg raises
• Short arc quads
• Abduction and adduction

Exercises to do while lying on your side:

• Side leg lifts

Exercises to do while sitting in a chair:

• Active knee flexion and extension
• Active assisted knee flexion and extension (Larrick’s flexion and extension)

Activity:

• Use walker or crutches for walking until your doctor tells you otherwise.

Weeks 1 – 3: Goals for Therapy

• Perform each exercise 10 times, 3 times a day.
• Straighten your knee fully with your heel supported.
• No greater than 10° extension lag during straight leg raise while lying on your back.
• Quad tone strength 3+/5.
• Fair quadriceps muscle tone.
• Moderate swelling of your knee is acceptable.
• Fair patellar (knee cap) mobility.
• Transfer from sitting to a standing position with full weight bearing on both legs.
• Independently walk using your walker or crutches.
• Walk at least 200 feet, 3 times a day.
• Independently get in and out of car.

Weeks 3 – 6: Exercises

Exercises to do while lying down:

• Ankle pumps
• Quad sets
• Straight leg raises
• Short arc quads
• Heel slides

Exercises to do while lying on your side:

• Side leg lifts

Exercises to do while sitting in a chair:

• Active knee flexion
• Active knee extension
• Active assisted extension and flexion in chair

Exercises to do while standing:

• Forward kicks
• Side kicks
• Backward kicks
• Marching in place
• Use walker or crutches for walking if needed

Stretching exercises:

• Extension on towel roll
• Slant board for ankle
• Knee flexion in chair with foot braced against wall

Ice and elevate your knee if swelling persists.

Weeks 3 – 6: Instructions

• Continue strengthening and stretching exercises at home.
• If extension is lacking, do passive stretching by propping heel on chair using 3–5 pounds over knee.
• Practice balancing without support with your eyes open and progress to having your eyes closed.
• Walk full weight bearing with straight cane on level surfaces.
• Continue with cane until you can stand on your surgical leg 10 seconds and you no longer walk with a limp.
• Begin varied lifelong exercise program such as biking, water activities, or walking.
• Patellar mobilization when needed.
• Scar mobilization when needed.

Weeks 3 – 6: Goals for Therapy

• 90° or more of active knee flexion
• 100° or more of active assistive knee flexion
• Full extension
• Independent home exercise program performed with control, 10 repetitions, 3 times a day
• Good quad tone
• Straight leg raise without extension lag
• Quad strength 4/5
• Short arc quad without extension lag
• Hamstring strength 4/5
• Minimal swelling in your knee is acceptable

Your goals for functioning independently

• Walk two blocks
• Walk normally
• Normal walking pattern with cane
• Sleep through the night
• Go up and down stairs without difficulty
• Perform activities of daily living independently

Weeks 6 – 8:Your Goals for Therapy

• Minimum of 110° active flexion
• Full extension
• Normal quad tone
• Quad strength 4+/5
• Trace to no swelling

Your goals for functioning independently

• Walk five blocks
• Stand on one leg for 10 seconds
• Normal walking pattern, with cane outside as needed
• Drive after instruction from your surgeon
• Get up off the floor
• Lock your knee
• Stand up from a sitting position without using your arms
• Perform your activities for daily living independently