TKR Physiotherapy program: building flexion and strength

This was something that I really struggled with. Please bear in mind that I have had absolutely no medication (pain killers or otherwise) since day 3 post op. This may well have slowed me down as I was unable to tolerate as much pain as someone who was on pain blocking medication. Nevertheless, here is the program I have followed.

I attended a ‘knee class’ and was given a program to start me off, but from there it was a lot like a circuits class with someone supervising overall but not giving individual direction. I have since added progression to the program using my own knowledge as a personal trainer.

Stage 1

When I first started the main focus was to get the knee bending as much as possible. As far as I understand, this was because it is a race against time – aka the scar tissue that forms, which you then have to break down.

Exercises I completed included:

• Stationary bike. To begin with you will be unable to rotate the pedals fully so rock them back and forth till you can. This could take weeks, so persevere. Also raise the seat as high as you can manage and still reach the pedals. This will help you to get going. Once you can get a rotation, lower the seat gradually. Also build up resistance gradually, and speed the pedalling up (do one or the other, not both!)
• Rowing machine. To start with, this will be very hard. Aim to bend the knees as much as you can when you let the chain retract, but to start with this will be very short strokes. Persevere because it takes a long time to warm up the scar tissue when you first start, so don’t give up after a few minutes!
• Stairs. To begin with you will need to use two rails and step up good leg first, the down bad leg first. Using shallow steps to start with, progress this till you can reverse that around.

Stage 2

Once these become easy, you can then progress to partial load bearing. Add these to the above program.

• Wall slide squats. Use a swiss ball, or simply a plastic bag against the wall if you do not have one. lower yourself as far as you can, try and make sure the load is even on both legs.
• Banded ham string curls. Do this standing up, lift operated leg up behind you and pull to encourage the stretch. I used a stretchy band around my ankle then pulled with the other arm. But, a towel would work just as well. Keep knees together.
• Seated heel slides. These are harder if you are sitting on the floor, easier if sitting on a chair. Put the operated leg heel on a sliding surface (again, a plastic bag works well, or some people use a skate board!)

Stage 3

Only progress to here when you can do the exercises above without pain.

• Assisted lunges. Hang on to a broom handle for example, so you have something to stabilise you and push down on. I found it easier to hold it on the other side to the operated leg. Only lower into the lunge as far as you can manage, aiming to progress the depth of the lunge as you get stronger. You might find that operated leg back is harder than operated leg forward, at first.
• Unbalanced wall slides. Now try and put more weight through the operated leg than the other. Progress this squat to at least 90 degrees, if not lower.
• Seated (and standing) leg lifts. Strap something heavy (like ankle weights) around the knee. Do this exercise both seated (keep knees together and don’t lift your thigh) and standing (straight leg raise out front, keep leg straight. With the straight leg raise, try to keep both hips level and don’t hitch that hip up when you lift the leg!
• Resisted ham string curls. Stand facing something you can anchor your band around, one end around lets say a table leg, the other leg around your ankle. Lift leg up behind you, keeping knees together, pulling against the stretchy band.
• Slow heel first step downs. This is the hardest of all so add this in last. slowly step off a step, leaving operated leg on the top of the step. Slowly touch your heel down, but do not step off the step, then lift yourself back up onto the step.

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As I said, there is not one exercise program that fits all, so please bear this in mind. Only progress through as much as the knee will allow. It doesn’t matter how long it takes. This all took me 5-6 months, and I know older less mobile patients were working through it much faster than me! The main thing is that you are making progress. 🙂