Dr. Troy Miles
How to Improve Range of Motion After Knee Replacement Surgery
Nearly five million Americans are living with artificial knees, and roughly 150,000 undergo knee replacement surgery in the U.S. each year. For these men and women, and the many others suffering from debilitating joint pain, total knee replacement surgery can be a life-changing event. However, surgery by itself will not typically produce the results most patients are looking for when it comes to improved range of motion. Achieving those results takes hard work at home and at the physical therapist’s office starting almost immediately after surgery is complete.
Knee motion is closely correlated with how functional the knee is after recovery from knee replacement surgery. It is not related to how well a surgery went in the operating room. In order to regain total range of motion after knee replacement surgery, patients should expect to put in a fair amount of work at home and at the physical therapist’s office.
Why do some patients have trouble getting their knee motion back after surgery? For one thing, there is only a small window of time after surgery when knee motion can be improved with stretching exercises, and once that eight to 10 weeks passes, and the scar tissue has formed, it is incredibly difficult to make any real progress.
With that being said, the first eight weeks following surgery are also the most painful, so doing the necessary exercises to improve range of motion during that timeframe can be extremely challenging. Another challenge is that you don’t want to overdue your stretching exercises while your body is still healing. Ideally, you should be going just beyond your comfort limit, so you know you’re making progress, but not so far that you’re putting yourself in real pain.
Here are five additional tips for anyone recovering from knee replacement surgery.
1) Use pain pills to your advantage. Pain medicines can take the edge off during the initial recovery period after surgery, allowing people to maximize their stretching exercises to regain full knee motion. I typically recommend that patients take their prescribed medications 30 to 60 minutes before their physical therapy sessions. This gives the medication time to reach its maximum effect, so patients can participate fully in therapy. This same concept applies when you’re working on range of motion at home. It’s best to take your pain medications a half-hour to an hour before you plan to work on your stretching exercises, because that’s when they will have the most impact.
2) Practice bridging your knee. One of the hardest aspects of regaining range of motion following surgery is achieving full knee extension. One way to work on this is by literally kicking your feet up on a coffee table while sitting on a nearby chair or couch, so you have nothing supporting your knee from below. Gravity helps in this situation by pulling the knee straight down and maximizing the stretch.
If you don’t have a chair and coffee table that will work for this exercise, then I recommend putting one foot on top of the other to get the same effect. You can also use weights. What you’re looking for here is a slow, constant, forward pressure. Continue that for 30 seconds, then rest and repeat.
Bridge stretches can be started immediately following surgery, however you don’t want to progress too quickly. By two weeks post-surgery, your knee should be at 90 degrees. For those first few weeks the only thing keeping your knee together is stitches, or sutures, and you don’t want to stress those stitches out too much, otherwise you can pop them open. So, 90 degrees by two weeks post-surgery is adequate, and then you can go forward from there.
3) Try using a rolling chair. Rolling chairs are nice because they give you a way to use your own body weight to slowly advance range of motion with your knee. Try sitting on the edge of a rolling chair, then planting your foot firmly on the ground and rolling the chair forward so it advances your knee motion. Once you reach the peak, slowly roll the chair back again. You can do this exercise for about 30 seconds, then rest in between sets.
4) Therapy doesn’t end at the physical therapist’s office. Many people have the misconception that therapy is only done at the twice-a-week therapy sessions they have with their physical therapists. This is the wrong way to think about physical therapy. In-office sessions are meant to serve as a time to practice new exercises and make sure those exercises are being done with proper form. Real therapy, the type that increases range of motion and produces the results people care about, is done at home. I recommend doing range of motion exercises at least three to four times each day. A physical therapist can help you come up with more exercises, as well. Part of each therapy session should be spent guiding you on your at-home exercise program.
5) Understand that there’s a deadline. The first eight to 10 weeks after surgery is the only time when you can really make big improvements to your range of motion. After that period of time, scar issue has formed and it’s unlikely that you will make much more progress with how well you can move your knee. Don’t be afraid to get in there during that time, but always use pain as your guide and avoid overdoing it by putting too much pressure on your joint.
There is no such thing as a “quick fix” when it comes to joint replacement, and hard work is required of patients who want to see the best outcomes following surgery. Knee replacement surgery can help restore a pain-free joint, and it can also help to restore range of motion, but most people cannot achieve the results they desire through surgery alone.
For more information about regaining knee motion after surgery, contact my office in Redding, California, and schedule a consultation appointment.