You’re home from surgery. Walker in the hallway, ice pack in the freezer, and a sheet of exercises from the hospital that doesn’t say much about the bigger picture. What does doing this right actually look like over the next month and a half?
What everyone gets told
Bend the knee as much and as often as possible. Get off the crutches the second you can get by without them. Push through some pain, because recovery is supposed to hurt.
That’s roughly the advice most people walk out of the hospital with. Most of it doesn’t hold up well once you look at how rehab actually plays out.
What actually matters
Pain and swelling control comes first, always. Once that’s settled, 3 things matter more than people expect.
Extension beats flexion, long term. Everyone tracks how far they can bend the new knee. Fair enough, it’s the easy number to measure. But a knee that straightens fully changes how you walk and how well your quad works far more than a few extra degrees of bend. We’re aiming for flexion past 100 degrees, ideally 120 or more, but extension gets equal billing. A knee that bends well but still sits slightly bent when you stand still has work to do.
Muscle weakness after surgery has a specific cause. Swelling and pain trigger something called arthrogenic muscle inhibition. Your nervous system dampens the signal to your quad and glutes to protect the joint. Loading up with heavy exercise too early usually backfires. What works is frequent, low-effort activation: simple squeezes, held and released, done often through the day. For people really struggling to get the muscle firing, we sometimes use NMES (muscle stimulation) or blood flow restriction training to bridge the gap.
How you walk matters more than how fast you drop the walking aids. Hobbling around without your cane or walker just to prove you don’t need it builds a limp that takes weeks to unlearn later. Stay on the gait aid until your walking pattern is smooth and even, not until you’re technically capable of a few steps without it.
What to do each week
Keep pacing your activity and icing regularly. Get your hands on an ice machine if you can- its a game changer.
Practice extension daily: heel props, prone hangs, whatever your physio has set you up with. Give it the same attention as flexion if not more! Some experts encourage 1 hr a day of extension work after knee surgery.
Do short, frequent quad and glute squeezes. Ten seconds, several times an hour, beats one long session at night.
Walk with your gait aid until the pattern is genuinely smooth, then progress off it gradually.
Don’t neglect the rest of your body. Your upper body, core, and other leg are picking up slack right now. A few minutes of general strength work for those areas pays off later.
Get through the first 6 weeks like this and most people are in a strong position, whether the goal is comfortable daily walking or getting back to sport.
If you’re in Collingwood and working through a knee replacement, or something about your rehab doesn’t feel like it’s tracking the way it should, reach out to the team at The Physio Hub. We’re happy to take a look and help you figure out the next step.
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by Matt Sheldon, Registered Physiotherapist.