Knee Conditioning Program

Purpose of Program
After an injury or surgery
return to daily activities
enjoy a more active, healthy lifestyle
return to sports and other recreational activities.
Should be performed under doctors supervision ensure that the
program is safe and effective.
 Strength:
reduce stress on your knee joint
help the knee joint absorb shock.
Flexibility:
restoring range of motion
preventing injury
reduce muscle soreness and
keep the muscles long and flexible
 Target Muscles:
Quadriceps
Hamstrings
Abductors
Adductors
Gluteus medius and gluteus maximus
 Length of program:
4 to 6 weeks,
can be continued as a maintenance program
two to three days a week maintain strength and range of motion in your
knees.
Getting Started
Warmup:
5 to 10 minutes of low impact activity, like walking or riding a stationary
bicycle.
Stretch:
After the warm-up stretching exercises strengthening exercises
repeat the stretching exercises
Do not ignore pain:
You should not feel pain during an exercise
Ask questions:
If you are not sure how to do an exercise, or how often to do it, contact your
doctor or physical therapist.
Stretching Exercises
Strengthening Exercises
Total Knee Replacement Exercise Guide
When to Start
Most patient begin exercising their knee the day after the surgery.
Some patient usually start the programme as soon as they are able.
Early Post Operative Treatment
Quadriceps Sets
Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10
seconds.
Repeat this exercise approximately 10 times during a two minute
period, rest one minute and repeat. Continue until your thigh feels
fatigued.
Straight Leg Raises

Tighten the thigh muscle with

your knee fully straightened on
the bed, as with the Quad set. Lift
your leg several inches. Hold for
five to 10 seconds. Slowly lower.

Repeat until your thigh feels

fatigued.
You also can do leg raises while .
Ankle Pumps

Move your foot up and down rhythmically by contracting the calf and
shin muscles. Perform this exercise periodically for two to three
minutes, two or three times an hour in the recovery room.
Continue this exercise until you are fully recovered and all ankle and
lower-leg swelling has subsided.
 Knee Straightening Exercises

Place a small rolled towel just above your heel so that it is not
touching the bed. Tighten your thigh. Try to fully straighten your knee
and to touch the back of your knee to the bed. Hold fully straightened
for five to 10 seconds.
Repeat until your thigh feels fatigued.
 Bed-Supported Knee Bends

Bend your knee as much as possible while sliding your

foot on the bed. Hold your knee in a maximally bent
position for 5 to 10 seconds and then straighten.
Repeat several times until your leg feels fatigued or until
you can completely bend your knee.
 Sitting Supported Knee Bends

While sitting at bedside or in a chair with

your thigh supported, place your foot
behind the heel of your operated knee for
support. Slowly bend your knee as far as
you can. Hold your knee in this position for
5 to 10 seconds.
Repeat several times until your leg feels
fatigued or until you can completely bend
your knee.
 Sitting Unsupported Knee Bends

While sitting at bedside or in a

chair with your thigh supported,
bend your knee as far as you can
until your foot rests on the floor,
hold from 5 to 10 seconds, then
straighten your knee fully.
Repeat several times until your
leg feels fatigued or until you can
completely bend your knee.
 Early Activity

Advance your walker or crutches a short distance;

then reach forward with your operated leg with your knee
straightened so the heel of your foot touches the floor first.

Remember, touch your heel first, then flatten your foot, then
lift your toes off the floor.
 Stair Climbing and Descending

At first, you will need a handrail for support and

will be able to go only one step at a time.
Remember, "up with the good" and "down with
the bad."

Stair climbing is an excellent strengthening and

endurance activity. Do not try to climb steps
higher than the standard height (7 inches) and
always use a handrail for balance.
Advanced Exercises and Activities

Standing Knee Bends

Standing erect with the aid of a

walker or crutches, lift your thigh and
bend your knee as much as you can.
Hold for 5 to 10 seconds. Then
straighten your knee, touching the
floor with your heel first. Repeat
several times until fatigued.
 Assisted Knee Bends

Lying on your back, place a

folded towel over your
operated knee and drop the
towel to your foot. Bend your
knee and apply gentle pressure
through the towel to increase
the bend.

Hold for 5 to 10 seconds; repeat

several times until fatigued.
Goal of Rehabilitation
Day 1-2 Day 3-5 Week 2-4 Week 4-6 Beyond
Week 7
Able to transfer an Straight leg Reach 90 of knee Patient able Able to drive
ambulation flexion to do the a car or other
progressive daily activities
resistance
exercise

ROM exercise
ACL Reconstruction PostOperative
Rehabilitation Protocol
Phase I: 1 14 days
Goals
Protect graft and graft fixation with use of brace and specific exercises
Control inflammation and swelling
Early range of motion (ROM) with emphasis on full extension, patella mobilizations
and flexion. Caution: avoid hyperextension greater than 10
Educate patient on rehabilitation progression
Restore normal gait on level surfaces
Brace
Postop brace worn locked in extension for ambulation and sleeping
May unlock for ROM exercises
Weightbearing status
Weightbearing as tolerated with crutches and brace locked in extension
If meniscal repair or microfracture, nonweightbearing for 4 weeks
 Exercises
Continuous Passive Motion (CPM) machine 2 hour sessions, 3 times a day at
slow, comfortable speed. Start at 50 of flexion, and increase 10 per day up to
90
ROM exercises (see figures below)
Extension no active terminal extension from 40 to 0
Passive extension sit in a chair and place your heel on the edge of a stool or chair; relax thigh muscles
and let the knee sag under it's own weight until maximum extension is achieved.
Heel props place rolled up towel under the heel and allow leg to relax
Prone hangs lie face down on a table/bed with the legs hanging off the edge of the table; allow the
legs to sag into full extension.
Flexion limit to 90
Passive flexion sit on chair/edge of bed and let knee bend under gravity; may use the other leg to
support and control flexion
Wall slides Lie on your back with the involved foot on the wall and allow the foot to slide down the wall
by bending the knee; use other leg to apply pressure downward.
 Heel slides Use your good leg to pull the involved heel toward the buttocks, flexing the
knee. Hold for 5 seconds; straighten the leg by sliding the heel downward and hold for 5
seconds.
Quadriceps sets in full extension
Straight leg raises in brace locked in extension
Hamstring sets
Patella mobilization
Isometric hip abduction, adduction
Ankle ROM and gastocsoleus strengthening with tubing/therabands
Phase II: Weeks 3 6
Goals
Restore normal gait with stair climbing
Maintain full extension, progress toward full flexion range of motion
Protect graft and graft fixation
Increase hip, quadriceps, hamstring and calf strength
Increase proprioception
Brace
May wean out of post brace when demonstrate good quad control
Weightbearing status
Weightbearing as tolerated, wean off crutches
 Exercises
Continue as above, maintaining full extension and progressing to 125
No active terminal extension from 40 to 0
Begin closed kinetic chain exercises
Stationary bicycling, stairmaster: slow, progressing to low resistance
Hamstring curls
Hip abduction, adduction, extension
At 4 6 weeks, partial squats, use table for support
Phase III: Weeks 6 12
Goals
Full active range of motion
Increase strength
Exercises
Stationary bicycling, stairmaster, elliptical: increases resistance
Treadmill walking
Swimming, water conditioning: flutter kick only
Balance and proprioceptive training
Closed chain quad strengthening: no knee flexion greater than 90 with leg
press
Phase IV: Months 3 6
Goals
Improve strength, endurance and proprioception
Begin agility training
Brace
Functional ACL brace
 Exercises
May start jogging program, forward/straight running only
Continue and progress strengthening
Progress to running program at 5 months
Begin agility training at 5 months
Side steps
Crossovers
Figure 8 running
Shuttle running
One leg and two leg jumping
Cutting
Acceleration/deceleration/sprints
Agility ladder drills
Initiate sportspecific drills as appropriate
Phase V: 6 months postop
Goals
Maintain strength, endurance and proprioception
Safe return to sport
Brace
Functional ACL brace for contact sports, jumping and landing or cutting and
twisting until 1 year postop, then per patient preference
Exercises
Gradual return to sports participation
Maintenance program for strength, endurance
 Return to sports criteria
MD clearance
Full range of motion
No swelling
Good stability on ligament testing
Full strength compared to other leg
Completed sportspecific functional progression
Running and jumping without pain or limp
EXERCISE FIGURES
 Thank you