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Curious about physical therapy after knee replacement surgery? In this article I’ll share my experience with TKR recovery. Physical therapy after knee replacement was aggressive (we started the same day as surgery!) but my initial sessions weren’t long.
I had a few sessions in the hospital that targeted my ability to function at home. Once I showed I could move around I was discharged from the hospital.
Following my hospital stay I had 7 visits at home with a physical therapist. The home therapy started off slow but the range of motion exercises ramped up quickly (and quite aggressively).
I was surprised to see how much progress I had made during the first two weeks of physical therapy (7 sessions). I was warned that the first few weeks would be painful and tough. I was not disappointed.
I kept hearing myself repeat the phrase I learned in high school athletics; no pain, no gain. Thankfully a good deal of gain came with the pain for me. Thus far the pain has been worth it.
Physical Therapy After Knee Replacement Surgery (In The Hospital)
My knee physical therapy in the hospital began just a few hours after I was moved into my room on the day of surgery.
My surgery was at 10:00am and my physical therapist came into the room at 4:00 pm. I was pleasantly surprised but questioned her if my knee could handle therapy so quickly.
I was first given instructions on leg and knee exercises to do while laying in bed. The therapist encouraged me to wiggle my ankles back and forth and in circles.
I believe these exercises increased circulation and engaged muscles that were “shocked” from surgery.
They asked me to flex and hold my butt muscles (glutes) for 5 seconds 10 times every hour.
As you can imagine I was hooked up to equipment and IVs after surgery. In order to stand up the nursing staff had to unhook the air cuffs on my legs and the ice cuff.
The therapist then had me sit up, then stand by the bed. With the support of my walker I alternately lifted each leg in a marching motion. I did this 10 times with each leg.
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I was able to use the walker to walk to the bathroom. This first walk was very short but I spent about 10 minutes in the bathroom standing up trying and finally succeeding to urinate for the first time.
That was the extent of my hospital therapy on day 1.
Physical Therapy After Knee Replacement Surgery (Day 2)
The next morning the physical therapist was back and eager to get me moving. She encouraged me to use my walker to go the restroom as a warm up walk.
She also encouraged me to sit up in a chair for breakfast. After using the restroom I walked with the walker down the hall passing about 4 rooms until I turned around and walked back to my room where I sat in my chair waiting for breakfast.
I was groggy from surgery and the pain medication but it felt good to move around and change positions.
After breakfast the therapist returned and gave me a choice to walk with walker to the physical therapy room or to ride in a wheelchair. I opted to walk.
It was a longer walk than I expected but I was able to walk to and from the therapy room. When I arrived at the therapy room I was given a “stair test” that consisted of walking up and down six steps.
Good leg up first and bad leg down first while keeping a tight grip on the handrails.
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Even though I don’t have stairs in my house I had to pass this test in order to be discharged. The walk back to my room completed the hospital physical therapy that I received.
It was aggressive and wasn’t easy but I believe it was good for my body and leg.
Aggressive Physical Therapy After Knee Replacement (Home Therapy)
Session 1 – Day 3 Post Surgery
After a couple of days sitting around and sleeping I was looking forward to activity even if it was going to be painful. When my therapist arrived she told me that the first meeting would be longer.
She needed to collect data and record it in her computer. She spent 15 minutes asking me questions and recording my answers.
Her questions were very similar to the questions asked at the doctor’s office and again at the hospital registration. After the interview she removed by original bandage from the hospital.
She inspected my wound and commented that there had been little discharge and she couldn’t see fluid oozing out of the wound. No infection, a good sign.
She cleaned the wound and applied another bandage, which she had brought. She gave me a spare bandage but told me I was unlikely to use it unless I saw unusual drainage.
She said she would take my staples out on day 12 and I’d be able to shower on day 13 (I gave myself sponge baths instead). During this first visit and every visit afterwards she took my temperature, pulse, breathing capacity and blood pressure and recorded each before starting my workout.
After taking my vitals she gave me a printed copy of exercises. I was to do these exercises on my bed and in a chair.
She rolled a towel and secured it with rubber bands and had me get a belt from a bathrobe to use with a couple of the exercises. We moved to the bedroom where she went over each exercise. I started by laying flat on my back on our double bed.
Before starting, I was instructed to roll my ankles and move them back and forth. Exercise one was to put my ankles on the rolled towel and to push down.
I used the rolled towel because I didn’t have a foam roller (pictured right). A foam roller would have been more firm for these exercises.
While doing this exercise she measured how far I was able to straighten my leg. She was surprised I was able to straighten it a full 180 degrees (my first success).
Physical Therapy After Knee Replacement Pictures:
Next I flexed my butt muscles while keeping my legs straight. I did this 10 times for 5 seconds each. Finally lying on my back she had me slide my ankle up towards my butt as far as I could and hold for 5 seconds. The pain began with this exercise!
After the first eight she had me put the robe rope behind my foot and told me to pull on the rope so I could increase the flexion (ouch). I moved back to my living room where she picked out a chair with arms and she moved it to the tile kitchen floor.
She had me sit in the chair and put a plastic bag over my foot to allow my foot to slide better. Holding the chair arms, I slid my foot back towards the chair as far as I could and held it for 5 seconds.
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After the eighth repetition she had me wrap by good foot around the bad ankle to help push it back even further. On repetition 10 she measured my flexion at 70 degrees!
It was painful but she said that 70 degrees was good for day one. Finally, she had me walk with my walker and she encouraged me to walk heel to toe and to push off with my toes.
She asked me to complete 3 sets of the printed workout daily and to ice after each workout.
The two-flexion exercises were painful but I felt like I had accomplished something on day 1. She encouraged me to work hard and that she would return in 3 days.
Session 2 – Day 6 Post Surgery
When the therapist arrived I had already completed one of my 3 daily workouts. After examining the incision and taking my vitals we started workout number 2.
To begin she added standing exercises to my existing routine. I was able to do these using our kitchen counter for support.
The extra exercises consisted of the following;
- Raising alternating knees up (marching) and holding in the up position for 5 seconds,
- Balancing on one leg and swinging legs to the side (10 repetitions),
- Pulling alternating legs up to my butt and holding for 5 seconds
- Balancing on tip toes then heels for 5 seconds (10 repetitions)
She watched and made positive comments during the routine. During the last exercise in the chair she measured by flexion again.
It was painful but I improved from 70 degrees to 88 degrees. She was very pleased and so was I. After completing my workout she took me on my first outside walk using walking poles.
I do not have stairs but I did have to step up and down at the elevated threshold at the front door. Just like the stair test at the hospital, bad leg down first and good leg up first.
I have an uphill driveway and I slowly edged my way down to a much flatter surface on the sidewalk. We walked to the end of the sidewalk and back, about 50 yards each direction.
She walked behind me encouraging me not to limp and to use proper technique. Before leaving she told me that she would order the staple remover and that it would be delivered to my house.
Session 3 – Day 8 Post Surgery
When she arrived she checked the staple remover box that had been delivered to make sure everything was in the package. She would be removing the staples in a few days.
Today she added a third set of exercises that I could do on the bed. The new exercises were all aimed at strengthening leg muscles while my leg and knee were straight.
During the last bed exercise she measured my flexion and it was only at 85 degrees.
We went to the final chair exercise where she again measured the flexion; with her encouragement and help I improved to 95 degrees. This was painful because she pushed on my leg.
It was my first pain level 10 on the 1 to 10 scale). She was very pleased and I was happy with the result.
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We took a longer walk together. I was still using my poles and we walked about 300 yards round-trip.
Session 4 – Day 9 Post Surgery
She was back the next day. I timed my pain medication so that it would be effective when she came. We did all 3 workouts and she decided not to measure my flexion since it had been only one day.
We went for a longer walk together. I carried the poles but was able to walk most of the time without them.
Before leaving she reminded me that she would be taking the staples out on her next visit.
She suggested that I put coconut oil or ointment on the incision the morning of her visit.
Session 5 – Day 12 Post Surgery
That morning I put ointment on my incision and was prepared for the staple removal. The therapist arrived and after taking my vitals she cleaned the wound and began taking out the 22 staples.
I didn’t feel pain at all and it took her about 5 minutes to complete the task. There was no bleeding or oozing during or after the removal of the staples.
She applied 8 Steri-Strips across the incision and told me they would all come off over time. She also advised me that I’d be able to shower for the first time 13 days after surgery.
She cautioned me not to let the shower water hit the wound directly. Next she called my doctor’s office and asked the nurse to set up my off site physical therapy at the therapist that I chose.
The next day I received a phone call from the offsite physical therapist who set up my first appointment.
The workout that day was routine until it came time to measure my flexion. It was painful but I improved to 98 degrees and was happy. We completed the session with another, longer walk.
Session 6 – Day 14 Post Surgery
I continued to do my workouts three times a day. I did not look forward to the workouts and was relieved at the end of the day when all 3 were complete.
On her next visit the therapist checked the wound and was happy with the way it looked.
She also mentioned the swelling had gone down quite a bit and that it almost looked like a knee again. After the workout I was able to bend my knee to 100 degrees. There is nothing like progress to lift your spirits.
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We took a longer walk together. I still carried my poles but I didn’t really need them. It was after this day’s session that I really felt like I could walk around the house without any support.
I kept a pole by my chair and by my bed just in case but I began to walk around the house on my own (very slowly at first).
Session 7 – Day 16 Post Surgery
This was my final home session of in home therapy. I finished with a bang. I was able to bend my knee 110 degrees!
Even with all the pain during the workouts, I felt that I had made a significant improvement over the seven sessions. The therapist was full of compliments. I thanked her for her help and she wished me luck with my new therapist.
I felt fortunate that the Physical Therapist was able to come to me. I was glad that during the early stages of recovery that I did not have to get in a car and drive for therapy.
My therapist was professional and very conscientious. She encouraged me and pushed me to make progress. Working with the therapist is one thing but the real gains come when you are working on your own with no oversight.
I had to fight thoughts of cheating and giving up. It is tough mentally to complete the workouts but for me the results were worth the pain (easier to say afterward).
I hope you have a positive experience with your hospital and home physical therapy. Pay attention to the therapist; follow directions, think positive and work hard.