Regular exercise to regain mobility and strength in your knee and gradually return to your daily activities is important for your full recovery. The following guidelines will help you better understand the exercise and activity program. Early Post-Operative Exercises Begin the following exercises as soon as you are able. They may be uncomfortable at first, but they will speed up your recovery and reduce postoperative pain. Quadriceps Exercises Begin the day of surgery when the anesthesia wears off or on the first day after surgery. Lie flat on your back, tense your thigh muscles and try to straighten your knee for 5-10 seconds. repeat this exercise about 10 times in 2 minutes, rest for 1 minute and then repeat. Keep practicing until you feel tired. Ankle Pumps Begin after anesthesia has worn off on the day of surgery or on postoperative day 1. Hook the foot up and down, pulling the muscles in the front and back of the calf, and hold for 5-10 seconds. Exercise periodically for 2-3 minutes, 2-3 times per hour. Continue this exercise until full recovery is achieved and swelling of the ankle and calf has subsided. Straight Leg Raises Start 1-2 days after surgery. Lie flat on your back, straighten your knee, tense your thigh muscles and do your best to lift your lower leg off the bed, hold for 5-10 seconds and slowly lower it. Repeat until you feel tired. The same exercise can be performed in a sitting position: straighten the knee by tensing the thigh muscles, suspend the calf, hold for 5-10 seconds and lower slowly. Repeat until you feel tired. Repeat until you feel tired. Continue this exercise until the strength of the thigh muscles has been fully restored. Knee straightening exercises Start 1-2 days after surgery. Make a towel roll and place it slightly above the heel so that it is off the bed. Tighten the thigh muscles to straighten the knee as much as possible and keep it straight for 5-10 seconds. Repeat until you feel tired. Supported Knee Flexion Exercises in Bed Begin 1-2 days after surgery. Slide your foot toward your hip and flex your knee as much as possible. Hold maximum knee flexion for 5-10 seconds, then straighten. Repeat several times until you feel tired or the knee can be fully flexed. Seated Supported Knee Flexion Exercises Begin 1-2 days after surgery. Sit on the edge of the bed or in a chair with your thigh supported and place the healthy foot behind the heel of the surgical side for support. Slowly bend the knee backwards as far as possible. Hold this position for 5-10 seconds. Repeat several times until you feel tired or the knee can be fully flexed. Seated Unsupported Knee Flexion Exercises Begin 2-3 days after surgery. Sit on the edge of the bed or in a chair with your thighs supported and bend your knee as far as you can until you can place your foot on the floor. After resting your foot on the floor, slide your body forward to increase knee flexion. Hold for 5-10 seconds, then fully straighten the knee. Repeat several times until you feel tired or the knee is able to fully flex. Early Activity Shortly after surgery you will begin walking short distances and doing daily activities in your hospital room. This early activity will help you regain strength and mobility in your knee. Walking Starting 1-3 days after surgery. Walking properly is the best way to help your knee heal. At first, you will walk with the help of a walker or crutches. Your doctor will tell you how much weight you can put on the lower leg on the side where you had surgery. Put some of your weight on the walker or crutches to be able to stand with balance and comfort. Move the walker or crutches forward a short distance; then move the leg on the surgical side forward and keep the knee straight so that the heel touches the ground first. When walking forward, the knee and ankle will flex and the entire foot will land completely on the ground. Once this step is complete, the toes will lift off the ground and the hip and knee will flex so that the next step can be taken forward. Remember, the heel hits the ground first, then the whole foot, and then the toes leave the ground. Walk forward as gently and rhythmically as possible, without rushing. Adjust your stride length as needed for walking. As muscle strength and endurance improve, you can gradually increase the time you walk. You can gradually increase weight bearing on the lower extremity on the operative side. You can then transition to using a cane on the opposite side until you are walking without any assistance. When you are able to walk or stand for more than 10 minutes, your knee is strong enough to share weight without a walker or crutches (usually 2-3 weeks after surgery), and you can then use a single crutch or cane (use the crutch or cane on the non-operative side). Going up and down stairs About 1 week after surgery. The ability to walk up and down stairs requires strength and flexion. At first you will need to take one step at a time with the help of a handrail. Generally, you will go up the stairs on the healthy side first and down the stairs on the operated side first. Remember “good leg first, bad leg first”. Until your knee is strong enough, it is best to go up and down stairs with help. Don’t try too many steps and use handrails for balance. You can start taking one step at a time as your muscle strength increases and mobility improves. LATER EXERCISES AND ACTIVITIES Once you are able to be able to walk independently for some distance, your activities can be increased. Your knee is already weak from the pain before surgery and the pain and swelling after surgery. Full recovery can take from a few months to a year. The following exercises and activities will help you make a full recovery. Standing Knee Bending Exercises Stand up straight with the assistance of a walker or crutches and lift your thigh and bend your knee as high as you can. Hold for 5-10 seconds, then straighten your knee so that you land heel-first. Repeat several times until tired. Assisted Knee Flexion Exercise Lie on your back and place a loose towel around your ankles. Flex your knee and slowly pull it toward your hip with the help of the towel to increase the angle of flexion, holding for 5-10 seconds. Repeat several times until tired. Resistance Knee Exercises A weight can be added to the ankle during the above exercises. This resistance exercise is usually started 4-6 weeks after surgery. Start with a 1kg weight and gradually increase the weight as you regain strength. Pedal Bicycle Exercises Pedal bicycle exercises can be very helpful in regaining muscle strength and increasing mobility. Start by adjusting your seat height so that your knees are just about straight when your feet are on the pedals. Start pedaling backward, and when you are comfortable pedaling backward, start pedaling forward. As strength increases (about 4-6 weeks), gradually increase the resistance of the bike. Perform each exercise for 10-15 minutes, twice a day. Gradually increase to 20-30 minutes per session, 3-4 times per day. Pain and Swelling after Exercise For 3-6 months after surgery, you may experience pain and swelling in your knee after exercise and activity. This can be relieved by elevating the lower limb and applying ice packs (for about 15 minutes per session), or you can reduce the intensity of your workouts appropriately.