Do you have knee surgery scheduled? Are you wondering if there is anything you can do now to make your recovery easier? Whether it is a new or old injury you’ve been dealing with that made you schedule surgery, you can still benefit from preparing your body now with exercise! Knee surgery prehab exercises that focus on improving range of motion and strength have been shown to improve function not only before surgery but also after! This can potentially decrease hospital stay times and improve long-term function and quality of life! We have put together some of our favorite knee prehab exercises to jumpstart your road to recovery, better yet it may even have you reconsider surgery!

 

Knee Surgery Prehab Exercises: Surgery is Scheduled, Now What?

If you’re asking yourself this question watch this video! Maybe you recently injured your knee or you’ve been dealing with knee pain for a long time. Regardless, you’re looking forward to getting better and can’t wait to get started. Guess what – the time is now ➡️ knee surgery prehab exercises!

 

Are These Knee Surgery Prehab Exercises Right For Me & My Surgery?

Great question! We will be reviewing knee surgery prehab exercises that would be beneficial for those preparing for a total knee replacement, arthroscopic knee surgery for a meniscectomy/meniscal repair, and ACL reconstruction. We will be providing a few variations from low to high levels. The most important goal prior to surgery is to keep your knee moving, preserve knee mobility and leg strength, and if possible improve your knee ROM and quadriceps strength!

If any of these exercises are making things worse, you’re nervous about performing them, or you’re unsure if you should be doing them – consult with your surgeon and/or physical therapist.

 

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Range Of Motion (ROM) Exercises

Below you will find a comprehensive range of motion and mobility exercises that target various muscles, joints, and structures throughout the entire lower body. Improving range of motion and general mobility throughout the lower extremity can only aid with your recovery! Patella (kneecap) mobility is vital for optimal knee health and is a must amongst knee surgery prehab exercises. When the patellofemoral joint (the joint between the patella and the distal femur) is stiff, affected by degeneration, or is unhappy – the knee is unhappy. However, this joint is very easy to mobilize on your own!

 

Knee Flexion & Extension Prehab ROM Exercises

There are NUMEROUS ways to regain knee ROM prior to and after surgery. When it comes to ACL reconstruction, in particular, one of the best indicators for good post-operative outcomes is normalizing the range of motion PRIOR to the surgery itself. This is why, in addition to allowing swelling to decrease, surgery is usually held off for a bit after someone tears their ACL. Shown in the video are just SOME of the many ways we like to improve knee ROM. In general, we can classify the exercises as either PASSIVE, ACTIVE-ASSISTED, or ACTIVE range of motion exercises.

LISTEN: HOW TO KEEP YOUR KNEE STRAIGHT AFTER SURGERY

Passive exercises rely simply on gravity to do the ‘stretching’ work. Exercises like supine knee props, the bag hangs, or seated knee flexion all rely on gravity to stretch the knee. Active-assisted exercises incorporate active movement into the exercise, in addition to an external force like gravity, your other leg, or even another person’s body. An example of this is the supine knee flexion against wall exercise. Gravity is pushing Craig’s knee into flexion, while he contracts his hamstring at the same time to add a further stretch to the quads. Note that this exercise and others can easily be made passive if Craig doesn’t contract! Active range of motion exercises uses the agonist muscle to move into the range. Some examples of this are the long arc quad to achieve full knee extension (using quadriceps) or supine heel slide to achieve full knee flexion (hamstrings). Consult with your Physical Therapist to find the best combination of a range of motion exercises for YOU!

 

Hip Flexor Stretch

Sample Knee Rehab Program Exercise

The knee is designed to be a stable joint. However, it rests between two joints designed for mobility ➡️ the hip and the ankle. When you lack mobility at the hip and/or the ankle, stability at the knee joint can be affected. Thus maintaining hip flexibility is very important for knee health! It is also important to note one of the quadriceps muscles (the muscles on top of the thigh) is the rectus femoris, which crosses the hip joint. Maintaining optimal flexibility of the rectus femoris is especially important for patella mobility and patella health. Here is a great video demonstrating how to perform a supported hip flexor stretch while laying on your back. This is a must for knee surgery prehab exercises!

 

More Prehab Content For You!

 

Seated Knee Traction Mobilization With Ankle Weights

When dealing with long-standing knee pain from conditions including knee osteoarthritis and meniscus issues, performing knee traction on your own can be your best friend. This is because we are off-loading the knee joint, which itself or tissues within this joint may be irritated and sensitive.

How do you do this?! Get ankle weights set up around your ankle. Get set up sitting on the edge of a table as demonstrated in the video and simply relax! We recommend trying it out for 2-5 minutes at a time, if you perform this for longer, your knee may become irritated and sore.

This exercise is NOT recommended for anyone who is having ACL reconstruction surgery.

 

Knee Strengthening Exercises

Below you will find comprehensive strengthening and stability exercises that target various muscles and regions throughout the entire lower body. Improving strength and stability prior to surgery is extremely important to make recovery easier because you’re bound to lose strength after surgery!

 

ACL Prehab Routine

Here is a GREAT program featuring ACL reconstruction knee surgery prehab exercises. The rationale for prehab prior to ACL reconstruction is simple: to maximize the function and health of the knee prior to surgery. The stronger your knee is going into surgery, the stronger it will be when you come out. The goals of prehab are to ⤵️

⚫️ Control joint swelling and edema

⚫️ Regain normal knee range of motion (ROM)

⚫️ Regain a normal gait (walking) pattern

⚫️ Improve lower extremity strength and coordination

It has been demonstrated that patients who exhibit full knee extension ROM, absent or minimal swelling, and no knee extension lag during a straight leg raise before surgery have better surgical outcomes. The single most important variable to work on in prehab is SYMMETRICAL knee extension range of motion. Pre-operative range of motion is indicative of post-op range of motion, so restoring full symmetrical knee extension is vital if you hope to achieve full range of motion after surgery!

To control swelling and pain, elevate the leg and use icepacks around the knee. Try to straighten your leg as much as possible when icing and keep icing sessions no longer than 15 minutes. It’s extremely common to have limited ROM due to swelling and pain following surgery, and regaining full knee ROM (especially extension) can sometimes be extremely difficult. Therefore, regaining as much range of motion as possible prior to surgery is of paramount importance. Preoperative quadriceps strength is a significant predictor of knee function after ACL reconstruction, so it is extremely important to regain as much quadriceps strength as possible prior to surgery. Also, strength and control of the gluteal muscles play a huge role in preventing a future non-contact ACL injury, so strengthening the hip musculature should be implemented as well.

In a recent study by Shaarani et al 2013, they examined the effect of a 6-week prehab protocol that included strengthening exercises (with a focus on the quadriceps) to a group that did nothing before surgery. The prehab group reported improved knee function subjectively, as well as scoring better on the single leg hop tests at 12 weeks post-op. Putting in a little bit of time and energy into prehab has the potential to drastically improve your rehabilitation outcome in those ever-so-important first couple of months of intensive rehabilitation.

 

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Quad Sets

It’s time to wake up that quad! Quad sets are a staple amongst knee surgery prehab exercises. This exercise (quad set) is paramount to re-gaining active control of your quadriceps muscles, which is the muscle on the front of your thigh. After an acute or long-standing injury (which can also include surgery), there can be swelling in the knee joint. This swelling leads to a phenomenon called arthrogenic inhibition, in which there is an inability to completely contract a muscle despite no injury to the muscle or innervating nerve. To combat this, lots of practice and developing a new “brain-body connection” is required. Follow this foolproof guide to wake your quad back up!

✅ Laying on the ground or table and place a rolled up towel/shirt under your knee. This will act as a lever which will make it easier to activate your quadriceps muscle. Attempt to squeeze your quadriceps muscle using these cues ⤵️

1️⃣ Really focus on squeezing your quad

2️⃣ Sometimes touching the muscle, massaging it, or hitting it can help

3️⃣ Think about moving your kneecap up and into your hip socket

4️⃣ Push your knee down into the towel roll

5️⃣ Lift your heel off the table

6️⃣ Move your shin bone in the shape of a “J” by moving your knee down and your heel up at the same time

7️⃣ Squeeze both quadriceps at the same time Happy quad setting!

 

Long Arc Quad (LAQ)

Sample Knee Rehab Program Exercise

Knee extensions (or long arc quads) are hands down my favorite exercise for ANY knee patient. It is the single best way to isolate the quads and will find its way into my programming at some point during the rehab process. While glute/butt strength is super sexy, we know in the research that it’s really a lack of quad strength that is correlated with a host of knee pain syndromes or poor post-surgical outcomes: patellofemoral pain syndrome, ACL reconstruction, patellar tendinopathy, total joint replacements, knee osteoarthritis, etc. Thus, quad strengthening is a must!

Most people do not have a knee extension machine at home, nor do they have ankle weights. But they can in fact get a theraband to work the quads in isolation at home as part of the home exercise program.

Try this little tip I picked up from @mick.hughes.physio on how to set this up at home without theraband slippage. I honestly don’t know how I didn’t know this before. Mind blown 🤷‍♂️  I’ll be honest, I don’t actually know how strong that resistance is around peak knee extension in the video. I guessed around 80lbs because that’s what I remember maxing out around last time doing single leg extensions on my own.

If you’re having significant knee pain with this exercise and are waiting to have surgery for a ACL reconstruction, meniscus related procedure, or total knee replacement ➡️ either decrease the range of motion or DO NOT PERFORM

 

LISTEN: IMPORTANCE OF USING THE KNEE EXTENSION MACHINE IN REHAB

 

Hamstring Curl Variations

Hamstrings strengthening is a must when it comes to knee surgery prehab exercises. Want to learn how to start and progress a hamstring strengthening program only using sliders. Hamstring strengthening exercises are essential for knee health. Did you know the hamstrings act synergistically with the ACL to prevent excessive anterior tibial translation on the femur⁉️ Demonstrated in the video are levels 1-7 for progressively strengthening the hamstrings only using furniture sliders.

1️⃣ Concentric hamstring curl-ins

2️⃣ Concentric hamstring curl-ins➕bridge

3️⃣ Concentric hamstring curl-ins ➕bridge➕eccentric curl-out

4️⃣ Single leg hamstring curl-in➕bridge➕straight leg raise

5️⃣ Single leg hamstring curl-in➕bridge➕straight leg raise➕curl-out

6️⃣ Standing hamstring dominant eccentric Reverse slider lunge

7️⃣ Reverse slider lunge➕eccentric hamstring curl-out

We would recommend most individuals to stick to levels 1️⃣-4️⃣ at most! Don’t have sliders? No worries, just grab a towel/pillow sheet/or any piece of clothing and perform these same movements on wood/tile floor. The versatility of this progressive hamstring strengthening program is what makes it so feasible for anyone to perform anywhere‼️

 

Hip Strengthening Exercises

Hip strength is always a primary focus in knee rehab. If your knee cannot tolerate much load or exercise, now is the perfect time to ramp up hip-strengthening exercises if you can tolerate them!

Clams

Sample Knee Rehab Program Exercise

While gaining back knee range of motion is the biggest preoperative indicator for a successful ACLr surgery, maintaining proximal strength of your core and glutes is a way to jump-start post-surgery rehabilitation. Learning how to activate these muscles in addition to building up as much strength as possible prior to surgery means that once your knee is strong enough to squat, hinge, lift, lunge, etc, you won’t have to worry about other weak links in the functional chain – your core and glutes – getting in the way of your rehabilitation. Glute strengthening is a huge emphasis in knee surgery prehab exercises!

1️⃣Lie on your side, with your affected leg on top

2️⃣Slightly squeeze your core. Maintain this activation throughout the entire exercise

3️⃣Push your bottom knee into the ground to keep your pelvis stable

4️⃣ROTATE your knee out and back. You are not just lifting the leg up, but actually rotating it backward

5️⃣Your shoulders, torso, and pelvis should not be moving at all. Only your knee should be moving. Maintain a straight line from your shoulders to your hips. By looking at the starting and ending position of your knees, you can ensure that you are not compensating from your back

6️⃣You should feel a deep muscle burning in the back of your glutes

 

Stepping Exercises

Forward Step-up

Sample Knee Rehab Program Exercise

Stepping exercises have been included in knee surgery prehab exercise programs that have led to improved function and knee strength. The forward step-up and its variations are excellent knee surgery prehab exercise as it works on functional lower body strength with great carry-over to daily activities. That is why we added it to knee surgery prehab exercises! Demonstrated first is the forward step up followed by a reverse step down. Demonstrated is stepping up with the left and down with the right, working the left side.

The next exercise is reverse step-downs working on the left side. This is a small variation working the left side harder, which also may feel better on the knee as it limits shear forces. Lastly is the reverse step tap, keeping as much weight as possible on the left and just tapping the ground with the right. I love the cue “don’t crush the egg” and people get it!

Take Control of Your Knee Health

The knees are true hard-nosed blue-collar workers! They get the job done when the hips and ankles may be taking some extra rest breaks. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle.

 

References

1. Swank et al. 2011, “Prehabilitation Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis”. Journal of Strength and Conditioning Research, Vol. 25, No. 2, (December 2011)
2. Topp et al. 2009, “The Effect of Prehabilitation Exercise on Strength and Functioning After Total Knee Arthroplasty”. American Academy of Physical Medicine and Rehabilitation, Vol. 1, 729-735, August 2009
3. Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L et al (2016) Does extended preoperative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med 44:2608–2614.
4. Randall Cooper & Mick Hughes, “Melbourne Rehabilitation Guide 2.0”.

 

About The Author

Craig Lindell PT, DPT, CSCS

[P]rehab Co-Founder & Chief Content Officer

Craig is a South Jersey native & Penn State Kinesiology Alumni. When the opportunity came, Craig packed his bags and drove to California to pursue his Doctorate in Physical Therapy from the University of Southern California. With [P]rehab, Craig oversees all digital content creation and multi-channel publication that reaches millions of people on a weekly basis. As a PT, Craig has a wide array of experience from working with various neurological conditions to working with collegiate & professional athletes across the Big Five in North American sports. Experiencing physical therapy first-hand as a soccer player in high school, Craig has a passion & special interest in adolescent athletic development working with young athletes to overcome injuries. In his spare time, Craig enjoys exercising, playing golfing, hiking, traveling, watching Philly sports, and spending quality time with his family.

 

 

 

 

 

DISCLAIMER – THE CONTENT HERE IS DESIGNED FOR INFORMATION & EDUCATION PURPOSES ONLY AND IS NOT INTENDED FOR MEDICAL ADVICE.