20 Jan Knee Surgery Prehab Exercises
Knee surgery prehab exercises that include range of motion and strengthening exercises have been shown to improve strength and function prior to surgery, improve strength and function after surgery, 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 spare you from surgery for the time being. Continue reading!
Knee Surgery Prehab Exercises
I have knee surgery scheduled, now what?!
Are you asking yourself this question? 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 Exercises 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. *NOTE* We will be providing a few variations from low to high level. 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.
Range Of Motion (ROM) Exercises
Patella (kneecap) Mobility
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!
First, begin sitting up with the leg to be mobilized completely straight with the quad muscles relaxed. This will maximize the ability for the patella to move. I like to go with 2 fingers on each side, if very stiff you can leverage your palm to create additional force. Shown here is patella movement in the 4 main motions (superior/inferior/lateral/medial). Be sure to work all four directions, and spend extra time on any directions that feel extra stiff. We recommend holding the position for at least 10 seconds, and repeating at least 5 times!
Knee Flexion & Extension ROM Exercises
There are NUMEROUS way 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 range of motion PRIOR to 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.
Passive exercises rely simply on gravity to do the ‘stretching’ work. Exercises like supine knee props, 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 use 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 range of motion exercises for YOU!
Standing Hamstrings Stretch
Do you feel like your hamstrings are limiting your knee extension ROM?! It is not uncommon for the hamstrings muscles to guard after an acute injury or to lose hamstrings flexibility as we get older. Here is a detailed video with great verbal instruction demonstrating how to perform a standing hamstring stretch.
Hip Flexor Stretch
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!
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Comprehensive Calf Mobilization
It is not uncommon to experience knee pain/discomfort if you have issues with calf flexibility! Here is a great video with demonstration and verbal instruction how to mobilize your calf!
1️⃣ I begin this 3 part calf mobilization sequence by 1-2 minutes of soft tissue mobilizations using a foam roller underneath my calf. You have the option of putting additional load with the other leg to make this mobilization more aggressive. You can go with or against the fibers.
2️⃣ Static stretching ⤵️
✅Gastrocnemius- Keep the knee straight as your dorsiflex (bring the foot towards your body) to maximize stretch of this muscle
✅Soleus stretch- Bend the knee slightly to target this muscle. 🔑Avoid letting the foot collapse in (pronating) the lizard is used here as an EXTERNAL CUE To avoid the collapse! Don’t squish the 🦎❗️ ✔️Perform either one of these for 2×30 seconds
3️⃣ Dynamic 3D Calf Mobility ➡️ while keeping the back leg loaded, begin moving in different directions, this is a dynamic mobility drill for the calf. I like to go to the left, middle, and right for at least 5 rounds. This is a great finisher after performing your knee surgery prehab exercises.
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 than that your knee may become irritated and sore.
This exercise is NOT recommended for anyone who is having ACL reconstruction surgery.
Knee Strengthening Exercises
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 months of intensive rehabilitation.
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 phenomena 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)
🏋️♂️ 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 it’s 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
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 the 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‼️
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Foam Roll Hamstring Curls
Don’t have sliders at home but you have a foam roller? Demonstrated in this video is a solid alternative using a foam roller compared to the traditional leg curl machine, standing leg curls, and slider exercises. The focus here is knee flexion from about 90-120 degrees. Did you know there is a hamstring muscle (biceps femoris short head) that only performs knee flexion⁉️ The rest of the hamstrings also help with hip extension, thus performing this exercise while maintaining an isometric bridge helps to target the hamstrings as well. Try this exercise for 3-4 sets of 30-60s and your hamstrings will be on 🔥
Hip Strengthening Exercises
The bridge is a FUNDAMENTAL hip strengthening exercise, especially for those that cannot tolerate standing, weight-bearing exercises due to knee pain.
Progressions and one (of many) rationales ⤵️
2️⃣Bridge taps for introduction of single limb loading and introduction of transverse plane loading through the hip as well as the core
3️⃣Single leg bridge with leg supported. While not encouraged, the patient can still derive some stability from the top leg pushing into the bottom leg
4️⃣Single leg bridge unsupported with short lever. Shorter lever is easier
5️⃣Single leg bridge unsupported with long lever. Longer lever is harder.
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 backwards
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
Side Lying Hip Abduction
When clams are getting easy or you want to mix it up, add this to your knee surgery prehab exercises!
1️⃣ Lie on your side with your affected leg on top
2️⃣ Bend your bottom leg
3️⃣ Slightly squeeze your core. Maintain this activation throughout the entire exercise
4️⃣ Push your bottom knee into the ground to keep your pelvis stable
5️⃣ Straight your top leg and lift it up and back. The key is that your are not just lifting the leg up, but also BACK a bit
6️⃣ You should feel a deep muscle burning in the back of your hips where your glutes are, not in the front of your hips. If you feel it in the front of your hips, make sure your hips are pointed directly ahead of you and not up to the sky, and also check that you are lifting the top leg backwards
Calf Strengthening Exercises
One of the easiest way to strengthen your calves is keeping it simple with standing heel raises. However, it is important to do them right to reap the full benefits when performing it amongst other knee surgery prehab exercises. When performed correctly (listen to instructions in the video) you will also work on ⤵️
✅ Terminal knee extension
✅ Glute and quad activation
✅ Progression into full weight bearing on that affected leg
✅ Working on active knee extension ROM
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 it’s 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 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 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!
All the same good information as the forward step-up, now we are working laterally! With this variation, the muscles on the outside of the hip will be contributing more. Find a variation that works for you for your knee surgery prehab exercises!
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- 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)
- 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
- 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.
- Randall Cooper & Mick Hughes, “Melbourne Rehabilitation Guide 2.0”.