In my latest Ask Dr. Geier column, I answer a reader’s question, which coincidentally, I receive from a huge number of patients in my practice every year. Essentially Keith, like many of my patients, wants to know about exercises after knee surgery.

Keith asks:
Thanks for all you do Doc! I know you probably do a lot of knee scopes. What are your sets of exercises that you recommend for strengthening post arthroscopy?

Great question, Keith! I perform a large number of arthroscopic knee surgeries. For some of these surgeries, like ACL reconstructions and meniscal repairs, I strongly recommend postoperative physical therapy. I think it is very difficult for those patients to regain full lower extremity strength, motion and function after those surgeries without a physical therapist to help twice a week.

For other arthroscopic knee surgeries, like partial meniscectomies, I am more flexible. Don’t get me wrong. I am a huge proponent of physical therapy, but I also understand how busy many working professionals are. If I think they are motivated and committed to working hard to return to normal after surgery, then I will share some instructions and exercises to help them recover on their own.

First, before I mention exercises specifically, I would emphasize that it can be critical for a patient to work to eliminate knee swelling. Not only is a large effusion (joint swelling) painful, but it can also cause quadriceps weakness. Using ice or other form of cold therapy 15 to 20 minutes at a time many times a day can help decrease swelling.

Exercises after knee surgery: Regaining knee motion

It is also important to work to regain normal knee motion. Basically a patient works to easily straighten his knee completely (full extension) and bend it all the way (full flexion). The patient often can regain full motion without another person forcing the knee to bend or a device to help with motion.

Exercises to regain knee range of motion include terminal knee extensions, where the patient sits in a chair or lies on a couch with the heel on a stool or several pillows and nothing under the knee. He then pushes the leg down to fully straighten the knee. To regain knee flexion, he can lie on the table and slide his foot toward his buttock. Using a strap or his hands to pull his foot back can help. Further along, the patient can try sitting on his heels.

Exercises after knee surgery: Regaining strength

Along the same lines, the patient should work to regain strength of the muscles throughout the lower extremity to return to sports, school and work without limitations.

Also read:
Ask Dr. Geier: Return to activity after meniscus surgery
Ask Dr. Geier – Recovery from meniscus repair
Ask Dr. Geier – Running after ACL surgery

Early in the recovery process, exercises could include straight leg raises. The patient lies on his back and slowly lifts his leg with the knee straight, doing multiple sets of 10 reps or more. Strengthening the quads by lying face down with the foot on a towel and trying to straighten the knee can be helpful. Likewise, lying with the knee bent and trying to push the heel into the table can help strengthen the hamstrings. Half squats with no weight and step-ups onto a short stool can help as well.

As the patient get stronger and more mobile, he can often perform more aggressive strengthening exercises. He might try wall slides at home. If he has access to a gym, he could use exercises like squats and leg presses.

Not a comprehensive list

It’s important to note that this list is by no means comprehensive but is a sample of some exercises can help regain motion and strength.

Cardiovascular exercise

Depending on the specifics of the surgery, the patient can also add in cardiovascular exercise, like riding a stationary bike, using an elliptical trainer, or swimming. Even jogging can be started, sometimes as early as 2 to 6 weeks after some arthroscopic knee surgeries.

Having said all of this, I still believe that physical therapy can help people even if they can work on their rehab on their own. Often they can return to sports or exercise faster if they work with a physical therapist than they can on their own, in my opinion.

Perspective of a physical therapist on exercises after knee surgery

I wanted to get the perspective of a physical therapist on a patient who wants to try to recover from arthroscopic knee surgery without going to therapy. Yves Gege, a physical therapist in Charleston, South Carolina, emphasizes how important PT can be for many patients.

“Although a patient is able to get back to their normal activities with their own exercise program, going to a physical therapist will ensure that you get back to your activities quicker, safer, and stay healthy longer,” Gege points out. “Your PT will give you a research based exercise program, ensure you do the exercises properly, and progress them appropriately. Manual therapy and/or modalities such as electrical stimulation and ultrasound can assist in bringing down inflammation and swelling. Research has shown that patients get better faster and have better outcomes with manual therapy and exercise than with exercise alone.”

If a patient insists on working on his own, he does offer some advice. “If a patient insists on doing his or her own rehab, I would tell them to take it slow, start with non weight bearing exercises and progress to closed chain weight bearing exercises as you feel stronger. You want to ensure that you have full range of motion in your knee or at least equal to the opposite side. The knee should eventually bend and straighten just as far as the non-operative side. Also you want to have equal strength on either side. This can easily be tested by using a leg press machine and testing each leg individually or if you don’t like gyms stand up from a chair using just one leg and then try the other!”

If you are preparing for arthroscopic knee surgery, or you recently underwent surgery, then you should discuss exercises after knee surgery with your orthopedic surgeon. Consider asking whether it is possible to rehab on your own and how to do it if it is a reasonable option.

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