Building Strength After Knee Surgery
The “other half” of knee surgery recovery… beyond the bend.
(Part Three of a Four Part Series)
By Yvonne LaCrosse, PTA
After knee surgery we spend a lot of time trying to get the knee to bend so we can walk without a limp, be active again, and move without pain. But stop for a second and think about strength. Range of motion is not so useful if you do not have the strength to move your knee. And oftentimes before and after knee surgery you are inactive and your once strong quadriceps and hamstring muscles suffer from muscle atrophy. I present building strength after knee surgery here so you can be an exception to the majority of knee patients who suffer a huge strength deficit after surgery… a deficit that can linger for weeks, months and even years.
STRENGTHENING: You most likely worked on muscle strength at a physical therapy clinic following your surgery. Have you ever heard the popular phrase, “If you don’t use it, you lose it”? This would apply to the knee after surgery. If you do not use the strength that you gained and continue with strengthening exercises you can become weak in the muscles that surround the knee and offer support and stabilization to the joint. If this happens, you usually end up back in therapy, complaining of knee pain and instability. Strength is a life-long goal that requires work to maintain, and even more work to keep gaining.
Many people fall into a pattern where they feel their daily routine is busy enough, or they go for daily walks and they feel this will take care of any strength issue; this theory is incorrect, as you need to strengthen the individual muscles that surround the knee. Before finishing physical therapy, you can ask your therapist for an advanced strengthening plan that you may be able to do at home or if you prefer to go to a gym, ask for advice on appropriately and safely using gym equipment to keep your legs strong. Another option could be to hire a personal trainer, or many physical therapy clinics will offer a membership plan to use their gym for a monthly fee. Below I have identified the muscles that attach to the knee that will require continued strengthening in order to keep your knee functioning well; please perform strengthening exercises on both legs.
ITB (Iliotibial Band)
Quadriceps: The large muscle group on the top of your thigh that extends (or straightens) your knee. This muscle group provides a natural brace to offer support and attaches to the front of your knee.
Wall Squats: With your back against a wall, feet forward and shoulder width apart, slide down the wall into a squat position. Try to hold this squat for 5 seconds, and then slide back up. Your knees should not go over your toes, and if you cannot slide back up the wall smoothly, you are probably are squatting too far down. See if you can do 3 sets of 10 reps.
Hamstrings: The large muscle group in the back of your thigh that flexes (or bends) your knee. This muscle group provides stabilization to the back of your knee, where it attaches.
Hamstring curls: While holding onto a chair, bend your leg back, bringing your heel towards your rear end. Your toe should point down towards the floor. Bring your toes down and touch the floor- this was one repetition. To make this more challenging, you can put on an ankle weight, or as pictured, use a resistive band provided by your physical therapist to add extra resistance. Try 3 sets of 10 reps.
Adductors:The large muscle group on the inside of your thigh that assists in knee flexion (bending your knee). This muscle group attaches on the inside of the knee joint and can offer support to the medial aspect( inside) of the knee.
How to strengthen: Resisted Hip Adduction
Tie one end of a piece of resistive band to a sturdy piece of furniture, the other end, tie a loop and put it around your ankle. Stand up nice and tall and try not to lean, hold onto something sturdy, such as the back of a chair, or a countertop. Starting with your leg upward, pull down towards the leg you are standing on, and then take it back out to the side- control the motion, do not allow the band to pull your leg out, slow this motion down. Try 3 sets of 10 reps.
ITB (Illiotibial band): This fibrous band attaches to the outside of the knee, providing a lateral stabilization.
How to strengthen: Resisted lateral stepping
You will need a space of about 15 feet. Take a step to the side, gently bend your knees without bringing your knees over your toes. Bring your feet together. Keep repeating this until you have walked sideways the length of the 15 feet; do not turn around, but instead, lead with your other foot on the way back to where you started. To make this more challenging, tie a resistive band (provided by your therapist) around your ankles. Repeat 3 times.
Gastrocnemius: This is the large muscle of the calf that attaches to the back of the knee joint and assists with knee flexion (bending).
The importance would be to strengthen each of these muscles so that they can provide the best support to the knee and act as shock absorbers during activity to keep the knee from becoming painful.
How to strengthen: Heel Raises
Hold onto something sturdy, such as a countertop or back of a chair. Lift your heels up from the floor, then slowly lower back down. Repeat for 3 sets of 10 reps.
Wisdom from BoneSmart – TKR recovery and an analogy to athletic training. ‘Let us look at a TKR or a BTKR recovery and see how, in many ways, it is analogous to increasing athletic training. Consider somebody who is a recreational runner and wants to take part in either a half-marathon or a marathon. Many folks look at running a marathon or a half-marathon as a goal to reach at least once in their life. Should they up their miles from two or three a day to say, eight to ten a day? What might that increase do to their bodies?’ To read the full article click here: TKR recovery and an analogy to athletic training
Your goal is likely not to spend hours upon hours refining your perfect quads and calf muscles. In fact function is really the true test of your knee surgery. We have had so many knee patients say that they have simply forgotten that they had a knee replaced as their function in the new knee is just as good or better than the other natural knee. When that happens to you, then you will finally know you have truly reached full recovery. With some of the stretches I provided in Part Two and the life goals I shared in Part One you can be well on your way to a happy and complete knee surgery recovery.
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here.