Exercises Before Knee Replacement Surgery: 8 Exercises to Prepare for Recovery
When knee pain makes everyday movements like standing up, walking, or getting out of a chair difficult, preparing for knee replacement surgery takes on greater importance. Strengthening the muscles around your knee before surgery may help you prepare for the physical demands of recovery.
Exercises before knee replacement surgery can help maintain muscle strength and joint mobility before your procedure. You can begin with simple movements at home, often without special equipment. In this blog, you will learn 8 exercises to try, when to start, how often to do them, and how to exercise safely before surgery.
Why Pre-Surgery Exercises for Knee Replacement Matter
Most people scheduled for a knee replacement spend their time thinking about what comes after the operation. They may give less thought to how they can prepare in the weeks leading up to it. Knee pain has a way of quietly cutting back how much you move each day, and those cutbacks add up. The muscles around the joint get weaker the less they are used, so preparing them before surgery may help support recovery.
Research suggests that prehabilitation may help patients prepare physically and mentally for knee replacement surgery. A study published in The Journal of Bone and Joint Surgery found that prehabilitation reduced the need for postoperative care by nearly 30% and saved approximately $1,215 in rehabilitation costs. However, the benefits can vary from person to person.
| Benefit | Why It Matters |
|---|---|
| Stronger quadriceps and hamstrings | Better support for the new joint post-op |
| Improved range of motion | Easier to regain full mobility after surgery |
| Potential improvement in post-op pain | Pain and medication needs may vary |
| Preparation for rehabilitation | May help patients prepare for daily activities |
| Improved upper body strength | Easier to use a walker or cane after surgery |
8 Exercises Before Knee Replacement Surgery
Chances are your surgeon or physical therapist has already mentioned some version of this list. Ankle pumps, quad sets, gluteal sets, heel slides, short arc quads, straight leg raises, seated knee flexion, and armchair push-ups are common exercises before knee replacement surgery.
Your body is going to call on these muscle groups as you start moving after surgery, so getting them ready beforehand may be helpful.
The repetitions below are general examples. Follow your surgeon’s or physical therapist’s instructions for the exercises, repetitions, and frequency that suit your condition.
1. Ankle Pumps
How to do it: Lie back and push your toes away from you, then pull them back up toward your shin. Find a comfortable rhythm and keep going.
Reps: 20 repetitions, once or twice a day
Why it helps: When you aren’t up and moving, blood can slow down in the lower legs. Moving your ankles helps maintain movement and circulation in this area. Your calves get a small workout out of it too. Ankle pumps alone can’t guarantee that blood clots will be prevented.
2. Quadriceps Sets
How to do it: Lie on your back with both legs out flat. Press the back of your knee down toward the surface by squeezing the muscle across the front of your thigh. Hold for 5-10 seconds and then relax.
Reps: 20 repetitions, twice a day
Why it helps: Your quads help you stand up, walk across a room, and step up onto a higher surface. If they go into surgery already weak, the first few days of recovery feel much harder than they need to be.
3. Heel Slides
How to do it: Lie on your back and drag your heel slowly up toward your body until the knee bends as far as it comfortably will. Then slide it back out to where you started. Tucking a plastic bag under your heel helps it move more smoothly.
Reps: 10 repetitions per leg, twice a day
Why it helps: You get to work on bending range and hip movement without standing or putting body weight through the joint. If your knee is more painful than usual, check with your care team before continuing.
4. Straight Leg Raises
How to do it: Lie on your back with one knee bent and the foot flat. Straighten the other leg and raise it up to around 12 inches off the surface. Hold it there for a moment before lowering it back down in a controlled way.
Reps: 10-15 repetitions per leg, twice a day
Why it helps: Your quads and hip flexors do real work here without your knee having to bend at all. Stop if it increases your pain.
5. Short Arc Quads
How to do it: Roll up a towel and slide it under your knee so the leg is propped up slightly. From there, push your leg out straight as far as it will go and hold for 5 seconds. Bring it back down slowly and leave the towel in place throughout.
Reps: 10-15 repetitions, twice a day
Why it helps: Fully straightening the knee can become harder as arthritis progresses. Practicing this movement before surgery may help you work on knee extension, although results vary.
6. Gluteal Sets
How to do it: Lie flat with both legs straight. Clench your buttocks together as firmly as you can manage and hold for 5 seconds. Then let go fully and breathe normally before the next one.
Reps: 20 repetitions, twice a day
Why it helps: Your glutes are doing quiet but important work every time you walk or climb a step. They keep your hips from shifting around. If they are underprepared going into surgery, your lower body has a harder time adjusting once the new joint is in.
7. Seated Knee Flexion
How to do it: Sit in a regular chair and slide your foot back under the seat as far as it will go without pain. Hold that bent position for 5 seconds, then bring the foot forward again.
Reps: 5-10 repetitions per side, twice a day
Why it helps: Getting into a car, sitting down at a table, and going up the stairs. These all need the knee to bend in a way that feels natural. Practicing that movement before surgery may make it feel more familiar during recovery.
8. Armchair Push-Ups
How to do it: Sit at the front of a solid chair with both feet flat on the floor. Put your hands on the armrests and push straight down through your arms until your body lifts off the seat. Lower yourself back down without dropping.
Reps: 20 repetitions, twice a day
Why it helps: Arm strength is one of those things that barely crosses anyone’s mind when they are preparing for knee surgery. After the operation a walker or cane becomes part of daily life, and your arms end up carrying far more of your weight than they normally do.
| Exercise | Primary Target | Position | Key Benefit |
|---|---|---|---|
| Ankle Pumps | Calves, circulation | Lying | Supports circulation |
| Quad Sets | Quadriceps | Lying | Knee stability |
| Heel Slides | Hamstrings, hip flexors | Lying | Restores knee flexion |
| Straight Leg Raises | Quadriceps, hip flexors | Lying | Strength without knee stress |
| Short Arc Quads | Quadriceps (end range) | Lying | Maintains full extension |
| Gluteal Sets | Glutes | Lying | Hip and pelvic stability |
| Seated Knee Flexion | Hamstrings, joint mobility | Seated | Prepares bending motion |
| Armchair Push-Ups | Triceps, shoulders | Seated | Walker and cane readiness |
When Should You Start Pre-Surgery Exercises?
Start as early as you possibly can, as that is the short answer. Most orthopedic care teams like to see patients begin a proper routine somewhere in the 4-8 week range before their surgery date. A University of Louisville study put patients on a program of 3 sessions a week for that same stretch of time before knee replacement. The ones who followed through came out of it stronger and moving better than those who hadn’t done anything to prepare.
| Time Before Surgery | Recommended Action |
|---|---|
| 8+ weeks out | Begin low-impact aerobic activity and range-of-motion work. |
| 4-8 weeks out | Add structured strengthening exercises 2-3 times per week. |
| 2-4 weeks out | Continue the full program, adjusting only if pain increases noticeably. |
| 1 week out | Keep movement gentle and avoid heavy exertion. |
| 1-2 days before | Rest and light walking only |
Muscles need time to respond to training. Starting earlier gives you more time to build a routine. If your surgery is coming up in 2 weeks and you haven’t started yet, ask your care team which gentle movements are appropriate for you.
How Often Should You Exercise Before Surgery?
Your exercise schedule depends on your current fitness, pain levels, and your care team’s advice. Some pre-surgery programs recommend exercising twice a day, but the frequency and duration should suit your needs.
Every day, easy ones: Ankle pumps, quad sets, and gluteal sets barely put any load on the joint. Most people can do them daily and feel fine afterwards.
Twice a day, a bit more effort: Heel slides, straight leg raises, short arc quads, and seated knee flexion are where most of the strength building happens. Many people find it easiest to do one round after breakfast and another in the evening.
Two or three times a week: Armchair push-ups don’t need to be daily. Doing them every other day lets your arms recover, and you will appreciate that extra upper body strength when you start using a walker or crutches.
Listen to your body: Feeling a bit sore in the muscles the next day is normal. Sharp pain in the joint or noticeable swelling is a sign to back off and let your care team know.
Don’t write off the bad days: Some days you just won’t feel like it. Even a 10-minute session is worth doing, because it helps you hold on to what you’ve already gained. A consistent routine of exercises before knee replacement surgery can help you prepare for recovery without pushing yourself too hard.
Can Walking, Cycling, or Water-Based Exercise Help Before Surgery?
Yes, they can. These are common exercises before knee replacement surgery because they build fitness without putting too much pressure on a sore knee.
Walking is a good place to start. It’s gentler on your joints than most other activities, and a slow walk on flat ground is usually manageable even when your knee aches. Many people find it easy to fit into a normal day as part of their pre-surgery exercise routine.
Stationary cycling is another solid choice. The pedals move your knee in a smooth circle, so the joint gets a good range of motion without much stress. Keep the resistance low at first and adjust the seat to a height that feels comfortable. Some people with arthritis find this manageable, but comfort and suitability vary.
Water-based exercise is especially worth trying. Pool walking and water aerobics take the weight off your knee while still giving your body a proper workout. The amount of activity that is suitable depends on your comfort and your care team’s advice.
| Activity | Joint Impact | Best For | Suggested Duration |
|---|---|---|---|
| Walking | Low | General fitness, muscle tone | Start with short walks and gradually increase |
| Stationary cycling | Very low | Knee bending, cardio | Begin with short sessions at low resistance |
| Pool walking | Minimal | Easing pain, core strength | Follow your care team's advice on session length |
| Water aerobics | Minimal | Working the whole body | Start gently and adjust to your comfort |
| Swimming | Minimal | Stamina and heart health | Begin with short sessions and increase gradually |
Safety Tips for Exercising Before Knee Replacement Surgery
Exercise helps a lot, but a little care goes a long way. Here are some ground rules to follow with your exercises before knee replacement surgery.
Ask your doctor first: Before you start, have a quick word with your doctor or physical therapist. They know how bad your knee is and can tweak the plan if needed.
Don’t skip the warm-up: A few minutes of slow walking or ankle circles gets your body ready. This can help you ease into the movements before doing more demanding exercises.
Know your stop signals: If you feel sharp pain in the knee, tightness in your chest, dizziness, or you’re struggling to breathe, stop right away.
Check the knee for swelling: Feeling a little sore afterwards is fine. A puffy, swollen knee is a hint that you’ve done too much, so rest it, ice it, and go easier next time.
Leave out the high-impact moves: Running, jumping, and sports like tennis or badminton are too rough on a knee that’s already worn down. They can wait until after your recovery.
Use a cane or walker if it helps: If pain makes you wobbly, there’s no shame in using one. Staying steady matters more than doing it all on your own.
Go up a little at a time: Increase your repetitions or exercise time gradually, as advised by your care team.
Apply ice afterward: Rest an ice pack on the knee for 15-20 minutes once you’re done. This may help ease soreness after your pre-surgery exercises.
Conclusion
Preparing for knee replacement surgery involves more than arranging help for the days after the operation. Keeping your muscles active and practicing suitable movements can help you prepare for standing, walking, and starting rehabilitation. Exercises before knee replacement surgery can be part of this preparation, but your routine should match your ability and your care team's advice. You don’t need to push through pain or rush your progress. Small, consistent efforts can make preparation more manageable.
With CureMeAbroad, you can connect with trusted hospitals and experienced orthopedic specialists for guidance on your knee replacement journey.
Frequently Asked Questions
1. Should I practice using a walker before knee replacement surgery?
Yes, learning to use a walker before surgery can help you feel more comfortable during early recovery. Along with pre-surgery exercises for knee replacement, you can practice standing, sitting, and moving with the device under professional guidance. This preparation may help you move more safely after the operation.
2. Can pre-surgery exercises help me use stairs after knee replacement?
Some exercises can help build the leg strength and control needed for stair climbing. However, exercises alone may not prepare you for every movement required on stairs. Learning the correct technique with a physical therapist can help you prepare for everyday activities after surgery.
3. Should I practice getting in and out of a chair before knee replacement surgery?
Yes, practicing sitting down and standing up from a stable chair can help you prepare for daily activities after surgery. These movements use your thigh muscles and require balance. Practice slowly with a sturdy support nearby, and choose a chair height that feels manageable.
4. Can I prepare my home while doing exercises before knee replacement surgery?
Preparing your home while following a routine of exercises before knee replacement surgery can make the transition to recovery easier. Keep frequently used items within reach, remove loose rugs and trip hazards, and arrange for help with tasks that may be difficult after surgery.
5. Do I need to learn breathing techniques before knee replacement surgery?
Learning to breathe steadily during exercise can help you avoid holding your breath when your muscles work harder. Exhale during the effort and breathe normally as you relax. If an exercise causes unusual breathlessness, chest pain, or dizziness, stop and seek appropriate medical advice.
References:
- Conditioning Before Knee Replacement: ECU Health / University of Maryland Medical System: 2024
https://healthlibrary.ecuhealth.org/orthopedics/management/conditioning-knee-replacement - Prehabilitation Better Prepares Patients for Knee Replacement Surgery: University of Louisville News (UofL News): 2011 (study); article published 2015
https://www.uoflnews.com/?p=24517 - Study Suggests ‘Pre-habilitation’ by Peer Coaches Prior to Knee Replacement May Hold Promise in Improving Outcomes: Hospital for Special Surgery (HSS) Newsroom: 2023 https://news.hss.edu/study-suggests-pre-habilitation-by-peer-coaches-prior-to-knee-replacement-may-hold-promise-in-improving-outcomes/
- Before Surgery Knee Exercises: Total Knee Replacement Pre-Surgery Exercise Videos: Allina Health: 2019
https://allinahealth.org/Health-Conditions-and-Treatments/Health-library/Patient-education/Total-knee-Replacement/Strengthening-exercises-before-surgery - Knee Surgery: Before Exercises: Vidant Health Library / Methodist Health System Health Library: 2026
https://healthlibrary.vidanthealth.com/surgery/treatment/knee-surgery-exercises - Prehabilitation May Reduce Joint Replacement Surgery Recovery: 5 Things to Know: Becker’s Spine Review (citing The Journal of Bone & Joint Surgery): 2015
https://www.beckersspine.com/orthopedic/prehabilitation-may-reduce-joint-replacement-surgery-recovery-5-things-to-know/
