Knee Surgery: Leg Movement, Rehabilitation, and Recovery Guidelines

How do you move your legs after knee surgery?

Moving your legs after knee surgery is a carefully orchestrated process that begins immediately post-operation, focusing on gentle, controlled movements to restore range of motion, prevent complications, and gradually rebuild strength, always under the strict guidance of your surgeon and physical therapist.

Understanding the Post-Surgical Landscape

Following knee surgery, the knee joint and surrounding tissues are undergoing a significant healing process. The primary goals of early leg movement are to reduce swelling, prevent stiffness, improve circulation to minimize the risk of blood clots (deep vein thrombosis - DVT), and begin the re-education of muscles that may have been inhibited by pain or disuse.

• The Critical Balance: Striking a balance between protecting the healing tissues and initiating movement is paramount. Too much movement too soon can jeopardize healing, while too little can lead to debilitating stiffness and muscle atrophy.
• Individualized Recovery: The specific movements and the rate of progression will vary significantly based on the type of knee surgery performed (e.g., ACL reconstruction, total knee replacement, meniscectomy), your surgeon's specific protocol, and your individual recovery rate. Adherence to your medical team's instructions is non-negotiable.

Immediate Post-Operative Period (Days 0-7)

The focus in this initial phase is on gentle, often passive or active-assisted, range of motion (ROM) and isometric muscle activation to prepare the limb for more dynamic movements.

• Key Movements:

  • Ankle Pumps: While lying down, repeatedly point your toes towards your head and then away. This simple action helps pump blood through your lower leg, reducing swelling and the risk of blood clots. Perform frequently throughout the day.
  • Quad Sets (Isometric Contractions): Lie on your back with your leg extended. Press the back of your knee into the bed or floor, tightening the thigh muscle (quadriceps). Hold for 5-10 seconds, then relax. This helps re-establish the connection between your brain and the quadriceps, which often "shuts down" after surgery.
  • Gluteal Sets: Squeeze your buttocks together, hold for 5-10 seconds, then relax. This activates the gluteal muscles, important for hip stability and walking.
  • Heel Slides (Assisted): While lying on your back, gently slide your heel towards your buttocks, bending your knee as far as comfortable, often using a towel or strap for assistance. Slide back to the starting position. This helps restore knee flexion.
  • Passive Knee Extension: Ensuring your knee can fully straighten is critical. This might involve placing a towel roll under your heel, allowing gravity to gently extend the knee, or your physical therapist manually extending it.
  • Continuous Passive Motion (CPM) Machine: Some surgeons prescribe a CPM machine, which gently and continuously moves your knee through a prescribed range of motion while you are resting.

• Precautions: Weight-bearing restrictions are common and must be strictly followed. Pain should be your guide; avoid movements that cause sharp or increasing pain. Swelling management (ice, elevation, compression) is crucial.

Early Rehabilitation Phase (Weeks 1-6, Varies)

As pain and swelling subside, the focus shifts to restoring more active ROM and initiating light strengthening exercises, often with a physical therapist.

• Progression of Movements:

  • Active Knee Flexion/Extension: Gradually increasing the range of motion you can achieve without assistance, within pain-free limits.
  • Straight Leg Raises (SLR): Lying on your back, keep your leg straight and lift it a few inches off the bed, holding briefly before lowering. This strengthens the hip flexors and quadriceps while maintaining knee extension.
  • Wall Slides/Mini-Squats: Standing with your back against a wall, slowly slide down a few inches into a mini-squat, keeping your weight evenly distributed. This introduces controlled weight-bearing and strengthens the quadriceps and glutes.
  • Stationary Cycling (High Seat, Low Resistance): Once sufficient knee flexion is achieved, stationary cycling with a high seat and very low resistance provides excellent, low-impact, repetitive motion that improves ROM and endurance.
  • Gait Training: With the aid of crutches, a walker, or cane, your physical therapist will guide you in re-learning proper walking mechanics, focusing on heel-to-toe progression and equal weight distribution.

• Principles: Gradual progression is key. Listen to your body and respect pain limits. Consistency in performing prescribed exercises is vital.

Intermediate Rehabilitation Phase (Weeks 6-12+, Varies)

This phase focuses on increasing strength, improving balance (proprioception), and preparing for more functional and sport-specific movements.

• Advanced Movements:

  • Leg Presses/Knee Extensions (Light Weight): Using resistance machines, starting with very light weights and gradually increasing, focusing on controlled movements.
  • Hamstring Curls: Strengthening the muscles on the back of your thigh, crucial for balanced knee function.
  • Step-Ups/Downs: Stepping onto and off a low step, improving functional strength and balance.
  • Balance Exercises: Single-leg stance, eventually progressing to unstable surfaces like a wobble board or foam pad, to enhance proprioception (your body's awareness of its position in space).
  • Proprioceptive Drills: Activities designed to improve joint stability and reaction time, such as mini-hops or controlled pivoting (if appropriate for your surgery type).

• Considerations: Return to light recreational activities (e.g., swimming, brisk walking) may be possible during this phase, always with your surgeon's approval.

Long-Term Recovery and Maintenance

Full recovery can take anywhere from several months to over a year, depending on the surgery. The long-term phase focuses on sustaining the gains made in rehabilitation and preventing re-injury.

• Ongoing Activity:
  • Continued Strength Training: Progressive overload principles should be applied to continue building strength in all leg muscles (quadriceps, hamstrings, glutes, calves).
  • Cardiovascular Exercise: Low-impact options like swimming, cycling, and elliptical training are excellent for overall fitness without excessive joint stress.
  • Flexibility and Mobility: Regular stretching and mobility exercises help maintain the achieved range of motion and prevent stiffness.
  • Listen to Your Body: Pay attention to any signs of overuse, pain, or discomfort, and adjust activity levels accordingly.

Key Principles Guiding Leg Movement After Knee Surgery

• Surgeon and Physical Therapist Guidance: This is the most crucial principle. Your rehabilitation program is custom-designed for your specific surgery and recovery needs. Deviating from it can lead to complications.
• Pain is Your Guide: While some discomfort is normal during recovery, sharp, increasing, or persistent pain is a warning sign. Do not push through significant pain.
• Gradual Progression: Recovery is not linear. There will be good days and challenging days. Progress slowly and steadily. Avoid the temptation to do too much too soon.
• Consistency: Regular, prescribed exercises, performed correctly, are far more effective than sporadic, intense bursts of activity.
• Swelling Management: Persistent swelling can hinder recovery and increase pain. Continue to use ice, elevation, and compression as advised.
• Proper Form: Focus on the quality of movement, not just the quantity. Incorrect form can place undue stress on the healing joint and lead to compensatory issues.
• Patience: Knee surgery recovery is a marathon, not a sprint. Celebrate small victories and remain committed to your long-term rehabilitation goals.

When to Seek Medical Attention

While discomfort and mild swelling are normal, contact your surgeon or physical therapist immediately if you experience any of the following:

• Sudden, severe, or increasing pain that is not relieved by medication.
• New or significantly increased swelling, redness, or warmth in the calf or knee.
• Fever (over 101°F or 38.3°C).
• Pus or excessive drainage from the incision site.
• Numbness or tingling in the foot or toes.
• Calf pain, tenderness, or swelling (potential signs of DVT).
• Inability to bear weight as instructed or sudden loss of ability to move the leg.

By understanding and diligently following these guidelines, you can safely and effectively move your legs after knee surgery, paving the way for a successful and lasting recovery.