Bone surgery

Information about exercises for knee replacement

A doctor talks about the importance of exercise during recovery. It’s difficult to damage the knee unless someone has a very bad fall.

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What’s really important after joint replacement is regaining a good range of movement. And a physiotherapy [exercise] programme is critically important in doing this.

Anything which allows you to try to get your leg moving in a full arc of movement is to be encouraged. And this strengthens the muscles around your knee and in the end improves the functional recovery that you get.

In a small number of cases, patients struggle with their range of movement. And what we’d like to do is to intervene early in that situation. And that’s one of the important checks at 6 weeks is to make sure your movement is coming back. And that’s a key part for us.

Sometimes when people were doing their exercises in the early stages of recovery, they wondered if they could damage the knee. Is there any way that they could damage it or is that highly unlikely?

If you follow the guidelines for recovery following joint replacement and specifically partial knee replacement, there are very low risks of damaging a knee replacement.

The thing that we’d wish to avoid are falls. And falls can lead to damage or sometimes fracture around a knee replacement. But that’s very, very unusual. And most people recover very steadily and avoid those sorts of issues if they stay within the realms of the recovery programme we lay out.

If someone did accidentally fall, who should they see first?

Well, I think once you’ve had a fall, if you’re able to get up and everything seems fine, then I think you can monitor that yourself.

If you have a fall and you feel new pain or there’s swelling in the knee and it’s clear that something more serious has happened, then I think initially the person to contact is your GP. And your GP tends to assess that situation and will refer you through the appropriate channels.

The people we interviewed were given a booklet of exercises to do at home by the physiotherapist. Exercising was one of the most important things for participants during recovery, and the booklet contained diagrams of the different exercises to do at various stages. Many people, though, would have liked to have been shown how to do the exercises by the physiotherapist before leaving hospital, and to have a TEPI video or a DVD showing how the exercises should be done that they could watch at home. Seeing the exercises being done would have helped them know exactly how to do them and if they were doing them correctly. Having had what they felt was a major operation, it was important to recover as well as possible.

David wanted to know if he should be progressing faster or if he was overdoing it. A physio appointment 3 weeks after surgery would have been reassuring.

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David wanted to know if he should be progressing faster or if he was overdoing it. A physio appointment 3 weeks after surgery would have been reassuring.

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Age at interview: 57

Sex: Male

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Is that booklet just about the exercises or the whole operation?

Just about the exercises.

So the physio showed you what exercises to do?

Not really, no. She went through the book with me and said, “Well, this is what you’ve got to do. Do it as often as you can but don’t overdo it. And then as you feel more confident, progress with a few more exercises, a bit more weight on it or whatever you feel is best.”

Was the explanation enough to know what to do or could it have been better?

It’s difficult to say really. You just know in your own mind how much you think you can do. But then you’re thinking, “Well, should I be doing a bit more? Could I do a bit more?” You just want a little bit of reassurance on occasions. It’s difficult to say. That’s what I was saying. If you’re an older person, maybe you would think, “Well, maybe I shouldn’t be doing that” and then it will take you longer to progress. And then if it was the other way, you could do too much and then end up back in hospital again.

So it’s hard to know how much is right for you to do?

Yes, yes.

What would have helped? Would going back to see the physio sooner help?

Maybe, it [the booklet] gives you one to three weeks, and then three weeks to six weeks. So maybe at the end of the third week, just going back and saying, “Right, this is what I can do. Is it enough? Should it be a bit more?” There is a phone number in the back if you are a bit uncertain, you can make an appointment to go and see them. But a lot of people might think, “Well, I don’t want to cause a problem” or “They’re busy people.” And maybe not call them. So, yes.

So the information was there, but it would be more reassuring to go back after three weeks?

Three weeks. Just to say, “Well, this is what I’ve been doing.” You can ask them, “The book says now go on to this; am I actually in a position to go on to doing that? And is this how it’s done?” Yes, just that little bit of reassurance I think. I don’t know, maybe it’s just me...

So the leaflet tells you what exercises to do, but what you want is something more personalised?

Yes.

In your case you’re doing this. Is that enough for you?

Yes. “Should I be further advanced?” or, “Am I further advanced than I should be?” Or, “Am I overdoing it?” or, “Is it just because I’m younger and I’m healing quicker?”

Lesley felt that watching the exercises at home on video would have been helpful. She was shown some exercises she could move onto at the follow-up appointment but felt she should have been told about these earlier. A few others were told at follow-up that using an exercise bike would help at this stage and they wished they’d been told that sooner.

Lesley did the exercises in the booklet 4 or 5 times a day. A video would have been reassuring. She couldn’t bend her knee flat and is now doing exercises to improve this.

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Age at interview: 58

Sex: Female

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The exercises, I tried to do the exercises at least four or five times a day. Because they did say, “Do small amounts often rather than a huge amount.” And you do get a leaflet telling you what to expect two we-, after two weeks, and then four weeks up to six weeks. So I did follow the book and I did do the exercises because I wanted it to get right as quickly as possible.

I think having the assessment in six weeks would have been better than having it in eight weeks. But I’m sure there’s a reason for that. Just to know that I’m doing the right things. Because having the book and speaking to someone on the phone, it would be easier perhaps if it was on the video, showing you the exercises, or seeing someone. Just for that reassurance that, “I’ve been doing these exercises for four weeks. Am I doing them correctly?” When I went for the assessment, sorry, when I went for the last appointment, for the eight-week assessment, I couldn’t bend my knee. I was still 5 degrees off what it should be. And I couldn’t bend my knee flat. So she did give me some exercises that I’m doing now. Which I could have known earlier as I’ve gone two weeks not knowing that.

Some people felt that an exercise DVD or website would have motivated them more. Seeing someone doing the exercises would have been encouraging and, according to Janice, not so lonely.

Janice struggled to motivate herself once she was mobile. An exercise video would have made her feel that someone was doing the exercises with her.

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Age at interview: 52

Sex: Female

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You mentioned you’ve been doing your exercises, but in a way you’ve had to motivate yourself to do that?

I’ve had to really motivate myself to do that. I find, especially now at six weeks on and you can do really all the things, I can do all the things that I could do before. And so then your day becomes busy. You know, you start doing your jobs, you start working. And the only thing I haven’t done is the hoovering because that’s not, I don’t, that I can feel is uncomfortable. And so then you think, you get up and rather than doing your exercises you think, “Oh, well, I’ll just put some washing on. I’ll just peg some washing out.”

Before you know, it’s lunchtime; you haven’t done them. And I’m still struggling to motivate myself to do the exercises actually. And we have got a friend who’s a physio, who just come in to see me the other day. It’s the first time she’d been in to see me since my operation. But she did just say, “Well, you know, you must do this and you must do that. And you’ll benefit more if you do.” So, yes.

So you had a little booklet with the exercises. Would it have been helpful to have them on video or anything else?

Oh, yes. Now that would have been good. I would have liked that actually. If you could have, it’s, yes, if you could put something on and do it with them, I think that that would motivate you more I think. It’s as if there’s someone doing it with you. Yes, that’s a good idea. I hadn’t thought of that. It’s quite a lonely thing. You know, you’ve got to get on the floor or on your bed or whatever and, you know, do these exercises.

Diagrams of the exercises were sometimes unclear and it was hard for Keith to tell if he was doing them right. A physio helped and showed him new ones to move onto.

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Age at interview: 71

Sex: Male

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I think a video would have helped greatly. As I said, I was lucky enough that I was able to go to a, you know, private physiotherapist, who was absolutely excellent. But I think being able to see how you should do the exercises properly. Because diagrams are quite difficult, you know, particularly when you’ve only got one picture of a particular exercise. Sometimes it wasn’t clear to me whether I was, you know, doing it right until I saw the physiotherapist. And some of the things I wasn’t doing right. And so I think, you know, a video could help, yeah.

So you saw the physio, was it a couple of times, before you then went back for your follow-up appointment at the Nuffield [NHS hospital]?

I think I’d probably seen her, yes, three times before I went back, yeah.

And can you tell me how the, those appointments were and how helpful they were for you?

With the physiotherapist?

Yes.

Oh, extremely helpful. I mean she told me, you know, which exercises, initially which exercises of the ones in the booklet I should be able to do, which ones I ought to delay doing because they were going to be a bit too much. And then which new exercises that I could be doing. So, which weren’t in the booklet. Yes, so that was really helpful. It was the sense of progress which was really useful.

Helene also felt it was unclear how to do all the exercises in the booklet just by looking at the diagrams.

Helene did some of the exercises wrong because they ‘weren’t explicit’. Knowing how long to do each one and having new ones to move onto would have been good.

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Age at interview: 66

Sex: Female

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So before you left were you given a booklet about the exercises to do?

I, a tiny… I think actually it's upstairs because it's … what I do is I take… if I do them downstairs, usually in the morning I do the ones upstairs, sort of in bed and, yeah I was sort of going through these and they weren't very explicit. Some of them said hold for a count of five or… the one I didn’t, which I completely got wrong was the standing one where it says step onto the, put your foot onto the first step. And I'm thinking, 'Why am I doing this, what's it doing for me?' And then realised I was supposed to lift my back, the other leg up, probably. It didn’t actually, you weren't, it didn’t say put your full weight. I may be wrong even now on saying that, that’s what I was supposed to do.

So you were given the booklet but it wasn’t always clear how to do all of the exercises

No, no it wasn’t and it's not a booklet, it's loose sheets that have been photocopied and, as I say, it was sort of clearer the ones that I had when I'd gone to the hospital, to the physio here in [place name]. The instructions are much clearer but unfortunately I never kept that, I didn’t have it still and it was all on an A4 sheets, not lots of loose pages. But, as I said, I had so much information, I then found…sorry if I'm going away from you…I found this book a long time afterwards and is this the one that’s got the, and it had better pictures, more exercises to do and I'm thinking, 'Where did you hide that Helene?'

Where was this book from?

This was given to me by the, actually on the …I think this was given to me on pre-op assessment.

Oh right, right. So that was helpful but what would you have really liked in terms of, you know, doing the exercises?

I think actually it might have been a better… I didn’t see any videos of the exercises. Now that might, because you’ve got somebody, a physiotherapist actually talking saying, you know, sort of, "One Mississippi, two Mississippi…" these are my seconds, Mississippi, saying how long to hold it, exactly how to do it and, you know, sort of wrong and right. Even doing sort of wrong and right whilst they’ve got somebody, the model, and doing it for them. So yeah again it's just the aftercare, it's so kind of lacking.

If you'd been given a DVD would that…?

Yes, yeah that would have been good, the same yeah, yeah.

And maybe information, because you said that you weren't sure - 'Am I doing enough, am I doing it OK; after two weeks what should I be doing after two weeks?

Yes, yes, yeah this is it. Because the exercise which are six I think it is – three up lying, three standing – and I was thinking, 'How do you progress from this; OK just do it for more, you know, more times – make a note on each, on the bottom of the page,' sort of. This day I did five, six the next day and so on, but it becomes boring when you're still doing the same ones but much, much longer. How lovely it would have been to have had new ones to do.

Geoff would have liked exercises on video showing how to walk down the stairs when people first come home.

Walking down 13 steps at home was daunting and Geoff sometimes wondered if he’d damaged his knee.

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Age at interview: 64

Sex: Male

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Was there a video showing the exercises as well or?

No, I don’t think so no, no. Had a booklet mm.

And did you use that booklet at all or because you knew from the first time?

Well no, I did use the booklet. It may change, things might be different but I did use the booklet and I read it quite a few times because I thought I was doing some things wrong which seems that I weren't. It all seems quite good now.

So did you find the booklet helpful?

Yeah, yeah. I found the website more helpful to be honest with you. If they'd have put those exercises on the website then I would, I think, looked at it more often.

So you would have liked to have the option to look at the exercises as well on video?

Yeah, it would be good to watch someone doing them as well, not just sort of, this is what you do, bend your legs and…yeah it would be good to have a video to watch.

So were there times when you were wondering, 'Am I doing this right?'

Only coming downstairs, I had a problem coming down the stairs. I could go up but I couldn’t come down, not properly and that…I was getting a bit worried about that. I was thinking, 'Well is it because it's not glued in?' I mean it's a stupid thing to think but if it's not glued in, is it bouncing up and down; it seemed strange, it was a strange feeling.

So a bit of information even in the booklet about going up and down the stairs at home would be helpful?

Yeah, yeah. Yeah I could stand on the bottom step and do that but coming back down thirteen stairs was a bit more daunting.

Penelope was surprised that the physio didn’t go through the exercises with her, and sometimes wondered if she was doing them right. A video would have helped.

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Age at interview: 65

Sex: Female

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I was surprised that, although the physios came to walk us, but I was surprised they didn’t take us through the exercises. We got the leaflet but they didn’t actually go through them whereas they did the first time round, yeah.

So that would have been helpful would it?

I think so. I think just to know you're doing them correctly you know, yeah.

So that was given in leaflet; would you have found a video of the exercises helpful, so if you were given either a website or a DVD to put in would that have helped?

Yes, because you can see it happening then can't you and you can see what's correct and what isn’t, yeah.

So you’ve got your little booklet and do you feel OK doing the exercises? Some people mentioned they weren’t always sure if they were doing it right or they would have liked to see a physio.

Yes, yes that’s the thing. Sometimes you think, 'Am I doing it…' I mean there's one where you lie on your side and lift the leg that’s gone…that you’ve had done up and down and then it says something about, then turn over and lift it the other way and I'm not quite sure what it means. I think I'm doing it right but I don’t know. Because the picture in the booklet only shows you the first bit; it doesn’t show you how you do the second bit so, yes, a video of the exercises would have been very good, yeah.

Is there anything else that would have been helpful at all?

Not that I can think of, no.

Keith paid for private physiotherapy so he could have advice on exercising and reassurance. Several other people also felt that physiotherapy would have been helpful shortly after surgery (see ‘Views and experiences of healthcare from people who had a knee replacement’).

Keith did his exercises ‘religiously’ but paid to see a physio for more guidance and reassurance. Positive encouragement and having someone to report to was important.

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Age at interview: 71

Sex: Male

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I was given a booklet of exercises, although I don’t recall any actual discussion of the exercises. So, but as I mentioned earlier, I went to see a physiotherapist fairly soon after and then the private physiotherapist.

And they very much said, you know, which exercises I should be doing at this stage, which ones, you know, progressing to later. Which was helpful. And I did do the exercises pretty religiously. And I was icing my knee very regularly after, certainly after, any time I did the exercises I would ice it afterwards. And so that, so the whole focus seemed to be on, you know, me doing exercises and icing the knee and... But that went quite well, yes.

So there were exercises in the booklet, which you started doing. But what made you feel that you would like to see a physio?

Well, I felt I needed more guidance on how to do them, when to progress, and when to progress on to other exercises. So, and also, you know, the fact of having to report to someone. Which I think is very important. And I mean as it turned out, the NHS physio, who I saw just once, she actually went in for, the second appointment in fact we, never happened with her. Because she went in to have knee surgery herself. She had warned me she was going to, might be called. And she was called.

But I mean it was encouraging, I mean I guess this was a week or so after surgery, for her to be saying, “You’re doing really well.” And the same with the physiotherapist I saw subsequently. It was that positive encouragement, you know, at times when one is becoming discouraged. Because, you know, it did feel like it was two steps forward, one step back. And I think I’d been warned that that was the case. So, you know, I’d start to improve and then I would do too much. Like I would go and try and do a bit of gardening or, you know, far too early, and then the next day would pay the price. And, but it was, so I’d start to feel a bit downhearted. But it was the physio saying, “Actually no, you know, this is how it, how progress goes. You’re really on, well on course.” Which I thought was very important.

Lesley wondered if there were any exercises people could do to help with kneeling. Being able to kneel again was important to several people, especially Peter, a plumber, who needed to be able to kneel for his job. He wondered if he’d be able to kneel once he’d fully recovered and whether he should have his other knee replaced.

If Peter can’t kneel, he can’t work. He wonders if he should wait until he has completely retired before he has his other knee replaced.

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Age at interview: 66

Sex: Male

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The main question that I’ve had all the way through is, “Can I kneel on them afterwards? Can I kneel on my knees afterwards?” And, to be honest, no one’s given me a definite yes or no. I think probably the surgeon got the closest in. And he said, “Well, medically speaking” and I think this is how it was put to me that, “Medically speaking, there is no reason why you shouldn’t. But…” And the ‘but’ is ‘everybody is an individual’. It will affect different people in different ways. How much you need to kneel down. How much you don’t need to kneel down. Whether it will cause you pain. Whether it won’t. It’s got, it’s an individual thing.

And that’s something that I’ve got to sort out for myself as and when I feel well enough and confident enough to kneel down on them. And obviously not on a hard floor. On a nice cushion or on a rubber pad, which is what I carry now anyway. But obviously, you know, being a little bit more careful to kneel on something soft. But again it’s something that I’ve got to try for myself when I feel ready.

That’s the bit that really worried me. The fact that, because of my profe-, of my occupation, if I can’t kneel down, I can’t work. And there’s people telling me, “Oh, no, you can’t kneel down on them. Oh, no, no, it’d be too painful.” And that sort of thing was putting me off all the time. That’s the sort of thing was making me think, “Well, do I really want to go through with it or do I stay on the pills? At least while I’m on the pills I can still kneel down.”

And even now I’ve got one knee done and I’m still thinking to myself, “Well.” That’s still at the back of my mind. Okay, I’ve still got one knee that I can kneel down on at the moment. If I go straight from having the left knee done, which has been done, and then go straight in and have the right one done, I’m not going to know until it’s too late. So do I put the right one off or do I go ahead?

And that is what’s on my mind at the moment. Do I go back to work and struggle with one knee that I can kneel down on? Because the pain is not that much from there at the moment. Or do I throw caution to the wind and get both of them done and hope that I can kneel down on them afterwards? That’s the decision I’ve got to make.

Jennifer, who’d had both knees replaced, said that kneeling had been a problem since she’d had her first operation. Although she rarely needed to kneel now, it had been difficult when her grandchildren were young and she’d wanted to play with them. Penelope also couldn’t kneel after her first knee operation and wasn’t expecting to after the second. However, at 65 she was happy she could walk without pain and do all the normal daily activities. Phillip and Geoff, who’d had both knees replaced, said they could kneel again on the knee that had been operated on first, and expected this to be the case with the second knee too. Lesley also said she could kneel again after her knee had healed completely.

A doctor talks about kneeling after knee replacement surgery.

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Up to 50 per cent, will find that kneeling is uncomfortable following joint replacement. But whether it’s uncomfortable or not, patients will not be doing themselves any harm by kneeling. So it isn’t true to say that you can’t kneel following joint replacement. But it’s very much up to each individual patient to see how they feel. But if you can do that and it’s not painful, and particularly if your work demands it, then we would encourage you to kneel.

So in the case of someone kneeling on the ground, maybe with a knee pad, they should…

Yes. There are ways to support patients who have to kneel. And knee pads and other appliances that you can use to protect you in that are really helpful.

Some people mentioned that their knee had been feeling numb since the operation and they would have liked to know if this was permanent. Lesley would have liked to have known about the numbness before surgery, and Janice said that she’d ask at the follow-up appointment because none of the health professionals had mentioned it.

Last reviewed August 2018.