Flexing the hip while also flexing the knee focuses most of the stretch on the knee joint. These first two videos demonstrate different ways to accomplish that. In the video below, notice how I am using my torso to generate the force needed to flex the knee. I then take up the slack created in the yoga strap with my arms. Also feel free to use your other leg to help generate flexion force as I demonstrate.
The next video demonstrates how to use the strap to improve knee flexion while keeping the hip extended. This is done in the prone position. This will focus more of the stretch on the quadriceps muscle. I recommend stretching in each of these positions for the best result.
Excellent knee function also requires full knee extension. The strap can help you achieve this as well. In the following video, I loop the strap over the knee to be stretched. I then place my other foot through a loop in each limb of the strap so that it does not touch the ground, but applies an extension force to the knee.
The use of a yoga strap for knee replacement rehabilitation is certainly not mandatory, but simply provides another option to assist you. Always remember to use ice after stretching, hold the stretches for as long as possible, and relax your mind and muscles as much as possible during the stretch.
3/17/2019 10:34:23 am
I underwent TKA 5 months ago and achieved zero degrees of extension and 120+ degrees of flexion in the first weeks following surgery. I gave up my cane within the first three weeks. My physical therapist was consistently pleased with my progress. However, I have yet to realize consistent pain-free weight bearing and continue to walk with a limp after just a few minutes of weight-bearing. My surgeon, his physician assistant and my physical therapist have all said it just takes time. At my last visit with the surgeon, he gave me an A+ on my recovery and motion. I requested and received more time with physical therapy--using a different therapist--to work on weight bearing. Have you seen this in patients: adequate ROM with poor weight-bearing?
5/12/2019 11:21:52 am
Everyone recovers at a different pace, and has a slightly different experience. That being said, it is unusual to continue having pain with weightbearing at 5-6 months from surgery...particularly if your range of motion is excellent.
1/24/2020 05:11:12 am
I had knee replacement 9 weeks ago. I have a bend of 117 and can completely straighten the knee. When I walk my knee is really stiff like I am still wearing a brace like I did before the surgery. Also every morning the knee is really stiff
1/25/2020 01:33:32 am
At only 9 weeks from surgery your experience is not unusual. This is due to residual inflammation. It may still also feel a bit warm. This should all dissipate with time. Keep gently stretching, use ice, and/or anti-inflammatory medications as needed, and time will almost always take care of this tightness. Expect improvement for an entire year after surgery.
12/28/2021 12:55:27 pm
I just had TKR on November 23... It is now December 28... I had my knee at 93. Then I over did with excerices... So now ism At 83.. till lots of pain and stiffness... Therapy only 2x a week... They have cancelled my therapy like 4 times. Short on help... So iam doing the best I can.. I hope ism doing ok. I can walk. My leg is straight out... I just have to keep. Working on stretching my knee.
12/29/2021 09:04:01 am
@Terry Elliott- Having disruptions in physical therapy has become very common. I hope resources like this website, and the videos I have posted online will be helpful to you. Thankfully, the exercises required to get a good result after knee replacement surgery are not difficult.
2/12/2021 03:46:15 pm
Hi Doctor Gorcznyski,
2/14/2021 10:28:18 am
While swelling (fluid in your joint) can create pain and make stretching unpleasant, it is not the reason people end up with a stiff knee. Scar tissue forms between the undersurface of the quadricep tendon and the femur as well as between the soft tissues on the sides of the patella (retinaculum) and the femur. This tight tissue creates a "checkrein" which limits excursion. This, unfortunately, becomes fairly permanent after about 6-8 weeks in most cases.
10/26/2019 11:08:51 am
So, I had RTKR on June 19, 2019, using the Stryker Robot Assist. I completed 8 weeks (2x week) as prescribed. After PT completed, my extension was 2 deg and flexion was 125 deg. I dropped by last week to have them measure and still have same. I ride bike outside 25-30 min 5 days a week, go to gym 3 days a week to do leg presses, leg extensions, and hamstring curls on machines, and 5 days a week, I do heel slides (20, holding for 5 sec), weighted leg lifts (prone and side). My new knee stays about 3/4 in larger than my other knee and is always 1 or 2 degrees warmer, and is extremely stiff across the top of patella and at top of glute tendon. Three month visit with OS said that's OK and xrays look good. Said the small swelling and warmth could last up to a year. After reading your suggestions, I feel I need to continue biking and weight training and leg lifts, but rather than the heel slide set, I need to flex the leg to it's maximum hold to maximum stretch as long as possible and do this throughout the day to accumulate one hour. Am I understanding you correctly? The stiffness is very annoying. Thanks for your reply.
10/28/2019 07:05:57 pm
The stiffness and warmth should gradually resolve with time. Continuing to gently stretch should be helpful. I agree with your plan to remain active. I would suggest eliminating the leg extension exercises as this can be irritating to the patellofemoral joint (kneecap). Other than that, as time goes by (months) you should feel progressively better and better.
10/31/2019 12:14:10 pm
Thanks so much for responding. I had already decided to drop the leg extensions as I felt it was stressing my knee too much. I've started the new stretching routine by doing 6 10 minute sets throughout the day. I've been doing it for 7 days now and I truly think I can feel a little difference. Thanks again doc!
10/28/2019 07:10:11 pm
It sounds like you are making good progress. I would expect gradual improvement in the swelling, tightness, and warmth for many more months.
12/28/2021 12:58:53 pm
I feel you...
3/6/2020 06:12:17 pm
I had RTKR on 1/17/20. Hit a flexion plateau of 75 at 5 wks (no issues with extension).
3/6/2020 06:30:54 pm
I would try to stretch so that you are holding the endpoint for a minimum of an hour per day. You can break this up into smaller segments if you wish- I would try to stretch for no less than 10 minutes at the endpoint during each session. If you can manage to maintain your endpoint stretch for longer than a total of an hour per day, your results may be even better.
4/29/2020 12:42:35 pm
Not sure if this will work for others. But once I reached 120 degrees, I would lay down watching tv and pull the leg back with my hand towards my back. I did this once and hour and had my heel to my butt in four weeks. I have a right medial knee replace PKR
9/2/2020 11:57:37 am
Hello! I had a MPFL reconstruction and partial replacement on left knee on 8/10/20. I am 2 degrees shy of full extension and at 73 degrees ROM. I feel I have fallen behind on ROM. Should I consider an MUA or continue to try stretching until 6 weeks post op? Also, I am fatigued after about 10mins if walking or standing. Is this normal? Thank you!
9/3/2020 05:21:48 pm
You are definitely a bit behind on range of motion for a standard partial or total knee replacement. Considering you also underwent a medial patellofemoral ligament reconstruction at the same time, your surgeon may not actually want you to go beyond 90 degrees until 6 weeks. If this has not been specified to you, it is worth calling the office and asking this question. If they do not want you to limit your motion, I would recommend stretching (using slow, long duration stretches as I describe throughout this website)until 6 weeks. If you do not progress significantly by 6 weeks postoperatively, it is only at that point that I would consider manipulation. And, yes, some fatigue is normal after surgery, sometimes for several months.
11/12/2020 11:54:20 am
11/26/2020 02:10:59 pm
Other than what I have published on this website, I do not have any other "tricks up my sleeve."
Connie S Doe
10/7/2020 06:14:18 pm
I am 6 weeks out of TKR ROM 110 flexion and almost full extension. I am experiencing that tightness on my knee and was reading your post. Could you give me the time durations of holding stretches . It seems that that is helping alot of folks.
10/8/2020 02:18:25 pm
I would try to achieve at least 60 minutes at the endpoint every day. Feel free to break this up into shorter segments, but I think a minimum of 10 minutes stretching at the endpoint works best. Avoid cycling your knee back and forth bouncing against the endpoint for only a few seconds. This only creates inflammation without much chance of tissue elongation. Check out the "all articles" tab at the top of this website for a variety of articles supporting my recommendation.
I have found your website very helpful. Im 3 weeks post op from RTKR. My first TKR was done 4 months ago. I'm 75+ years old and the second surgery has been a little more challenging, but comparing to others in the discussion, I feel I'm on track. My Ortho doc is pleased with progress. Thank you for your website! Ruth
11/29/2020 01:18:22 pm
I was wondering what your opinion was of quad sparing TKR vs traditional surgery. Thank you
12/7/2020 08:37:05 pm
The literature does not show a significant long-term difference between surgical approaches. Every approach has risks/benefits. If you like your surgeon, I recommend they use the approach they feel most comfortable with.
1/28/2021 12:15:19 am
Hi. I had bilateral TKR in 9/1/20. I am still in PT 2X/week. I have had a very slow but sure recovery. I have met my ROM and extension goal. My right knee feels great. Only squatting is challenging. My left knee isn’t so great. I cannot squat, sit to stand,or descend steps without major pain under the patella. PT believes we can work through it. I walk fine, minimal swelling on either knee.
2/13/2021 04:48:56 pm
Unfortunately, other than time, stretching, and then progressive strengthening, I do not have any other recommendations. A total knee that remains chronically painful is unusual, but deserves evaluation by your surgeon.
2/14/2021 09:00:37 am
2/14/2021 10:39:55 am
Early after surgery (first 6 weeks), swelling (fluid in the joint) can cause pain and make stretching unpleasant. The problem is that if a patient allows that unpleasantness to interfere with stretching their knee, scar tissue forms which permanently limits knee excursion. This is why I push patients to stretch consistently early on following surgery. It does not get easier with time, it gets harder.
3/19/2021 10:24:11 pm
Very simple and effective.
6/21/2021 08:15:22 am
I had a Total Right knee replacement 10 weeks ago. At six weeks I had a MUA. I am at 113 flexion. I can’t seem to get beyond that. My pain is in the back right side of the knee when I bend, almost like something is pinching. Any ideas about this? The front of my knee has never had pain only the back since the surgery.
6/23/2021 08:42:12 pm
Long duration stretching, plenty of ice, NSAIDS if you tolerate them. Consider static stretching brace, for example JAS. All of this plus patience and persistence. Best of luck to you.
6/27/2021 04:18:43 pm
I am at 6 weeks can flex to 100°/ with help 106° swelling is way down, I'm sure there is some but doesn't seem bad. My flex hasn't gotten any better than at three weeks. when I'm on my back the therapist says he's actually pushing pretty hard, but in the prone position he says it actually feel pretty soft,( I just can't take the pain) and I can take pain pretty good. The pain is in inner side of my knee and is VERY tight. He says in his experience that in the prone position if it's soft, it's normally not scare tissue. My question is, how do you know if it's scare tissue? Or has something just not fell in place legitimates ect. ?
6/28/2021 12:32:28 pm
Stiffness with extended hip (prone position), but not with hip flexed suggests tight quadriceps tendon. If it is tight in both positions, it is most likely just scar tissue/adhesions. It is important to try and relax as much as possible into the stretch, otherwise it is just a strength contest between your therapist and your angry quadricep muscles.
1/20/2022 04:53:59 pm
I just found your site and have subscribed on utube. You’re just what I need. I’m getting discouraged, 9 weeks postop TKR. My PT tells me my range of motion is great yet I am still having so much stiffness in back of knee along with what I can describe as shin splints feeling. I was able to stretch my quads with yoga strap till I tried the elliptical machine for 5 minutes and after that my shins have been killing me. I’m having trouble walking with a normal gait, my leg feels stiff. Also I can slowly manage going up the stairs but forget going down! I was a very active person so I feel like I’ll never get my life back. Sorry for all the complaining! If you have any suggestions I’d really appreciate it. Thank you!
1/22/2022 01:00:12 pm
You didn't include your range of motion, so I can not give you specifics. But in general, slow, steady stretching with no days off- is the answer. That and patience. Once your motion is functional (0-115+), your body will heal, and your pain and happiness will improve for the rest of the year. If you are significantly behind schedule with motion, I do have other more specific recommendations for you, with videos and articles to peruse throughout this website.
Dear Sir, I can across your website when I was 5 weeks post op unicompartment left knee. My education from day 1 has been poor. And I only discovered how poor after reading your site. I am now 6 weeks post op. Since reading your comments I have been stretching for minutes not seconds for total 1 hour thru out the day . As well as prone knee hang for about 40 minutes total thru out the day. Flexion is 92 and extention 5. I have PT 2x week. Was never told about the importance of the 1st six weeks from PT or MD. And yes I was told to rest from day one. But what is that definition? I thought the sooner that I was up and about walking that I would recover quicker. Probably why I had so much pain during therapy and at home exercises. Before surgery I literally never sat all day so my idea of rest was maybe after being up and around the house for an hour was to ice and elevate for half an hour or so. Then back up. After all I have read on your site I feel like I am not going to get much more rom if any because I am at 6 weeks. Do you have any suggestions? I so much appreciate your time and all the help you have provided to others. I am sure the world is a better place because of you 🙂
2/26/2022 03:29:21 pm
I disagree with the concept of "rest from day one." Active rehabilitation is much more effective. Daily stretching, and gentle walking- That is really all it takes. Walking, alone, is inadequate to rehabilitate your knee. Dedicated stretching must be done, from day #1. If you have not regained an acceptable range of motion, it still might be possible for your surgeon to help by manipulating your knee under anesthesia, or beyond this performing arthroscopic lysis of adhesions followed by manipulation. I describe both these options in the "stiff knee replacement algorithm" article. However you proceed, stretch, stretch, stretch. That is the key to a good result following knee replacement surgery.
2/23/2022 04:34:39 am
I had TKR November 8, 2021, 16 weeks ago. I have full knee extension, but flexion is only 90. I am very discouraged. I cannot walk on my own and my flexion has not improved in the past 7 weeks. My ortho doctor says he is not concerned about my slow progress because I have lymphedema in both legs and I have relapsing/remitting multiple sclerosis. I do not agree and I am very concerned about my progress.
2/26/2022 02:48:53 pm
Lympedema is a major problem. Depending on how severe your case is, flexion beyond 90 may not be possible- since your calf may press against your thigh. At 16 weeks post-op, it is unlikely that stretching alone will improve your motion. If your lymphedema can be significantly improved, and if your tissues were impinging, as I described above, I suppose some progress could be possible, but I would not be very optimistic at this point. Long duration stretching is, in my opinion, the only chance of improvement at this point.
6/21/2022 12:45:29 pm
I had tkr 14 wks ago only had physio for 5wk check u at 8 week but now don't know what do for best walk cycle rest stretch or put my leg up at 8wk check had 90%bend n 95 straight help please
6/29/2022 12:41:47 pm
I am not sure I totally understand your question. Stretching is the most important thing to do to obtain a good result after total knee replacement. It appears your range of motion is limited. I would focus on regaining range of motion as much as possible. As for activities, walking and cycling should both be fine to do.
6/29/2022 07:22:22 am
I am 7 weeks post op TKA with some swelling and stiffness. My flexion is around 125, extension 0. My question is it normal not to be anywhere near heel to butt. I have a relative whose surgeon did an MUA because he wanted her to be able to do heel to butt. I don’t think I’ve ever been able to do that. I have like 6 inches between heel and butt. Should I be worried?
6/29/2022 09:13:00 am
You have excellent range of motion for this stage following total knee replacement. If our goal after total knee replacement is heel to butt, we would basically have to manipulate nearly everybody. This is not a reasonable expectation, and I would suggest your relative's experience is an outlier. Your current range of motion should be adequate for nearly all desired activities. In my opinion, you have nothing to worry about.
9/7/2022 12:13:58 am
I am now a little over 7.5 months post TKR surgery. I achieved 135 plus degrees of flexion within the first 6 weeks. However, I still have a fair amount of pain which the doctor has identified as Illotibeal Band Friction Syndrome. I experience the following:
9/7/2022 12:32:04 pm
Iliotibial band friction syndrome is not an uncommon problem. Stretching is usually curative. This question has inspired me to record a video of how I recommend patients stretch the muscles that attach to the iliotibial band. (The iliotibial band itself really does not stretch). A quick youtube search should provide a variety of options to begin with. Soon, I will post a video of my own, where I will demonstrate my recommended way to stretch.
9/7/2022 12:56:29 pm
10/24/2022 11:51:32 am
I have been doing PT exercises for stretching the IT band and strengthening supporting muscles (glute med) religiously for the last 8 weeks and I am still experiencing about the same amount of pain and stiffness. I have the most trouble going from a sitting to standing position, and moving the joint after a period of inactivity can be quite painful (in bed). I am now 9+ months post surgery, and growing increasingly concerned that this is not going to resolve on its own or just with PT.
11/6/2022 03:42:31 pm
If this problem is not resolving after adequate PT, it is crucial to prove the diagnosis is correct. In my practice I would offer you an MRI with MARS protocol. This will rule out stress reaction, and can confirm inflammation at the iliotibial band as it crosses the lateral femoral condyle. Once confirmed, a cortisone injection could help, and, rarely, release of the ITB could be done surgically.
9/12/2022 01:28:14 pm
I'm almost 6 weeks out and at 5 measured 80 degrees flexion. I think my extension is good. How can I tell if there is scar tissue. My thigh (front) and shin are both very tight. I wish I had known about your site weeks ago. The dr told me basically nothing and the PT has me hold for 30 seconds. I'm going to ask the PT about your site tomorrow. I hope it's not too late for me to not have to have another procedure. Am I a lost cause at this point because I'm not at 90 degrees? They did tell me to massage the scar area. Does that do any good or is stretching the only thing that can get rid of it?
9/17/2022 08:25:31 am
If you were my patient, I would offer you a manipulation under anesthesia at this point- and definitely before post-operative week 8. Then, make sure you stretch all day, every day to maintain/regain range of motion. Unfortunately, 5-80 degrees at post-operative week 6+ is not likely to result in a good outcome. This is not yet a lost cause. Get some help from your surgeon, get caught up with your knee range of motion, and then stretch diligently, and for long durations afterward. Massage is not bad, but only stretching will help you at this point. And- I doubt stretching alone (without manipulation) will be effective now.
9/19/2022 05:24:39 pm
At 6 weeks and a day, the PT measured me at 120. They are assuring me that I will get more flexion than that. I have been holding the stretches longer than their 30 seconds, maybe 5 minutes, but I can't quite handle more than that even though I am trying. I feel a little less stiff and can walk a little better. I don't see my dr until the week after next which is almost 8 weeks after surgery. I'm scared of the MUA, so I'm stretching as much as I can. Why do the PTs tell us we will get more flexion in the coming weeks if it's not true?????
9/24/2022 05:09:19 pm
If you are at 120 degrees at this point, there is absolutely no reason to consider manipulation. You may gain a few more degrees over the next few months if you keep working at it, but 120 is a perfectly functional range of motion, and you should be very pleased with the outcome of your hard work!
10/16/2022 11:18:47 am
I am pretty happy with my flexion (about 125) at this point. However, I'm still having to take an NSAID for some swelling and stiffness in the quads and also in the shin. My doctor said this is normal and I need to take an NSAID as long as it feels this way. I'm still stretching, riding the stationary bike, walking just until it hurts, swimming (a little) and at PT I do the total gym and scoot around on the chair. Are there any other exercises I can do to help make this go away? I am at 10 1/2 weeks, but I've read that swelling and stiffness can last 3 to 6 months.
10/23/2022 08:47:14 pm
@Nancy- This seems like a reasonable plan. Looking back at your past messages, you've made excellent progress. I think some swelling/stiffness is within normal expectations and is likely to resolve gradually over the next several months.
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