After your TKR operation, you might feel less stable standing on the operated leg. There are three reasons for this feeling:
1: There are two main ligaments deep inside the knee joint; The Anterior cruciate ligament or ACL and Posterior cruciate ligament or PCL. The PCL is sometimes spared but may be weakened after surgery while the ACL is completely removed.
2: The new joint surfaces are not the exact replica of your natural knee and feel a wobbly
3: There is often decreased muscle strength from inactivity beforehand and from the surgery itself.
These are only one of the three factors of joint instability that we can improve, and that is, you guessed it, strengthening! You need to exercise and strengthen two main muscle groups to stabilize your knee. They are the Quadriceps and Hamstrings! The Quad group is a set of 4 muscles in the front of the leg that starts at the hip and finally attaches to an area just below the kneecap. The Hamstrings are a set of 3 muscles that start at your SIT bones in your buttocks and attach to the back of your knee.
The solution is to strengthen these muscles, giving them the ability to take over the role of stabilizing the knee joint.
There are so many ways to strengthen these two muscle groups, but we will start with some basics:
Seated knee extension: Sit in a chair with some ankle weights on your legs or a resistance band tied on your ankle and then to a sturdy chair leg. Straighten your knee and slowly return to the starting position. Start with enough repetitions to cause muscle fatigue, and once that gets easier, increase the weight/resistance.
Wall squats: Start in a standing position with your back against the wall. Bend your knees as if you are going to sit down in a chair and hold this position for at least 15 sec. Perform several repetitions to muscle fatigue. As you get stronger, hold the pose longer.
Bridges: Start by lying on your back with your knees bent. Keep your feet flat on the floor, hip-width apart. Contract your buttocks and lift your hips off the floor towards the ceiling, being careful not to arch the low back. Return to the starting position. Repeat at least 20 times to fatigue. As this gets easier, consider holding a weight on your abdomen for an extra challenge.
Standing knee bends: Use an ankle weight on your legs. Start in a standing position with your hands on a counter or wall. Slowly bend your knee so that your heel comes closer to your butt. Return to start position. Perform to fatigue.
For more of a challenge, try:
Squats: Start in standing with your feet hip-width apart. Squat and bend your knees as far as you comfortably can, keeping your back straight and shoulder slightly forward of your hips. Make sure your weight is transferred to the heels of your feet, not your toes. Return to the standing position. As you become more comfortable with the exercise and improve your strength, start to hold onto weights or kettlebells to amp up the workout!
Deadlifts: Start in a standing position and hold onto a broom in both hands. Keep a slight bend in your knees and hinge from your hips while keeping your spine straight. The broomstick should come to the mid-shin level then rise to a standing position. Perform this exercise for several minutes focusing on contracting your gluteal muscles and not straining the back. As you get comfortable with this exercise, slowly add a little bit of weight. You can swap out the broom for hand weights or wrap ankle weights around the broom!
When it comes to strengthening any muscle, it’s important to add weight or resistance and work to muscle fatigue. Exercise will cause mild discomfort, and that is OK! Do this work 2-3 days a week with a rest day in between, and you will notice improved strength and stability in your knees!
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