This post was co-authored by Grace McClure and Dr. Nicholas Frisch
Throughout your knee replacement recovery, you’ll likely be monitoring, obsessing over, and measuring one thing: range of motion. Chances are your doctor and physical therapist will give you range of motion milestones to hit and chances are it won’t be easy to get there. Gaining back knee flexion (bending), extension (straightening), adduction (movement towards middle of the body), abduction (movement away from middle of the body), rotations (inward and outward) must be worked towards. It not something that happens overnight.
When thinking about range of motion (ROM), that irritating saying, “no pain, no gain” comes to mind. To hit your range of motion goals after knee replacement surgery, you’re going to have to work through some pain and dedicate yourself to improvement. Besides putting in good old fashion work, there are things you can do to accelerate and improve your post-op knee range of motion. Read on as we walk you through the best things you can do after knee replacement surgery to hit your ROM goals.
Dr. Frisch explains, “Range of motion is critical to success after knee replacement. I see my patients back at 6 weeks to check their motion specifically. Not everyone is the same and everyones motion will be different throughout the recovery, but in general I like to see between 90 and 110 degrees of flexion at this visit. As long as you are progressing appropriately, there is typically no need for any concern if you don’t meet these numbers. For those patients who may be slower to progress, I typically like to see them back more regularly and make any changes to their protocol at those times.”
Range of Motion Basics After Knee Replacement Surgery
First, we need to start off by saying that everyone is different. Some people are naturally born with more flexion and extension in their knee joints, some people have complications or severe osteoarthritis degradation to overcome, some people may experience knee stiffness, and so forth. In fact, one of the best indicators of your knee range of motion after surgery is your ROM before surgery.
A completely straight, unflexed knee joint will measure 0° of flexion. A fully bent knee will max out at about a full range of motion of 135° degrees of flexion.
As a general rule, a knee flexion of about 125° will allow you to carry out most normal activities. For daily living, a minimum flexion of around 105°-110° is required. Here’s the approximate range of motion flexion required for everyday activities:
- 65° to walk
- 70° pick an object off the ground
- 85° to climb up stairs
- 95° to stand from a sitting position
- 105° to tie shoelaces
- 115° (or greater) to squat or sit cross-legged
- 125°+ covers most activities. However, squatting or sitting on your heel may always prove challenging.
In a study conducted with 108 total knee arthroplasty patients, the mean postoperative active flexion was 111°
Knee Replacement Range of Motion Timeline: Where You Should Be After Surgery
Not only do people have different ROM potential to begin with, people also heal at different rates. With that in mind, here are the flexion goals our team of medical advisors (US-based orthopaedic surgeons and physical therapists) look for in their total knee replacement patients.
- Stage 1 (0-2 Weeks)—65-90° flexion. This amount of flexion allows for walking without assistance, standing, and some stair climbing (likely with support). Before you leave the hospital, your doctor will be looking for flexion as close to the 90° as possible.
- Stage 2 (2 to 6 Weeks)—115° flexion. At this point, you should have made noticeable improvements from your early recovery days. This means moving around normally, bending to the ground, sitting down, and even tying shoelaces!
- Stage 3 (12 Weeks +)—A goal to hit 115°or greater should be the aim. The timeframe for this varies, but should be consistently work towards. A flexion of 125° is great and 135° is excellent (whether you’ve had a joint replacement or not!).
Throughout each stage, it’s important that you keep working your surgical knee and artificial knee prosthesis. The first 3 months of your recovery are critical for working out your new knee to gain back flexibility, bending, extension, and movement. If you stay idle, inconsistent or not fully committed to gaining back range of motion, your knee may become stiff. If your knee becomes stiff, you risk the need for revision surgery and a joint that will cause lifelong issues.
Exercises to Increase Your ROM
If you worked at a PreHab program before joint replacement surgery, you’ll already be leaps and bounds ahead for achieving optimal range of motion. If you’re reading this before your joint replacement surgery, great! In the weeks leading up to surgery, we strongly encourage you to start a daily PreHab program of exercises and everyday movements that will help build strength and movement in your joint.
If you’re newly into recovery, you will likely be setup with a physical therapist or occupational therapist. Taking advantage of as many sessions as possible is key. However, strictly relying on in-class sessions to optimize your ROM isn’t enough. It’s absolutely, positively imperative that you supplement classes with an at-home guided ReHab program.
A great at-home program will include “early exercises” that will help get you mobile after surgery, “functional exercises” that will help bring back regular movements, “advanced exercises” that aim to build strength and push you further, and later stage “maintenance exercises” after the 12+ week mark where you engage in low-impact exercises to keep fit and keep moving.
Haven’t had surgery yet? Get matched (for free) to a top surgeon who has the tools to improve your ROM before surgery. The better your movement before surgery, the easier it will be to gain ROM in recovery.
The 5 ROM Exercises You Should be Doing Daily
Pro Tip: People who’ve suffered from chronic pain or range of motion limitations are often scared to fully flex their joint. However, please know that a lot of your recovery is about “emotionally letting go” of expecting pain.
1. Seated Knee Flexion (Knee Bends)
This exercise helps increase knee range of motion and strength in your quadricep to enhance mobility.
- Sit on a chair with a rolled towel under your surgical leg.
- Keep both feet flat on the ground.
- Slide one foot back behind the stationary foot, bending your surgical knee.
- Hold for a few seconds, then slide your foot forward.
10 reps, 2x per day
2. Seated Knee Extension
This exercise is one you should do throughout the day to cut down on stiffness. It also helps strengthen the quad muscles at the front of your thigh.
- Sit on a chair.
- Straighten your surgical leg and bend it back down.
10 reps, 2x per day
3. Short Arc Quads (Lying Kicks)
This exercise improves the endurance of your quad muscle and allows for greater control over leg movements.
- Lie on your back with a rolled towel under your knee
- Slowly straighten your surgical knee by lifting your foot up while keeping your knee on the rolled towel
10 reps, 2x per day
4. Heel Slides
This is a range of motion exercise that strengthens thigh and improve movement.
- Lie on your back in bed with your legs straight.
- Keeping your non-surgical leg flat, bend your surgical knee by sliding your heel toward your buttocks.
10 reps, 2x per day
5. Ankle Pumps
Ankle pumps help to improve circulation and blood flow, both of which promote healing and reduce swelling. Swelling is a major roadblock to regaining full motion.
- Lie on your back.
- Gently flex your foot up and then point down. You can move just your surgical side or move both ankles at once.
10 reps, 2x per day
For a daily PreHab exercise plan (which can be applicable to at-home ReHab exercises), click here.
Bonus Exercise: Water Therapy
If you have access to water therapy, this is one the of best ways to work out at a higher intensity, while offloading most of your body weight. Water therapy lets patients work on their range of motion through leg exercises, stretching, and even jogging—all inside a swimming pool.
Most major cities in the US have a water therapy (sometimes called “pool” or “aquatic therapy”) center. Click here to read more about the benefits of water therapy after a joint replacement and to find a water therapy center near you.
With PeerWell’s ReHab program, you can track and measure your ROM at home for the first time ever. You just need the PeerWell ReHab app and your smartphone or tablet. PeerWell is proud to bring this innovative technology to our app users as helpful tool to track progress!
Dr. Nicholas Frisch, M.D., OS, MBA is an award-winning orthopedic surgeon based out of Rochester, Michigan. He focuses on minimally invasive joint replacement surgery and complex revisions. Dr. Frisch completed his residency at Henry Ford Hospital in Detroit and his Adult Reconstruction Fellowship at Rush University Medical Center in Chicago. Dr. Frisch is has won Orthopedics Best Clinical Article Award, the AAHKS Healthcare Policy Fellowship, Outstanding Resident Award Henry Ford Hospital, the Ford Motor Co. Connected Health Challenge, and more.
In pain? Preparing for surgery? PeerWell Health helps you fast forward to better with 1:1 doctor visits, physical therapy, and a custom at-home program for your condition.
Beneficial site with clear, precise easy to follow step by step diections to progress. Open and informative as to what to expect painwise.
Thanks, Jo Ann! Glad to hear you’ve found our content helpful and glad you’re having a proactive recovery!
I’m at 15 weeks after knee replacement. I can achieve flexion of ~130° when pulling with a strap, and tolerating a bit of pain. I continue daily flexion stretches to this point of slight pain. How do I know when I reach my maximum potential? Am I overdoing it? Should I stop my stretches short of pain? Pre-OP. I could teach 150°.
I am at 13 weeks post op. I have only achieved 55 ROM on my own and 60 with PT help. I have had a MUA and 2 weeks later still stuck. I am not sure what to do.
My surgeon said he reached 115 when I was under anesthesia. But awake my PT is only able to reach 52 right now. The more I move, the stiffer it is and it swells like crazy.
My surgeon says keep pushing, but I’m afraid I’m headed to being handicapped if something does not give soon.
Hi Genora. Thank you for sharing your experience with us. We’re sorry to hear that it has been a struggle to increase your ROM, even after your MUA. If you’re feeling a bit worried and frustrated, it’s completely understandable. But, we’re here to tell you that there is always hope, and if your surgeon is giving you the guidance to push – keep going! We’d like to invite you to join our FB group especially created for patients in your shoes to get some added support and be able to ask some questions! Here’s the link for you. https://www.facebook.com/groups/jointreplacementsupport
I am at 20 weeks and after a manipulation I am only at 95. My doctor says that is”functional” and has sent me back to work as a certified nursing assistant with no restriction despite still using a cane.i have no Idea what to do
At pre-op of 150deg could you sit on your heel?
When age 30+\- I could sit on either heel for extended periods.
Hi Bruce! Thanks for commenting :). This would be a great question to ask in our Facebook group, created especially for patients who would like extra support around Total Knee Replacement. I’ve added the link for you here! https://www.facebook.com/groups/jointreplacementsupport
I am exactly in the same situation, I will keep doing what I have been doing to get to this point!
Very good site. I’m 17 days post TKR and all you have said is true. I had 130 flex toon pre TKR and am at 120 now. But my goal is to get better than where I start and i am hopeful that i can do the goddess pose at some point post rehab. Sounds like exercises two time per day might be better? my sheets say 30 reps or 3 sets of 10 once a day. I had robot assisted surgery.
PS. I am a bit like gumby so i have always had bendy joints.
My name is Cheryl, I had my TKR December 6th 2021, I had a MUA on February 25th 2022, due to lack of range of Motion, prior to MUA my leg was pretty straight no problems, but my ROM was 55, my range would go up then back, after MUA my calf muscle was strained which left me with leg I could not put a lot of weight on, but worked through, now an issue with getting my leg straight and ROM, now still in PT my ROM was 83 now it appears going back to 70, I am so disheartened by all of this, I ve done all my exercises and continue to go to PT. What am I doing wrong! I’m 61 in pretty good health, please help
Thank you for reaching out, Cheryl. We’re sorry to hear that your TKR journey has been challenging. Feeling disheartened is completely understandable. We commend you for continuing on with your PT. You most certainly are doing your part! We’re more than happy to help you. If you’d like to talk to us one-on-one for specifics, you can book a chat with us right here :). Just tap this link: https://peerwell.health/book_social
I’ve had problems from my first knee op infected wheat back in to clean after a month back in on a drip two years of misery found I have metal allergy so now after revision I’m trying hard to make sure keep it mobile the problem is after years on pain meds the effect is downto 20% I have found ice and heat alternating plus pool helps I constantly do the ankle therapy all the time don’t know what else I can do in this Day I still find it barbaric that there is no alternative keep watching Star Trek
Thank you this helped alot I am starting my 6th week after total knee replacement surgery. I had 2 weeks home therapy right after surgery and now I sm in my 4th week of outside therapy. My motion is 93 that’s ther most I’ve done I go to the 6th week check up in a few days I’ll hopefully be at 100 degrees! This made me want tio exercise my knee more. Thank you
Wahoo, 100 degrees! Glad to hear that you’ve found our content helpful with your knee ROM!
I am 2 weeks in after TkR and proud to say i Reached 120. So happy i did water exercises before my surgery but your exercise steps are really helping me to get back to normal life. I am 71 and just learned to swim at 70. I feel great!
This is very helpful & simple directions. Most of theses exercises were provided by my therapist. I had tkr on May 26,2021. Home thearpy for two weeks and after about 3 weeks of out patient therapy was only able to bend about 75 degrees. So unfortunately I had to return back to surgery for joint manipulation and steroid injection due to development of scar tissue. Now I am bending between 90-93 degrees; thank God!!! Thanks for the information it reassured me that exercises that I am am doing will help toward my recovery. I really like the info on the range needed for activity of daily living. Makes me see how important it is to keep pushing through even though it’s a bit painful from time to time.
I’m up to my 6th of recovery, was very poorly when I came out of hospital and after 3 days of being home spent a week in bed , lost a stone in weight and was very weak, doing well now , not sure till I go to physio at what range I am at but I know my leg has moved up on its bend by the length of my foot !!!!im managing stairs better and am able to drive with no pain in knee , so managed my emergency stop perfect
I am nearing my 5th Week post surgery and am at 92 degrees. I was hoping to be further but baby steps are better than no steps. I have a lot of stuffy and still swelling w the pain behind my knee when I push myself. Is there an exercise to help this?
Excellent and very clear cut instructions. Very much appreciated 👍 Hats off to you guys
My 14th week after total knee replacement and only have 90 degrees motion am really wonder what should I do to increase to 110?
I also had two weeks of at home PT immediately following surgery and now go to out patient PT. Five weeks after surgery I was at 122 degrees but only 119 this week after skipping home exercises for a few days. Very, very important to work at home as well as with PT. The exercises above are great. I’ve done all of them and more at PT. I like to work both legs to prepare the other one for TKR in a few months.
I am scheduled for TKR in 3 weeks. What exactly causes the loss of ROM after TKR? Swelling of course, but beyond that? Is it like with shoulder tendon repair where the tendons are shorter and have to be stretched out? or is it from shortened muscle fibers that need to be stretched? Is it possible to to be too aggressive, too soon with ROM after TKR? Thank you!
I am 10 days out and my PT is upset because I have not reached 90’. Today they manipulated the knee but it was so painful the swelling the the rest of the day has been almost unbearable. Trying to do the exercises and get where they want me feels like I’m failing at every step of the way. Feeling very defeated!
Hi Jessi! We’re sorry for the delay in response, and we’re also sorry to hear that you’re feeling defeated. There’s always hope! Please feel free to join our Facebook group which can offer amazing community support for patients going through similar experiences. I’m posting that link for you here: https://www.facebook.com/groups/jointreplacementsupport
My problem is getting my leg straight! It’s 15 weeks from my operation now! I have most of the time in the day put 4.4kg on my leg. And in the last 5 weeks got a brace to pull it straight, I wear it around 8 hours a day set at the highest setting! I can only get it to 12 Degrees now! I get a painful back when walking or standing.
Hi there, Syl! We’re sorry to hear that you’re having trouble getting your leg straight. It sounds like you’re doing your due diligence, which is terrific. Every individual makes progress at a different rate and it can be frustrating when you’re not where you want to be. Keep up the good work, and if you’re feeling a bit concerned still, we always recommend you reach out to your care team and let them know what’s going on. In the meantime, we’d like to invite you to join our Knee and Hip Replacement community on Facebook. Great place to share experiences! Here’s the link for you. https://www.facebook.com/groups/jointreplacementsupport
Hello,
I had tkr 5 weeks ago and I’ve only achieved 85 degrees flexion thus far. I mistakenly was less aggressive with rehab in those first couple of critical weeks. Am I now doomed to never get more than about 100 degrees? The 85 degree point has held steady for about the last 12 days- I’ve reached a plateau of sorts, no matter how much I aggressively rehab, the knee is stiff and “stuck”.
Have you any encouraging advice for me? I’m very discouraged.
Thanks.
Reed
Hi Reed. We’re sorry to hear you’re feeling stuck. To answer your question, yes, there’s always hope and plateaus are meant to be broken! You might find it useful to ask this question in our Facebook community group for Hip and Knee replacement patients. There is tons of great information in there. You can find it here: https://www.facebook.com/groups/jointreplacementsupport
This is very helpful. My range of motion is 127. I am going to reach that goal of 135. No pain no gain. Thanks for information.
We’re happy to hear you found it helpful, Alfreda! You may also find it useful to join a great Facebook community group for Hip and Knee replacement patients. You can find it here: https://www.facebook.com/groups/jointreplacementsupport.
I got 120 flex and 0 extension after 27 days. Still a lot of pain at night.
We’re sorry to hear that Mike. If you’d like extra support, please feel free to join our group on Facebook. You’ll find tons of information and lots of community as well. Here’s that link for you! https://www.facebook.com/groups/jointreplacementsupport
Hi! I am 12 weeks out and had flexion at zero for several weeks but extending was poor – really focused on that in therapy and now flexion is +3, extension 105. It is stiff, so I’m doing water aerobics too, and my exercises daily. I think I can do this. The surgeon said he could do a manual manipulation and I really don’t want to do that. Any suggestions?
Hi Cathleen! We’re happy to hear that you’re making some progress and you’re doing great with your daily exercises and water aerobics. We think you can do this too :). Please feel free to join our Facebook group, where you can post questions and get lots of useful information. I’ll post that link for you here: https://www.facebook.com/groups/jointreplacementsupport
Thank you for your response, I don’t have Facebook, so I’ll just take what I can from this site. I take it the stronger I can get the muscles surrounding the knee, the better off I will be and also able to improve range of motion, is that correct?
Thanks again, Cathleen
Hi again, Cathleen! Generally speaking, yes, strengthening the muscles surrounding the knee is important. However, because every situation is unique, we always recommend talking to your care team. If you’d like to chat with our care coordinator and get some questions answered, let us know and we’ll schedule a quick chat :).
This was one of the best articles I have ever read online. Clear, concise, and to the point. It has reassured me after knee surgery as you cover all the bases. I will be supplementing my PT exercises. I am printing it to make sure I have a copy and follow the directions correctly.
Many, many thanks
Hi Phylia! Thank you. We’re happy that you found our article useful! Having some reassurance after surgery can be a relief, for sure. We always suggest you talk to your current PT prior to starting any new exercises. Also, we’d like to invite you to join our Facebook group, which you may find useful as well. There are tons of great people on there with their own knee surgery experiences, advice and tips. Here’s that link for you! https://www.facebook.com/groups/jointreplacementsupport
I’m 1 week 2 days out from total knee. My flex is 0 and my extension is 63. The therapist said that was good. I have rented a flex machine I’ll be moving it up to 70. I just can’t get my knee to lift and I’m worried about this. As far as pain, not too bad today but I do stay stiff. Anything you can tell me at this point?
Hi Carey. Thank you for your message. We’re sorry to hear that you’re feeling a bit worried. But, it’s normal to feel this way, especially soon after your TKR. We always suggest talking to your doctor to express your concerns, as each case is unique. However, we have a group on Facebook that may be really helpful to you which is filled with great advice from other TKR patients. Here’s the link for you! https://www.facebook.com/groups/jointreplacementsupport
I’m 10 days after tkr struggling to get 85 ,and that’s with a belt pulling
Thanks for reaching out with your comment, Mark. 10 days is still pretty fresh, so don’t be too tough on yourself! As you likely are aware, it takes some work and persistence, but increasing your ROM can be done! Continue to follow your doctor’s guidance and you’ll likely see improvements in the coming days. Also, please feel free to join our FB group just for Knee and Hip Replacement patients! Here’s the link for you. https://www.facebook.com/groups/jointreplacementsupport
Hi, I’m about 12 days out of surgery and have had so far 2 sessions of pt in home. My knee flexion is about 85 degrees. I try to do my exercises everyday and I’m aiming to get to the maximum numbers. Also I can keep my leg completely straight at 180. I’m going to see my surgeon in 2 days and hoping to do better than that. I’m so motivated but feel those numbers should have been better. I’ll be continuing with a pt outside the home after Christmas.
I woke up this morning though, for the first time with severe stiffness and pain in my thigh and all around my knee. I got very upset and scared but also the weather is really cold and raining, could this be the cause of these pains? Thank you for listening.
Hi Mona. We’re sorry to hear that you’re experiencing severe stiffness and pain. It’s good that you’ll be seeing your surgeon, who will likely give you helpful information and hopefully help ease your worries. Also, it’s great to see how motivated you are and the progress you’ve made so far. Keep at it! You can also feel free to join our Facebook group created for knee surgery patients just like you. There’s a lot of great information on there. If you’d like to check it out, here’s the link for you. https://www.facebook.com/groups/jointreplacementsupport
I am two years post op from my tkr. This article was very informative, even at the stage I am. My knee flex measures at 130 degrees and I never knew if this was good or not. I am in my mid 60’s.
Hi Deborah! We’re glad you found this article helpful, and we’re glad to hear that it answered an important question for you. We’ve been letting our readers know that we also have a wonderful group you can join on Facebook, specifically for knee and hip joint replacement patients. You’ll find tons of helpful tips, information and other patient experiences on there. Also a great place to ask some questions! Here’s that link for you: https://www.facebook.com/groups/jointreplacementsupport
I’m 5 weeks out. My knee flex is at 106 degrees and leg very straight. Today I have therapy and by Thursday he wants me at 115 degrees. I’ve worked very hard with exercise but also worry I’m behind. Leg feels great, not as stiff or swollen.
Hi Carey! Most post-TKR patients have similar worries, so you’re not alone. However, kudos to you for putting in the work! We’re so glad to hear that your legs are not feeling stiff or swollen. Well done! Please feel free to join our Facebook group for knee replacement patients just like you. You’ll find tons of useful information in there. Here’s the link for you! https://www.facebook.com/groups/jointreplacementsupport
I am going on 7 weeks after TKR. Very frustrated as only 90degree bend. I work hard to bend knee but very stiff and patella is very tight. What can I do? My doctor at 6 weeks appt said to keep working at it. UGHHHH its so painful at times. Will I eventually get more bend with time? The straightening is ok just bending is awful. Suggestions helpful I’m just so worried.
Hi Mary. Sorry to hear that it’s been so painful at times for you. The struggle is real, and you’re not alone. But, listening to your doctor is key to improving, so keep working at it! We encourage you to join our joint replacement group on Facebook – full of supportive people going through the same things you are, as well as tons of helpful information about Post-TKR. Here’s that link for you: https://www.facebook.com/groups/jointreplacementsupport
Hello. I’m at the end of week 8 of TKR. It has been a lot of work but I’m still struggling with my flexion. I’m trying so hard to get to 90-100 I’m only just at 85. My extension is like -5. So this is good. I do know I must be able to achieve this flexion as I used a CPM machine and was able to achieve 110 befor I turned it back in. I would like to thank you all for the info you all have and this page gave me. I have requested to join the FB page as well
Hi Cynthia! Although it can be a struggle at times, we’re happy to hear that you’re putting in the work and making progress. Thank you so much for your kind comments. We’re happy you found the article beneficial, and we’re looking forward to chatting more with you in the FB group!
DONT GIVE UP ….2 weeks post surgery I could only reach 70 degrees bend and the surgeon wasn’t happy. Said I had to work harder. It wasn’t until my GP got my pain management sorted that I started to see results. I’m now 14 weeks post surgery and have a bend of 147. It’s taken a lot of hard work and tears but you will get there eventually. I set a goal every day of what I wanted to achieve and believed I could get there. Stay positive, everyone achieves at different rates so don’t compare yourself to others. This is an individual journey but one that requires a great support team.
Thank you for your comment, Wendy! We completely agree that each person is unique with a completely different set of circumstances, which is why comparing your progress with someone else’s progress is counter productive. It’s an important (and inspiring) reminder for those who are working hard to increase their ROM. You didn’t give up – you kept going, stayed the course, made your goals and ended up getting great results! We’d like to invite you to join our Facebook group for hip and knee replacement community support :). Here’s that link for you! https://www.facebook.com/groups/jointreplacementsupport