The first two weeks after a total knee replacement set the tone for everything that follows. Get the right movement in early — not too much, not too little — and you protect your new joint's range of motion, keep swelling under control, and build the quad strength you'll need to walk confidently again. Skip it, or overdo it, and stiffness or setbacks can creep in that take months to undo.
This guide breaks down exactly which exercises matter most in days 1–14, how often to do them, and the red flags that mean you should stop and call your physiotherapist.
Clinical Precaution: Always follow the specific programme given by your surgeon or physiotherapist. This guide reflects general best practice for a standard total knee replacement recovery, but your surgical technique, implant type, and personal health history can change what's right for you.
Why the First 14 Days Matter So Much
In the first two weeks after surgery, your body is doing two things at once: healing the surgical site and laying down new scar tissue around the joint. That scar tissue has a short window where it's still pliable. Move the knee through a safe range regularly during this period, and the tissue forms in a way that allows flexibility. Leave the joint still for too long, and scar tissue can tighten around it — a major driver of the stiffness that makes later rehab so much harder.
This is also the window where quadriceps activation returns. Your quad muscle effectively "switches off" around a joint that's been operated on (a phenomenon called arthrogenic muscle inhibition). Early, gentle activation exercises are what wake it back up — and a strong quad is what stops your knee buckling when you stand or walk.
Before You Start: General Safety Rules
- Ice and elevate after every session: 15–20 minutes of ice with your leg raised above heart height helps control the swelling that exercise stirs up.
- Some discomfort is normal; sharp pain is not: A dull ache or pulling sensation during stretches is expected. Sudden, sharp, or worsening pain is a signal to stop.
- Little and often beats one long session: Five short sets spread through the day maintain range of motion far better than one exhausting workout.
- Use your walking aid as prescribed: Most patients need a frame or crutches for the first 1–2 weeks, even once walking feels easy — it protects the joint while soft tissue heals.
Days 1–3: Waking the Muscles Up
The goal here is purely activation and circulation — not strength or big range yet.
1. Ankle Pumps
- How to do it: Point your toes up toward your shin, then down like pressing a pedal.
- Dosage: 10 reps, every hour you're awake.
- Why it matters: This is the single most important exercise for preventing blood clots (DVT) in the early days.
2. Quad Sets (Static Quads)
- How to do it: Sitting or lying with your leg straight, push the back of your knee down into the bed and tighten your thigh muscle. Hold 5 seconds, release.
- Dosage: 10 reps, 4–5 times a day.
- Why it matters: Directly overcomes muscle inhibition to restore knee stability.
3. Gluteal Sets
- How to do it: Squeeze your buttock muscles and hold for 5 seconds.
- Dosage: 10 reps, 3 times a day.
- Why it matters: Often overlooked, but glute strength directly supports how your knee tracks when you walk.
4. Heel Slides
- How to do it: Lying down, slowly slide your heel toward your bottom, bending the knee as far as comfortable, then slide back out.
- Dosage: 10 reps, 3–4 times a day.
- Why it matters: This is your main tool for regaining bend (flexion) in the joint.
5. Straight Leg Raises
- How to do it: Tighten the quad first (as in the quad set), then lift the whole leg a few inches off the bed, keeping the knee straight.
- Dosage: 10 reps, 3 times a day.
- Why it matters: Introduced once your surgeon or physio confirms it's safe (for some patients this is introduced from day 3–4 rather than day 1).
Days 4–7: Building Range and Load Tolerance
By now, walking distances are increasing and it's time to add movements that challenge range of motion a little further and start reintroducing standing balance.
1. Seated Knee Flexion
- How to do it: Sitting on the edge of a chair or bed, slide your foot back under you to bend the knee as far as tolerable, hold 5–10 seconds, then straighten.
- Dosage: 10 reps, 3 times a day.
2. Seated Knee Extension
- How to do it: Sitting with your knee bent to 90°, straighten the leg out fully, hold 5 seconds, lower slowly.
- Dosage: 10 reps, 3 times a day.
- Why it matters: Controlling the lowering phase is what builds real quad strength, not just the lift.
3. Standing Knee Bends (Mini Flexion)
- How to do it: Holding onto a stable surface, bend the operated knee slightly, bringing the heel toward your bottom, then lower with control.
- Dosage: 10 reps, twice a day.
4. Standing Hip Abduction
- How to do it: Holding onto a stable surface, lift the operated leg out to the side, keeping the knee straight and toes forward.
- Dosage: 10 reps, twice a day.
- Why it matters: Builds hip stability, which takes pressure off the healing knee during walking.
5. Short, Regular Walks
- Target: Aim for several short walks rather than one long one — around the house every 1–2 hours is a reasonable early target, increasing distance as swelling and pain allow.
Days 8–14: Consolidating Function
Pain and swelling are typically settling by now, and the focus shifts to normalising how the knee moves during everyday tasks.
1. Sit-to-Stand Practice
- How to do it: From a firm chair with arm rests, practise standing up and sitting down with control, using your arms only as much as needed.
- Dosage: 8–10 reps, 2–3 times a day.
- Why it matters: This is one of the best functional strength exercises available — it mimics exactly what your knee needs to do dozens of times a day.
2. Step-Ups (Low Step)
- How to do it: Using a stair rail or stable support, step up onto a low step with the operated leg leading, then step back down.
- Dosage: 8–10 reps, once a day, only once balance and confidence allow.
3. Stationary Cycling (No Resistance)
- How to do it: If you have access to a stationary bike, pedalling with the seat raised and no resistance is excellent for range of motion and gentle strengthening.
- Note: Some patients begin partial pedalling (rocking back and forth) as early as day 7–10, progressing to full rotations as flexion improves.
4. Continued Heel Slides and Knee Extensions
- Keep progressing the range on both — by day 14, many patients are working toward roughly 90° of flexion and full extension, though this varies by individual and surgical approach.
Warning Signs: When to Stop and Call Your Physiotherapist or Surgeon
Contact your clinical team promptly if you notice:
- Sudden increase in swelling, redness, or warmth around the knee
- Calf pain, swelling, or tenderness (a possible sign of DVT)
- Wound that's leaking, opening, or looks infected
- Fever or feeling generally unwell
- A sharp increase in pain that isn't settling with rest and ice
- The knee giving way or feeling unstable when weight-bearing
None of these are exercises to "push through" — they're reasons to pause and get assessed.
Why Guided, In-Home Physiotherapy Makes a Difference Early On
The first two weeks are exactly when small errors compound — a heel slide done too aggressively, a walking pattern that's quietly favouring the wrong side, or a missed warning sign. Having a physiotherapist assess your knee in your own home during this window means your exercise programme is tailored to your actual range of motion and progress, not a generic timeline, and any red flags are caught early rather than at your next hospital follow-up.
Rehalign's physiotherapists work with patients across the West Midlands in the days and weeks following knee replacement surgery, building a progressive home exercise programme, checking your walking pattern, and adjusting your plan as your knee responds.
If you're recovering from knee replacement surgery and want a tailored rehabilitation plan in your own home, book an assessment with Rehalign — our physiotherapists will meet you where you are in recovery and build a plan around it.
Frequently Asked Questions
Most protocols aim for roughly 90° of flexion and full, or near-full, extension by around two weeks, though this varies with surgical technique, swelling, and individual healing. Your physiotherapist will track your specific progress against realistic milestones rather than a fixed number.
A dull ache, tightness, or pulling sensation during stretching exercises is normal and expected. Sharp, sudden, or worsening pain is not, and should prompt you to stop and seek advice.
Most early-stage programmes call for short sessions spread across the day — often 3–5 times daily — rather than one long session. Frequent, brief movement maintains range of motion more effectively than infrequent, intense sessions.
This depends on your strength, balance, and your surgeon's or physiotherapist's assessment, but many patients transition from a frame to a stick, and then to unaided walking, gradually over the first few weeks — not on a fixed schedule.
Yes. Overloading the joint in the first two weeks can increase swelling and pain and slow overall progress. This is one of the main reasons a physiotherapist-guided programme, rather than a generic exercise sheet, matters most in this early window.