Recovering from Total Knee Replacement? Start with These Safe, Effective Week 1 Exercises
The first week after total knee replacement surgery is all about reducing pain, controlling swelling, and restoring basic mobility—without putting unnecessary stress on your new joint. While it might feel counterintuitive to move so soon after surgery, doing the right exercises early on is crucial to avoid stiffness and speed up your recovery.
As a physical therapist, I guide patients through this phase every day. The exercises in this guide are designed to gently activate the quadriceps, restore range of motion, and support circulation—all while protecting your surgical knee. You won’t need any fancy equipment, and you can do everything at home, often in just a few short sessions per day.
This first week is also when your mindset matters most. You don’t need to push through pain to make progress—what you need is a structured, repeatable routine that keeps you moving safely and steadily forward.
Now, let’s get into the best exercises to do in Week 1 after knee replacement—starting with gentle stretches and quad activation drills to help you move with less pain and more confidence.
🔽 Want a quick-reference PDF? Scroll down to the bottom of this post to grab your free printable plan!
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Week 1 Knee Replacement Exercise Routine: Reduce Swelling, Regain Motion, and Rebuild Strength
Your first week after total knee replacement should focus on gentle exercises that help you manage swelling, activate the quadriceps, and restore early range of motion—especially full knee extension. Below is a PT-approved routine to follow at home using minimal equipment, with an emphasis on safe, repeatable movement.
Aim to complete this routine 2–3 times per day unless instructed otherwise by your surgeon or physical therapist. Avoid any movement that causes sharp pain, and focus on slow, controlled motion.
1. Hamstring Stretch with Strap
- Purpose: Lengthens the hamstrings to reduce tension behind the knee.
- Benefits: Supports smoother knee extension and reduces post-op tightness.
- How to Do It:
- Lie on your back, loop a strap around your foot, and keep your leg straight.
- Lift your leg until you feel a stretch in the back of your thigh.
- Hold for 20 seconds, repeat 5 times.
- Pro Tip: Use a Stretching Strap with loops for better control and positioning.
2. Calf Stretch with Strap
- Purpose: Gently lengthens the gastrocnemius muscle, which can become tight after surgery and restrict knee extension.
- Benefits: Improves flexibility and supports full straightening of the knee.
- How to Do It:
- Sit with your surgical leg straight and loop a strap around the ball of your foot.
- Gently pull your toes toward you until you feel a stretch in the calf.
- Hold for 20 seconds, repeat 5 times.
- Pro Tip: A stiff Stretching Strap helps you to keep effective tension.
3. Quad Set (Towel Under Knee)
- Purpose: Re-engages the quadriceps without bending the knee.
- Benefits: Reduces muscle shutdown and kickstarts recovery.
- How to Do It:
- Lie on your back with a towel roll under your knee.
- Tighten your thigh to press the knee down into the towel roll.
- Hold for 2 seconds, perform 30 reps.
- Pro Tip: Use a Thick Yoga Mat to lie on for more comfort and support.
4. Quad Set (Towel Under Ankle)
- Purpose: A variation that helps encourage full knee extension.
- Benefits: Keeps the quad active while allowing the knee to stay straight.
- How to Do It:
- Lie on your back with a towel roll under your ankle.
- Tighten your thigh to press the knee down.
- Hold for 2 seconds, perform 30 reps.
- Pro Tip: Do your exercises on a portable Massage Table for even more ease and support.
5. Straight Leg Raise
- Purpose: Builds quad strength without moving the knee joint.
- Benefits: Supports knee stability and improves muscle control following knee surgery.
- How to Do It:
- Lie on your back with one leg bent and the other straight.
- Tighten your thigh and lift the straight leg to the height of your bent knee, then lower slowly.
- Repeat for 10 reps and complete 2 sets..
- Pro Tip: If you can’t lift the leg yet, have a helper assist the movement gently.
6. Short Arc Quad
- Purpose: Isolates quad activation through a small range of motion.
- Benefits: Helps improve strength without straining the new joint.
- How to Do It:
- Rest your knee over a foam roll while lying on your back.
- Straighten the knee by lifting your heel off the surface, pause briefly at the top.
- Lower slowly and repeat 15 times for 2 sets.
- Pro Tip: Use a Foam Roll behind the knee for proper support.
7. Long Arc Quad
- Purpose: Strengthen the quad through a longer, more functional range.
- Benefits: Builds muscle control needed for walking and stair climbing.
- How to Do It:
- Sit with your leg dangling off the side of a bed or chair.
- Straighten the knee by kicking your foot straight out, pause briefly at the top.
- Lower slowly and repeat 15 times for 2 sets.
- Pro Tip: Use an Ankle Weight on the ankle to slowly increase the resistance.
8. Heel Slides
- Purpose: Improves knee bending range of motion safely in early recovery.
- Benefits: Reduces stiffness and prevents scar tissue buildup.
- How to Do It:
- Loop a strap around your foot.
- Slide your heel slowly toward your buttocks, keeping your foot on the surface.
- Hold for 10 seconds and repeat 10 times.
- Pro Tip: Use a Stretching Strap with loops for ease and for the best results.
9. Heel Prop
- Purpose: Passively improves knee extension (straightening), which is a priority in Week 1.
- Benefits: Prevents long-term stiffness and helps normalize gait mechanics.
- How to Do It:
- Prop your heel on a towel roll or foam roller.
- Place an ankle weight on your knee and allow the knee to relax and straighten.
- Hold for 5 minutes, build up to 10 minutes if restriction still exists.
- Pro Tip: Increase the Ankle Weight gradually to progress your stretch and extension gains.
Bonus: Ice Pack and TENS for Early TKR Pain and Swelling
- Purpose: Reduce pain, inflammation, and muscle inhibition during early recovery.
- Benefits: Enhances comfort and reduces swelling, especially after exercise.
- How to Use:
- Place TENS pads just over the painful area of the knee.
- Apply ice for 10–15 minutes post-exercise.
- Pro Tip: Use the Ice Pack and the TENS Unit at the same time for maximum efficiency.
Looking for a simple way to stay consistent?
👉 Download the free Week 1 Knee Replacement Exercise Program (PDF) + Exercise Tracker (PDF) to follow and log your daily progress.
Week 1 Knee Replacement Exercises: Final Thoughts
Completing your first week of knee replacement rehab is a big deal—and sticking with a consistent routine now lays the foundation for everything that comes next.
These early exercises are designed to help you rebuild confidence, regain range of motion, and re-engage your quadriceps without putting unnecessary stress on your healing joint. It’s not about doing more—it’s about doing the right things, regularly and mindfully.
Even small improvements this week—like better straightening, less swelling, or easier movement in bed—are signs that your recovery is on track. Celebrate that.
In the coming weeks, your rehab will start to focus more on functional strength, walking, and controlled movement patterns. Stick with it—you’ve already taken the most important first step.
If you’re looking for more targeted guidance, be sure to check out our related resources, including:
Why Trust Physical Therapy Simplified for Early-Stage Post-Op TKR Guidance?
At Physical Therapy Simplified, our mission is to provide an accessible, trustworthy source of physical therapy guidance that anyone can understand, follow, and benefit from. We want you to feel confident that you’re getting evidence-based advice and the best exercises in the first week after a total knee replacement—all designed to reduce pain and restore your highest functional potential.
This article was written by Andrew Harkins, PT, DPT, OCS, a licensed physical therapist with over twelve years of clinical experience. He is certified by the American Board of Physical Therapy Specialties as an Orthopedic Clinical Specialist and has worked with thousands of knee replacement patients—from early post-op care to full return to functional potential.
Andrew has also served as a teaching assistant at the University of Pittsburgh’s Doctor of Physical Therapy Program, where he contributed to musculoskeletal coursework with a special focus on knee rehabilitation and surgical treatment recovery strategies. His knowledge and hands-on experience ensure that the information you’re reading is not only accurate but clinically proven to help.
