Your First Week of Physiotherapy After Knee Replacement

The first week after knee replacement surgery is the most critical period of your entire recovery. What you do (and do not do) during these seven days sets the trajectory for your range of motion, strength, and overall outcome for the months ahead. In our work with hundreds of post-surgical patients in Dubai, we have consistently seen that patients who commit fully to their first-week physiotherapy program recover faster and achieve better long-term results.

This guide walks you through what to expect day by day, the specific exercises you should be doing, how CPM therapy fits into the picture, and the milestones you should be aiming for. We have also included red flags that require immediate medical attention.

Day 1: The Day of Surgery

Most knee replacements in Dubai are performed in the morning, and physiotherapy begins the same day. This may seem surprisingly early, but research consistently shows that early mobilization leads to better outcomes. You may still have a nerve block providing pain relief, which actually makes day-one exercises easier than you might expect.

What Happens on Day 1

• Ankle pumps: The very first exercise, usually within hours of surgery. Simply pump your foot up and down (like pressing a gas pedal) to promote blood circulation and prevent blood clots. Aim for 10 repetitions every 30 minutes while awake.
• Quad sets: Tighten your thigh muscle (quadriceps) while lying flat, pressing the back of your knee into the bed. Hold for 5-10 seconds, relax, and repeat 10 times. You may not feel much muscle activation on day one, and that is normal.
• Deep breathing exercises: Important for preventing pneumonia, which is a risk after any surgery under general anesthesia. Take 10 deep breaths every hour while awake.
• Bed mobility: Your physiotherapist will teach you how to safely get in and out of bed, using proper technique to protect your knee.

Day 2: First Steps

Day two is when most patients take their first steps. This is both a physical and psychological milestone. Your physiotherapist will guide you through the process.

What Happens on Day 2

• Standing: With your physiotherapist's support and a walker or crutches, you will stand at the bedside. This may last only 30-60 seconds initially, and that is perfectly fine.
• First steps: Most patients manage 5-10 steps with a walker. The goal is weight-bearing as tolerated, meaning you put as much weight on the operated leg as feels comfortable.
• Continued bed exercises: Ankle pumps, quad sets, and adding gluteal squeezes (tightening your buttock muscles while lying flat).
• Sitting in a chair: If you are able, sitting in a chair beside the bed for 20-30 minutes. This is important for preventing blood clots and getting your body accustomed to the upright position.
• CPM introduction: If you are recovering at home (many patients in Dubai are discharged within 24-48 hours), day two is typically when CPM therapy begins. Start at 0-30 degrees for 1.5-2 hour sessions. See our CPM settings guide for detailed instructions.

Days 3 and 4: Building Confidence

By days three and four, you are settling into a routine. The initial post-surgical fog is lifting, and while pain remains significant, it is becoming more manageable. These days are about increasing your activity level gradually.

Exercise Program (Days 3-4)

• Walking: Increase walking distance with the walker. Aim for 3-4 short walks per day, gradually extending from one room to moving around your home. Each walk should be 5-10 minutes.
• Seated knee flexion: Sitting in a chair, slide your foot back along the floor to bend your knee. Use your other foot behind the heel to help guide it. Aim for 40-50 degrees of flexion.
• Straight leg raises: Lying flat, tighten your quad, and lift your entire leg 15-20 cm off the bed. Hold for 5 seconds. This is challenging and you may need to build up to it. Even attempting the exercise activates important muscles.
• Heel slides: Lying on your back, slide your heel toward your buttock, bending the knee as far as comfortable. Use a towel around your foot to assist if needed.
• CPM therapy: Increase to 4-6 hours per day, split into 2-3 sessions. Progress the range to 0-40 or 0-50 degrees as tolerated.

Practical Milestones

By day 3-4, you should be able to:

• Get in and out of bed independently (or with minimal help)
• Walk to the bathroom with a walker
• Sit in a chair for meals
• Complete your exercise program 2-3 times per day

Days 5 to 7: Gaining Momentum

The final days of the first week bring noticeable improvement for most patients. Pain is decreasing, confidence with the walker is growing, and the knee is beginning to respond to consistent exercise and CPM therapy.

Exercise Progression (Days 5-7)

• Increased walking: 4-6 walks per day, 10-15 minutes each. Practice turning corners, navigating doorways, and walking on different surfaces in your home.
• Stair training: If you have stairs at home, your physiotherapist will introduce stair climbing with support. The rule: "Up with the good, down with the bad." Lead with your non-operated leg going up and your operated leg going down.
• Increased knee flexion: Target 50-70 degrees of active flexion. Continue heel slides and seated flexion exercises.
• Standing exercises: Standing heel raises (both legs), weight shifting side to side, and mini squats holding onto a counter for support.
• CPM therapy: 4-6 hours per day, range progressing toward 0-50 to 0-60 degrees. For detailed daily scheduling, see our guide on how many hours to use CPM per day.

Essential First-Week Exercises in Detail

1. Ankle Pumps

Purpose: Prevents blood clots, promotes circulation
How: Push your foot down (like pressing a gas pedal), then pull it up toward you. Move only at the ankle.
Frequency: 10 reps every 30 minutes while awake
When to start: Within hours of surgery

2. Quad Sets

Purpose: Activates the quadriceps muscle, essential for knee control
How: Lying flat, tighten your thigh muscle, pressing the back of your knee into the bed. You should see your kneecap move slightly.
Frequency: 10 reps, 5-10 second hold, 3-4 times per day
When to start: Day 1

3. Straight Leg Raises

Purpose: Builds quadriceps strength, important for walking
How: Lying flat, tighten your quad (as in quad set), then lift the entire leg 15-20 cm off the bed with the knee straight. Hold 5 seconds, lower slowly.
Frequency: 10 reps, 3 times per day
When to start: Day 2-3 (may take a few days to achieve)

4. Heel Slides

Purpose: Improves knee flexion (bending range of motion)
How: Lying on your back, slide your heel toward your buttock, bending the knee. Hold at the maximum comfortable bend for 5 seconds, then slide back.
Frequency: 10 reps, 3-4 times per day
When to start: Day 2-3

5. Gluteal Squeezes

Purpose: Activates hip muscles, supports walking and stability
How: Lying flat or standing, squeeze your buttock muscles together. Hold 5-10 seconds.
Frequency: 10 reps, 3 times per day
When to start: Day 1-2

For exercises that complement your CPM sessions, see our dedicated guide on exercises to do alongside CPM therapy.

The Role of CPM in the First Week

Continuous Passive Motion plays a crucial complementary role during your first week. While your physiotherapy exercises are active (requiring your muscles to work), the CPM provides passive motion (the machine does the work). Together, they address both strength and mobility.

How CPM Complements First-Week Physio

• Between exercise sessions: CPM keeps the joint moving during the hours between your active exercise sessions, preventing stiffness from setting in
• Swelling management: The gentle pumping action helps drain excess fluid from the joint
• Pain gating: Gentle passive motion can actually reduce pain perception through stimulation of mechanoreceptors
• Preventing adhesions: Consistent motion in the first week is critical for preventing scar tissue from limiting your range of motion

Learn more about how these two therapies work together in our article on CPM versus physiotherapy.

First Week Goals and Milestones

These are general targets. Do not be discouraged if you fall slightly short, especially with flexion range. Some patients take 10-14 days to reach 70 degrees, and this does not mean their long-term outcome will be any different. Consistency matters more than speed.

Red Flags: When to Call Your Surgeon

While first-week discomfort and challenges are normal, certain symptoms require immediate medical attention. Contact your surgeon or go to the emergency department if you experience:

• Fever above 38.5 degrees Celsius that does not respond to paracetamol
• Increasing redness that spreads beyond 2-3 cm from the incision
• Sudden increase in pain that is not relieved by your prescribed medication
• Calf pain, tenderness, or swelling (could indicate a blood clot / deep vein thrombosis)
• Difficulty breathing or chest pain (could indicate a pulmonary embolism)
• Wound drainage that is cloudy, foul-smelling, or increasing after day 3
• Numbness or tingling in your foot that does not resolve with repositioning

For comprehensive guidance on managing post-surgical symptoms, read our guide on managing pain and swelling after knee surgery.

Tips for First-Week Recovery in Dubai

• Home setup: Before surgery, arrange your living space so everything you need is on one floor. Place a chair with armrests near the bathroom, and remove tripping hazards (rugs, cables).
• Temperature: Keep your home at 21-23 degrees Celsius. Too warm increases swelling; too cold causes muscle stiffness.
• Hydration: Dubai's climate demands extra attention to hydration, even when staying indoors. Aim for 2.5-3 liters of water per day. See our guide on hydration after knee surgery.
• Nutrition: Protein-rich meals support tissue healing. Consider foods that support knee recovery and protein timing strategies.
• Help at home: Arrange for someone to be with you during the first week. In Dubai, many patients hire a temporary caregiver or nurse for the first 5-7 days.