Recovering from a total knee replacement (TKR) is a journey, and one of the most important parts of that journey is getting your knee moving and strengthening again. After surgery, you will likely hear about two main types of exercise: hydrotherapy (water-based) and land-based (exercising on solid ground). Both play a key role, but when should you start each? Let’s break it down to help you understand their benefits.
Land-based exercise: The very first step in recovery
Why it’s important:
Land-based exercises begin immediately after surgery, focusing on early mobilisation and weight-bearing (as tolerated). Here’s why they’re essential:
- Early mobilization: Standing and walking (with assistance from mobility aids) as soon as possible after surgery (day 0 or day 1) helps prevent complications (e.g. blood clots and stiffness) and regain function.
- Weight-bearing movements and bone health: Practicing movements such as walking, standing and gentle knee exercises prepares the knee for daily activities. Bones adapt to the stress placed upon them and as such controlled weight-bearing stimulates bone remodelling, which is crucial for long-term joint health.
- Muscle activation: Strengthening key muscle groups, such as the quadriceps, hamstring, glutes and calf muscles, helps support knee stability.
Hydrotherapy: A great tool for enhancing recovery
Why it’s helpful:
Hydrotherapy is highly beneficial, particularly for patients struggling with weight-bearing exercises, pain or joint stiffness. It involves performing exercises in warm water, making it an excellent option for early rehabilitation after wound clearance. Here’s why:
- Low impact: The buoyancy of the water helps support your body, so there’s less stress on your knee. This makes moving easier, especially while your knee is still healing and may be swollen or painful.
- Improved range of motion: Water (especially warm water) allows you to gently move your knee through its range of motion, helping to reduce stiffness and increase flexibility without putting too much pressure on the joint.
- Pain relief and reduce swelling: The warm water is soothing and can help relieve post-surgery discomfort.
So, which one should you choose?
Both hydrotherapy and land-based exercises have a place in your recovery and there is no proven benefit that one method is better than another. The main advantages of hydrotherapy are buoyancy (which facilitates movement and reduces stiffness) and hydrostatic pressure (which facilitates reducing swelling). It can also increase exercise load by creating resistance through water turbulence. Hydrotherapy is great for moving your knee in the early stages (after wound clearance, usually 4-6 weeks post-surgery). If you’re having trouble with land-based exercises, hydrotherapy can be a good confidence booster. However, land-based exercises are the key to bone health and functional strength to rebuild your new knee and confidently return to everyday activities. Combining both types of exercise can further enhance the range of motion, manage swelling and improve knee function post-surgery.
Why seeing a physiotherapist is key
Whether doing hydrotherapy or land-based exercises, working with a physiotherapist is the best way to ensure you’re doing the right exercises and rebuilding your new knee.
- Personalised plan and track your progress: Everyone’s recovery is different. Your physiotherapist will create a rehab plan specifically tailored to your needs, guiding you through exercises that help your knee heal and strengthen.
- Proper technique: Doing exercises with the right form is crucial to prevent further injury. Your physiotherapist will ensure you perform each movement correctly to get the best results and avoid setbacks.
Your physiotherapist is your partner in this process. We are here to help you progress safely and ensure your recovery goes as smoothly as possible!
References:
- Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based
rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis
Rheum. 2009;61(2):184-191. https://doi.org/10.1002/art.24420
- Lee CH, Kim IH. Aquatic exercise and land exercise treatments after total knee
replacement arthroplasty in elderly women: a comparative study. Medicina. 2021;57(6):589. - Gibson AJ, Shields N. Effects of aquatic therapy and land-based therapy versus land-
based therapy alone on range of motion, edema, and function after hip or knee replacement:
a systematic review and meta-analysis. Physiother Can. 2015;67(2):133.
https://doi.org/10.3138/ptc.2014-01 - McAvoy R. Research report: aquatic and land-based therapy vs. land therapy on the
outcome of total knee arthroplasty: a pilot randomized clinical trial. J Aquat Phys Ther.
2009;17(1):8-15.
