Exercises to Strengthen Legs Before Knee Replacement Surgery & After

Slow Motion Strength Training Exercises to Strengthen Legs Before Knee Replacement Surgery & After

Slow Motion Strength Training Exercises to Strengthen Legs Before Knee Replacement Surgery & After

Is a knee replacement in your future? You might think reducing activity, avoiding exercise or doing everything to “stay off of it” might be the best gameplan. However, studies show consistent strength training in the weeks and months leading up to knee replacement helps to make a quicker and full recovery compared to those who don’t.

In this article, we discuss what a knee replacement surgery is, how to approach strength training before and after surgery, as well as specific exercises to do. Ready to take care of those knees? Let’s get into it….

Jump to Topic:
What is a Knee Replacement?
Strength Training Before Surgery
Strength Training After Surgery
Exercises To Do Pre & Post Surgery

What is a Knee Replacement?

Simply put, knee replacements replace arthritic and deteriorated joints with well-functioning joints. Knee replacements are an increasingly popular surgery. In the last 15 years, knee replacement surgeries have tripled in the United States (Singh et al., 2019; Topp et al., 2009). Over a million knee replacement surgeries take place annually (Singh et al., 2019). The increase is a positive as these surgeries have immense value.

These surgeries, though, are not a given. Replacing an arthritic knee with a new knee doesn’t guarantee healthy function and movement. Some suffer from long-term knee stiffness, a lack of range of motion, pain, swelling, and instability after a replacement.

Many who go through surgery never fully regain their leg strength and functional ability (Skoffer, Dalgas, & Mechlenburg, 2014). Knee replacements also require a much longer recovery time than hip replacements (Skoffer et al., 2014).

Knee replacements can help solve a problem, but the outcomes are not certain.

How can positive outcomes become more certain? Strength training – both before AND after surgery – addresses critical side effects of knee replacement surgeries.

Strength Training Before Surgery

Focusing on the quadriceps is key when strength training before surgery. In the first month after a knee replacement surgery, the quadriceps on that leg lose about 60% of their strength (Mizner et al., 2005).

If you’re looking for a reason why some people lose function after a replacement and never regain it, this may be it. The quadriceps are a critical muscle group for regular movements, such as walking and standing.

Strength training before surgery helps in a few ways. First, it builds a better baseline level of strength. Therefore, post-surgery, the person has a better chance of still being functional after losing strength.

Pre-surgery training reduces pain in the arthritic joint (Topp et al., 2009). It also leads to better overall balance and functional ability after surgery (Topp et al., 2009). This could be explained by the addition of strength, which underlies balance.

Strength Training After Surgery

Strength training after surgery is also important for the knee joint’s long-term prognosis. In addition to the quadriceps, several other muscle groups lose strength following surgery:

  • hamstrings
  • hip adductors
  • hip abductors
  • tibialis anterior (front of the lower leg) (Skoffer et al., 2014).

Considering all of the impacted muscles, it’s easy to see why many never fully regain function and strength afterwards.

The main benefits of training are increasing the size of the quadriceps muscle size and strength (Skoffer et al., 2014). The muscle growth specifically is seen in the fast-twitch, or type 2 muscles. These muscle fibers are the main ones responsible for challenging movements, such as standing up quickly from a chair or walking up steep stairs.

Recommended Exercises Pre- And Post-Knee Replacement

With the quadriceps being the muscle group most impacted by surgery-induced strength loss, the quad muscles are the main focus of pre- and post-knee replacement training. The following are recommended quad-focused exercises:

If pain occurs during any of these exercises, try the following adjustments.

  • Reduce the range of motion. This applies to the leg extension, leg press, or sumo squats. Move through as large of a motion as you can while omitting the part where pain is present.
  • Move your feet. For the leg press, consider rotating your toes outward or move your feet higher on the footplate. For the sumo squats, move your feet further apart. For the wall sits, move your feet further from the wall.

As noted before, other local muscles lose strength following surgery. It’s important to train these muscles (hamstrings, hip adductors, and hip abductors) as well. Here are a few exercises to add into your workouts for pre- and post-operation:

  • Leg curls (hamstrings).
  • Dumbbell deadlifts (hamstrings).
  • Hip adduction. This can be performed with a machine or standing with resistance bands.
  • Hip abduction. Similarly, this can be performed with a machine or while standing with resistance bands.

To obtain the benefits of pre-surgery training, aim for a minimum of six weeks of exercise (Topp et al., 2009). Ideally, training will take place regularly for several months beforehand. Following surgery, be patient. Post-surgery benefits likely require several months to fully obtain (Skoffler et al., 2014).

After surgery, start with a light resistance in a minimal range of motion. Gradually build the range of motion and resistance over time. Pay attention to how the knee responds in the days following the session. These reactions will serve as a guide for determining whether or not to continue progressing at the same pace.


Knee replacements are an increasingly common yet challenging procedure. Many people never fully regain their strength and functional abilities after surgery. Strength training can help ensure a quicker and full recovery.

Pre-surgery training might be most critical. People who train for at least six weeks prior to surgery can reduce their short-term pain, plus benefit from better outcomes after surgery. Post-surgery training also helps with regaining strength and muscle.

The quadriceps are the focus of training, although other leg muscles should be trained as well. Start with a partial range of motion and light resistance. Gradually build both over time.

  • Mizner, R. L., Petterson, S. C., Stevens, J. E., Axe, M. J., & Snyder-Mackler, L. (2005). Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. The Journal of Rheumatology, 32(8), 1533-1539.
  • Singh, J. A., Yu, S., Chen, L., & Cleveland, J. D. (2019). Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample. The Journal of Rheumatology, 46(9), 1134-1140.
  • Skoffer, B., Dalgas, U., & Mechlenburg, I. (2014). Progressive resistance training before and after total hip and knee arthroplasty: a systematic review. Clinical Rehabilitation, 1-16.
  • Topp, R., Swank, A. M., Quesada, P. M., Nyland, J., & Malkani, A. (2009). The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM&R, 1(8), 729-735.

Featured Trainer Kippy Benefield

Featured Trainer Kippy Benefield

Featured Trainer Kippy Benefield

Female trainer helping female member with her plank form

Born and raised Texan, Kippy Benefield is passionate about being fit and feeling good which led to her career as a Personal Trainer…

But just like our Founder, Matt Hedman, Kippy struggled with osteoarthritis in her knee. She battled constant pain and swelling, making it hard to exercise comfortably–let alone enjoy it.

She knew there had to be a better way to exercise without the constant aches and pains. After doing some research she found slow-motion strength training.

This brief and intense way of exercise changed the way she strength-trained forever.

“Slow-motion strength training has kept me safe and strengthened my quadriceps, my hamstrings, and my calves to the point where I don’t have pain or swelling anymore.”

Trainer coaching member on how to do bicep curls

Kippy also feels like this workout has helped her through a big transition in her life. “I can’t say enough about how this method has kept me feeling good and strong through menopause and now post-menopause.”

The workout alone made a profound impact on Kippy’s health and life, so she decided to become a bigger part of it.

“I saw the difference exercise has made in my life, and, as I aged, I wanted to help other people get healthier too.”

In March 2015, Kippy went through the extensive certification process and joined The Dallas team of Personal Trainers at The Perfect Workout.

She loves the personal side of training others as she gets to work closely and knows almost everything about her members.

“The relationships are priceless. The biggest reward is celebrating all the victories, big and small.”

Female trainer coaching female member on the compound row with a quote in it

Not only has Kippy experienced results herself but she’s helped many members make significant changes in their personal health and well-being.

One of Kippy’s members had hip replacement years ago and she trained at The Perfect Workout before having surgery.

After she went through Physical Therapy, she came back to train with Kippy, and they started rehabbing her. This post-surgery member could only press 20 pounds on the Leg Press when she returned, and now she is pushing 215 pounds!

Kippy’s had members who’ve had incredible strength gains, along with some results you can’t exactly see – but definitely feel.

“I have another member who reversed osteopenia by being on a once-a-week workout regimen… after having it for 10 years.”

Kippy looks forward to helping as many people as possible reach their fitness goals by educating them about our method of strength training and coaching them to succeed.


Kippy Benefield
Certified Personal Trainer
Colleyville, TX

If you would like to find a trainer near you, see all of our locations here. If you are new to The Perfect Workout, try a workout with us and book your FREE Introductory Session.

Member Feature Marshal Ryan

Member Feature
Marshal ryan

Member Feature
Marshal ryan

member strength training post surgery doing bar dips

Marshal Ryan’s wife finally enticed him to try The Perfect Workout after she’d been doing the workout for six months…

“She kept bragging about how great The Perfect Workout was and I saw that she was getting toned up.

At first, I didn’t think it was for me. I thought, ‘What could they possibly do in 20 minutes?’

My wife kept telling me, ‘It's harder than you think.’ So I agreed finally to try it out.”

“I was aging, sitting behind a desk, and gaining weight.

I wanted to lose a few inches and get a little stronger, but I really didn't want to go to the gym and spend hours doing it.

After going through the Introductory Workout I could see that it was harder than what I had imagined and it would fit my schedule. So, I signed up right then.

Since sticking with it, I’ve lost about 20-25 pounds and several inches in my waist… and certainly gained strength. And I just feel better.”

When it comes to working with his trainers, Marshal knows he’s in good hands…

“You develop a friendship and a rhythm to it. Gary knows me, he knows what to expect out of me. He pushes me (and I expect him to push me)… it's just a good working relationship.

The trainers know how to position you properly in the machines, you're not using those twitch muscles to jerk around a lot. It really is structured as a slow-motion exercise.

I like that especially since I am getting older. I don't break stuff!”

Eight months into The Perfect Workout Marshal had seen a lot of results. But he had a spinal stenosis nerve issue on his spinal cord which locked down his right-hand side and was severely painful. Doctors said he needed to have neck fusion surgery…

“I took a couple of months off of my workouts during the pandemic to get the surgery done and it took five or six months to recover. I returned in December 2020 and Gary helped me ease back into it.

I was able to rehabilitate here, and now we're almost up to where I was in weights before the surgery.

I have worked out in gyms before, and to me, this is much more. It works without having to spend hours in the gym.

I love it. It's worth every penny to me and I look forward to it. It's part of my routine and I don't feel like the week is complete without it.”

Marshal Ryan, 64
Colleyville, TX

If you’re a current member and you’d like to share how The Perfect Workout has helped you achieve results- inside and out, please apply by filling out this form.

If you are new to The Perfect Workout, try a workout with us and Book a FREE Introductory Session.

The Workout That Solved Every Problem

The Workout That Solved Every Problem She Wanted Solved

The Workout That Solved Every Problem She Wanted Solved

Susan Hauser - She wanted to maintain bone density

Susan Hauser, 73 years old, was mourning the loss of her husband and recovering from cancer.

During an extremely difficult time in her life, a phone call brought a glimmer of hope.

Here is her story…

“My husband passed away five years ago. That was a very difficult time because I was coming out of cancer as well.

While I was visiting friends in Phoenix, my daughter called and said, ‘I'm signing you up for this.’

I said, ‘For what?’

‘For The Perfect Workout. You need to do this.’ she said. ‘Give me a year and we'll go from there.’

I agreed.

That was five years ago.

One of my major goals was to maintain bone density so that I didn't end up with osteoporosis, which is what my mother had. Her condition was severe, too. Her spine started collapsing. I did not want that to happen to me.

I also wanted to maintain strength and my activity levels. I needed to maintain as much wellness as I could.

And I'm not a gym rat, I have never enjoyed two hours in the gym doing four sets of 25, or whatever it is! I just don't do that.

But I quickly learned that The Perfect Workout solves every problem that I wanted to be solved.

My bone density has gone up, as opposed to down, and I have maintained that throughout the five years. I feel better. I can go and do whatever I want to do.

I love the fact that this workout is 20 minutes. I love the endorphins that kick in after the workout. I love feeling that good feeling later when I'm tired.

And it's made a major difference in my health.

Female Client maintaining her bone density

I had a second round of cancer in the last year and a half, and Raechel kept me going that entire time. We never stopped doing The Perfect Workout. She worked with me no matter what was going on. And it's been unbelievable how much strength I maintained during that entire saga.

Raechel and I had an immediate connection. We have developed a real friendship and connection that’s become very special to me.

She's very good at what she does. She knows the body and knows what I need. She can tell within about 45 seconds of walking in the door what's going on with me that day – whether I have strength or not – and she works through that.

After having surgery, throughout the pandemic, and even being on chemo, Raechel worked around me and my needs. That’s pretty special.

I see The Perfect Workout as a part of my long-term future, and I don't see myself stopping.

Member Testimonial Quote about maintaining bone density

If anyone were skeptical about starting The Perfect Workout, as opposed to doing a two-hour gym workout. I would say you really need to try it.

If you're willing to spend two hours in a gym, why would you not spend 20 minutes at the studio and have the rest of your day to do whatever you want? You will feel better as opposed to depleting yourself. You’ll feel better than you did before you went in.

I think The Perfect Workout truly is revolutionary. This workout does everything that needs to be done as you get older. And that's what's key for me.”

Susan Hauser, 73
Plano, TX

If you are new to The Perfect Workout, try a workout with us and start with a FREE Introductory Session.

Quickly Recover from Surgery + (best way to avoid)

Prehab Is Your Best Chance At Quickly Recovering From Surgery

“When my doctor gave me two choices about the pain in my right shoulder- Either live with it or have surgery, I felt hopeless.”- Sherry Chriss, client.

Facing surgery is scary and quite common for a lot of adults. Although every surgery can’t be avoided, one solution to prepare for a swift recovery and potentially avoiding surgery altogether is slow-motion strength training. We call this prehab or “prehabilitation” and it’s happening in our studios and virtual training sessions every day.

Prehab for Total Knee Replacement

One of the most common surgical procedures our clients face is a Total Knee Replacement (TKRs), and they are as popular as ever. More than 381,000 TKRs take place every year, and researchers expect that number to grow six-fold in the next 20 years [1].

The surgery can be very helpful as it enables people with severe knee osteoarthritis to decrease or eliminate their pain while improving their functional ability. However, a TKR also leads to a period of inactivity during recovery, and that inactivity has drawbacks. People lose about 60% of their quadriceps strength within the first month following surgery.

Considering that information, it’s no surprise that people with TKRs have demonstrated slower walking and stair-climbing speeds when compared to their peers.

Medical Diagram of a before and after total knee replacement

Studies Show...

Researchers at the University of Louisville conducted a study comparing people who “prehabbed” against those who did not (control group) for five months prior to surgery. Like our clients, the individuals who strength trained fared very well.

The exercise group trained three times per week prior to the surgery, including exercises such as the leg curl and leg extension. Following the surgery, both groups received the same physical therapy.

Watch one of our clients on the Leg Extension! 

Before the surgery, strength training prevented knee pain from increasing and improved the participants’ functional abilities like getting up from a chair, walking speed, and stair-climbing speed.

One month after the surgery, the control group experienced losses in quadricep strength and walking speed, whereas the exercise group did not (when compared to baseline tests). Three months later, functional ability and strength in the operated leg were greater in the exercise group. 

Overall, the study found quadriceps strength was associated with greater functional ability and less knee pain. Researchers in a study out of the University of Delaware found the same connections when monitoring quadriceps strength days before and one year after a TKR [2].

They also noticed that quadriceps strength before surgery also predicts dynamic balance a year after surgery. Dynamic balance is tested by seeing how quickly a person can stand from a chair, walk around a sharp turn, and then return to the chair.

Balance and strength are some of the most important benefits of slow-motion strength training, especially in older adults who fear falling.

How Long Do You Prehab For?

If a TKR or any other major joint surgery is in your future, you might wonder how long you should train for prior to the procedure. As mentioned, the study included five months of prehabilitation, although we have clients who have only trained for 3 months leading up to their surgery and still experienced a quick and less-painful recovery period. Obviously, the earlier you start, the more strength you will build prior to surgery.

The process of strengthening before a surgery just makes sense. The joints are healthier when their surrounding muscles are stronger. Strength training before a joint replacement surgery allows you the opportunity to build healthier joints and muscles that you will simply work to maintain after surgery, instead of having to build them for the first time.

If a surgery like TKR is in your future, or you want to do whatever you can to avoid one, slow-motion strength training is the solution.

Clients Who Have Avoided Surgery:

In addition to those who have prehabbed before surgery, we’ve helped many people prevent injuries and avoid surgery altogether.

Michael Slosek

Michael, 66, had been told by his doctor that he needed a hip replacement. He also wanted to lose weight, gain overall strength and stamina, and a 20 minute workout was very appealing to him. Michael’s strength training results speak for themselves:

  • No longer has back or hip problems
  • Has more energy and stronger muscles
  • Able to hit the golf ball 20-30 yards further at the driving range
  • Has been able to avoid hip replacement surgery

“The Perfect Workout has a great thing going. You feel like you have a workout when you come here. I’ll continue to do it.”

Mary Jane Bartee

When you have medical conditions like fibromyalgia, osteopenia, and pelvic prolapse, you’re going to be very careful about exercise. “Anything that’s fast-moving and aggressive aggravates it,” says Mary Jane (MJ) Bartee. Slow, safe movement is what first appealed to her about slow-motion strength training. MJ’s strength training results are nothing short of fantastic:

  • Her most recent bone density test showed that her osteopenia is gone
  • The pain from her other conditions is more manageable, resulting in less medication
  • Her pelvic prolapse has greatly improved, to the point where the doctors aren’t talking about surgery anymore

“It’s quick and accommodating,” says MJ. “20 minutes and I’m done. It’s something I do for myself, and as long as I’m functioning as well as I am, I’ll stick with it.”

Her Story of injury prevention

Sherry Chriss

After unsuccessful physical therapy and cortisone shots for an injured shoulder, Sherry was desperate for an alternative to surgery. She was also distraught about the effects of menopause, including loss of bone density, decreased upper body strength, and weak legs. A year after she began strength training at The Perfect Workout:

  • Sherry’s bone density scan improved, surprising even her doctor.
  • She no longer has shoulder pain, and no longer needs surgery.

“I enjoyed it right off the bat, and little did I know how fantastic it would turn out to be. My husband and I have both seen great results, so we’re committed to doing The Perfect Workout for the rest of our lives!”

Don’t wait for post-surgery to start building up strength. In fact, surgery may not be necessary if you take action now. It only takes 20 minutes, twice a week and you’ll get a lifetime workout guaranteed to get you stronger.

  1. Topp, R., Swank, A. M., Quesada, P. M., Nyland, J., & Malkani, A. (2009). The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM&R, 1(8), 729-735.
  1. Mizner, R. L., Petterson, S. C., Stevens, J. E., Axe, M. J., & Snyder-Mackler, L. (2005). Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. The Journal of rheumatology, 32(8), 1533-1539.

Kelly and Richard Got Toned and Strong!

kelly and richard got toned and strong!

Strength training helped Kelly get toned, and Richard estimates that he got 50% stronger, improved his posture, and lost about 75% of the aches and pains that he had in his back and shoulders.

Kelly Alessandro doesn’t know how much time she has left. Not at The Perfect Workout, but in life. Two years ago she was diagnosed with sarcoma, a very rare form of cancer, and doctors initially didn’t give her a very good chance of survival. She’s gone through surgeries, chemotherapy, and radiation treatments. Through it all, she has stayed mentally and physically strong. Kelly attributes making it this far in part to the fact that she’s in such good shape, thanks to The Perfect Workout. “I was able to recover so much better from all those surgeries because I had a strong core, because I was so strong,” she says.

The story begins before Kelly got cancer. About two and a half years ago, she saw an ad for The Perfect Workout and decided to investigate slow-motion strength training. “I had no idea it was going to be as good as it was. Most people don’t get it. They think you have to spend an hour.” Kelly didn’t need to lose weight, she just wanted to “tone it up” and get stronger. Within a couple weeks she started seeing results, and she was hooked. Six months into her workouts, she got the bad news. She had surgery, then took five weeks off to recover. When she started her workouts up again, she was actually receiving chemotherapy at the same time, and feels like the workouts helped.

It was around this time that she finally got Richard to start working out with her. “Kelly kept nagging me,” he jokes. “I didn’t want to listen to her tell me I had to work out. She kind of shamed me. She just had major surgery, she was going through chemo, and she was still doing it.” Richard approached it with gusto the same way Kelly had, and made good progress.

Richard and Kelly agree that having a trainer keeps it safe and makes it fun. “The whole staff at Laguna Niguel has been great!” Richard is serious when he says, “I hate going! But the hate only lasts for 20 minutes. I just jump right in. I try to have fun with it. When I’m done, I’m done, and I go home and have my protein shake. The Perfect Workout is 1/335 of my week. For 1/335, I can do anything!” With everything they’ve been through together, Richard and Kelly have a remarkable sense of gratitude, and with some sarcoma experts they’ve just found, they also have a new sense of hope. Their trainers at the Laguna Niguel studio say, “Kelly’s spirit is always upbeat and positive. We’ve been honored to work with her and her husband, Richard, and their courage and determination has touched all of our lives.”