Knee Replacement Rehab: who to see and what helps

Knee Replacement Rehab · Kitchener, Waterloo & Cambridge

A knee replacement gives the worn joint new metal and plastic parts, and the rehab that follows is mostly about three things: getting the knee to bend and straighten, rebuilding the thigh muscle, and walking evenly again. The American guideline written for physiotherapists says supervised physiotherapy should be provided after this operation, with strengthening that is progressed at high intensity. Rehab at CARESPACE runs alongside your surgeon and hospital team, and the first visit is with a physiotherapist, who assesses and treats you that day.

What knee replacement rehab involves

Most people begin exercising the knee within hours of surgery. The guidebook Waterloo Regional Health Network (WRHN) gives people having a knee replacement has them on a two-wheeled walker for all walking, doing ankle pumps every hour and thigh-tightening and knee-bending exercises three times a day, and aiming to bend the knee to 90 degrees in the first two weeks, while the staples are in. Once the staples are out it sets no end point on how far to bend. Its rules for at least the first six weeks are different from a hip’s: no kneeling, no pillow under the knee in bed and no lifting beyond 5 to 10 pounds.

A partial knee replacement should take less time to recover from than a total one. If you are still living with an arthritic knee, see Knee Osteoarthritis; getting ready for surgery, and osteotomy, are on Joint Replacement Rehab.

What recovery usually feels like

• Stiffness and swelling in the joint for up to 8 to 12 weeks
• Some pain with activity and at night, common for several weeks
• Numbness in the skin around the incision, which most people have and which usually fades
• Clicking of the metal and plastic when you bend the knee or walk, which most people feel or hear
• Bruising that can spread up the leg, and is normal

Warning signs after a knee replacement

Call 911 if you develop chest pain, shortness of breath or you are coughing up blood. A blood clot that has travelled to the lungs can show itself this way: as sudden shortness of breath, sudden chest pain, or chest pain in one spot when you cough. The instruction is the one in the guidebooks Waterloo Regional Health Network (WRHN) gives people having a hip or knee replacement.

Call 911 or go to the nearest emergency department if, after a fall or a blow to the new knee, the pain is severe, the knee has changed shape, you cannot move the knee or put any weight on the leg, or the leg below the knee is numb, tingling, pale, bluish or cold. Those signs are drawn from British Columbia’s and the NHS’s advice on knee injuries, in Ontario terms and read cautiously for a replaced joint. After any other fall onto the new knee, contact your surgeon’s office the same day: a fall in the first few weeks can damage it and may mean further surgery.

If you went home with a nerve block catheter for pain relief (WRHN leaves one in for up to four days after a knee replacement): call 911 for a seizure, and go to the nearest emergency department, or call the anesthesiologist on the number your hospital gave you, for pain or swelling where the catheter enters the skin, ringing in your ears, a metallic taste in your mouth, or a numb mouth or tongue.

Go to the nearest emergency department, too, if you are home from hospital and cannot urinate.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Contact your surgeon’s office or hospital care team right away, the same day, for any of the signs below. If you cannot reach them, go to an urgent care clinic or an emergency department that day. Do not save these for a rehabilitation appointment: nobody at CARESPACE can rule out a blood clot or an infection.

• Signs of a blood clot in a leg: redness, swelling, warmth, tenderness or pain anywhere in either leg, including severe pain in the calf
• Signs of infection: a fever above 38°C, or chills; redness, swelling, warmth, tenderness or increasing pain around the incision; any drainage from the wound, above all thick or foul-smelling discharge (green, brown or creamy yellow); an incision that opens; or pain in the joint that keeps increasing, with activity and at rest
• Lots of bleeding, or a dressing that is soaked through
• A sudden increase in pain that is not related to activity, or pain that is not controlled by the medication you were prescribed
• Dizziness
• Nausea or vomiting you cannot control, or severe constipation or diarrhea that does not improve with medication
• Pain, burning, urgency or frequency when you urinate
• A bloody nose, or blood in your urine or stool

What the evidence says about rehab after a knee replacement

• The main source is the American Physical Therapy Association’s 2020 guideline on total knee replacement. “Strong” or “moderate” means its panel had a high level of certainty about the benefit (larger for strong) and wrote “should”; “best practice” is the panel’s consensus where trials are lacking.
• Supervised, and early. Supervised physiotherapy should be provided, and should start within 24 hours of surgery and before discharge (both moderate).
• Strengthening, pushed hard. Physiotherapists should design and progress high-intensity strength training and exercise programmes in the early post-acute period (within seven days of surgery), to improve function, strength and range of motion (moderate).
• Balance and walking practice. Training in balance, walking and moving evenly on both legs should be included (strong). Bending and straightening exercises, done with help and on your own, are best practice.
• Ice and muscle stimulation yes, bending machines no. People should be taught to use cold therapy for early pain after surgery, and physiotherapists should use neuromuscular electrical stimulation to improve thigh muscle strength and walking; ask when you book whether it is available. Continuous passive motion machines should not be used after a first, uncomplicated knee replacement. All three are moderate.
• What is less certain. A 2021 review for the United States Agency for Healthcare Research and Quality found that different rehabilitation programmes after knee replacement may lead to comparable pain, range of motion and daily activities, on low-strength evidence, with too little research to say which components or settings work best.
• Exercise before surgery. Physiotherapists should design pre-surgery programmes of strengthening and flexibility exercise (moderate). The same review found such programmes may shorten the hospital stay and increase strength, with similar pain, range of motion and daily activities afterwards, on low-strength evidence.
• Massage. A 2024 review (11 trials, 940 people in all) found that massage went with less pain at one, two and three weeks after surgery and more knee bend at one and two weeks, each result resting on two or three trials. The authors rated the evidence low to moderate in quality; most trials were from China, and nothing was measured beyond three weeks.

What your surgeon and hospital team look after

The wound and staples, blood thinners, pain medication and the decision that you may drive stay with your surgeon, physician, nurse practitioner or pharmacist. A knee that stays stiff is theirs to judge too: limited motion from scarring normally gets better with physiotherapy and range-of-motion exercises, and when it does not, a surgeon may recommend manipulating the knee under anaesthesia. If pain, a limp or loss of function appears or worsens months or years on, the UK guideline says a physician should refer you back to the orthopaedic service.

How each CARESPACE service helps after a knee replacement

Physiotherapy

A physiotherapist can measure how far the knee bends and straightens, check the swelling and how well the thigh muscle switches on, and build the programme: bending and straightening work, strengthening that is progressed firmly, and balance, walking and stair practice until you move evenly on both legs. They can also guide the move from walker to cane.

See our physiotherapy team →

Massage Therapy

A Registered Massage Therapist can work on the thigh and calf muscles around the new knee. The evidence for it covers only the first three weeks and is low to moderate in quality, so it is an addition to the exercise programme and not a substitute for it. Ask your surgeon’s team when massage near the incision is allowed. A calf that is newly painful, red, warm or swollen is a warning sign for them, not a reason for massage.

See our massage therapy team →

Kinesiology

Once the early restrictions are lifted, a kinesiologist can take on the strengthening: a supervised leg programme, stepped up over time. It suits people aiming for work on their feet, long walks or the gym.

See our kinesiology team →

Personal Training

Orthopaedic surgeons advise regular light exercise to keep a replaced knee strong and mobile, and a personal trainer can keep that going for the long run. They list walking, swimming, golf, light hiking, biking and ballroom dancing as realistic, and most advise against running, jogging and jumping.

See our personal training team →

Other services people ask about

Occupational therapy has a part in daily activities after a joint replacement; Joint Replacement Rehab covers it.

Where most people start

With a physiotherapist: before the operation if you want a programme to follow, and afterwards as soon as your hospital’s plan allows. Bring the exercise sheet you were sent home with.

How your team works together

Your surgeon’s team decides when the staples come out, how the wound is doing and when you may drive; your physiotherapist works on the bend, the thigh muscle and your walking around that. Massage therapy can be added in the early weeks, once your surgeon’s team allows it. Later, a kinesiologist can run the leg strengthening and a personal trainer the long-term routine.

Browse by service: physiotherapists, registered massage therapists, kinesiologists and personal trainers.

What to expect at your first visit

1. Your operation. The date, total or partial, whether the staples are out, and what your surgeon has restricted.
2. Measurements. How far the knee bends and how straight it goes, in degrees, plus swelling and thigh muscle strength.
3. Walking and stairs with the aid you are using.
4. Treatment that day and a home programme with targets.

What you can do at home

• Do the hospital exercises every day until your first physiotherapy visit; starting early helps long-term strength and movement.
• Ice the knee after exercise, as your hospital sheet directs.
• Keep the leg raised when you rest, and avoid standing for long periods.
• Sleep without a pillow under the knee; lying on your side, put the pillows between your knees.
• Avoid twisting on the knee, and leave heavy household jobs such as vacuuming or carrying shopping for the first three months. That includes the snow shovel.
• Expect the leg to feel slightly weak or to give way at first, and a nerve block catheter can occasionally add to the weakness: take great care when you stand up or walk.
• Use handrails and your cane on stairs, and treat icy steps and driveways as off limits for now.

How long recovery takes

Full recovery can take several months or longer. Most everyday activities come back within three to six weeks, the NHS suggests trying to walk without an aid after about six weeks if you feel ready, and return to work is usually around 6 to 12 weeks, depending on the job. American orthopaedic surgeons report that more than 90% of modern total knee replacements are still working well 15 years after surgery. Your surgeon’s dates are the ones that count.

Knee replacement rehab in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Massage Therapy in Kitchener, Kinesiology in Kitchener and Personal Trainer in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Massage Therapy in Waterloo, Kinesiology in Waterloo and Personal Trainer in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How far should my knee bend after a replacement?

The early target is 90 degrees within the first two weeks. In the longer run, orthopaedic surgeons say an average of 115 degrees is generally anticipated and that most people can almost fully straighten the knee. The bend you had before surgery often predicts the bend you end up with.

Can I kneel on a knee replacement?

Not at first: WRHN’s guidebook rules out kneeling for at least six weeks, and the NHS says not to kneel until your doctor says you can. After that, surgeons describe kneeling as sometimes uncomfortable but not harmful.

How soon can I drive with a new knee?

Your surgeon decides, usually at four to six weeks, and never while you are on prescription pain medication. The NHS tells people in the UK to wait at least six weeks after a total replacement and three after a partial one.

Is physiotherapy after a knee replacement publicly funded in Ontario?

For people who meet the province’s criteria, yes, at government-funded physiotherapy clinics. The criteria include having been discharged after an overnight hospital stay, or having had day surgery within the last 12 months, and needing physiotherapy for that condition; Joint Replacement Rehab lists them. Those clinics assess whether you qualify, so ask your hospital team before you pay for care. CARESPACE is pay-per-visit, with a receipt for your extended health plan.

Is there physiotherapy for a knee replacement in Cambridge?

Yes: begin with Physiotherapy in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Jette DU, Hunter SJ, Burkett L, et al., for the American Physical Therapy Association. Physical Therapist Management of Total Knee Arthroplasty. Clinical practice guideline, Physical Therapy, 2020.
• Waterloo Regional Health Network. Knee Replacement Guidebook. Hospital guidebook, WRHN @ Midtown; file posted June 2026.
• Konnyu KJ, Thoma LM, Bhuma MR, et al. Prehabilitation and Rehabilitation for Major Joint Replacement. Comparative Effectiveness Review No. 248, Agency for Healthcare Research and Quality, 2021.
• Chen R, Jin Y, Jin Z, et al. Massage for rehabilitation after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 2024.
• National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder (NG157). 2020.
• American Academy of Orthopaedic Surgeons. Total Knee Replacement. OrthoInfo.
• NHS. Knee replacement: recovery (reviewed September 2026) and Knee pain (reviewed December 2023).
• HealthLink BC. Anterior Cruciate Ligament (ACL) Injuries (when to call a doctor after a knee injury). Current as of November 2022.
• Government of Ontario. Get physiotherapy. Updated November 9, 2026.

Related conditions

Joint Replacement Rehab
Hip Replacement Rehab
Knee Osteoarthritis
Knee Pain

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Book online with a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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