Physical Therapy Before a Total Knee

PT before a Total Knee? Here’s why you need it.
Keisha Sollie, DPT

Numerous studies have shown the improvement that patients demonstrate with participation in physical therapy prior to joint replacement surgery. In fact, most insurance companies require patients to perform “prehab” before they go under the knife. So what’s the reason for this, and why exactly do you need it?

Research has shown that aerobic power as well as muscle strength deteriorates to a greater degree in patients with Osteoarthritis (OA) than the average adult without OA. In addition, OA leads to decreased balance, decreased joint range of motion and joint instability. However with participation in physical therapy, after only one month, patients substantially improved both strength and endurance. Although these terms may sound irrelevant, the improved measures lead to increased ability to climb stairs, walk and rise from a chair, all activities that are required in order to successfully participate in LIFE. Sounding a little more relevant now, right?

An additional perk of performing physical therapy is that we offer patients the ability to perform their “prehab” in an aquatic setting. When most people hear the word aquatic, physical therapists typically get one of two responses. One is, “I love to swim, I think the pool sounds great!” or second, “I hate water, do I have to get my hair wet?” Well rest assured good folks, neither of these responses is entirely accurate. Although the exercises take place in the water, there is no swimming involved here. From a therapeutic standpoint, water offers a great deal of benefits for our patients, especially those with painful conditions such as arthritis. Utilizing the warm water as a medium induces muscle relaxation, therefore leading to improved range of motion while performing exercise. In addition, the buoyancy of the water leads to decreased body weight and ultimately a decrease in compression and pressure on the joint surfaces.

One of the biggest motivations that lead a patient to seek physical therapy services is quite frankly the most obvious. That nasty four letter word, pain. Research has demonstrated that compared to land based physical therapy, aquatic therapy patients had a significant reduction in pain levels. However, both land and aquatic physical therapy equally benefit patients in range of motion, walking distance/time, and muscle growth.

Ultimately, participation in a therapeutic exercise program for OA sufferers prevents future loss of mobility, improves knee ROM, prevents muscle atrophy (shrinking), and decreases a patient’s overall pain. As therapists, our goal is to keep you moving with less pain for as long as possible!


Fisher, N. M., & Pendergast, D. R. (1994). Effects of a muscle exercise program on exercise capacity in subjects with osteoarthritis. Archives of physical medicine and rehabilitation75(7), 792-797.

Levin, S. (1991). Aquatic therapy: a splashing success for arthritis and injury rehabilitation. Physician and sportsmedicine19(10), 119-126.

WYATT, F. B., MILAM, S., MANSKE, R. C., & DEERE, R. (2001). The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. The Journal of Strength & Conditioning Research15(3), 337-340.

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