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Aquatic Therapy Rehabilitation for Total Knee Replacement

Aquatic Therapy Rehabilitation for Total Knee Replacement

Coping with knee pain or knee injuries can be both physically and emotionally exhausting. You may be thinking that “The pain will never go away” or “Rehab is going to hurt” or “I will never run again.” Well, both of those thoughts and the pain can be significantly diminished with warm water therapy.

What Is a Total Knee Replacement?

A total knee replacement is a surgical procedure a patient undergoes when their knee joint is damaged or diseased. The procedure involves replacing the affected knee joint with an artificial joint. Total knee replacement can significantly improve daily function and movement as well as reduce pain. Physical therapy is important for getting the best results during recovery. 

Benefits Of Using Aquatic Therapy For Rehabilitation

The water is a great environment for patients rehabbing knee injuries, or any type of injury/surgery, because “any exercise you can do on land you can do in the pool with the added resistance or assistance of the water.”- PT at Kansas Joint and Spine Institute.

Additionally, the water is a great place to work on balance and strengthening the accessory muscles too. If the patient is using dumbbells, hydrotones or the balance rings at the same time someone else is in the pool, then they have to work twice as hard on their balance. Combining a strengthening exercise with an additional person in the pool creates waves and an “unstable environment.” Creating this unstable environment in the pool allows patients to strengthen additional muscles, making the transition to walking on land and uneven surfaces a lot easier.

The warm water used in aquatic therapy also improves blood flow, which soothes sore muscles and alleviates pain. The reduced pain encourages patients to stretch and strengthen the knee joint. The water also creates an increased buoyancy that removes some of the pressure and stress on the knee joint. 

Case Studies About Aquatic Therapy Rehabilitation for Total Knee Replacement

Clinical studies have proven the benefits of exercise in a warm water environment when recovering from knee surgery. A study by Drs. Mary Sanders and Daryl Lawson concluded that “an aquatic environment may be ideal during all phases of ACL rehabilitation post surgery.” Particularly following an intensive procedure, the added buoyancy of an aquatic environment relieves pressure on sensitive joints as they recover, allowing patients to slowly rebuild their strength through directed exercises.

During recovery from procedures typically performed on patients with osteoarthritis and other chronic conditions, such as a total knee replacement, the positive effects are even more pronounced.

Take the example of a Total Knee Replacement performed at the Kansas Joint and Spine Institute in Wichita, KS (from our video library). The patient received the surgery as a result of an injury that occurred 29 years prior! Fragments were beginning to break off of her knee cap and were “floating around,” which resulted in the need for this major surgery. The patient had the knee surgery and 4 days later she was in the pool.

“It was very pain free, I guess because gravity was not pulling my knee. And I loved it! But when you get out you can feel the workout. But I really was impressed!”- Knee Replacement Patient

The physical therapist, described in the case history that total knee rehab is a painful process because in order to move forward at all with the rehab process, you must work to move the joint. Therefore, you are constantly causing trauma and inflammation to the knee, but using the pool for therapy helps ease that pain and reduce the swelling.

clinical studies about knee rehab and aqua therapy

Speaking from much experience, the PT states that most patients who are discharged from the hospital from a knee surgery will be instructed to use aquatic therapy at the Kansas Joint and Spine Institute. She emphasizes the importance of starting off slow with controlled movements and then increasing the quantity and speed of the exercises as the joint warms up in the pool.

Aquatic Therapy Exercises for Knee Replacement

improve knee  rehab

For this particular rehab, individuals can perform many different exercises. It is important to work on the whole body rather than focusing on the knee to improve recovery. To strengthen the whole body, a clinician can focus on stretching, strengthening, jogging and walking exercises. 

One possible exercise is underwater bicycling, which involves kicking in a cycling motion. This is a particularly great way to stretch and improve range of motion. The patient can also do core stabilization exercises like sitting in a pike position and ensuring that their toes stick out of the water while making small circles with their hands to hold their body’s position. With an underwater treadmill, the patient can do walking and jogging exercises.

In our video, for example, the patient begins in the aquatic therapy pool, slowly warming up the joint with gentle squats, then hamstring stretches and lunges. Next, the PT has the patient put fins around her ankle (as you can see in the video) and perform knee extensions. The faster you kick in the water, the more resistance you will feel. Lastly, the patient finishes on the treadmill walking at a slow pace to get the joint used to the “walking motion.”

Numerous other exercises can be performed for knee rehabilitation. Watch the full video case study in our video library and see how the water can help ease knee pain for total knee patients!

To find out how aquatic therapy can impact rehabilitation, download our tip sheet, “5 Ways Aquatic Therapy Impacts Rehabilitation” here>>

knee inflammation and aqua therapy

Can Patients Run Underwater After Knee Replacement?

Since hydrotherapy after knee replacement surgery is recommended for successful recovery, patients can start running underwater after the procedure. Using equipment like the HydroWorx the underwater treadmill, individuals can start running without putting heavy stress on the knee joint.


Contact HydroWorx for More Information

Aquatic therapy can be highly beneficial to recovery after a total knee replacement. Contact us to get in touch with our team and learn more.


37 comments on “Aquatic Therapy Rehabilitation for Total Knee Replacement”

    1. I agree-Had my knew joint replaced April 27th and was told by the surgeon
      not to submerge it (bath, pool, etc) util fully healed over, as they worry about infection.

      With the home physio routine + the hospital physio routine it certainly was enough. It’s now July 2nd and I’m ready for the pool.
      The rate that each person closes up fully will differ, but once healed over, then certainly okay.

  1. I’m surprised after knee replacement they let her get the knee completely wet. The incision would not be sealed yet.

    1. Some clinicians will use tegaderm or opsite which completely seals the incisions and wounds and allows the patient to get in the water sooner and begin recovering sooner!

  2. I live in Ireland, I,v had total knee replacement 7weeks ago and I am still on crutches with terrible pain at night. I was always fit & weigh just 80 kegs.l left hospital after 2days, physio wasn’t named .you don’t see anyone until after the 12th week, your on your own. Wish I could get some of the care you get in America. They are doing something wrong over here

    1. I agree with you very much. They are doing something very wrong over there. I had my Total Left Knee Replacement on April 26th. They would take me down to Physical Therapy twice a day the next day after surgery and had you moving right away. Which continued once I got home with a home Physical Therapy…..I would not advise the one that I had. She did not know what she was doing. Within 3 weeks after surgery I was going the a Physical Therapy Clinic and got a lot of good results from that. But as soon as the incision was all healed up and got the Doctors ok, I was in my pool and started out doing some of the same exercises they had me doing at the clinic. And then very soon the Lord started showing better ways to do some of the exercises to get better movement and mobility and how to get my knee to bend back further and further. I was exceeding the doctors expectations. By the end of June I was walking about 10 to 11 blocks and by the middle of July I was walking 27 block which is a little over 2 miles. Good luck to you. But no matter how much it hurts….GET UP AND MOVE OR YOUR REPLACEMENT WAS FOR NOTHING!!!!!

      1. I had a TKR in Jan. 2017. I attended a class to learn exercises prior to my TKR about 6 weeks before the procedure. On day 2 I got up and walked with a walker to the door of my room and back, and given exercises to do in bed. Day three went up and down some stairs, and had more exercises added. Went home on the afternoon on day three, and started out patient therapy a week later. We were told that the most range of motion would happen in the first 6-8 weeks. No pool therapy, and told that could not use a pool until the incision was all healed up. there is a therapeutic pool close to me, and the physio gave me exercises to do there. Take your pain meds and move!

  3. I had TKA Dec. 2015, have not had good recovery. Had PT for
    6weeks or so, is it possible for water therapy to help this far out of surgery?

    1. I had TKR on sept. 30 th 2015/ I joined the gym 6 week s ago doing aqua zumba in the pool 4 time s a week my knee feels so much better my balance is very much improved try it you’ll luv it plus I lost 15 lbs

  4. if after 3 years and my husband had a stroke and keeps falling on my knees or I am lifting him out of floor I am 68 years old and over weight my knees hurt like crazy

    will water therapy help with the pain

    my insurance is too high to come up with the 13,000 ded

  5. I had a double knee replacement on the 15th August this year and 9 weeks down the track I am still in a lot of pain and still taking pain medication (which I hate) . I have been told by my specialist 2 weeks ago that I am way ahead of in my progress as I am walking without walking aids, but why am o still in so much pain there are some nights even after taking my pain medication I still can’t sleep because of the pain?

  6. Hi,
    I’m 57 yo. I’ll have a total knee replacement on January 24, 2017 . I live in New York. I would like to find a place for hydrotherapy. Any of you know a place over here ? Thank you.

  7. I believe this would be great in helping with the pain and for a faster recovery! Can you tell me more of the details please and which clinics offer this service? As someone who just underwent a knee surgery, this is something I would love to give a try.

  8. My husband had total knee replacement May 12, 2017. He was doing therapy the same day. Movement is important to keep scar tissue away. His doctor used what he called glue and his incision healed very quickly. He could get it wet after two weeks if he wanted. He’s is doing land and water exercises and doing quite well. Kaiser in California has knee replacement down to a science, with pre surgery classes and post therapy.

  9. I had a TKR in late January 2016, and I still have pain, especially at night. My knee is stiff as well. After reading these comments, I’m going to try water exercises to see if it will help, and if it will help me lose the 10 pounds I’ve gained since the surgery.

  10. I had a TKR on June 14,2017 and although it’s been three month my knee is still sort and stiff. I decided to try aquatic therapy after trying water therapy it seem to have a positive impact

    1. That’s great to hear! Hopefully you are able to move better in the water, which will help your recovery. Be patient, it takes time.

  11. I am 63 live in Australia and am now 6 weeks post Rt TKR. I was up on crutches and walked to the bathroom the morning after the surgery and commenced physio exercises and post exercise icing to the knee. discharge was on day 3. I had 3 visits at home from the community physio over 2 weeks, and 2 sessions at the hospital over the following 2 weeks. I did the exercises diligently and have been off crutches for a week. The key is to work through the discomfort to attain your goals. I started Hydro Therapy with my own Physio last week and am finding it really beneficial the warm water allows greater flexibility and helps build up those muscles that years of painful Osteo Arthritis have taken their toll on. I still get pain at night waking around 2am but I find if I get up and move around it helps a lot. Good Luck to all you fellow TKR’s

  12. Thanks for pointing out that water is a great environment for rehabilitation because the water can add resistance or assistance to any activity. My husband is going to have knee replacement surgery soon, but I hadn’t heard about the benefits of aquatic therapy for recovery. I appreciate you sharing some benefits of water therapy for injury rehabilitation!

  13. I like that you pointed out that, with water, the pain and swelling are reduced to help you continue to move your joints. I will share this information with my cousin to give them an option. This will be needed because their father would need a knee replacement surgery. It is because it was cracked when he had a bad fall after playing basketball last weekend.

  14. Swimming pool exercises suits most age-groups and tailor-made for people suffering from specific conditions such as fibromyalgia and arthritis. Also, it is great for enhancing your balance, endurance, and flexibility. Just a short workout in the pool and you will be done and dusted for the day! Wow! What’s not to like? So grab your swimming suits and let’s take a plunge.

  15. I’m on week 10 post tkr and I’ve been attending the local pool twice a week for the past 3 weeks where I do my exercises in the water and swim a bit. Afterwards I find I am very stiff for the rest of the day. Is there anything I can do to improve this?

  16. I’m 70 years old and had a complete knee replacement March 31. I was walking just hours after surgery and went home the same day. Started therapy 5 days later and finished 6 weeks later. My knee bend measures 119 degrees. I also walk over a mile a day. I was told the most important thing was therapy. You have to move and stretch. Everyone is different but keep moving. You’ll need to keep taking pain meds for some time. Starting water therapy now. Good luck.

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