Building Muscle after Knee Replacement – BoomerMuscle

Building Muscle after Knee Replacement

Rebuilding muscle after knee replacement surgery is a long, slow process. It takes longer to rebuild it than it does to lose it. Here’s my progress after one year.

About 40 years ago, I destroyed my right knee doing something stupid. Really stupid. I had never been on snow skis before, but I decided to take a buddy up on the idea of me putting on a pair and letting him pull me across a frozen lake on a snow mobile – at a high rate of speed. 

Ah youth. Young men do stupid things sometimes. I paid the price this time. Surgery removed virtually all of the soft tissue like tendons, ligaments and cartilage. The surgeon said, “walk very carefully for the rest of your life.” So I did.

But a little more than a year ago, the arthritis got so bad I could barely walk. Working out was impossible. I hobbled about with a cane until the replacement surgery in May, 2018.

I’ll skip how painful it was, except to say that ice was my best friend for a long time. Finally around September, some 5 months post surgery, I got back in the gym

Immediately after knee replacement surgery. Both knees badly atrophied following months of inactivity pre and post.

September, 2018, 5 months post surgery as I try to rebuild muscle after knee replacement surgery.

If you’ve ever had a layoff from the gym, you know that you can lose muscle fairly quickly, especially if all you do is sit around with an ice pack like I did for 5 months. The first days back in the gym were tough mentally. I was skittish about applying any pressure to my knees.

I used much lighter weights than even my usual routine of lighter weights and higher reps. Both legs are pretty badly atrophied compared to my previous normal state.  

I am focused heavily in my rehab efforts on the two muscle groups that surround the knee, the Vastus Medalis and the Vastus Lateralis, which I’ll illustrate below

Those muscle groups are critical to protecting your knees. They are even more crucial for someone like me, who has a knee with virtually no internal protections left. I focus here as I rebuild muscle after knee replacement surgery.

Conventional wisdom says Leg Extensions are great for the Vastus Medialis on the inside of your leg. I do them religiously on my leg days, but I use much lighter weights than I have in the past. 

And instead of doing 8-12 reps, I am doing 18-21 reps with super light weight. It seems to work and I get to failure this way.

The two key muscle groups that protect your knee.

December 17, 7 months post surgery. Slow progress on right leg in rebuilding muscle after knee replacement.

The Vastus Lateralis started to come back pretty quickly on my ‘good’ left leg, as you can see at left. But the right leg continues to lag behind. Hack squats really target this muscle.

I do hack squats on my Powertec home gym. It has a great station for this. Steel pins spot you. The foot pad is angled upward and the shoulder apparatus is heavily padded. Perfect for someone who works out alone as I do.

Again, I dropped the weight significantly here. Like I said, I was already a believer in lighter weights and higher reps, but now on legs, I go even lighter with more reps.

Now, about 13 month post surgery, my left leg is back to relative normal. My surgical right leg has improved slowy, steadily but still lags behind the left.

My leg workouts consist of:

  • Leg Extensions on machine
  • Hack Squats on Powertec gym
  • Leg Press on Powertec sled
  • Hamstring Curls on machine
  • Glute Kickbacks on machine

June 29, 2019. Left leg back to ‘normal,’ right leg improved but still lags behind in rebuilding muscle.

Lighter Weights and Higher Reps

You will read a lot of inaccurate things about building muscle. One old saw says you can’t muscle if you don’t lift heavy weights. That’s just flat out wrong.

It has been proven over and over again that “hypertrophy,” the process of building muscle, happens best when using lighter weights and higher reps to “failure” or exhaustion in each set. See my post on Building Muscle after 60 here, it includes links to studies that back me up on this.

Lighter weights are also best for us older people. I used to lift heavy, until it gave me arthritis in my shoulders. Starting a few years ago,  I go lighter and in fact I’ve built more muscle this way, even as I age into my 60s. Your body can only take that heavy abuse for so long.

Now as I rebuild my legs, I am going even lighter with the weights to play it safe.

I used to do legs one day per week. Now, I do them twice. But I drop the volume down to only 3 sets per exercise instead of 5. And I use much lighter weights, while still taking the higher reps to failure. I’ve also added some right-leg only sets on the Leg Extensions with a very light weight. And for calves, I finish each of my Leg Press sets with Calf Raises to failure.

On top of that, I do 20 minutes of cardio on my Precor elliptical machine. You can adjust both resistance level and elevation on a Precor, so it also provides some resistance power.

I admit to being frustrated by what I see as slow progress in rebuilding muscle after knee replacement. But I don’t think I can push any harder than I am now. At 63, I’m older and I hope a little wiser than that youthful knucklehead I was when I first injured my leg.

This link will take you to a good article on leg extensions, pretty much everything you ever wanted to know. It cautions against going too heavy on this exercise, and that’s especially true if you’re recovering from surgery. 

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Brian Patterson

I've been resistance training for nearly 50 years. As a younger man, I used to believe in using ever-increasing amounts of weight. Until one day in my mid-50's, my aching joints could not take the punishment any more. I had to develop a new way of working out that was effective, but free of pain. I found it. It works great. I'd like to share it with you.