Most return-to-sport guidance after total knee replacement is built around time — weeks post-surgery rather than what your knee can actually do. This protocol takes a different approach. Progression through each phase is determined by objective criteria: strength, range of motion, balance, and functional performance. Not the calendar.
What's Inside:
This protocol was developed by Emma Glynn, APA Titled Musculoskeletal Physiotherapist and Clinical Exercise Physiologist, combining Level 1 and 2 evidence to guide structured return to activity and sport following total knee replacement. It is surgical approach–agnostic and adaptable across age groups, activity levels, and sport preferences.
Pre-Operative Phase — Education and Preparation Covers prehabilitation goals, the "go-for-surgery" criteria across quadriceps strength, knee range of motion, 6-minute walk test performance, and Timed Up and Go — and how to use pre-op preparation to support post-op outcomes.
Phase 1 — Foundation and Protection Post-operative pain and swelling management, early range of motion, quadriceps activation, and safe mobilisation. Includes objective criteria required to progress to Phase 2.
Phase 2 — Gait, Strength and Function Restoring symmetrical gait pattern, achieving functional ROM (0–115° flexion), closed-chain strengthening, dynamic balance assessment via the mSEBT, step-up control testing, and the 5x Sit-to-Stand test. Objective criteria required to progress to Phase 3.
Phase 3 — Conditioning and Controlled Sport Building strength symmetry, reintroducing low-impact sport (cycling, pool work, golf swing), dynamic single-leg control, and 6-minute walk test performance. Objective criteria required to progress to Phase 4.
Phase 4 — Return to High Impact Sport and Performance Hop testing (single-leg hop, triple hop, 30-second double-leg hops), T-test agility, KOOS Sport subscale confidence assessment, and surgeon or physiotherapy clearance. Includes guidance on which patients require hop testing and which do not.
Phase 5 — Discharge and Re-Injury Prevention Transition to self-managed conditioning, long-term maintenance strategies, injury prevention principles, and load management education.
Final Notes: Suggested return-to-sport timelines for cycling, golf, swimming, hiking, running, and tennis. When to regress or seek review.
Who this is for:
This protocol is designed for adults who have had a total knee replacement and are working toward return to recreational sport or higher-level activity beyond basic daily function. It is suitable for use in conjunction with physiotherapy-guided rehabilitation and in collaboration with the treating surgeon.
Progression through each phase should be guided by a physiotherapist. Not every patient will return to high-impact activities, and individual goals and risk profile should inform how the protocol is applied.
A note on what this resource is — and isn't:
This is a general educational and clinical reference resource. It does not replace individual physiotherapy assessment, diagnosis, or treatment, and does not create a physiotherapist-patient relationship. All progression decisions should be made collaboratively between the patient, their physiotherapist, and treating surgeon.
Developed by: Emma Glynn | APA Titled Musculoskeletal Physiotherapist | Clinical Exercise Physiologist The Hip and Knee Physio — Camberwell, Melbourne
