Why Is Physical Therapy Important After Knee Replacement Surgery
Regaining your range of motion and strength after total knee replacement surgery is critical to regaining your ability to do the things that are important to you. You will start the following exercise program soon after your surgery. Your physical therapist will help you with the exercises initially and you will be expected to continue the exercises as instructed. As you recover, some exercises will be discontinued and others may be added. Please let your therapist or surgeon know if you are having difficulty with your exercises.
Exercise : Standing Straight Leg Extensions
I hook one end of the band to the leg of a table or a fixed object and insert my foot in the other end. I stand upright, far enough away from the chair so the band is taut and I face away from the support.
I keep my leg straight in a locked position and slowly bring my leg forward 5-6 inches. The band will stretch and I can return my leg back to the starting position.
The muscles of the front quadriceps and front hip should be engaged. After a few repetitions the thigh muscles should burn .
If I bend the knee during this exercise it puts additional pressure on the joint and causes me pain.
Once Ive completed the exercise for the front of the thigh, I turn and face the chair, table, or stationary object the band is hooked onto. This exercise is just like the first exercise, however the difference is in the direction the leg moves. Instead of moving forward a few inches I move my heel back, away from the chair or table.
I feel the hamstring muscle flexing as I do this exercise. Once again, I keep a straight leg to avoid pressure on your knee joint. I move the heel backward 5-6 inches and slowly return to starting position while concentrating on the muscles of the upper leg.
My routine: 2 sets of 10 repetitions
Extending The Life Of Your Knee Implant
Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.
To assist doctors in the surgical management of osteoarthritis of the knee, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Surgical Management of Osteoarthritis of the Knee – Clinical Practice Guideline | American Academy of Orthopaedic Surgeons
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May Physiotherapy And Advanced Postoperative Total Knee Replacement Exercises
Once you have regained your independence for short distances, you will then progress to more advanced exercises to facilitate your full recovery .
Physiotherapy Exercises include:
Step 1: Stand behind a table or chair and hold for supportStep 2: Bend your knee as much as you canStep 3:Keep your knee bent and hold for 5-10 secondsStep 4: Slowly straighten your knee and return your heel back to the floorStep 5:Repeat 3-5 times
ASSISTED KNEE BENDS
Step 1: Lie on your back and place a towel around your ankle Step 2:Bend your knee and apply a gentle pressure through the towel to increase the bentStep 3:Keep your knee bent and hold for 5-10 secondsStep 4: Repeat 3-5 times
KNEE EXERCISES WITH RESISTANCE
You may add light weights around your ankle to repeat all of the above exercises
Cycling helps to regain knee mobility and muscle strength.
Step 1:Adjust the height of the seat so that your foot just touches the pedalStep 2: Peddle backwards firstStep 3:Peddle forward only after a comfortable cycling motion has been established whilepeddling backwardsStep 4: 10-15 minutes twice dailyStep 5:Progress to 20-30 minutes, 3-4 times weekly, and increase the tension of the peddlesif able
Contact us today on to book a consultation at our Prahran office, where we can understand your specific rehabilitation process.
Defining The Strength Of The Recommendations
Judging the strength of evidence is only a steppingstone toward arriving at the strength of a CPG recommendation. The operational definitions for the quality of evidence are listed in Table 2, and rating of magnitude of benefits versus risk, harms, and cost is provided in Table 3. The strength of recommendation, listed in Table 4, takes into account the quality, quantity, and trade-off among the benefits and harms of a treatment, the magnitude of a treatments effect, and whether there are data on critical outcomes. Table 5 addresses how to link the assigned grade with the level of obligation of each recommendation.
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Recognizing The Signs Of A Blood Clot
Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. They may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.
Warning signs of blood clots. The warning signs of possible blood clots in your leg include:
- Increasing pain in your calf
- Tenderness or redness above or below your knee
- New or increasing swelling in your calf, ankle, and foot
Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
- Sudden shortness of breath
- Sudden onset of chest pain
- Localized chest pain with coughing
Revision And Reaffirmation Plans
This CPG represents a cross-sectional view of current treatment and may become outdated as new evidence becomes available. It will be reviewed in 5 years and will be updated in accordance with new evidence, changing practice, rapidly emerging treatment options, and new technology reaffirmed or withdrawn.
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Muscle Balance Is Important
Even though you might only have knee replacement on one knee, its wise to exercise both legs. More important than appearance, having one leg that is much stronger than the other could result in injury.
Theres even a case for giving more attention to your good knee. After surgery youll be dependent on your other leg for a few weeks .
Its not uncommon to see someone overcompensate on their good leg and wind up injuring it as well. Professional athletes frequently experience this problem.
They rehabilitate one leg and return to work early, only to injure their strong leg because its working harder. It is best to exercise both legs for overall body strength and a speedy recovery.
Potential Benefits Risks And Harms Of Implementing This Recommendation
Benefits are as follows:
- Physical therapists can provide the care team with valuable information to assure the most appropriate discharge setting.
- Involving physical therapists in discharge planning can prepare the patient for a safe and independent transition to the home environment.
- Health coaching and financial incentives can improve patient functional performance.
- Inpatient rehabilitation may not be more beneficial than discharge directly home.
Risk, harm, and/or cost are as follows: No expected risks or harm are associated to implementing the recommendation.
Benefit-harm assessment: There is a preponderance of benefit for this recommendation that led the work group to upgrade the recommendation strength in the presence of low evidence quality .
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Difference Between Beginner And Advanced Knee Replacement Exercises
If you havent read my beginner knee replacement exercises article I recommend doing-so before this article.
The beginner exercises were the first step for me as I developed strength around my knee. As Ive improved my strength Ive looked for ways to adapt the exercises and make them more challenging.
I want my quadriceps, hamstrings, ligaments, and tendons to not only be strong for recovery but also be flexible during surgery. I can feel the progress Ive made and Im confident going into surgery that Ive done everything to ensure success and a speedy recovery.
Youll notice that many of the advanced knee replacement exercises in this article are similar to the beginner. The main difference is that Im now using a band and ankle weight to create resistance.
The reason for the band and ankle weight is to focus on muscle strength. Ive been doing high repetition exercises without resistance and my muscle endurance is fantastic.
When I first started doing the exercises I would become tired at about 10 repetitions however now I can do 20-30 repetitions and still remain strong the rest of the day.
The band and ankle weights will add resistance and allow me to do fewer repetitions, which in theory, should help with building muscle strength over endurance. Remember, I dont stop my activity with these exercises. I also get exercise with my routine of long distance swimming, hiking, biking, walking, and pickleball.
Lets get started!
When Surgery Is Recommended
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity a bowing in or out of the knee
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
Total knee replacement may be recommended for patients with bowed knee deformity, like that shown in this clinical photo.
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Do I Need To Go To An Outpatient Physical Therapy Clinic For Treatment
Yes, I would highly recommend that you seek in-person rehabilitation postoperatively in an outpatient physical therapy clinic. The primary reason for this is that most people are unable to stretch their own knee past the initial point of pain. Its an instinctive protective mechanism that most people simply cannot push themselves through this type of pain. A physical therapist will help you regain full knee mobility and he/she will guide you through the next 2-3 months of rehab. You should expect to begin outpatient physical therapy approximately 7 days post-op after a total knee replacement surgery.
Most people are unable to stretch their own knee past the initial point of pain.
To achieve an optimal functional outcome after a TKA, it is critical to gain more than 125° of knee flexion . I always tell my patients that if they achieve 135° knee flexion, they will receive a ! I say this because the average person requires a minimum of 125° knee flexion in order to be able to put on shoes and socks and squat down to pick items up from the floor. However, achieving at least 135° knee flexion will allow someone to kneel down on the ground and never be limited by their total knee prosthesis regardless of the activity.
Quick Recovery Tips After Getting Total Knee Replacement
Total knee replacement surgery is one of the best ways to treat problems affecting your knees. Recovery from total knee surgery, or replacing damaged joints with metal or plastic implants, usually takes around three to six weeks. However, what you do within this period dramatically affects the speed and quality of your healing. Besides follow-up appointments and physical therapy, you can engage yourself with other things to ensure you are on track to getting better.
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Best Exercises After Total Knee Replacement Surgery
Dr. Tim PT, DPT, OCS
Congratulations! Youve decided to finally go through with it and have a total knee replacement surgery. The joint replacement surgery itself is the easy part. You get to go to sleep and wake up with a brand new knee joint thanks to your orthopedic surgeon. Now, however, the acute postoperative phase begins.
You get to go to sleep and wake up with a brand new knee joint thanks to your orthopedic surgeon.
Knee pain, leg swelling, and joint stiffness will dominate during this acute postoperative phase. This phase will require a large amount of dedication, commitment, and hard work on your part. Unfortunately, surgeons sometimes do a poor job of accurately portraying the true amount of hard work that patients will need to put forth to obtain an optimal functional outcome postoperatively. As a physical therapist, helping my patients through this difficult phase is an immensely gratifying experience and one that I am excited to help guide you through as well. Physical therapy exercises after a total knee replacement surgery have been found to speed up and improve physical function.
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What Activities Can Be Done After Knee Replacement
There are plenty of activities that you can take part in following your knee surgery. The Knee Society has compiled a brief list of acceptable activities for those who have undergone joint replacement surgery.
These activities include cycling, swimming, low-resistance rowing, walking hiking, low-resistance weight lifting, and stationary skiing machines.
Anything that puts a vast amount of stress on the joint should be avoided completely to minimize complications and the chance of reinjury.
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Knee Exercises With Resistance
This exercise will require ankle weights. Place the weights around your ankles and repeat any of the exercises mentioned above for the early recovery stage.
You can begin this resistance training from 4-6 weeks post-surgery.
Start at one pound weights and slowly increase as your joint becomes stronger.
These weights can be found at all sporting goods stores.
Engage In Exercise And Physical Therapy
Daily movements can help kickstart your recovery. Based on your case, your physician will prescribe simple exercises you can do at home or in an outpatient setting.
A physical therapist may guide you on how to perform physically-extensive activities correctly. Post-operation exercises vary depending on where you are in your recovery timeline. Short, frequent walks are also essential to a speedy recovery.
While exercise is vital in regaining your range of motion and strength, take care not to overdo it. Pushing yourself too hard and too quickly will just set back your recovery. Signs of over-exercising are swelling and lingering pain.
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Section : Resistance Band Exercises Before Tkr
Exercise bands, also known as resistance bands, have been used in physical therapy for decades. More recently theyve gained popularity for individual workouts as a way to increase strength, range of motion, and flexibility.
Exercise bands come in different sizes, colors, and strengths. For serious workouts the bands are thick, but for people recuperating from injury, such as a sprained ankle, the bands are lightweight and thin.
The following exercises utilize lightweight thin bands, perfect for adding a small amount of resistance to exercises. I purchased the Golds Gym bands for under $10 and they come with 3 bands, each with a different strength.
Currently Im using the 1st band and after a few weeks I plan to work my way up to the 3rd band. I like the gradual increase in band strength because I can make sure Im progressively gaining strength.
Home And Outpatient Physical Therapy
If you are sent home, you may choose to have a home care PT visit you. This option is usually for people who can’t travel to an outpatient physical therapy center.
Your goal for home physical therapy is to make sure you can move safely in your home. You will keep working on knee ROM and strength. Walking and stair climbing may also be a part of your home physical therapy.
Scar tissue will form as your incision heals. Your PT may use gentle scar tissue massage and mobilization to help improve the mobility of your incision. This can help the skin and other tissues around your knee move more freely.
If you can travel to a physical therapy center, you may begin outpatient physical therapy. There, you will keep improving your knee ROM. You should be able to bend your knee to a 90 degree angle by the end of week 2.
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Advanced Exercises To Prepare For Knee Replacement
Your knee replacement surgery is fast approaching. Youve met with your doctors, organized your home and cleared your schedule for the next 2 months so you can focus on preparation and recovery.
Your doctor has given you information to read and prepare for surgery and youve learned that your legs and body should be in shape. If youve been exercising and want to take your workout to the next level, Ill share my advanced exercises for pre-knee replacement surgery.
Keep in mind that this article outlines my exercises and may not be applicable in your situation. The reasons for knee replacement differ from person to person. Activities and movements that cause pain for me may not cause you pain and vice versa.
I talked with my doctor before starting these knee replacement workouts and its important you do the same. If you decide to try my workout, start slow and gradually work your way up to more weight and resistance.
These exercises may not be for you if:
- You have trouble extending your leg to a straight position
- Have damage to ligaments, tendons, and muscles
- Have severe inflammation or pain in your leg
- Have difficulty standing or sitting down