2 Critical Exercises For Complete Success After Knee Replacement
- chelsie462
- 3 hours ago
- 10 min read
This article is a transcribed, edited summary of a video Bob and Brad recorded in August 2024. For the original video, go to https://youtu.be/GQp73wn6Ha8
Brad: All right, total knee replacement. Now, Mike, Bob, and I have worked with literally thousands of patients after a knee replacement, and we're going to offer you our experience and expertise on how to have your best results.
Mike: Now, sometimes it's hard to remember all the details the surgeon tells you for after you go home. What should you do? What should you not do? So, we're just going to narrow it down to two critical exercises you need to be doing for complete success.
Brad: There you go, I like that. Now, this information is even more critical these days, as it is common that you may only stay in the hospital for one day or one night after the surgery, versus three days years ago, so let's get to it. Mike, what other really important thing do you need to know?
Mike: It's important to make sure you stay on top of your pain medications after you leave. Because if you're in more pain, you're less likely to do exercises that need to be done, so make sure your pain is manageable and don't try to tough it out.
Brad: Right, if there are any problems with it, make sure you call your doctor, talk to the doctor, or the doctor's nurse to get things on track. Very critical. All right, now, the basic concept you need to understand is scar tissue after this surgery. They are in there cutting, they're hammering, they're doing all kinds of aggressive surgery, and there's scar tissue that starts to form right away. So if that scar tissue forms in a sense that it actually locks the knee up, that's the big problem. Mike, do you want to talk a little more about that?
Mike: So the acronym we want you to remember is STAR, so scar tissue and range of motion. So to prevent scar tissue from building, we need to move the knee. If you were to just lock your knee out straight after surgery, for two weeks, and you try to bend it, you're going to be behind, you're gonna be stuck, it's going to take a long time, and it's going to be painful when you first start moving it. If you've ever had a cast in the past and you first start moving, just think of that. But in this case, you don't want that.
Brad: Right, get it moving right away. Let's get to the two exercises, Mike. Okay, the first thing you need to address is knee flexion, or bending the knee. You can do this in bed, depending on how you have your bed set up. Now, if you try to go back and forth like Mike is doing, it's going to be difficult, because the heel tends to stick and slide on the sheets, so you can try this and see if it works. If you have a helper with you, it'll probably work on the sheet. You'll simply put, this represents the bed sheet, you simply put a cookie pan down, that's nice and smooth.
Mike: A cake pan.
Brad: A cake pan, cookie pan, and then you simply slide it back.
Brad: If there's someone to help, you can actually push a little bit. The person with the bad knee is going to tell you when to stop, listen to them.
Mike: Ow, ow, ow, ow, ow, ow, ow.
Brad: Okay, the other thing you can use is a belt. Okay, with the belt, the person with the surgery is in complete control, and that oftentimes goes much better; they're more relaxed. Make sure you breathe and relax as much as you can, even though there's pain involved.
Brad: Now, there is a device that works much better than this, and that's called the knee glide, and you'll see why. Mike, can you lift your leg up? This is not necessary to do range of motion in bed. Some people find it very helpful, depending on how hard it is to get out of bed, but if you use the knee glide, can you lift your leg up? And you can see it slides back and forth. Very nice. You can put it on the bed, put your heel on there, and it's much easier, isn't it, Mike?
Mike: Mm-Hmm.
Brad: Yes, yes. Now, the heel might need a little cushion. You simply take a towel, put that on there, that's helpful, and work it back and forth.
Mike: You can also use your other leg to help if you don't have a belt handy and you're comfortable doing this.
Brad: Good point, Mike. Excellent, excellent, excellent. Now, as you get better, this will not be needed, and you'll do all your range in a chair. Now, if you're in a chair, you want a firm chair that has an open spot under it, so a recliner will not work, and then you'll use your cookie pan on carpet, not on a hard floor, just won't work so well, and you can simply slide it back and forth. You can do this barefoot or with your shoe on, whatever works, very good. Again, like Mike mentioned, your other foot can go over the operated leg, pull, pull, pull, you can help with this hand, stretch that knee, and get that scar tissue to break loose. It's going to be a little uncomfortable, or you're not going hard enough. Back and forth, back and forth.
Brad: Now, the knee glide is an option, and there are some big advantages to it. For one thing, it slides back and forth better, it's on a track, so it doesn't have a tendency to go off track, and another big thing is it actually has a handle for carrying it, but it doubles as a stilt, so you can actually go downhill, and it's amazing what a little incline can do to make the knee bend easier. Again, you can grab here, you can grab here. And you're gonna do this at least three times a day. Spend about three to five minutes on flexing the knee, breaking that scar tissue apart. It's not very fun, but it is necessary. The faster you get to it, the easier the whole process is.
Mike: And we should mention that if you have a wood or linoleum floor, you can probably do it in your socks or use a towel. You don't need the baking sheet for that. But the knee glide works anywhere.
Brad: That's right, yeah. A towel doesn't work very good on carpet. All right, now you're going to do your flexion exercise, and then right after that, or shortly after, you can take a break. You're going to do your extension, or get the knee straight, which is very critical, particularly for a good walking pattern after you have your replacement and things are better. As far as bending your knee, we would like to get it to 120 degrees or more, so remember that. Now, you can also do extension, straightening your knee, in bed. Mike, you want to talk about it?
Mike: When straightening your knee in bed, some people, obviously, I didn't have a knee replacement, so my knee can get straight; some people might be limited to start. It just depends upon what limitations you had before the knee surgery; some people's hamstrings tighten up on them. So you may just begin by lying with a towel underneath you for support.
Brad: Right, so we got a towel roll, and it really works well.
Mike: And you can put it there and let gravity just slowly pull your knee down. Typically, what we do with patients is have them just lie here for a duration of time. Some people even put an ice pack over their knee while they're doing this because it feels good. You can set a timer for two minutes, five minutes. We've had people work up to 10, depending upon what they can tolerate, and just letting gravity work on pulling that knee down eventually helps.
Brad: Right, now as a therapist, we'll actually give some assistance and push down on it, really paying attention to how painful it is. If you don't have that leg, you could take your other foot and go over the top, but not so good, 'cause that's where the surgery is, and there's an incision there. You'd have to cover it with a towel.
Mike: If you can activate your hamstring and back of your knee muscles and actually drive them down, you can certainly do that, as long as it feels okay. Hold it for five seconds and then relax as well.
Brad: All right, now let's talk about doing this in a chair. Get a firm chair with armrests, an upright chair. You can either slide your foot in a cookie pan or a cake pan, on carpet, you would use a towel roll or socks on a smooth floor. This doesn't work so good. And we'll also talk about the knee glide, which works very well, because that's what it is made for. So the concept is the same on all three. You simply straighten out as far as you can, and it should be as straight as your other knee, assuming your other knee is good, and if it goes part way and there's a higher spot, we need to get it all the way down. That may take some days or even a week or two, depending on your situation. Get at it sooner; it will go easier. Hands above the knee, above where this incision is, or the bandages, push down. We do not want to get things dirty there, so keep them clean. Keep that in mind. Infection is something we avoid at all costs. Push. And you may spend a few minutes doing this. It will not be comfortable when you get to the part where it stretches, and you can bounce on it a little bit like that. If you happen to have the knee glide, it does work nicely, it's a little smoother. I would have shoes on, it works better, or at least socks are fine, and do the same thing. Mike, do you have any suggestions?
Mike: Make sure you're sitting at the edge of the chair when you're working on your extension. You're going to really struggle if you're far back.
Brad: Right, exactly.
Mike: Another nice option is to use a stool of sorts. If yours has wheels, great. It doesn't have to have wheels. Brad can show it from the chair perspective there.
Brad: Yeah, the wheels are a big advantage because then you can go back and forth, or maybe you can slide your foot across the surface of the stool. Wheels are helpful.
Brad: After you get done, you've had enough stretch, things are looking better, and this is where the therapist actually takes measurements, but you'll get a feel. You can also test and see if it's like this, if this one's a knee, if it's the same level as your other one. Then when you ice it, this is the place to do it. Put your cold pack, your towel, clean towel over it, then the cold pack, weight it down, and if you go like this, which I've done many times with patients, it gets a nice stretch.
Brad: It is uncomfortable, and what I would tell them is just allow it to stretch that knee painfully until you decide, "I've had enough," then simply bring the stool in, and that changes the amount of pressure on it, and then there's a big sigh of relief. You've done this, Mike?
Mike: Mm-hmm.
Brad: And the person's much happier there, and then finish icing for 15 to 20 minute,s and then take that off. Do the whole procedure two to three times per day.
Mike: And be wary if you ever eat cake or cookies from Brad because they'll taste like feet.
Brad: Why, Mike, why? The next thing, and they'll tell you this, make sure you get your walking in using your walker. Do not go from a walker to a cane, or without anything, until you get the okay from your therapist. You do not want to fall because of a misjudgment call. Mike, do we have anything else going on that can help them out?
Mike: If you'd like to check out more videos on how to work your knees, you can check the video link on the screen.
Brad: What is it?
Mike: I don't know, because I can't see it right now.
BRad: I'm curious. Let's take a look and see. I did some research on it. Ah ha ha!
Brad: Right, so once you get your knee to bend and to straighten, you still need to work on strengthening so that you can walk up and down steps, uneven surfaces, etc. So this is all done, and we have information for you for complete success.
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