This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2022. For the original video go to https://www.youtube.com/watch?v=T7bXV43L5X8
Bob: So we're going to talk about the mistakes that we see people make after a total knee replacement. Brad, you and I have probably seen maybe thousands of patients.
Brad: Oh, yeah, for sure. Thousands. They are usually pretty fun to work with.
Bob: Yes, they are. Let's jump right into it, Brad. So number one they don't have a home plan for after the operation. So like they get home and they suddenly realize, " I don't have any food. I can't go out and drive and get some food. I can't make it up the stairs." They don't have rails.
Brad: They don't put the little grab handles that you can put on easily beforehand, makes a big difference just getting in the house.
Bob: How are you going to shower? You know, lots of things. And you may even need to go to a nursing home for a while. I mean maybe if you're that dependent.
Brad: Actually, we have a video of a woman, she was young at the time. She went to a nursing home. She had both knees done. She owned a restaurant. She went back and was completely active with going up and downstairs, carrying things, et cetera.
Bob: Brad, we're eventually going to have a checklist here of things you should think about before you go home. So we'll actually have a PDF.
Brad: Oh, there's going to be a printout. And for free, you can print it out and have a list of things you should do.
Bob: Go to bobandbrad.com and go to the program section and look for knee replacement.
Brad: Right. And if you do this quickly and it's not there it's because we haven't had time to upload it. We are definitely working on it.
Bob: All right. Number two. They're not taking enough pain meds. Everybody's worried about becoming dependent on narcotics. Right?
Brad: Which is understandable.
Bob: Yeah, that's understandable, but this is a painful surgery. They're going in there and they're hammering and they're cutting in there.
Brad: Bob! You don't have to go into detail, they're not going to be awake for that.
Bob: So, anyway, you've got to take the narcotics and the problem is, Brad if you wait too long like let's say you go, "oh, I'm going to see how I do without them." Then it gets really bad and you can't catch up.
Brad: So yeah, just do what the doctor prescribes. They'll make adjustments. You can report back to them, they're very well in tune and they do not want to over-medicate you as well. You'll be fine.
Bob: They know when to take you off and just depend on them. All right. Number three. I see this one way too off Brad. Doing too much too soon. That's your middle name. They progress to a cane too quickly or they progress to no cane too quickly. And all of a sudden they find out their range of motion in their knee gets worse and the pain of the knee gets worse.
Brad: Yeah. You really need to take a step by step. You usually have a thing therapist that you're working with and follow their instructions. They'll help you out.
Bob: My mother-in-law was a, a good example of this. She was doing great and she started using the cane, and she went downhill.
Brad: She didn't fall though?
Bob: No, she didn't fall.
Bob: All right. Number four. I don't know if you tell patients this, Brad but they listened to other people too much.
Brad: Oh yeah, yes.
Bob: Like other patients. They go, "oh my knee was going so much better at this point already." Or maybe it was worse at this point. But the thing is they have a very poor memory and it quite often is not what they thought. Or if you have two knees done you're going to find one goes way easier than the other.
Brad: Typically. Yeah.
Bob: It's hard to predict.
Brad: As a matter of fact, Bob, I would go so far as if I had two people, two patients with a total knee replacement and one was doing really well, and the other one was not and was having some problems and maybe a week or two behind, which is no big deal, I would never schedule them at the same time.
Bob: Deflate them.
Brad: Yeah. The one who wasn't doing so well would say, "why am I not walking with a cane?" And so you really, it's a lot of psychological.
Bob: Yes. Yeah.
Brad: Us therapists are psychologists sometimes.
Bob: It's psychological warfare.
Brad: Whatever. There's a lot of positive attitude that needs to be approached.
Bob: All right. Number five. This is my opinion. I don't know if you agree with Brad but you are given a whole bunch of exercises to do after knee replacement. But there are two that I think are really important, the ones that you should focus on. And that is, you want to bend the knee as far as you can. And you want to straighten the knee as far as you can. The strength will eventually come.
Brad: Right! Range of motion and that's why then the therapists are measuring it every time we come in.
Bob: It's a race against scar tissue. So one thing that we have found, Brad, do a little self-promotion now, we have found the knee glide that we created to help with the bending and the straightening really helps it along. I've had people that were stuck and actually got along further, Brad I want you to demonstrate how you can do assisted flexion with the knee glide.
Brad: Right. I do want to say that therapists will probably have you, what they call, wax the floor. You must have a sock on, you need a shiny floor and then you're going to go back and forth like this.
Brad: It works fine. And you know, we've been we did that for 15 years and we decided, boy something would be helpful. So, this works really nicely. Now you can assist like this to bend it more. And then to straighten it you could bring it out and I'm going to just push down. And the knee glide really works well because it's comfortable.
Brad: And the big benefit is sometimes putting it at an angle like this makes a big difference. A little incline can help you get an extra five degrees without any issues. And once your range of motion gets back and then you can strengthen your hamstrings by angling it the other way and it works quite well for you.
Bob: It's a lot more comfortable on your ankle, I think. Brad, I want you to show this really quickly in bed. Because I think it's a huge advantage that you can start exercising your knee in bed before you even have the strength to get out of bed.
Brad: Right. So, that first week after surgery, in the first day or two, while you're lying there you can actually get the knee moving like this.
Bob: You might put a towel underneath the heel.
Brad: Yep. You can. There are a couple of options you can do to get it moving more. Let's say you just don't have the strength, but you know, it's going to bend more. You can take a towel and go under the knee and that may help, but it's even better yet if you can get a belt or a strap or a gate belt and get it around your foot. You don't have to tie it or anything, just wrap it around there. And now it's just like, rein's on a horse. You're going to just, whoa. Whoa, Bessie.
Brad: But no, it really does works well. It gives you a lot more leverage, so you're not working. You can relax. And that's a key with range of motion, learning to relax.
Bob: Right. You have to trust yourself. And I mean I find people do better themselves than with me pushing on them.
Brad: Yep, exactly. I'd much rather have the patient put the force on the leg because they trust themselves. They don't trust the therapist.
Bob: So one of the big advantages of the knee glide is the weight, I mean, I could carry it with one finger. You can carry it from room to room or you can transport it easily.
Bob: Right? It's very easy to clean if you use it from one patient to another. We're happy with it because it works and it fits a need that has been out there for years and now it's filled.
Bob: So another one is actually if they don't do their prehab exercises.
Brad: Ah, yes
Bob: I know that's before surgery but if you do your prehab your knees can be ready for the surgery. Plus you know what is coming.
Brad: As a matter of fact, the knee glide works excellent for prehab to get your knee, if your knee can be straightened and flexed all the way before surgery the chances of rehab going well is going to be much better. I was going to say there are a lot of hospitals that offer a prehab course. You go maybe an hour or two and typically a therapist teaches it and they'll give you some exercises to do a week or two before the surgery. And they'll talk to you about things you do. You'll get rid of your throw rugs at home. Put grab bars in the bathroom.
Bob: A lot of hints that will be helpful.
Brad: It's really worth it if they offer it. Make sure you take advantage of it.
Bob: All right. Number seven. The final thing that we see quite often is people trying to go back to work too soon. I know for many of you, you can't take that long off. I mean you don't have money coming in but it's good if you could do at least eight weeks. You go back to work too soon and you don't get the result that you want in the knee. It's quite devastating to spend all the time and money to have the knee done and then not get the results you want.
Brad: I know I've had people go back to work, I remember one guy in particular, he was a carpenter. So he had to get down on his knees.
Bob: Oh geez.
Brad: And the doctor said, yes, you can, but you need a knee pad. You need to do it carefully. So we actually practiced getting up and down on the floor. So that he was very well aware and that he would not damage his knee.
Bob: So again, at least eight weeks if possible 12 weeks is even better. Take it for what it is worth, our advice. This is after seeing thousands of people.
Brad: Yeah. Good luck with your knee and thanks. You're going to say why didn't I do it before?
Bob: Yeah. Why did I take so long? All right. Thanks.
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