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For The Best Knee Replacement Results-Must Do This BEFORE Surgery

This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2023. For the original video go to

Brad: We have worked literally on thousands of total knee replacements. By we, I mean, Bob, myself, and Mike. We've done it for years and we know firsthand what's going to get you the best results overall.

Mike: And for the best results, you want to know what you need to do before having surgery.

Brad: And that's the point. Most of our patients have had prehab, in other words, classes prior to surgery. However, most of them have not followed through on doing their exercises prior to surgery. And that's critical.

Mike: Unless the surgeon orders you not to do them, which in certain cases happens if a knee is just too worn out or it's very painful, they might not have you do them. But it's important to do them if it's applicable to you because you're going to improve your range of motion and get better strength before the replacement, making the recovery process go faster.

Brad: Absolutely. The better shape you are in before going in, the better results afterward. The primary goal with prehab is to get the full range of motion. In other words, that sore knee, the one that's going to get surgery has full extension as well as, as much flexion as possible. Once you have that, then you also want to get as much strength, mostly in the quadriceps, and in the hamstrings. However, you do not want to ignore the hip strength because that will be affected by a weak knee. We'll show you that as well.

Mike: And you want to make sure to do these exercises one to two times a day and start roughly about a month before surgery because again, after surgery these are going to become a lot easier and your knee rehab is going to go smoother.

Brad: That's right. And a nice thing about the prehab, the exercises you do after surgery are very similar and some are actually identical. All right. So typically, it's about four weeks prior to surgery. You'll be starting these and for range of motion, a real common exercise, if you have a smooth floor, you take a towel, put it down, and then you simply do what we call wax the floor. So you go back and forth to get the range of motion in the joint. Now you want to have full extension. So what you're going to do is slide it all the way out, toes come up, and get that knee to fully extend. It may already go to full extension, then you're done, you don't have to work that. If not, you can compare it to the other leg. If one is straight and the other one isn't, we need to get them to be equal. Doesn't always happen. It depends on how bad your knee is, but it will help.

Brad: Then we want to bend it. You'll do 10 more to straighten it and then pull it back to bend it. You can take this foot on the heel or the toe and give it a little pressure to get the flexion. You can actually grab it around your knee if you have enough mobility and pull it up towards your chest to get the full range of motion. Not everyone will get that either, but the whole idea is to increase the range of motion.

Brad: Now we do have another option that works very well, especially if you don't have a smooth floor. Okay, now this is a really nice option. You can use this tool known as a knee glide. It works excellent for knee replacements. It's built very well, and it's very light. Mike's going to demonstrate how it works.

Mike: So right now I have it set up for knee extension like Brad was showing earlier. So I go out as far as I can. I hold it, kind of lean forward, and press down whatever is tolerable for you. Do not make it hurt more than it already is. And you're also going to stretch the hamstrings a little bit here. If you haven't done an extension range of motion exercise, your hamstrings are probably tight, and they have to learn to elongate again. So not only is your joint bothering you, but these muscles have to get stretched out as well.

Mike: Now if I want to work on flexion, meaning bringing my knee back, you're going to have to scoot it a little more under your chair for that and you can bring it back. It slides really nicely. If you're like me and have bad ankle range of motion, you can certainly bring your heel up. It's not going to hurt the amount of knee bending you're having.

You might want to get a chair that doesn't have something right under the seat for your leg to catch on but bring it back as far as you can. You can also assist with the other leg to bring it back and hold it there as well. You can hold it for 10 seconds, five seconds, or whatever you can tolerate, do that five or six times.

Brad: There's one more big advantage to the knee glide, it has a stilt so you can actually go downhill. Now we've found with experience that sometimes the range is really accelerated by going downhill because of the angle of the knee, and the ankle, as well as moving downhill. So there you go.

Brad: All right. Now, if your knee is so painful, it's hard to walk on and doing this is uncomfortable, you can actually do this on your couch long seated, or in your bed, and it works very well.

Brad: The real big advantage is if you're having a hard time getting full flexion this way, we're going to show you how you can use a belt with that. So what you do to get more knee flexion is simply take a belt, go around down by your ankle, and you're simply going to pull and stretch that. Stretch, and usually, if you go a little lower with the belt, you get better leverage. You'll figure that out very quickly.

Brad: And then for full extension, if you're by yourself, you just simply lock your knee down. If you have someone you trust, they can give you gentle pressure or simply go up in a long-seated position to get full extension there. You can also work it into flexion and pull here. It's just a real, another handy option. And you really do need a knee glide to do the option. The great thing about this is you will use this in bed after surgery as well because it's going to be sore for that first week.

Mike: Another option if you do not want to have a knee glide or you're sick of doing floor scrubs, is if you have some type of bike of sorts or a fitness membership at a gym, you could certainly use a bicycle there. Or if you have a pedaler at home, you could do that as well. Now, the closer you are to the pedals, the harder it's going to be to flex your knees. So if this was further away from me, it would be a lot easier to flex my knees. So what you want to do is start with the rocking motion, if that's easy and tolerable, you could certainly do the full range of motion, go forward and backward. You see the closer I get to the pedals, so they'll be adjusting the seat on a stationary bike, the more knee flexion I'm going to get. You can also go further away if you want to work on your knee extension and push your knees straight as well.

Mike: I would start with no resistance to begin with. Just get the range of motion going. If you have the full range of motion and it feels good, you could certainly add resistance, but that's going to be more for strengthening.

Brad: That's right. And again, if you have a stationary bike as opposed to using this as Mike mentioned, the height or how high you have the seat or how much you lower it is going to be critical. So you have to work with that carefully. Okay, what we're going to do next is some strengthening exercises. You have your range of motion. Now, one basic quadriceps strengthening exercise is to simply kick straight out as high as you can and down. So it's not up and down as fast as you can. It's meaningful and slow. Hold it, and go back down. That's one and that's two. And when you do it like that, you will definitely notice a big difference versus a short, fast motion. I call it cheating.

Brad: So if this is too easy, you can do 10 of them, and it's like you need some more resistance, you can simply add an ankle weight. I've had people who don't have an ankle weight simply put on a winter boot. If you live in the south or it's warm, put on a heavier shoe. It doesn't take more than a couple of pounds to make a difference and do the same thing. Three sets of 10 would be great before. After surgery, you'll get to that, but it'll be a couple of three weeks for sure.

Mike: Another way to make it harder is just to hold it up there for three seconds.

Brad: An isometric.

Mike: And then go down because you get an isometric strengthening at the top. I'm going to show you on the knee glide. If the knee glide is easy and your range of motion is good, you could certainly do this with an ankle cuff like this as well, or a boot as Brad was saying. I don't know if the boot will fit too well on this footplate, but maybe.

Brad: It'll fit.

Mike: Maybe cowboy boots would.

Brad: It'll fit.

Mike: So I just go back and forth like and obviously, to make it a little more challenging, you want to put the kickstand up, and then you can go uphill. Making it more challenging for the quads. If I want to turn it around, it's going to be more challenging for the hamstrings to pull towards me with some weight to resist it.

Brad: And actually, with the hamstrings, I've rarely had to put ankle weights on. Typically without the weights is adequate to work on it. Let's go on. There are other options for hamstring strengthening.

Mike: Yes.

Brad: Another way to get those hamstrings stronger, if you do have some resistance bands, or a loop band, put it on something solid like a handrail for your steps or a piece of furniture that's very heavy and you do need a loop. So it's nice if you have these, you simply just loop them together and you have your loop resistance bands and just put it around your ankle. Get the distance proper so that you pull it under and you'll definitely get a hamstring strength and naturally change your resistance simply by moving your chair in or out for more resistance. Three sets of 10 is the goal. Start out with 10, see how that goes. Don't overdo it the first week.

Mike: Another simple exercise to try if you feel comfortable with the other ones is just some basic mini squats. So you're just going to bend your knees a little bit and then straighten back up. Do not do a full range of motion squat. Do what your knees can handle. Try to get some bend and some straightening in it. Hold onto something for support. You can do it at a stairwell, a countertop behind a chair like Brad is going to demonstrate, and just try to do 10 reps each set and try to do three sets if it's possible for you.

Brad: So the big thing is, like Mike mentioned, is don't go down too far. If you go too far and your knee starts to hurt, you may collapse and fall, and it'll be a big problem. So if you feel that way, have a chair behind you so you can sit pain-free, be cautious, and take it easy. If it starts to hurt, you're done, go back up. Don't think a little pain is okay and more pain is better, not the way to do it. Good precautions. Stay safe. And that knee will get stronger.

Mike: And the last part is hip strengthening because the hip is connected to the knee, so we want to strengthen that as well. So the first exercise is just going to be marching or hip flexion. You can alternate or just do one leg at a time. Hold onto something for support. You could do it behind a chair like Brad, or at a countertop. Hold onto a cane if you feel steady and just make sure you feel safe with this. Do 10 repetitions on each leg.

Brad: If it feels too easy and you can go up to two or three sets of 10, you want more weight, simply take that ankle weight and put it on again, or a pair of shoes. Heavier shoes offer more resistance. So out to the side is next. Make sure you don't lean over with this. Just the leg is moving. There you go. You won't go as high, but that's okay.

Mike: Toes pointed straight ahead. You're going to feel this on both hips as well. And you're just going to do 10 reps. And then once you're done, switch legs.

Brad: Yes.

Mike: You get work on both legs because as you're trying to balance here, the leg you are standing on is working as well.

Brad: And then you do the hip extension, make sure the knee stays straight. We're not bending the knee. We have already done that. We're working the hip, knee straight, and kick behind you. This is what you'll want to do. And again, wait if you want.

Mike: 10 to 15 reps. Work up to three sets if it's tolerable for you.

Brad: That's right. Both legs, it's all good. Once again, prehab, what you do before is really going to make a difference because it gets the knee prepared, and you're already ready for the after-surgery rehab.

Mike: You'll be prepped and very studious and ready to go.

Brad: Your surgeon will be proud and you'll be happy because you'll be going to the ballroom dancing. Yes, yes. People are going to be doing the waltz, the polka, and even the jitterbug.

Mike: I can't do those. And my knee is fine.

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