This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2022. For the original video go to https://www.youtube.com/watch?v=AuB81KHzv-g&t=35s
Bob: Alright, Brad, the first goal after you’ve had a knee replacement is you want to get the knee bending as far as possible and straightening as far as possible because what is being laid down?
Brad: Well, Bob, the body is trying to heal with scar tissue. Right. To make it strong again.
Bob: So, you’re racing against it.
Bob: Now, the knee will get strong but if you don’t get the motion, you may never get it.
Brad: Range of motion comes first, strengthening next.
Bob: Right, it’s important that we start right away. So, when you’re in bed, you could start by taking a cake pan if that’s all you have.
Brad: Make sure there aren't any cookies in it.
Bob: Right. So, put your feet in it. Don’t eat after you’ve done this, but you can actually start going back and forth.
Brad: Right, because your knee is going to be very weak and very sore, you want to minimize the resistance by using the cake pan.
Bob: You’ll probably have to have someone help you.
Brad: Yeah, or help yourself, but yeah, do what you can to get it moving.
Bob: Another option, a better option, is to use the knee glide.
Brad: Yeah, you can adjust it and put your heel on there and then just slide. This slides effortlessly. When you want to straighten it, you can do a little push-down on your thigh. Pull up on your knee, take a belt from home, or if you have a stretch strap, these work better because there are loops in them. If you don’t have one though, a belt will work. You can go around the knee or under the knee, and get your hands in the straps for a better grip, especially if you have arthritic fingers, this is a real-life saver.
Brad: Another option is to hook the loop around your foot, which actually works very nicely. Put it right around the foot and work it that way. Very smooth.
Bob: The thing that we know is you want to be in control right, Brad? You don’t want somebody pushing on that knee too much because it’ll hurt.
Brad: Right, as a therapist we have done that many times. The patient becomes anxious because they tighten up because someone else is creating the force versus them being in control. Okay, now the seated position is another way you can really work the range of motion. In the therapy room, this is where we do most of it, I would say. Again, if you’re at home and you have carpeted floors, you can take the cookie sheet or cake pan. Put it down and that’ll act as a nice slippery surface.
Bob: If you have a tile floor, you could just put a washcloth down.
Brad: Yes, a nice shiny floor and you can get a similar advantage. One thing that’s important that you can do to help, let’s say I only get to here. You want to get to that 90 degrees or 120 are very typical goals. The other leg over the top, I’m going to push, oh, hurts. If you have a knee replacement, you know exactly what I’m talking about.
Brad: Also, Bob mentioned earlier, make sure you work on straightening it as well.
Bob: Both hands.
Brad: Yes, hands above the knee. A little pressure down.
Bob: Again, let’s show a better option, Brad.
Brad: We’ve used this cake pan for years and other options, then we realize, this is not working very well.
Bob: Yeah, it wasn’t ideal.
Brad: Let’s get something that works in all situations. That’s why we use a knee glide. Again, much easier to use. You get the same overpressure here.
Bob: We have found we get better results with the knee glide.
Brad: Yes, and one big advantage that the knee glide does have is you’ll look, there’s a little handle here.
Bob: It’s got stilts.
Brad: The handle works as a stilt so you can have an incline and you can go downhill, which makes quite a difference. It fits the body; the ankle tolerates it as well. And the knee, you can go down. Once you get stronger, then we like to work the hamstrings, which are often neglected. Going up this little incline really puts stress on the hamstrings, more than you would think. Even on a healthy knee.
Bob: I’ll tell you what, Brad, flatten it out once. Go back, not around the ankle but actually push off the toe or the device.
Brad: That gives you a little more leverage. The device is also very light, about three pounds.
Bob: Right. Okay, we’ve done lying down. We’ve done sitting. Now, we’re going to do standing, this is very functional.
Brad: We are going to use the steps, I’ve used these with many many knee replacement patients. They have stairs at home. It’s really nice if there are handrails on both sides for safety and they might start with their foot on the first step and rock forward; stretch, stretch, stretch. Then back, you can do 10-15 of these. Then, once this gets easy, you simply go up one level on a step, again, grab the rails, and lean forward.
Brad: What I always have people do is rock forward, and also go up and down. It gives a different stretch to the knee. Do whichever one works better for you. Sometimes you can combine it and you’ll know, you’ll feel it. It’s a nice way to take advantage of the steps.
Bob: Not too much pain.
Brad: No, not too much, but stretch. Okay, now this is something at the end of every treatment, this is one thing we’ll do with patients to straighten their knee out as well as ice the knee.
Bob: That provides comfort.
Brad: Right, so we’re going to use a cold pack. I have a nice gel pack here in the seated position. Again, get a stool about the height of your chair. Early on, you’ll put the stool right under the knee and it won’t bend so much. Put a cold pack over it. The weight of the cold pack actually helps straighten it. As it gets too comfortable, I always go up to my patients, I push the stool out a little bit, more pressure, and then it stretches and they say, “oh thank you” in that cynical way. Then as the tool gets out, it stretches more.
Brad: Another trick you can do is to take your toe and rotate it out this way. Then the pressure goes on the joint slightly differently.
Bob: A little different angle.
Brad: That can be the trick to getting a few extra degrees
Bob: So, it’s really just gravity right, Brad?
Brad: Gravity, extra weight from the cold pack. Just this position does wonders, wait about 15-20 minutes for people.
Bob: A different option is you can actually get in bed, put your ankle on a rolled towel, and I actually straighten all the way. If you don’t straighten it, you actually just sit there like this. Then put the cold pack on there. It doesn’t look like it’s bad, but if you have a total knee replacement, it could be a lot of stress.
Brad: Right, and the idea is don’t make it so stressful that it’s really painful because then you tighten up. You want to get that medium stretch. You can adjust that by where you put the towel and get a stretch, so it’s stretching but not making you cry.
Bob: You want to relax.
Bob: Well, there you go, Brad. You want to make your surgeon happy; you want to make you happy. If you want to make the people around you happy. Bend that knee! Straighten that knee!
Brad: Right. It’s definitely the key to success. We’ve done it on thousands of patients and one way or another. Bob & I can fix just about anything, except for
Bob: A broken heart.
Brad: The knee is not that far; well, it is kind of far from the heart. Good luck!
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