“They told me it was the Fastest recovery they’d seen.”
I was pleasantly surprised when my client told me what her physical therapists had said regarding her rehab from a knee replacement. Knee and hip replacements are becoming more and more prevalent these days. Aging, inactivity, arthritis, and excess weight have inflicted a heavy toll on joints, and, with people living longer, joint replacements are commonplace in order to continue some quality of life. Many people are tired of living with pain, and getting a new knee or hip will give them relief.
An important aspect of getting a joint replaced is the recovery process required to get the involved limb moving and weight-bearing again. Patients undergo physical therapy to stretch and strengthen the joint and surrounding muscles back to ‘normal’ range of motion and capacity to support weight. However, most people don’t consider what they should be doing BEFORE surgery. They are counting down the days until they can get ‘fixed’ and start fresh.
If you plan to have a knee or hip replacement, one way to put yourself in the best position for recovering faster and stronger is exercising before surgery, or ‘pre’-habilitation. This may seem counterintuitive, especially if you’ve been inactive for a while. It was difficult enough staying motivated to exercise even before your joint was in such bad shape. You may ask, “Why start exercising now while my joint hurts? Shouldn’t I just wait until after surgery and physical therapy?” Rather ask yourself, “How important is the speed of my recovery time? How soon do I want to be functioning at my best again?”
Studies have compared patients who exercised before joint replacement surgery with control groups who only did after-surgery rehabilitation. The pre-surgery exercise group had better recovery times, less pain, and better performance of movement tasks such as walking, stair climbing, sitting, and standing. Another key to consider is the burden placed on the non-surgery leg. Patients with joint replacements commonly overuse and stress the other limb to compensate for the weaker surgery side, leading to muscular imbalances and further joint deteriation in the non-surgery side. Strength and conditioning for both limbs will help minimize further complications down the road.
Going back to the client I mentioned earlier, whose physical therapists said her recovery was the ”fastest they’d seen”, she began an exercise program with me two months leading up to a knee replacement. She had me come to her home once a week for a one hour session. Rather than thinking I’m a miracle worker, perhaps her therapists’ comments reflected the absence of other patients coming in who actually began exercising before surgery.
We worked on strengthening and stretching her knees as well as her hips and ankles. Consider your body as one interconnected, kinetic chain, where problems in one area will affect others up and down the line. Weak hips will cause muscular imbalances and compensations in other areas, putting undue stress upon the knees. The same goes vice versa. We also worked on her upper body, because she would undoubtedly rely on her arms to help get up and down throughout her recovery.
Below are some of the knee, hip, and ankle exercises she performed. You can try these at home every day or every other day, but just make sure and consult with your doctor before beginning an exercise program. Do what you can, and depending on the severity of your joint condition, you may need to skip some of these if they cause any pain. Exercises are listed in order of challenge for each joint. You can start at 8-10 repetitions and gradually work up to 20. After that, try the next exercise on the list. The key word is GRADUAL. Listen to your body, avoid causing sharp pain, and back off some if your joint pain increases.
Quad sets – Sit on your bed with your legs straight and a rolled towel under your knees. Contract your quadriceps (front of your thigh above the knee), trying to push the towel into the bed. Hold for a couple seconds, relax, then repeat.
Straight leg raises – Lay on your back with one leg bent and the other straight. Tighten your abs, avoid letting the arch in your lower back increase, then lift your straight leg up to 45 degrees, pause, and lower down in a controlled manner.
Short arc knee extensions – Sit on your bed with a pillow folded under your knee, allowing your leg to be bent about 30 degrees from straightened out. Slowly lift your foot, straightening out your leg, pause, then lower in a controlled manner.
Sit-to-stand – Start at the edge of your bed with arms crossed at chest. Keeping back straight, lean forward until shoulders are over your feet, then contract your glutes and quads as you stand up straight. Use your hands on the bed if you need to.
Bridge – Lay on your back with feet flat and legs bent about 90 degrees. Keeping your heels down, contract your glutes and slowly lift your butt up until you are straight from shoulders to knees (or lower if needed), then slowly lower to start. Try keeping your knees in line with your feet throughout the movement.
Clamshell – Lay on your side with both knees bent about 90 degrees and stacked on top of eachother. Without twisting your hips, slowly lift your top knee as high as you can manage, then slowly lower back to start.
Side leg lift – Lay on your side with bottom leg bent and top leg straight. Keeping your body straight from your shoulders to top foot, toes pointed forward, slowly lift top leg about 45 degrees (or lower if needed), then slowly lower to start.
Sit-to-stand – See above description.
Seated heel raises – Sit at the edge of a chair with your feet flat on the floor. Contract your calf muscles and slowly lift your heels off the floor. Pause and slowly lower to start.
Seated toe lifts – Sit at the edge of a chair with your feet flat on the floor. Contract the muscles on the front of your lower leg and slowly lift the balls of your feet off the floor. Pause and slowly return to start.
Standing heel lifts – Stand tall holding on to the back of a chair or counter. Without bending knees or hips (keep knees unlocked), slowly lift heels off the floor, pause, and slowly return to start.
Standing toe lifts – Stand up and lean your back against a wall. Without bending your knees or hips (keep knees unlocked), slowly lift the balls of your feet just off the floor, pause, and slowly return to start.
Hamstring stretch – Sit at the edge of a chair with your leg out straight and your heel on the floor. Keeping leg straight (but not locked) and your back straight, lean forward at your hips and reach for your toes until you feel a good stretch at the back of your thigh. Hold 10 seconds, relax, and repeat 2-3 times.
Calf stretch – Stand facing a wall at arm’s length. Place your hands against the wall and step back with one foot. Keeping your back heel pressed into the floor, bend your front leg and lean forward until you feel a stretch in your back calf. Hold 10 seconds, relax, and repeat 2-3 times.
Seated hip flexor stretch – Sit sideways at the edge of a chair. While holding the chair, slide your outside foot backward down the floor until your knee is in line with your hips and shoulders. You may start to feel a stretch at the front of your hip and thigh. Slightly lean back to feel more of a stretch if needed.
Beginning an exercise program early will bring you to your surgery stronger, more flexible, and, afterwards, better able to get back to doing things you love without so much pain.
– Jeremiah Brem, CSCS, EP-C