Post-TKR Exercising

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Preface

I'm doing this post because I keep writing the same stuff over and over again on the subject of exercise.  So here it all is in one place.

Why Exercise?

Simply because:

1. Your quads and glutes have atrophied from months of non-use.  Ever see someone's bicep after an 8-week cast is removed for a broken arm?  Budduh...soft as budduh... {as we pronounce it in Brooklyn}  You have to rebuild the strength in your quads, glutes and core...period...no choice...accept it.2. And why exercise?  You do this to take pressure off your knee.  Right now, all the work in your leg is being done by your knee without any supporting musculature.  You must rebuild all that strength to take that pressure off the new joint.

3. And this is not short-term!  You have to stay strong the rest of your life.  Going up and down stairs takes leg strength.  You need to get that back.  And you certainly don't want to walk with a limp or a cane the rest of your life.  You need that leg strength.

4. And, no...you don't get this from PT.  Those sessions are short-term and designed to get your 0 / +120 ROM back.  After that, you're on your own.

5. Finally, this takes work...hard work and a commitment to your overall health and well-being.  It doesn't happen overnight; it will probably take up most of your first year post-TKR.  It usually starts when you finish PT and are recovered enough to start some serious exercise...S  L  O  W  L  Y  !!!

Credentials

I'll be having my 28th operation in 17 years in March 2017...another one on my spine.  Two shoulder rehabs, four knee scopes, artificial hip, back fusion, TKR...I've been through it all.  

But this is not about my veracity in giving advice on post-TKR exercise, it's about FREE recommendations from a true expert personal trainer, my daughter Kate.  Consider:

- Graduate nutritionist from Rutgers University (anatomy, physiology, biology, chemistry)

- Certified by the American College of Sports Medicine (two-year study and examination program, the "gold standard" in Trainer certifications)

- Certified by the American Council on Exercise (16 multi-disciplinary credentials such as spinning, kick-boxing, yoga, water aerobics and more)

- Graduate Assistant, Rutgers University, Department of Nutrition, (2000-2001)

- Personal Trainer for the Rutgers University men's NCAA basketball team (2001-2002)

- Corporate Personal Trainer, Medifit, 2003-2010 (Personal Trainer, Site Manager, Program Director)

- Corporate Personal Trainer, PlusOne Fitness, 2010-2013 (Personal Trainer and General Manager/Program Director of five corporate fitness centers for Bank of America, Dallas, TX)

- Mother, Breast Cancer Survivor, 2013-present

By any account, Kate knows this stuff cold...for the past 16+ years.  If you don't believe in what she's advising you, go try and find a more accomplished expert...you won't.  (...and I'm not just saying that because she's my daughter...).  PS: Post-cancer...she's 5'1" tall, back to a size 1 with 3-4% body fat at 122 pounds (solid muscle) and kicks P90X's butt!!!  And all of this with a compression fracture of L1 and a missing coccyx, removed after she fractured it slipping and falling while squatting 310 pounds years ago.  Did not stop her at all.

Recommendations

- Warm up on a bike for 30-45 minutes (set the seat high enough for full leg extension...hey, you have your ROM back so now use it).  You can do a very slow treadmill but you cannot go fast enough to cause any impact on the knee. The bike or an elliptical is better for the warm-up.  Zero impact.

- Then do your stretches. Before anything else...S  T  R  E  T  C  H  !!!  Get down on the mat.

- Once warmed up and stretched, start your exercises that specifically strengthen the quads (leg presses, curls, squats, abductor and adductor for inner thighs), calves (toe raises, calf press, balance board), hips (hip lift, hip lunge) and glutes (leg pull, kickback, flutter kicks).  Stretch out the hamstrings.  

- For all your exercises, start with NO weight but perform 3-4 sets of 12-15 reps each until you are at ease with every exercise and are not tired out by them.  (NOTE: If you can't do that many to start, do what you can and build up to it.)  More reps, no weight...you must build endurance before strength.

- Use your good leg to stabilize yourself during the exercise...don't use the good one to fake the reps.  The idea is to get the bad leg as strong as the good one before you fully exercise them together again.  You can even isolate the bad leg for the exercise (good one on the floor) but this could be tough at the beginning.  

- Once you can't tell one leg from the other (feeling balanced and not relying on the good one), start adding weight...slowly....like 5 pounds at a time, again using the good leg to stabilize yourself.  

- Alternatively, use exercise bands around your ankle.  Face the bar and pull straight back to work your glutes (unless your gym has a machine for that).  No weight and minimum (10# or 20# band) to start.  A set of bands and elastic ropes with handles at home are great to use too.  There are YouTube videos on leg exercises using the bands.

- Any pain, strain or swelling means you did too much too fast.  Back off...you'll eventually have equal strength in both legs.  

- Finish your workout with more bike or walking...take time to cool down.  

BIG NOTE: You are NOT to do this every day.  You NEVER work the same muscle group two days in a row.  The exercise breaks down muscle; the rest day allows your body to rebuild it stronger.  So, if you don't want to take a day off, use the odd day to work core and upper body.  Total health.  Lose weight, eat healthy, eliminate artificial sweeteners, hydrate, chart your progress, stay focused.

Conclusion

This is your life and your choice.  You can sit back, relax and limp the rest of your life or get a good part of that life back.  No, you will not do any high impact sports or exercises again, but there is always cutthroat shuffleboard.  You will never get your old life back but you can live THIS life to the fullest!

"Never give up. Never surrender." - Tim Allen, Galaxy Quest

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  • Posted

    Chico, I love your posts and this CE at a good time. I'm going through 4 weeks of muscle building now. Mine have atrophied and it's hard work, but I'm determined to get the muscles back. The muscles in my calves are hard and knotted so there's a lot of deep massage too. Thanks for all of your suggestions.

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  • Posted

    You make me tired just reading one half of what you posted. You must have something you so hyperactionated. Yes we need to exercise but not all people are your age and in your mind frame. I'll do what I can. At 81 years my muscles aren't in the best condition but using the adage: slow but sure. Thanks for your advice anyway.

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    • Posted

      I'll be 69 in 2 weeks so it's not easy for me either.  At your stage, however, you need to have more limited, achievable goals.  I asked my PT about people your age and TKRs.  He told me exactly that...more limited goals focused on SAFETY!  In and out of bed, tub, shower...personal hygiene and dressing (socks are a big pain for me)...cooking and light cleaning...up and down steps...in and out of cars...walking with or without an aid.  No, I don't see either of us bench pressing 250 pounds...we just have to make life as good and as safe as we can.

      Have you thought about your local YMCA?  They have a Silver Sneakers program of water aerobics and exercise tailored just for people like you.  Check it out!!!

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    • Posted

      I am 65 am doing all of the exercising you discussed. I just focus and go. There isn't a Y nearby. There is a Planet Fitness and I think my insurance has the Silver Sneakers plan on it. I have several pieces of equipment in our gym at home so that's good. Apparently, at 18 weeks post tkr I wasn't doing the right exercises. I am miserable but don't let on to hubby or kids. Im waiting on that 12 month mark. It will be a cold day in hell before I get my right knee done. But, sir, you are an inspiration to all of us. Good luck with your upcoming procedure Chico.

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    • Posted

      Hi debi

      I’m 18 weeks rtkr post op. I will meet you on that cold day in Hell to have my left one done. I hate posting because I hate being negative but at 70 years old this has been the worse experience of my life. Nothing has gone really wrong but the pain and pills and depression all have gotten to me. I pray for the day when I wake up and don’t feel that God awful rubber band feeling around my leg. Feel better.

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    • Posted

      Hi Arlene,

      l hear what you are saying. l am not a negative person. But this has been an awful experience. l have been up and down with my knee. Like you nothing terrible has gone wrong (as yet) its just been the whole experience. l have suffered the depression which l have never had before and although you tell yourself its just a knee operation its one of the biggest.

      l am making the most of life having not being able to get around since January. At least now l can walk although sometimes not far.

      l had the rubber band feeling but its gone. Sometimes l forget which leg l have had done and then it hits me with a pain or an ache. l never thought that would happen.

      This site is excellent.

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    • Posted

      Post-Op Depression arises from two distinct sources:

      1. It's a known condition - Docs know that POD exists...they've known it for decades but never tell you that, in cases when "original equipment" (knees, his, etc.) are replaced, depression is a sub-conscious reaction to that event. The problem is that they NEVER tell you about it or what to do. Discussion...

      POD

      You can get rid of it without drugs or psychoanalysis. Once you know the cause, "grow a set" and kick it out the door. You actually have power over this even though it doesn't feel like it at first.

      1. Expectations - This is also both predictable and "curable". It comes from our belief that "I should be better than I am right now" and "I don't know why this pain is still here. It should be gone by now". Whatever the terminology in your brain, SHOULD must be deleted from your lexicon. With a knee, there is no "should"...there's just reality. And if you have expectations, they will almost always be wrong resulting in a depressive state. When you hear yourself say this bad word, a red flag has to go off in your brain as a warning to change your mindset. There are no comparisons...there are no expectations. Just YOUR experience...and it usually takes a year to really feel better. Time, work and patience...concentrate all your focus and energy on those three things. All your other mental gymnastics are just a waste of time and energy.

      Now hear this...

      PTSD

      ...and feel better.

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    • Posted

      Hi Chico.

      Thank you. l wish l had read this sooner. lt so makes more sense now.

      They prepare you so much prior to the op. But they dont tell you or prepare you for the journey a head.

      Especially the POD .

      Thank you.

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    • Posted

      POD is just a Jedi Mind Trick...really. Got it when my hip was replaced 10 years ago. Called my cousin The Doc and he told me about it. Gone immediately once I knew it was fake even though it seems soooooo real.

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  • Posted

    Hello Chico, was very good article you posted very much liked...

    Question is would much everything you stated about the exercizes even though had not gone through any TKR or even PKR would you advise I should do everything you listed? my knee is weak with some nervouseness thats been like this now for 10 months, I do have lower back disc bulging pinched nerve but I been using two canes to get around I am hoping to get better on my knee & rid of the nervouseness in the glute down to my knee & foot so I just want to be careful with the leg machines doimg forward &reverse curles to cause any interior damage to the knee just wanted to here your advise on this what you think? thanks much...

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    • Posted

      No.  This regimen is recommended after a TKR to rebuild leg strength.  For your knee, you need to see an orthopedist, get some imaging done and have her give you a diagnosis and treatment plan.  If it's spine related, you need a neurosurgeon.  They usually start with an MRI but the definitive study is a CT/Myelogram with contrast.  Only then will you know what's wrong and how to fix it.  Exercise may only make you worse...have no idea.  Go see the docs and get fixed.  No one should live with back and knee pain.

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  • Posted

    Chico, this was so interesting.  Thank you.  It DID shock me just how much exercise was suggested but at the same time it opened my eyes to what was achievable after knee replacements.  It's sort of linked - when the arthritis first flared up I used two sticks - the pain was so bad I couldn't walk at all without them but then ended up with weak core muscles and weak leg muscles so was told to aim to get rid of them one at a time, which I did, as arthritis eased slightly, but was so unfit that we got the treadmill and bike and gradually got some strength in legs and core muscles back and as arthritis got worse again never went back to the sticks.  It seems it's so important to get muscles in as good place as possible before the knee replacements too, and as much flexibility as possible.

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  • Posted

    Oh Chico Mark . I do the exercises my PT gives me 3 times a day. I walk @ the house with one crutch. My Tkr was 3 1/2 weeks ago. I am 78 & desperate to get back to normal. Your exercise plan looks frightening. I haven't had a pain free night yet & ice it frequently. I fel tired & down at times but I WANT my active life back. Thanks for any advice . Your daughter sounds an amazing lady . Eileen

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    • Posted

      You're not ready for this yet.  First, you have to finish your PT so you get your ROM back.  Next, you start the exercise.  HOWEVER, as my response to Janice, above, elderly people who have other health issues need to do what they can...period.  This is a guide for people who can do this.  If you're too old to handle the entirety of this regimen, then you do what you can.  If your legs and quads are really weak, this is a perfect way to get them back.  My suggestion is to start slowly and get as far you can.  Some success is better than none.  Can't warm-up with 45-minutes of stationary bike?  Start with 20 minutes and grow from there.  Use your best judgment...it might take you a year to do the whole thing...or you may only get halfway there.  Either way, you'll be stronger than when you started.  

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    • Posted

      Thank you SO much Chico Marx for replying with good advice I much appreciate it. I am lucky not to have any other health issues,I only weigh 7 1/2 stone just not very robust. I have determination & go in me though & normally very active.i am just the exercises p t has told me to do 3x a day. I walk around house using one crutch but take 2 when out which sadly isn't very often. I stretch my leg out straight & have 97 bend but am working on they too. Thanks again Eileen

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    • Posted

      Again, this is a recommendation for AFTER PT has gotten you your ROM back and you're off the crutches...even though some people overlap the end of PT with the start of the gym work a bit.  Individual choice.

      Just remember...  The above routine is NOT for the faint of heart but this regimen, or something closely resembling it, is absolutely necessary for regaining your leg strength so those muscles can support the knee.  Can't emphasize this enough.  The work does not end with PT...rebuilding quads, glutes and core is mandatory work!

      NOTE: It will be very, very difficult to get out of bed, off the couch, out of the recliner, etc. to go and do this.  No one wants to...and you have to be crazy to be excited about it. Nevertheless, it all starts with the first step...then the next...then the next.  You can't do this haphazardly...you have to make it part of the routine of your life.  Don't think about it...just do it.  After a while, it gets easier.  I know this from so many previous rehabs.

      For me, ALL of this is on hold until after my spine surgery on March 24th.  My quads look like toothpicks...never been this weak in my legs in my life.  But I can't do the exercises without more severe back pain so I just have to wait.  For everyone else right now, go out and get your life back!!!

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    • Posted

      sorry you have so much trouble with your back Chico Marx. Yes I can imagine your exercises are on hold. I hope you soon get the op & then soon start on the recovery. I can't imagine I'll be ticking all the boxes 'done' but eventually I am determined to do my best. Good luck

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    • Posted

      Good luck with your surgery, I will be thinking of you. My second knee is being done March 26th. Thanks for all your posts they help so many people.i tried what your daughter said and did the alphabet with my big toe and had a banana, it was kind of fun.🙏🏻For your surgery 

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    • Posted

      You are instrumental for so many of us on this site to progress, succeed and stay positive. Your advice is beyond anything I expected to find on a forum. Without your kindness in answering so many questions and giving knowledgeable advice, I think I might have lost my mind by now. I am 12 months on December 10th, after bilateral TKR and your posts inspire me not to give up. Thank you for everything. I hope that your upcoming surgery is a great success, with a fast recovery time . I am sure you will have many of us thinking of you on March 24th.

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    • Posted

      Thank you for your kind words. I tell people right up front that I'm "Not-A-Doc" but I have both been through soooo much plus have access to insanely knowledgeable people about lots of this that writing these discussions and sharing them is just my way of giving back. Yes, some posts have been controversial and even arguable...but that's a good thing. You want people to THINK and not just accept what's being handed to them.

      The docs are not the "gods" people made them out to be in the 50's. They make a diagnosis based on their best available information and then prescribe a treatment that their literature suggests works for most people. If it doesn't work, they try the second best treatment...and so on until you get relief...or not. There's no magic here.

      So patients have to inform themselves, get educated on all that data and start to ask questions. You must be your own, best health advocate...no one else will do that for you. For example, check your own medication interactions or go beyond western medicine to see what can help you. It's your life, your body...stand up for yourself!!!

      My spine op on January 22nd will consist of double LLIFs at T12/L1 and L1/L2 from the side after which, they'll close me up, flip me over and open me up from the back to install two supporting rods from L3 to T12 so nothing shifts in the future. The extra metal will bring me to an even FIVE pounds. Just think...when I'm dead and reduced to ash, I'll still weigh five freaking pounds!!!!!!! Damn... Doc promises a week in the hospital and then a week at home with no rehab afterward. He will keep his promise or I'm calling Carmine and Paulie from Brooklyn to pay him a little visit. Lead pipes applied to reluctant knees make for some painful truths of their own...ask Nancy Kerrigan.

      Thanks again...

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    • Posted

      That is a lot of surgery for such a fast recovery, and I hope that is exactly what happens for you. A friend of mine had a donour disc inserted at C6 and was doing well in no time at all. Within a couple of weeks he went from severe pain to feeling like a new man. This was done at Toronto Western hospital, where I had my surgery. The surgeons there are top notch, and apparently my surgeon has never had anyone have the issues that I have had with tightness, etc. I guess I am lucky enough to be the unique one. Fortunately, he didn't write me off and has sent me for several tests, all coming back fine. Lucky for me I found this forum and your advice and while I am riding a roller coaster of feeling I am over it, to realizing the next day that I am not, I do know that I will be over it soon and it will be a distant memory, that I will be able to share with others to let them know there is hope.

      Best wishes with your surgery.

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    • Posted

      The LLIF (or XLIF or OLIF) fusion surgery is the best kept secret on the planet. Search YouTube for "Globus LLIF Technique" for a cute animation of the procedure and "Globus ELSA" for one on the device itself (AMAZING!!!). One night in the hospital, no brace, no rehab, total and immediate pain relief...in my case it was foraminal stenosis that turned my legs into rubber bands.

      That's why it's important to find a doc who does this procedure to see if it applies to anyone's particular case. The upcoming surgery is a hybrid consisting of the side LLIF to insert the two devices and then the rear opening to put in the supporting rails. If it was just the LLIF, I'd be out in a day.

      Hey, I've had 35 general anesthesia procedures in the past 19 years...I'm a pro at this. Lots of small stuff like seven trigger fingers, carpal tunnel, etc. but the knee, hip and spine metal were all "fun". I completely rehabbed the hip replacement in six weeks (5 hours a day, six days a week) so I expected the knee to be the same. Right... That's where I hit my own brick wall. Long and tough recovery that I was not prepared for. The spine stuff is easy to moderate...no problem. I've got great surgeons here in Fort Worth.

      Thanks for your thoughts... JC

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    • Posted

      Wow Chico!!! That's an impressive operative history! I think I'd be aski g for my money back if I had your body. Reading all these posts I appreciate how lucky I've been with my tkr, touch wood!!! I hope your upcoming surgery is all plain sailing and wish you a very speedy recovery! 🤞🤞👍👌

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    • Posted

      Wow Chico!!! That's an impressive operative history! I think I'd be aski g for my money back if I had your body. Reading all these posts I appreciate how lucky I've been with my tkr, touch wood!!! I hope your upcoming surgery is all plain sailing and wish you a very speedy recovery! 🤞🤞👍👌

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    • Posted

      For me, it was 45 years of playing hockey. I only gave it up when I had my hip replaced and the doc told me that I had the choice of keep on playing and having the hip last three years or give it up and having the hip last 25. No-brainer. Sold everything the next day. Really, REALLY miss it but sometimes ya just gotta be the adult in the room.

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