Post-TKR Exercising

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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