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
19 likes, 130 replies
kathleen_65043 CHICO_MARX
Posted
I love reading your posts you give great advice and your are right iris up to us all after tokeep up with the exercises but it’s so hard and as I said to my Dr the other day I did not realise How painful the op was he gave me one of his fav smiles and said don’t eyed will get there please god I hope so it’s taken a lot out of me
jill49814 kathleen_65043
Posted
Pain is not that bad now after 3 months past operation. Still very painful every time I get up from chair. I’m trying to work on getting my leg straight like the other one. I put around 5 lbs of pennies in a sock and balance the pennies evenly in sock and hang it over my ankle while I lay on my stomach on bed . I keep it there for 5 minutes. I do this twice a day
I’m trying to walk 5000 steps a day. I have a Fitbit . I don’t accomplish this every day. Still am not sleeping that soundly but am doing better than a month ago. Looking forward to end of next May when hopefully most everything will be back to normal.
kathleen_65043 jill49814
Posted
Hi Gill yes the pain is vile
I walk around the house fine but once I’ve rested getting up anc walking again is a real pain some days I don’t know what to do with the leg I find going up stairs is painful as still only doing one at a time my knee bend is only 90 degrees But working hard on getting it more I’m still convinced my knee is not right as it locks and sticks seeing physio Tuesday so I hope she can put my mind to rest as I’m convinced it’s going to have to be re done I did not get on with my consultant at all so I have refused to see him waiting on a new one my left knee needs doing but can’t face if yet so I’m leaving it till end of next yr as long as it holds out
It’s no fun getting old😂😂😂
I hope you improve keep in touch x
CHICO_MARX jill49814
Posted
Having the fit bit is great because your progress is measured in STEPS not in distance or time. Similarly, you don't set a target step count and achieve it at the expense of pain. Not the way to do it. This is NOT about hitting some imaginary, artificial number goal.
Walk until you can't. Note the steps. Did your knee swell? Too much pain? Back off, recover and use a lower max step count. Use that maximum until you are comfortable with it...then increase gradually. Your knee has to be the deciding factor...not your head! Use the software to track and chart your progress. Takes time and work. That way, you stop putting so much pressure on your brain!!!
Leg straight? Do #3...
https://patient.info/forums/discuss/tkr-rom-work-at-home-620053
Gravity is a harsh taskmaster but this one, simple exercise will get you to zero. And you don't need pennies... Have fun...
CHICO_MARX kathleen_65043
Posted
Takes a lot out of all of us. No one is ever prepared for this op...especially me. 30 general anesthesia ops in 18 years. Rehabbed two shoulder, a hip replacement, spione fusions...never a problem. Killed it at rehab. For the hip, I did 5 hours a day, six days a week in a therapy pool and gym. Full and COMPLETE recovery in six weeks. Thought I'd breeze through the knee. Even had my band book a gig for 10 days post-op. WRONG!!!!!!!!!!!!!
At 2 months, I was still drooling on my pajamas. The knee is the toughest recovery on the planet...well, maybe after a heart transplant and/or brain surgery. It just takes a full year...period. I'm now 2 1/2 years p/o and I'm absolutely fine...because I overcame my disappointment that I couldn't rehab the knee in 6 weeks, got determined to to the work and give myself the time necessary to recover. It's difficult physically, mentally, emotionally and spiritually. It will absolutely test you to your limits and beyond. You will have to find strength you never knew you had. Maybe this will help...
https://patient.info/forums/discuss/tkr-and-ptsd-569521
Take it to heart. Calm your soul and do what is necessary...
kathleen_65043 CHICO_MARX
Posted
loriannie CHICO_MARX
Posted
I am just at a one year mark, and the dr says i am right on track. however, I have a painful bump just above the knee. the dr said its a suture that didnt dissolve and I will always have it. the outside of my knee is still warm and hurts. I do everything, swimming, hiking, yoga, and I am at 10,000 steps a day, my dr says I am too hard on myself, and because I do so much, my knee will take a little longer to heal. I was back to work ( childcare, lifting) at 7 weeks .. Chico, were you completly pain free at a year? or did it take longer? this is not a fun journey, and i hope this will be worth it,
CHICO_MARX loriannie
Posted
Not in one year but that was due to extenuating circumstances. At 8 months, I had to stop my exercise program (had gotten to 11,000 steps a day) because I developed bi-lateral stenosis at L2/L3...could barely walk 100 feet. It was like extreme sciatica down BOTH legs. Took months to get it diagnosed and fixed. Lateral Lumbar Interbody Fusion (LLIF) too care of it. Only then could I resume the rehab.
I'm 2 1/2 years on the knee...zero pain (except the nerve pain when kneeling on a hard surface)...great ROM...no more noises...rare tightness. It all comes in time...
missmagwumps CHICO_MARX
Posted
Thank you so very much - my gym days are over as far too expensive in Central London but I can fashion a regime at home......bless you Chico....x
CHICO_MARX missmagwumps
Posted
Exercise bands set...20, 30 and 40-pound resistance with handles, ankle strap and door closure attachments. $25...Amazon. Put the door attachment at ankle, wait or shoulder height, depending on the exercise...close the door. Now attach the selected band and then finally the hand or ankle attachment to the end of the band. Some kits come with a video or there are tons of them on YouTube. Have fun...get strong...it will definitely help.
CHICO_MARX missmagwumps
Posted
I scored the ULTIMATE rehab victory!!! The TotalGym XLS is an AMAZING home machine. Everything anyone would ever need for rehab. List is $2,000 USD; normally sells for around $800 USD. Someone was moving out of the neighborhood and I picked it up...brand new, never used...for $100 USD, I basically stole it. Check your local Facebook Marketplace and local outlets to see who's selling one.
j68551 CHICO_MARX
Posted
Aquatic Therapy for TKA Rehab Patients
"The water is a great environment for patients rehabbing knee injuries, or any type of injury/surgery, because “any exercise you can do on land you can do in the pool with the added resistance or assistance of the water." Additionally, the water is a great place work on balance and strengthening the accessory muscles too". PT at Kansas Joint and Spine Institute
"Aquatic therapy has been shown to have a beneficial effect, and it is typically begun two weeks after surgery, after the wound has healed. According to a new study published in the Archives of Physical Medicine and Rehabilitation"
Bangkok-Johnny 69 years. My case: Multiple orthopedic operations in the 60s and 70s In 2014 primary TKA in Sweden resulting in a deep periprosthetic infection. Now in recovery/rehab after a Two-stage TKA here in Bangkok where I am a resident. I couldn't swim for three years due to the infection. Now, after buying a six-months pool-membership I enjoy every session. Pool-day almost every day! My gait is improving and and my atrophied quadriceps is finally increasing in volume, this also thanks to my PT whom I see twice a week.
Best regards,
Bangkok-Johnny
CHICO_MARX j68551
Posted
I agree. Doing this work in a pool is the absolute BEST!!! The only issue is when you can start. I have heard of a lot of different doctor orders saying that the scar cannot be immersed in water from anywhere from 2 to 6 weeks. My doc said six; always follow your doc's orders.
However, when I rehabbed a hip replacement in '09, I was in a therapy pool in 10 days and did the full rehab in six weeks. Can't do that with a knee which takes much longer but once you get into a pool, ahhhhhhh..... It's absolutely great if you have a YMCA close by.
JRS11 CHICO_MARX
Posted
After PT they gave me some stretches and strengthening to do and I do them religiously every day, rotating the very strenuous ones. I am sure I am not even touching your list, I do my slides and I use my 6" block, use the recumbent and my treadmill, do my slides, clamshells, straight leg raises. So what am I missing, this was what the PT's told me to do?
Thanks for your post
CHICO_MARX JRS11
Posted
"The proof is in the pudding." It's the results that matter. No more knee pain, walking correctly, regaining your balance, doing stairs up and down alternately without holding onto anything...in other words, a normal life. If the exercises given to you by the PT achieve those results, GREAT!!! If not, step up the exercise to the next level. I followed my daughter's routine and was climbing stairs two at a time without touching a banister at 14 months. Worked for me. Everyone gets to make their own call on this but the rebuild must be done one way or another. Good luck!!!
loriannie CHICO_MARX
Posted
13 months, doing the stairs good, but I am afraid to let go of the banister.. it is taking me forever to build the strength in the muscle,, I love the rowing machine but had to back off to 20 minutes, as still making the knee swell,, I still swear by swimming and walking,, I need to kick up the quad exercises more,, I have the exercises my trainer gave me, and they work,, just need to get them done,,