Post-TKR Exercising
Posted , 61 users are following.
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
mary81398 CHICO_MARX
Posted
Thank you thank you thank you. I found this site frustrating to navigate. You kindly replied to me earlier. I did look you up but didn't see this routine. 8weeks and starting water PT today... stairs ok now going slowly, sleeping better etc...just need to pace myself which i'm poor at. Your advice is GOLD 😃 No need to reply CHICO_MA x
CHICO_MARX mary81398
Posted
https://patient.info/forums/discuss/post-tkr-exercising-565527
susane91705 CHICO_MARX
Posted
thankyou for all this information. I will try. I know, I am incharge of my own life.
I am 8 weeks now, and feel I am doing ok. I need to get my leg back a little more,
I was at 95 deg two weeks ago, so feel I am at 100 deg now. My leg is good and
straight. I havent walked with a stick since 3 weeks. My next challenge is the
stairs. Best wishes Susane
CHICO_MARX susane91705
Posted
Stairs are the biggest challenge. Going up requires quad strength gained in the exercise program while going down requires a good ROM so the knee can bend. Remember, "stairs" means going up and down with alternate legs without holding onto anything...like a normal person. This takes time and commitment. It's usually the last hurdle in a year-long recovery...
Mastering Post-TKR Stairs
PS: Stairs are a controversial topic as some people were taught "up with the good" while others were instructed "up with the bad". I was told the latter and was going up stairs two at a time in 14 months because my quads got super strong. Your choice.
susan95498 CHICO_MARX
Posted
CHICO can you repost the things needs to do after surgery
CHICO_MARX susan95498
Posted
Click on my name, Discussions and then See All. I have about 30 out there...lots of topics...
Hopgo CHICO_MARX
Posted
Thanks so much for your info and words of encouragement. And your daughter ....WOW !! I am 60 yr old and recently retired. I am an avid racquetball player and generally fit person. I hope to teach the grandkids to waterski and try to keep up with them as I get older. I'm counting on this TKR to allow me to accomplish these goals. So far I have to admit I am a bit discouraged........I had visions of being further down the road at 5 weeks.......I know it's early in the process and once I get it through my thick skull I'll be better off !! I probably pushed the exercises and walking too much at the beginning which may be contributing to my pain and stiffness. I was told that I wouldn't damage the bright and shiny new joint but I guess I didn't take any muscle and tendons into account. Thanks again...it makes a difference !!
CHICO_MARX Hopgo
Posted
"I had visions of being further down the road at 5 weeks..." - The Words of a Delusional Person
I had the same ridiculous expectations. Rehabbed a hip replacement 5 hours a day, six days a week...completely done in six weeks. Knee...piece of cake. WRONG!!!!!! How could I be so dumb? Maybe I never listened to the doc...maybe he set my expectations? Don't remember. One thing I do know is that virtually everyone makes the same mistake. "Oh, I'll be back to work in a month!" Uh...nope...
You can push a hip and a shoulder...the knee is a different animal. The knee and only the knee (so, not your brain) controls the recovery which is slow and easy. NO PUSHING! Do that and you end up with "balloon knee"...swelling and pain for three days...guaranteed. At 5 weeks, I did 8,200+ steps one day and paid dearly for that mistake. PS: Walking progress is measured in steps, not time or distance. Get a fit bit, smart watch, etc and chart your progress. Gradual progress or the knee swells.
So your discouragement is based on false assumptions...get rid of them. The knee is the most Zen of all surgeries: "It will be better when it's better." Had mine done at 68 after years of SynVisc shots and a move to a warmer climate. Unavoidable at that point. Knocked me down for months!!! The whole thing takes a year...less if you're lucky but I've been on here for over 3 years and I can count the "lucky ones" on one hand.
The worst of the pain is the first 90 days...then it goes away gradually as you transition off the heavy duty meds. Stiffness also reduces imperceptibly until you barely feel anything at one year...may take up to 18 months. Same with the clicking/popping sounds. Then you have to keep the knee active ALL THE TIME or stiffness can return at any time...even years later.
Post this on your fridge...
Reality
...and don't forget your oars for the boat part...
Hopgo CHICO_MARX
Posted
Thanks again Chico_Marx..........you are a wise man.......I picture you living in a hut in Tibet with plenty of zen. Only kidding......I truly appreciate your response ........and yes I must say the Dr did set me up for an unrealistic recovery time line. At least that was my interpretation. I have been pushing too hard and despite the fact my swelling has been minimal, the pain and tightness (fullness feeling in the knee) snap me back to reality. I'm gong to take it easy this weekend and do the bike along with the stretches you recommended. You mentioned the 90 days of "heavy duty meds".........did you mean 3 months of narcotics ? It's a long process.........ugh.
Thanks again..........enjoy the weekend
CHICO_MARX Hopgo
Posted
The opioids can last around 90 days...titrated. Most people are off them before that but others really need them. Titration is the method used to reduce the level of the drug in your bloodstream slowly by lowering the dosage and/or lengthening the time interval between doses...no "cold turkey". Docs will also switch people from the hydrocodone/oxycodone-based drugs to the lesser strength Tramadol and then finally just to RX-strength ibuprofen (800 mg TID) for a little while. You cannot stay on the NSAIDs long term or they'll eat through your stomach.
The stronger you get, the less meds you'll need. Just gotta get past that 12-week hump where the pain is at its worst and then start the muscle rebuild that will take the pressure off the joint. Docs don't tell people about this and give them very unrealistic expectations about the pain, length of recovery, return to work, etc. If they told patients the absolute truth, I think many would run the other way.
For me, delusional was telling my bandmates that I'd be just fine to do a gig 8 days after surgery! I was such an idiot...
And, no Tibet. Very happy to be out of the cold of New Jersey and in the warmth of Texas...out in the country just west of Fort Worth. At 71, still working full time in IT (telecommuting job) and trying to get back in a band (blues/rock bassist, vocalist). Started on drums and guitar in 1959...gigging all my life. Gotta keep that going but the knee plus two spine surgeries (one fusion) in the past three years has kept me sidelined. Three+ years post-op now and doing just fine.
mary81398 CHICO_MARX
Posted
5 months and walking well, stairs etc no problem. That tight band around the top of the knee persists (cupping from the masseuse has made a big difference) but i'm at the gym doing strength work and walking with an increasing incline and speed plus reformer pilates at home. I'm also concentrating on balance work. Even though the musclature isn't perfect that knee is super strong! CHICO you were my saviour. Can't thank you enough, from beautiful TASMANIA AUSTRALIA xx
CHICO_MARX mary81398
Posted
Bad news...the work doesn't end. This is a lifelong recovery. I'm at 3+ years and have heard from long term TKR patients. We all agree: Stop using the knee and the stiffness returns...no matter how many years post-op you are. Gotta stay active...gotta keep the knee moving.
My strength came back pretty fast even though I had to stop my rehab to get a spine fusion one year post-op. After 45 years of hockey, there was a considerable amount of muscle memory built into my lower body. At 14 months...even with the fusion...I was able to climb 2 stairs at a time without holding on. The PT was stunned. Eh...no big deal for me.
But now, I have to stay active...I don't want to risk dealing with the stiffness again. Massage, PT, acupuncture...anything that works. Just keep it up!!!
mary81398 CHICO_MARX
Posted
Yep, i'm never one to stay still! Luckily exercise is a part of me(ex snow ski instructor) Till the next op then CHICO 😃 x
Doesn't this site annoy the hell out of you with caps lock and sign in!! grrr
CHICO_MARX mary81398
Posted
Competitive skiing is a complete no-no, but...a light, easy ski just may be possible. The trick is that you CANNOT TWIST THE KNEE!!! I found a solution. Look at the post below with the picture of the DonJoy Defiance Single Hinge brace. You may be able to do a bit of light skiing after all... Everyone gets to make choices...
Hopgo CHICO_MARX
Posted
Great advice Chico.........As a former college hockey player , avid racquetball player and waterskier I have a hard time sitting still. I always had visions of playing in the "old mans" league has I got older and older.......well........as I sit here with a 2 1/2 pound weight replacing my real knee it seems like a distant dream !! Regardless I will not sit still.......running around with the Grandkids will do just fine !! Thanks Chico !!
CHICO_MARX Hopgo
Posted
I SHOULD BE PLAYING GOAL IN AN OVER-70 LEAGUE RIGHT NOW!!!!!! Damn... So tough to give it up but I had no choice when they replaced my hip in 2009. Doc said I could go back to playing but that the hip would last 3 years instead of 25. Same with the knee. In this case, you must avoid all pounding (running, jogging, singles tennis, etc.) and torquing (twisting the knee in hockey, skiing, etc.). However...
I'm DYING to get back on my skates...just for an easy glide...no quick turns or competitive moves. So I called DonJoy, the huge brace manufacturer. Spoke to their med techs and told them I needed a brace that would absolutely not allow my knee to twist...ever. Answer: Donjoy Defiance with Single Hinge model (there are many different braces and models within each). This was a very specific recommendation. Their top of the line, custom fit Defiance SH has a $900 list price. I'm saving my pennies, oiling my bearings and hollow-grounding my blades with a 2" rock. Can't wait...
mary81398 CHICO_MARX
Posted
No probs..i have this brace already! Used it before i had my surgery in Japan and Australia. I could ski with it when i couldn't walk much!
I'll let you all know how everything goes in September after the Australian ski season. Don't worry, ALL my professional ski sports buddies with new knees are skiing again. No bumps runs etc but enjoying the mountains. I'm heading to my mountain Falls Creek tomorrow, for walks and RnR. Special place. Season doesn't open till June, but i'll go back in august to ski for a month.