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
Hopgo CHICO_MARX
Posted
Awesome suggestion..............If the brace works it's worth it's weight in gold !!
bggsbunny CHICO_MARX
Posted
Hi Chico,
Thanks for your advice, and the Exercise Program, and for passing on some optimism for the future, when I was being confronted by so many negative thoughts regarding the failure (in my mind's eye) of the TKR. Will revise my exercise program to incorporate your suggestions. Thank You
margie99601 CHICO_MARX
Posted
Thank you for your posts. I am 65 and had TKR 6 weeks ago. I have not been able to tolerate the side effects of the oxycodone nor the Tylonel with codeine because these meds caused my whole body to ache like the flu and felt ill. I am also very weak. I have fibromyalgia along with severe arthritis in my feet, back arthritis, and told I need both total shoulder replacements.
I believe because I could barely walk or stand before surgery that this is why I am in such pain after surgery. I started going to PT class 2x a week but find I can barely do the exercises given. I have not been able to do anything but the leg straightening on the couch and I did do knee bends. I ride the bike 10m at the start of class. This wears me out so much that I have not been exercising at home. My measurements are good though, 123 bending and down to zero straightening.
My surgeon said not to worry about the
exercises since measurements good. I went off the opiods but still feel achy all over like the flu. I'm just taking Tylonel and Sulindac which I used to take before surgery with Cbd oil. Because of the pain I recently tried marijuana. BUT I'm still very achy and sleep mist days almost all day! Then up at night etc. So my sleep is all messed up. The achiness is of great concern to me. Is this normal? I want to exercise but since surgeon told me its ok for now not to I dont know what to do. Im feeling hopeless. What do you suggest? I feel like I'm behind others that have had TKR.
CHICO_MARX margie99601
Posted
Unfortunately, "hopeless" is not an option. This is brutal surgery and none of us were prepared for the pain and recovery. All your feelings are totally valid...we've all been there...but they can't get in the way of your progress. You're only 6 weeks in while the first THREE MONTHS are always the hardest. The 0 / +123 ROM is FANTASTIC at six weeks...took me 12 to get that far. Everything you're going through is disgustingly normal!
IMHO, ten miles on a bike is waaaay too much. Just use it to warm up so you can start the strength exercises. You can do them at home with a set of exercise bands ($25 @ Amazon) instead of a gym. It's still important to maintain your ROM this early. Here are some things you can do at home...
ROM At Home
Getting your strength back is your main focus now. As you progress, you will start to have more energy and tolerate more daily activity. Gotta have determination and patience. Maybe this will help...
PTSD
The weakest opioid out there is Tramadol (Ultram)...see if you can tolerate that. If not, Tylenol Arthritis Strength is OK. Remember...both acetaminophen and ibuprofen are meant for short-term use. Don't want to erode your stomach lining. The pain will absolutely pass. Lots of your muscles ache because your body has shifted the work load off your dead quads, glutes, hip flexors and core to other muscle groups not used to the workload. Just have to rebuild them and the aches and pains will subside. SLOWLY!!!! This takes time and work. The mary jane is especially good... s a t i v a in the morning and i n d i c a at night. My wife does this for her brain as she had aneurysm surgery a while ago.
Post this on your fridge...
Reality
Toughest rehab ever. Stick with it!!!
margie99601 CHICO_MARX
Posted
Thank you so much for your support. I'm feeling much better now.
I appreciate you very much!
mechele37095 CHICO_MARX
Posted
Thanks CHICO , my word , you're full of useful information , still reading through it all . Best wishes Mechele
CHICO_MARX mechele37095
Posted
I wrote those discussions when I realized that I was typing the same stuff over and over. Now I just give people the links...waaaaay easier. Again, everything is from my perspective except for the cold, hard science that I get from excellent sources. My goal is to get people to give up their expectations, "embrace the horror" (Steve Buschemi, Armageddon), work hard and have patience. This is truly a body, mind, spirit experience and everyone needs to realize that your whole being is affected. Gotta take care of that inner child who is rebelling against the brutality of the op. Stay focused...you'll be fine.
tricia55158 CHICO_MARX
Posted
Thank you so much for all your exercising information. This is exactly what I needed to know. I had a partial knee replacement 4 months ago. I still get pain when I exercise. I have pain in the back of my knee almost constantly. If I walk too far( 15 minutes) I have to take it easy for the next 5 days. is this because I haven't strengthened my muscles? Thank you .
Tricia
CHICO_MARX tricia55158
Posted
Your knee hurts because it's taking the load the muscles usually handle. Rebuild the muscles and they will ease the pressure on your knee. Count steps, not time or distance, when you walk. It's the steps that affect your knee. Use a pedometer of your choice and chart your progress. If it hurts, you did too much that day. Back off, recover and resume slowly. Took me 8 months to get back to 11,000 steps a day. Think long-term...
kim2003is CHICO_MARX
Posted
Hi Chico,
I've been reading the different questions and answers with interest and your info is great! I'm one of the lucky ones and have had a text book healing so far. currently at 6wks with some aches and stiffness depending on use but almost off pain killers completely. Consequently I want to get into a regular muscle rebuild and was wondering if you know of any downloadable videos or videos you can buy with a tailored exercise program suitable for post tkr patients? I need my other knee replacing too and as this one has gone so well (so far.....) I have surgery scheduled for 7th January. It'll be very interesting to monitor the healing process in comparison to this one. Keeping everything crossed it does as well but not holding my breath!
CHICO_MARX kim2003is
Posted
I haven't seen any specific YouTube videos for TKR patients but then I stopped looking when my daughter wrote this one up for me. That was 3 1/2 years ago so there may be something there that I don't know about. However, it's also very likely that there are videos of each individual exercise that she recommended as they are all pretty standard. If so, you could save the URLs in a common file that you can access on demand. That would work. (Also check out the VLC media player. There are instructions out there that show how to use VLC to record and save YouTube videos directly on your computer.)
I also need #2 done eventually although I have zero pain there now. For me, I've decided to do a COOLIEF procedure to see if that works before jumping into a second TKR. This is a "cooled radiofrequency abaltion" technique that deadens the nerves around a joint thereby stopping the pain. FDA-approved, 15-minute, under sedation procedure that has shown to be very effective for osteoarthritis of knees, hips, shoulders and elbows. Lots of reports on up to 2 years relief with one year being most common. Check their website for a certified doc near you.
If you do #2, I wish you great success again with it.
margie99601 CHICO_MARX
Posted
Thank you for your inspiration. Since my TKR I have done very little PT. It's been a little over 3 months now since the operation.
The first month I was very sick from the drugs but I did stretch my leg and pushed it down quite often. Next month I went to PT classes twice a week and did ride bike 15m each time and then tried to do exercises. However I could only do 4-5 repititions while others did 15. Yet my ROM was zero for straightening and 123 for bending which was better than others in the class. I also did no exercise at home. This is because both my feet are very arthritic so cant stand hardly at all and have used a walker lady several years for balance and to sit every little while. I say admit I let myself go now many yrs. I am 65.
I am overweight and have lost but not enough. I keep trying. I am going to get on my ellyptical machine today because of your inspiration. I do still need 2 total shoulder replacements but terrified to have more surgery. Hard to get to appointments and PT.
My house lots of stairs also. I don't have pain in my knee right now. It was very misaligned before surgery. I also have fibromyalgia but it comes and goes. What do you suggest for me? I see my surgeon in a week so hope my measurements are still good.