“What am I missing?” my new client Pam asked me. “I thought having my knee replaced meant that I’d be able to walk up and downstairs normally again, but I still limp down stairs like I did before surgery—sometimes worse! My PT said I did great through therapy. Why am I not still progressing? I just don’t get it!”
Pam was about 12 weeks post-op when she contacted me. As I explained to her, it was wonderful that she had done so well in therapy, but 10-12 weeks of physical therapy was just the beginning in getting her back to what she would consider “fully functional.”
Good physical therapy is important post-op to restore range of motion and reactivate the muscles of the hip and thigh. The goal of PT was to decrease her overall pain, get her range of motion to at least 90˚, and allow her to do basic activities of daily living. Mission accomplished.
To be able to climb and descend stairs without undue pain and fatigue, she needed more. Here’s where medical exercise comes in.
The goal for medical exercise after a knee replacement (and good physical therapy,) is all about re-integrating the kinetic chain. In other words, getting the whole body to work together again in a coordinated way to produce desired movements. This sets the stage for further conditioning in strength or in cardiovascular challenges as the client desires.
The Key: Getting the Whole Body to Work Together Again
Restoring Muscle Balance & Coordination
The first step for Pam would be to restore muscle balance to the hip. Since she did very little activity prior to her surgery (her knee pain was quite severe,) she lost a lot of strength in the muscles around the hip as well as the leg. The increased pain made her want to sit more, resulting in shortened quadriceps (front thigh) and hip flexor (front hip) muscles. Although she did some quad, and even a little bit of hip strengthening exercises in physical therapy, her muscles were not working in enough coordination to support her going down stairs in a “normal” way. To do that, we would have to get all of her hip and leg muscles working at the right time and in the right amount to balance and support her body weight over that new knee.
She asked about the machines in her gym. Could she get some instruction from a trainer and do the circuit machines for her legs? I explained that in order to control her body weight on 1 leg going down steps, she would have to do more than sitting on a machine and bending or straightening her knees. The problem is not just muscle weakness; it’s lack of muscle balance and coordination. We have to get the right muscles firing at the right time, and in the right amount, without provoking pain or strain in the process.
Pam decided to go for it, and we began working in earnest toward getting her to walk down stairs again. Although her expectations were that she would be required to work her legs hard in every session, her early exercises were mostly centered around her hips, abdominals and shoulders. Spinal stabilization was a priority, as she learned to keep a stable neutral spine during exercises for the hips and shoulders. These exercises helped her coordinate movement from the inside, out—literally strengthening her foundation so that arm and leg challenges were not so difficult.
She learned that the exercises didn’t need to be physically difficult to be challenging and promote learning. I’m happy to report that within 6 weeks, she was reliably walking down stairs “normally,” and had picked up couples’ tennis again without pain.
Not every knee replacement story will unfold as smoothly as Pam’s did. Good “pre-hab” or pre-surgery exercise can dramatically shorten the time it takes to restore someone’s “normal” function, such as walking down stairs. But the central message here is not to be discouraged if you’re not 100% where you want to be after physical therapy.
If you would like to learn more about medical exercise after knee replacement, or would like to take advantage of our complimentary screening, please contact us or call us at (804) 823-9600.