This is the final episode in our TKA Survival Kit blog. The final episode is going to talk about the exercises initially to do after a Total Knee Arthroplasty/Repalcement.
There are many different exercises. These are some of the best and easiest to start with.
1) heel slides
2) quad setting
3) quads over a roll
4) walking
1) Heel slides.
This is a great first exercise to try and get some stiffness out of the post surgical knee. It seems really easy before you have surgery but it is not so easy after surgery. The description is that the person is lying on their back in bed. They started to bend the surgical leg, sliding the heel of their surgical leg up towards their buttock. When they reach as high as they can go, the slowly straighten the surgical leg and the heel slides away from the buttock. It sounds so easy but it is not. What surprises most of the people is how weak the surgical leg becomes after surgery that the friction of sliding their foot up/down the surface they are laying on can be so difficult (and painful). One trick is to use a large black plastic garbage bag. Place the garbage bag under the surgical foot with part of the bag going up the leg. Then trying to do the heel slide, the foot will stick to the bag and the layers of the bag will slide over each other and greatly reduce the friction of the foot sliding.
Doing this exercise 5-10 times every couple of waking hours is a good place to start in your first week. Remeber that your knee just had major surgery and movement is helpful but too much movement can easily cause more pain.
2) Quad setting.
Quad setting means to start using the muscles on thr front of your thigh, the quadriceps. The quads are usually not working as well after surgery and they can be very difficult (and painful) to contract. With this exercises you will roll up two towels together. The towel roll should be about 10-12 inches wide and quite thick to start with. The surgical knee is bent up, slowly and gently, and the towel roll is placed underneath the knee. The client is then asked to push the knee down into the towel, keeping the foot of the surgical leg on the bed. The quads are contraction is held for about 2-3 seconds, then slowly (with control) relaxed. The quads are difficult to get the contraction then with relaxation they shut down immediately. This exercise can help with the modulation of the "turning on/off" the quadriceps muscles after surgery.
Doing this exercise for 3-5 times, every 2-3 hours, when awake and slowly increasing the numbers to 8-10 times by the end of the first week.
3) Quads over a roll.
This exercises is very similar to the quad setting exercises, right above this one. The towel roll is placed under the surgical knee, that is bent up. The client is asked to push the surgical knee down into the towel roll and lift the foot up into the air. The client might not be able to lift the foot completely off the bed at first. This is normal but the foot should be unweighted from the bed. In some people, we might see only a flicker of a quads contraction. Many people need a second person to help with this exercise. When the client contracts the quads muscle, the second helper lifts the client's foot off the bed and helps to hold it in the air for 2-3 seconds. Then helps to slowly lower the foot to the bed.
The goal is by the end of the first week to be able to lift the foot off the bed without help and lower it down under their own control. This exercise should be practiced rigth after doing the Quad setting exercise, see above. Trying to lift the foot off 3-5 times, every 2-3 hours and slowly increasing the numbers to 8-10 times by the end of the first week.
4) Walking.
This is critical to get up and walk. Nobody expects you to walk without a walker for the first few weeks after surgery. Please do not try to be a hero and walk without a walker. I have seen many people fall because they did not want or think that they needed to use a walker. What does walking do? It helps get the fluid/swelling moving in your surgical leg, it helps to counteract the constipating effects of the pain medication you are taking, (which you are taking on a schedule, correct?) and it get the muscles working in the surgical leg to name only a few benefits.
It is generally best to start with a 2 wheeled walker, 2ww, they roll easily but stop rolling when weight is pressed on the handles. To get up from a chair or bed, try to raise the height of the bed or chair if possible. the surgical leg will be straighter and the non surgical leg will be bent. Place one hand on the walker, usually the non-surgical side, and the other hand goes on the bed or the arm of the chair to help push down, leaning forward (remember nose over toes) and using the non-surgical leg to stand up. Once the client is standing take a good long moment or three. Post surgical people can have funny things happen with their blood pressure, like it can take a while for it to regulate. Trying to walk while they are dizzy is a recipe for diaster. So take a minute and let their head settle. When the client states that they feel okay the order of walking goes something like this; 1) walker, 2) sore leg, 3) good leg and repeat this process. Just remember they have to make it back to where they started, i.e. bed or chair. Many times people would go for a walk and I would ask them to turn around and head back to their bed/chair. They did not think that they walked that far but it was a struggle to get back to their bed/chair.
Trying to walk 2-3x/day with a 2ww is a great place to start. If you recall in part 4 of this blog series we talked about hydration. If you are hydrating enough, you will be getting up to go walk to the bathroom. Those count as walks.
There you have it. You are ready to make the most of your total knee arthroplasty (TKA) experience as productive as it can be. It is not a nice easy surgery to recover from. It is a lot of hard work and continually doing the exercises day after day, multiple times per day.
If you are getting ready to have a knee or a hip replacement, get a plan in place and call New Leaf Physiotherapy for your inhome/mobile physiotherapy needs. 250-826-7300 to talk with Lyndsey, a certified Rehabiliation Assistant, to help you book your assessment.
New Leaf Physiotherapy is a mobile physiotherapy service that sees clients in West Kelowna, Kelowna and Lake Country.
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