Category: Knee Care

How Much Should I Be Walking After My Knee Replacement?

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“I want to get back to Normal. I want to start walking without this walker. When can I do that?”
One thing you really want to keep an eye on once you’ve had your knee replacement surgery is how much swelling is in the knee.
If you are doing a lot of walking the chances of your knee staying irritated and swollen are pretty high.

If you have a lot of swelling in the knee, you’re going to have a lot more pain, and also it’s going to be difficult to bend or straighten the knee.

And if you keep the knee swollen and irritated there is a greater opportunity for you to develop an infection or a DVT.

However this does not mean that you shouldn’t be walking, for practicing how to walk normally. But what it does mean is that you need to make sure that the amount of walking that you’re doing is not irritating your knee.

The amount of walking that you’re able to do was going to change on a daily basis. Some days depending on your pain level and whether you are tired or not may be better than others. Some days may be worse.

But the general trend in your ability to walk should improve on a weekly basis. You will find that you will be able to walk better and for longer periods of time as you go through the healing process.

Your challenge is going to be to focus on how your knee is responding to the amount of walking that you’re doing.

Once people get home from the hospital they find that there are all sorts of things that they need to be doing. Things like doing the laundry, taking the garbage out, even trying to do things like vacuuming and other household chores.

When you’re trying to recover from a knee replacement surgery, things like that need to be put a side and on the back burner. Its a better idea just to focus on how your knee is responding to the things that you’re doing rather than how many things you can do.

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Recovery from knee replacement surgery: what to focus on first.

This particular article is for anyone who has recently had a total knee replacement.
When you’re discharged from the hospital after a surgery the doctors and nurses generally load you up with lots of instructions and lots of paperwork and send you on your way.

Don’t feel bad if you feel overwhelmed and a little confused by the time you get home. That amount of information in a very short period of time frequently leaves people in the dark about what is supposed to happen when they get home.

For anyone who has recently had a knee replacement surgery, from a physical therapy standpoint, there are only two things you really need to be concerned about. And there are three things that you really need to focus on doing.

Your home health nurse can especially help you with the two things you need to be concerned about. They are number one, preventing and infection, and number two, preventing a blood clot or DVT.

the three things you need to focus on doing after a knee replacement surgery are bending the leg, straightening the leg, and elevating the leg to manage your swelling.

It’s really that simple from a physical therapy standpoint. This is because the only thing that really does not return without a lot of effort after a knee replacement surgery is your range of motion.

Your ability to walk will return on its own. The ability to lift your leg will return on its own. The ability to get up and down from a chair, or get in and out of the bed, will return on their own.

But what makes all of these activities a lot easier to do, is having good range of motion in the surgical knee.

This is just as important for those who had their knee replacement some time ago. If you’re still not able to bend your knee or straighten your knee it’s a lot more difficult to move around.

So what should you be focusing on?

For knee flexion really focus on any activity that allows you to stretch the knee into flexion. This could be the heel slide. Or it could be something as aggressive as standing up and sitting down from a chair with your knees bent. If you try to do this last movement please make sure that you’re not trying to put all your weight on your leg.

In order to straighten your leg, the exercise you want to focus on is the hamstring stretch or the calf stretch. Both of these movements can be done either in sitting or lying down on the bed. Or with the calf stretch you can do that when you’re standing up. I have written a previous blog post about that with a photo.

So just remember for those of you who have recently gotten out of the hospital and are a little confused with what to do next, the emphasis should really be on preventing infection as well as blood clots or DVD.

And also you should be emphasizing bending your leg, straightening your leg, and elevating your leg.

If you number that mild that’s really only five things that you really need to think about and focus on in order to have good recovery from a total knee replacement.

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Recovery From Knee Replacement: A Routine. Not A Job.

Recovery from any type of surgery, especially something like a total knee replacement, is a matter of consistent effort to improve your overall function. Is it a “routine” or a “job”?

The Difference Between A Routine And A Job

Doing both a routine and a job takes effort. One you don’t really have to think about to do it and the other, you hate thinking about and you probably hate having to do it.

There are a lot of misconceptions of what life will be like after you get your new knee (skip to the bottom if you had a TKR awhile back). Right after surgery, some think that “resting” is the best approach to recovery. “Waiting until the pain goes away” to get moving is one of the most common misconceptions.

And this is understandable. Only the uninitiated cannot fully understand how painful having a knee replacement can be. And with that much pain, you want to make sure that you’re doing the “right” thing because you don’t want to make matters worse!

On the other side, some have the misconception that a “boot camp mentality” is needed. Here the notion of “No Pain, No Gain” rules. People think that they need to do as much as their body will let them before losing consciousness is how they’ll get “better”.

In order to avoid these two traps in your knee replacement recovery, it’s a good idea to take a step back and consider what is really going on.

Recovering from a knee surgery is really like recovering from any physical injury, like stubbing your toe or even breaking one your fingers in an accident. It’s a matter of 1) avoiding anything that makes it hurt worse, and 2) allowing nature to do the healing.

After stubbing your toe, you don’t stop walking do you? However, you’re careful not to stub your toe again. And, you’re not going to go on a 100 mile trek either. You basically nurse your injury with moderate movement and wait until it feels better to do more demanding activities.

And even if you have broken a finger or even your arm, there is an unconscious understanding that “I won’t be able to use this thing the way I want to until it’s healed”. The doctor may put a cast on it for several weeks so it will heal in a normal alignment. But, you basically have an understanding that “nothing is really wrong with it and it’ll heal in a matter of time”.

The same can be said in your recovery or rehabilitation period of your knee replacement. Healing will take place over time. All you have to do is not injure it again.

So What Should I Be Doing While Recovering From A Knee Replacement?

Having a good outcome from your knee surgery is a matter of developing a consistent daily routine of working on your range of motion with and managing any swelling that may be going on.

You want to look at your recovery and rehabilitation as a “routine and not a job”.  A routine is something that you do without much thought. You just go about it and move on to the next thing in your day. A routine usually is a matter of habit and is done at relatively fixed times.

Typical daily routines are things like brushing your teeth, washing your face, eating your meals. Routines like these are important to healthy living. And, they all take effort and you want to do a good job at it. But, you don’t really have to put much thought into doing them.

All the routines mentioned above generally take place at regular times. And, indeed, they usually need to take place before you head to your “job”.

So a good routine for your knee recovery should take place at regular times. And the routine needs to take place before you do any “work”.

A job on the other hand is something that takes some determination to do and is more likely a “burden”. It’s something that you do, but, to be honest, you’d probably like to be doing something else. You put up with it. But, it’s not something you live to do.

What Is The Recovery Routine?

In short, exercising and elevating at fixed times everyday.

If you’re like most people, the whole point of having your knee joint replaced is to get rid of the arthritis pain so you can move normally and enjoy your life again, right? The real objective is to “be and walk normal again”.

So, you need a recovery routine that helps you do this.

Generally, the two things that stop people from walking normally after a total knee surgery is pain and stiffness (and also, not having a good understanding of what to expect).

A routine that addresses decreasing your pain and stiffness is what you need to work into daily life. And, it’s a lot simpler than you may think.

Pick 3-4 specific times of the day to do it and get it done. Keep doing this routine until you don’t have to do it anymore (that is until the pain and stiffness is gone – it could be 2 months or longer. How long have you had the routine of brushing your teeth?)

Most pain and stiffness people have right after surgery has to do with inflammation and swelling. So, if your routine emphasizes keeping the inflammation and swelling down, you’re going to get rid of  a lot of pain. So pain will be less of a factor to walking normal.

Inactivity also plays a big role in the area of stiffness and swelling. This is because moving your muscles actually helps to decrease swelling. And the effect that movement has on “stiffness” should be pretty obvious.

So your daily recovery routine should include elevation above the heart level (as much as possible) and “movement”. The movement we’re talking about is simply “bending and straightening” the knee and doing your ankle pumps.

But What If I’m Still Stiff A Year After Surgery?

Some people still have problems with ROM and stiffness long after they’ve had surgery. This stiffness may be due to scar tissue build up or simply tight muscles. Have a physical therapist evaluate your restriction and get you on a program.

If it’s scar tissue you may need a more specialized treatment.

However, if you’re still dealing with tight and stiff muscles, then getting on a daily routine that targets the specific muscles that are restricting normal motion is needed.

If you’ve been hampered for a while after your surgery, then it’s probably not just your knee that is stiff. Over time, your stiff knee will affect your hip and your ankle. So having a physical therapist develop a range of motion routine for your hip and ankle will also help your stiff knee.

In either case, whether your knee replacement is within 6 mos or has been over a year, a regular daily routine needs to be adopted to “get back to normal”.

For most people, a routine that manages any swelling or inflammation, and works at stretching tight muscles and soft tissue is the best approach to get normal motion back in a stiff knee.

 

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Scar Tissue Stopping Range Of Motion?

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The focus for anyone after you’ve had knee replacement surgery should be on getting as much range of motion (ROM) back as fast as you can. This means developing a consistent daily routine of exercising, along with elevation and icing to manage your swelling.

Some people ask “Yeah, but how long do I have to do that?” The answer is, basically, “as long as you have to”. You can use your “good” leg for a reference (that is, if it really is good). You want the ROM of both legs to be relatively even. So, that means that you’re not finished working on ROM until they match. This may take several months or even a year. Just keep it moving.

But getting ROM back right after surgery is a lot different than if you had your surgery a while ago. In the beginning, you may have been taught how to do scar massage.  But, if you’ve had multiple surgeries a simple scar massage probably won’t work.

If you have had several surgeries, then you’re going to have more scar tissue and have a greater amount of knee replacement adhesions.

Most ortho docs will probably want to “manipulate” (put you under anesthesia and forcefully bend the knee to break up the scar tissue – it sounds worse than it is.) the knee and free it up. And then from there its more rehab for maintaining and gaining more ROM.

It’s better if you can get the ROM back without having to have a manipulation.

But what if I’ve already had a manipulation and I still don’t have a good ROM?

Well, If you’ve had a manipulation and still don’t have good range of motion there are some different approaches that some people consider. Especially if you’re sure your limitations are due to scar tissue.

Scar tissue is made up of “soft tissue”. Soft tissue includes muscle, tendon, fascia, etc. So, if you’re in the boat of having a “stuck” knee and you’re sure it’s because of scar tissue, It may be beneficial to find a physical therapist that specializes in something called “soft tissue mobilization”.

But wait! Soft tissue mobilization is a “catch all” phrase that includes techniques as general as basic massage to the more specialized osteopathic techniques of “strain-couterstain” and “muscle-energy” techniques.

There are some pretty specialized physical therapy approaches to scar massage and mobilization. Two that come to mind are the Graston Technique, and ASTYM. Physical therapists can get certification in either of these approaches to soft tissue mobilization and they can be used along with the well known ROM exercises that most TKR patients are familiar with.

Npw, you may or may not have therapists in your neck of the woods that know about these two techniques. However, it’s easy to do the research just by going online. If you can’t find a therapist listed in your area, you can go to the respective websites above to see how to locate certified clinicians.

And, even if you don’t have anyone right in your area, don’t give up hope. Reach out to the nearest clinician that you can find, or, even use the contact form on the official website. Let them know your predicament and see if they have any suggestions. They can only say “no” and even so, you won’t be any worse off than you are right now.

So, whatever, you do, don’t give up looking for new solutions. You probably already know what hasn’t worked in the past. So, steer clear of those things you’ve already tried. But, look in other areas. Sports therapists, massage therapists, Chiropractors can all be good resources and may have insights you may not have considered yet.

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3 Activities To Recover From Total Knee Surgery

Have you had a total knee replacement in the past month and anxious to get back in the game?
Don’t be. You have to give yourself time to heal correctly. Treat yourself like a million dollar athlete. & I understand that it’s going to take time to get back to normal.

I told my patients there are two phases recovery from a total knee replacement.

The two phases of knee replacement recovery

The first phase of the healing phase. That’s usually when you have a lot of pain and a lot of swelling.The healing phase can last several weeks. And even longer if you don’t take care of yourself and let your leg rest properly.

The second phase is the rehabilitation phase or we call it the rehab phase. This phase can overlap with the healing phase. Its marked by increased activity and focus on maintaining your range of motion and increasing your strength.

You may be one of those who have had a  total knee replacement and in a hurry to get well. It’s understandable. But, full recovery will take several months. You won’t be back in the game next week.

Have to first go through the healing process and then the rehab process.
Think about this for a minute: when someone breaks a bone it generally takes 6 to 8 weeks for the bone to heal. Back in the day you would be in a cast for that amount of time. After the cast came off then you would have to go to physical therapy to get your range of motion back and also your strength and learn to walk all over again.

Well a total knee replacement is similar to a fracture of a bone in that it has been injured by the surgery. The tissues need to heal. The joint needs to heal. And after that you need to get stronger and learn how to walk again. That all takes time.
Patience is truly a virtue in this situation.

3 Things That Will Help Recovery From Knee Replacement Surgery

But its hard to be patient when you think that there’s something else that you “should be doing”.
Honestly, there are only three activities you really need to focus on during recovery from knee replacement surgery.
1.Bending your knee or flexion

2.Straightening your knee or extension.

3.Elevating your knee to manage and reduce the swelling from the surgery.
If you focus on these three activities and schedule them into your day, you will be better in no time.

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