Total Knee Replacement Exercises

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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Knee Replacement and IT Band Pain

NOTE: The information contained in this post is for those who may be several months out from their surgery. This information is not for someone who has had a knee replacement in the last 2-3 months.

The combination of having a total knee replacement and IT band syndrome is not uncommon. It’s basically an overuse injury caused by walking with poor mechanics at the knee and hip after surgery.

What Is The Ilio-Tibial Band?

IT Band - credits Medicinenet.comThe ilio-tibial (IT for short) band is actually a tendon of the Tensor Fascia Lata (TFL) muscle that stretches from the hip, down the side of the leg, and into the tissues at the side of the knee.

A tight IT band can limit how much you can bend your knee, cause poo patellar tracking, and it’s hallmark is intense knee pain when you’re descending stairs or a hill.

In most cases, stretching the tissues will give relief. But, it’s also important to understand what may be causing the shortening in the first place.

Sitting down for long periods, especially with the knees apart, puts the TFL/ITB complex in it’s shortest position. If you’re job keeps you in the car or at a desk for most of your day, then your ITB will probably get short.

After a knee replacement, as matter of convalescence you’re going to be sitting down more often than not.

And it’s easy to overwork the TFL after knee surgery because it has the job of lifting your leg and helping you walk while the other muscles are recovering from the surgical incision.

How To Stretch The IT Band

So, how do you stretch your IT band? There are several ways. But, most of what you’ll see online are techniques that seemed to be geared more toward extreme athletes, yogis, and 20 somethings that are still invincible.

The following are a couple of different ways you can try to get some relief from nagging IT band syndrome.

  1. Side-lying IT band Stretch

sidelying iliotibial band stretchThis stretch, as you can see, will stretch all the tissues on the side of the leg. There is nothing you have to do with this particular stretch except for lay down and go limp.

As long as your knee (and the rest of your body) is comfortable, gravity should do the work of stretching the tissues.

2. The supine IT/Quad stretch

Iliotibial band stretchThis stretch is designed to target the muscles and tissues at the junction of the thigh and hip, as well as the tissues right above the knee.

Once you get into this position, you will feel the tightness over the top of the thigh. Again, just get into the position and allow the tissues to stretch and lengthen.

The pull on either of these positions should be gentle and I would encourage anyone who tries them to resist the temptation to be aggressive with your stretching.

Consistency is more important that intensity.

As you can see in either of these stretches, you’re putting your body in a position that is somewhat opposite of the typical sitting position to counter act the effects of sitting for prolonged periods.

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Bending Your Knee After Knee Replacement Surgery

Bending your knee after knee replacement surgery is an important milestone that you want to reach as soon as you can for a successful knee replacement recovery. But, getting your knee to bend after a knee replacement can be a struggle for a couple of different reasons.

While it may not be easy at first. If you keep doing it little  by little you’ll  start to see some improvement.

The primary complaint that most have is the pain. In addition, you also have to realize that getting your knee to bend is also a race against scar tissue build up. And the body starts to build scar over the surgery as soon as the doctor closes you up.

Don’t End Up Like Chester

Do you know who Chester Goode was? Most people living now wouldn’t remember, but some from the older generation will probably remember that his character on the old western TV series Gunsmoke.

Chester Goode was Marshall Matt Dillon’s sidekick deputy. The part was played by Dennis Weaver. And the one thing that people remember about Chester was that one of his legs didn’t bend. It really stood out when he and Matt Dillon where in trouble and he had to run here or there. Having a leg that won’t bend is something you can’t miss.

Most people who’ve recently (or not so recently) had a total knee replacement surgery can identify with Chester. The stiffness, pain, and not being able to bend the knee normally is pretty frustrating.

So How Do You Get The Knee To Bend?

In order to get your knee to bend after a knee replacement, you have to control the pain and the swelling that comes along with any surgery. This is usually done with ice and elevation of the leg. There are also pain medications that your doctor wants you to take on a routine basis while you’re recovering.

Many people don’t realize how important this is. But, if your knee is swollen you’re going to have trouble lifting it, bending it, walking on it, etc. Plus, it’s just going to hurt more.

Here are the steps to decreasing your swelling and getting your knee to bend.

 

  • Elevate your leg on pillows above heart level at regular intervals throughout the day. Generally for at least 30 minutes. (sitting in a recliner chair does nothing for you. You need to be as flat on your back as possible.)
  • Use ice packs as directed by a healthcare provider at the same time you’re elevating.
  • Take your pain pills routinely as the doctor has prescribed them so that you’re out of pain when you need to bend the knee.
  • Do your ankle pumps periodically while your leg is elevated above your heart.
  • Do gentle bending ROM exercises when the swelling is at it’s lowest point.
  • Schedule these steps throughout the day about 4-5 times and do them every day.

 

By following a similar outline as I have listed above, you should be able to better manage the typical type of swelling that comes with having a knee replacement. But, naturally, you don’t want to listen to me. This should be supervised by a home care health professional.

By staying consistent with pain management, controlling your swelling, and being religious about your bending and straightening exercises, you should see progress when you’re trying to bend your knee after knee replacement surgery.

 

 

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