back pain

Flexibility exercise

A total knee replacement will help your mobility in the long term, but short term you are going to spend a lot of time on your back. You want to minimize that time as much as possible. Four things are essential to get you up and around as soon as possible, and you can’t afford to neglect any of them. They are, in order of importance:

o Exercise for strength

o Exercise for flexibility

o Therapy to reduce swelling

o Nutrients to promote healing

I want to talk about the first three items in this article. I have covered nutrients in another.
Exercising for strength is really about helping your leg regain the strength it had before the knee surgery. Several things happen during a knee replacement. A large incision cuts through a lot of muscle fiber, and this then induces a lot of swelling. Both of these make movement difficult.

What we know now, that they didn’t know 35 years ago, when I first had knee surgery, is that you don’t have to wait for the incision to heal before you start physiotherapy. The physio will promote the healing, as well as maintain functionality that would have been lost if the leg was immobilized for 5 weeks before working it. They will start physio in the hospital, but it is imperative that you continue it at home. Even skipping one day will have a negative effect. Now, when you are a bit more able to get around, and start to do some walking or climbing of stairs with your cane, you can use your judgment about the strengthening exercises. You don’t want to over use your joint and cause swelling. But you must do the flexibility exercise every day to make progress.

Ideally you started exercising before the knee replacement, trying to increase strength in your leg before surgery. If not, you just have to start wherever you are when you get home and work hard to get stronger every day. The three ways you get stronger are increase your repetitions, increase your resistance, or slow down the speed you do the exercises at.

Increasing repetitions is easy, but of limited use. Don’t bother going beyond 15 reps. Adding resistance is actually easy as well, if you use a little imagination. If you are doing your leg lifts in slippers, try doing them in a shoe, or a heavy boot, or with a towel hanging across your foot, or against a resistance band. You don’t need any special weight lifting equipment. Once you can do your repetitions with some resistance, slow down so that it takes 5 seconds to extend your leg. Do ten repetitions like that and see what kind of a workout you get. Progressive resistance is the best way to increase strength, not just increasing your repetitions continuously.

Increasing flexibility is critical for full recovery. Every day you should strive for a slightly greater bend. You should definitely see measurable improvement every four days. If not you may need to get into a physiotherapists office for active hands on work. Try going for a nice warm bath, once your staples are out. Let your leg soak in the warm water for fifteen minutes or longer, then dry off and try your flexibility exercises. Don’t push too hard, but expect improvement.

Swelling can be reduced several ways. Initially you need to spend time lying down, with your leg elevated above your heart for an hour each session at least. I’m talking three or four pillows high of elevation. I hope you like reading or listening to the radio, or even watching TV for an hour at a time.

It is best to do this after your exercise sessions, when you may tend to suffer from some inflammation. You can help control any tendency towards additional swelling by wrapping a bag of frozen peas or beans (or baby carrots if you prefer) in a towel and placing the cold pack over your knee for 15 minutes. Then switch it to under your knee for another 10. Try to get a second session in at night before you go to bed. After all, as the days go by, you will be working your leg more and more. The end of the day is a good time to try and have gravity suck the fluids out of the joint.

Exercising for strength, exercising for flexibility, and doing the correct therapy to reduce swelling are all critical elements in your recovery. Follow the advice of your doctor and therapists, and get a little better every day.

Paul Stevens is a Certified Personal Trainer and was recently the recipient of a new Stryker Triathlon artificial knee. You can read about his experiences pre and post surgery and take a look at his informative knee replacement links at his blog site:

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