back pain

Flexion contracture

After having a knee replaced there are several important aspects to getting the knee and entire leg affected back into functional operation or fitness. Your strength will come back rather quickly during rehabilitation with the operated leg, mobility generally follows then your dynamic balance.

Getting your full knee mobility back will take a concentrated effort on part. We have all heard about how important it is to get the knee to bend also known as knee flexion however, getting the knee to fully extend after the surgery can be difficult if not more so then getting it to bend.

Your knee depending on how long you have suffered with pain and swelling before surgery had started to slowly develop what is known as a flexion contracture. In other words your hamstrings in back of the knee which bend the knee during walking were tightening up due to the swelling and anatomical changes taking place in the knee joint itself.

If left unattended too they will develop a contracture which will not allow you to fully extend the knee when walking and, you will develop what is known as a swing-through gait. When our knees were in better shape or if you have never had a problem with them, you were walking with a heel-toe gait which presents itself as as a smooth walking pattern.

Of course the best time to address this issue would have been before surgery if you are aware of it as it does not take place overnight if not, then it will be addressed after the surgery in rehabilitation.

There are a number of ways to address hamstring mobility however, I will touch on just a few that I use in the home health sector when working with my total knee replacement patients.

1. Seated Hamstring Stretch, place your affected leg up onto a chair in front of you and place a small rolled up towel underneath your ankle. With your leg hanging you lean forward getting your torso over your knee and slowly and gently press down on your leg above the knee with both hands. The downward pressure you produce should put a slow passive stretch on your hamstring muscles. Hold this position for a slow count of 10.

2. Sit at the end of a chair be sure not to get so far out however that you end up on the floor. Hold your affected leg out straight placing the heel on the floor. Again lean into the knee gently with both hands and hold for a slow count of 10. many find this exercise more effective then the one listed above.

3. While sitting in a recliner with your leg up or, laying down in bed be sure that there is an opening or space directly underneath your knee gently contract or tighten your thigh muscles as you tighten your thighs your hamstrings will relax causing them to stretch. Hold this exercise also for a slow count of 10.

The exercises listed above are just a small sample of many that can be done to get the required results. What exercise or exercises you choose to do will depend on your overall physical condition and what exercises you feel are more effective.

By working diligently on getting your leg to fully extend after the knee surgery will be just as important if not more on establishing a smooth functional gait or walking pattern in the months and years ahead. By having a good heel-toe gait you have a smoother stride, less energy used to walk with, less chance of a fall when you are moving your feet properly, and less hip and back pain which is possible if your gait mechanics are not sound.

Give these exercises a try or consult with your orthopedic surgeon and physical therapist for more details and information on the importance of strong and flexible hamstrings after surgery.

Richard Haynes PTA/CPT
Punta Gorda, Florida.

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