Orthopedic/Injuries>>Total Knee Replacement Outpatient Therapy Program - 1/4/2007
Total Knee Replacement Rehabilitation Program
Outpatient Physical Therapy
Total knee replacement is now a routine operation for knee pain and disability. The end result should be a painless and movable knee which you can use quite normally in daily life.
Due to the pain and stiffness after the operation, you will have to work hard to regain muscle power, mobility and knee bend. Co-operation with your physical therapist is vital for you to achieve the best start with your new joint, and to set the program for the following months. Your program will consist of strengthening, range of motion, scar massage & mobility, edema/pain management and gait training.
It may take three months for all the pain and swelling to settle down and you will have to keep your knee working during this time.
Range of motion
It is useful, but not essential, to get a 90 degree bend before you leave hospital. Your knee should continue to increase in range of motion over a long period.
To lead a 'normal' life and to ascend and descend stairs normally, a 110 degree knee bend is useful, but your knee may bend even further than this in many cases. We strive for 120 degrees of flexion and full extension; however, there are multiple factors that can affect the outcome. Early and aggressive range of motion is a key factor to positive outcomes.
If your knee bend is poor even after your best efforts it may be necessary to manipulate the knee under anesthesia. The surgeon will bend your knee in theatre while you are unconscious for a short period. After this you will need to work hard to maintain the extra movement gained.
Exercises after knee replacement
Exercising the main muscle groups around the knee is very important both before and after having a total knee replacement.
Exercise regularly, for instance for 10 minutes 6-8 times a day. Do not spend all of your time exercising or your knee may become inflamed, swollen and painful. It needs a mixture of rest and regular exercise, which will be uncomfortable. Icing your knee following exercise is also helpful in controlling pain and swelling. Do not let the ice pack on for more than 10-15 minutes. Frozen vegetables, such as peas, are a cheap alternative to an ice pack and mold around the joint nicely.
Static quadriceps exercise. This exercise can be done when others cannot, such as when you are visiting, standing or just after operation. It activates the large quadriceps muscles at the front of the thigh and helps the knee remain stable when it is close to being completely straight.
To perform - have the knee straight, tense up the front muscles of the thigh as if you are trying to straighten the knee and lift the heel. Hold for a few seconds then relax. Try not to tense up the buttock muscles or to try too hard. Sometimes doing the exercise with both legs at the same time will give the affected knee the right idea.
Sit with your knee bent over a rolled up towel, high enough to be able to lift the heel off the ground. Tighten up the knee muscles and lift your heel off the ground
Keep your knee firmly down on the roll. Hold for a few seconds, trying to get the heel as high as you can, relax and repeat. People with patellar (kneecap) problems may need to avoid this exercise if it causes pain.
Straight leg raise
Sit or lie with the leg out straight. Tighten the thigh muscles, straighten the knee and lift the whole leg six inches (15cm) up off the bed or floor. Hold for three seconds then lower slowly.
DO NOT do this if you have a total hip replacement.
Passive knee stretches
Sit or lie with your leg out in front of you. Put the heel up on a block or pillow so that the the knee hangs in mid air. Let the knee stretch for five minutes, or less if it is too painful.
Knee bends on the bed
You can use a board for this exercise, and at home you can use a tray. Keep the heel down on the board and slide the foot towards you, bending the knee. Hold it at the full bend for three seconds then release.
Knee bends in the chair
Sit in a chair with your foot on the ground. Slide the foot firmly towards you and then release. Hold for three seconds each time in the fully bent position. Do not allow your hips to move, just the knee.