Exercises for Knee Replacement

One of the best, proactive steps you can take to prepare for and ensure a strong recovery post knee replacement surgery is to engage in regular exercises that strengthen and stretch your knee.  Doing strength and range of motion exercises for your knee is the number one factor you are in control of throughout the knee replacement process; exercise greatly impacts the overall functioning of your knees. From all I have seen training knee replacement clients for over a decade, the candidates who participate in exercises gain much greater strength, flexibility, and physical independence than those who do not exercise. Here are some guidelines to follow to help you get started on your program of exercises for knee replacement.

Best Exercises for Knee Replacement

What do I need to strengthen for my knee replacement?

The number one muscle you need to strengthen both pre and post knee replacement surgery is your quadriceps. Now, if you are pre operation, then the strength exercises you select for your quadriceps most likely will need to be non weight bearing.  The non weight bearing quadricep strength exercises continue as your goal immediately post operation for upto six weeks, where you will then be able to gradually progress to weight bearing quadricep strength exercises.

Another important goal to target as part of your knee replacement exercise program is doing unilateral quadricep strength exercises.  What this means is that it is important to do one leg strength exercises such as the shuttle found in a weight rooms.  Sometimes a rather large strength discrepancy can occur and grow between the two legs and when you only perform two leg exercises; in two leg strength exercises, the strong leg always does more work leaving the other leg weak.   Quadricep strength exercises for knee replacement are crucial to do both pre and post surgery for optimal recovery.

What are the best range of motion exercises for knee replacement?

First off, it is important to note that range of motion and stretching are defined differently; they are not the same. Range of motion has to do with the range of mobility you have at your joint.  At the knee, our range of motion is in flexion, or our ability to bend the knee, and extension, the ability to straighten our knee.  The term stretching refers to a muscles length and can impact the range of motion at a joint.  For instance, at the knee, your quadriceps and hamstrings muscle length will impact range of motion if they are short and tight.

You need to focus first and foremost on gaining and maintaing as much flexion and extension you can achieve at your knee joint. This is your goal both pre and post knee replacement surgery.  Although the goal is to achieve as much range of motion as possible, you must still work through your pain free range of motion.  Again, just like the strength exercises, if you are pre operation, then the range of motion exercises should be non weight bearing. Similarly, post knee replacement surgery, the range of motion exercises can progress to weight bearing options. The stationary bicycle is an excellent tool and exercise to improve your range of motion as it works both flexion and extension of the knee in a non weight bearing capacity.

The good news here is that there are so many easy range of motion exercises you can do in the comfort of your home. There are ones you can do lying on your back or stomach with no equipment at all.  If you have a body ball or could get one for your home, then there are also some fabulous body ball flexion range of motion exercises.  In addition, using a theraband provides even more flexibility exercise options that will help you gain good range of motion at your knee.  Everyone going in for or recovering from knee replacement surgery should do both range of motion and strength exercises for their knees.

Are there specific stretching exercises for knee replacement?

Yes, there are specific stretching exercises for knee replacement that will benefit you the most.  Your stretching routine should target two muscle changes that occur in your body when you have knee arthritis or knee replacement surgery:

  1. What muscles get tight and negatively impact the range of motion at my knee?
  2. Which muscles automatically tighten due to the pain and trauma of arthritis, surgery, and altered gait?

Stretches for Knee Replacement

If your quadricep muscle shortens then it can limit the flexion or bending ability you have at your knee. Stretching out the quadriceps will facilitate a greater range of motion of flexion at your knee. What this translates to in daily ability is being able to do tasks with ease such as getting in and out of a car, sitting in a low chair or on the toilet, and sitting in tight spaces such as a movie theatre or airplane.  A tight hamstring is what limits your knees ability to straighten. Needless to say it is very important to stretch out your hamstrings so that you can extend your knee. We need extension at our knees to perform daily tasks such as walking and standing with an even pelvis so we do not experience back pain.

Therefore, the two most important muscles to stretch are your quadriceps and hamstrings. There are however, two other leg muscles that get tight on knee replacement people and they are the calves and the IT Band or illiotibial band. Make sure your pre and post knee replacement stretching exercise program includes all four of these muscles.

The Knee Replacement Exercise Program

There are the three most important elements to include in your knee replacement exercise program:

  1. Strength exercises for your quadriceps
  2. Range of Motion exercises for both flexion and extension of the knee
  3. Stretches for all the muscles around the knee

The great thing about all these exercises is that they really do make you feel better, loosen your knee, and improve your overall function.  Give yourself a goal to begin doing at least two quadricep strength exercises, one flexion and extension exercise, and a stretch for your quadriceps and hamstrings.  Learning exactly what exercises you need to do for you your knee replacement will help you recover strong. There is a complete knee replacement exercise program you can benefit from which will highlight all the exercises you need for quadricep strength, flexion, extension, and stretching.  Learn more and receive a copy of the Knee Replacement Exercise eBook and/or video here.

 Knee Replacement Exercises

Knee Arthritis Exercises

Knee Arthritis Exercise Range of Motion Knee Arthritis Exercise

Living with knee osteoarthritis daily can be a painful, disruptive nuisance, but knee arthritis exercises are an excellent self treatment tool at your disposal.  Whether you are still working and managing a career around the limitations of your knee arthritis or are active grandparents needing to keep up with your family, maintaining an exercise program is essential.

Right now, there are three amazing people close to me who are all at different stages of the progression of their knee osteoarthritis.  My aunt has chronic, debilitating pain in both of her knees and is still working while she waits for treatment and possibly surgery. Then there is my mom who has had arthritis for a long time and is able to manage it with exercise and pain medication daily.  Lastly, is a long time family friend who is going in for her knee replacement surgery next week.  No matter what stage you are at along the knee arthritis continuum, there is one common treatment recommended across the board for relief and recovery; it is exercise. Exercise helps relieve pain, maintains range of motion, and provides endurance strength training for people with knee arthritis.  If you are not exercising you are doing your knee, body, pain level, and independence a disservice.

What are the best exercises for knee arthritis?

It is important to note that no matter how far along you are in having knee osteoarthritis or how close you are to having surgery, that the exercise goals will remain the same.  Understanding how arthritis affects your knee joint and overall body will demonstrate the importance of why specific exercises are necessary for better function and pain relief.  Arthritis wears down the cartilage in your knees causing friction and wear and tear of the bones at your joint.  When this occurs pain begins and with the onset of pain comes a decrease in range of motion around the knee.  Pain and instability at the knee joint stimulates a response in the surrounding muscles to tighten in order to protect and stabilize. Therefore, in addition to pain and the changes in daily function, arthritis causes a decreased range of motion and tightening of muscles at your knee joint.

Range of Motion & Stretching Exercises for Knee Arthritis

The best exercises for knee arthritis should begin with range of motion movements and stretching.  Your knees range of motion includes both flexion and extension.  The goal for your knee exercise program should be to take your knee through its greatest pain free range of motion.  My aunt in the example above is using a body ball to gently flex and extend her knees where the weight of her legs is supported by the ball.  Doing range of motion exercises also lubricates the joint relieving stiffness, freeing more movement, and maintaining mobility. My mom uses a stationary bike to oil her knee joints and feels great benefit from doing this on a regular basis.  Tight muscles impact the flexibility around your joint, so in addition to doing the range of motion exercises, it is crucial to stretch the muscles around your knee.  A thorough knee stretching program for knee arthritis should include stretches for the quadriceps muscle, hamstring, calves and iliotibial band or IT band.

Strength Exercises for Knee Arthritis

Range of motion and stretching exercises come out the front runners with a slight lead ahead of strength exercises for knee arthritis; however, strength is a strong contending competitor in second place that should not be forgotten about.  Gaining flexibility around your joint first allows you to build strength through a greater range of motion which gives you more function.  The strength we are talking about here is not bulging, powerful machine lifting strength, but rather strength of endurance to do daily activities.  The main muscle you can focus your attention on is the quadriceps muscle.  Having muscular endurance strength of your quadriceps will help you recover stronger post operation, maintain independence, and absorb some of the load on your knee thereby possibly decreasing some of your pain.

Training Exercise Program for Knee Arthritis

 If you want pain relief, want to maintain function and mobility, and are preparing for knee replacement surgery, you will benefit from engaging in an exercise program.  You will need to have range of motion, stretching, and quadriceps strength exercises in your arthritis exercise program.  The overall goal for anyone living with arthritis in their knees is to keep as much flexion, extension, and strength around their joint as possible.  Specific knee exercises for arthritis will not only improve your joint mobility, but also give you a much greater sense of over all well being.

Start your knee arthritis exercise program today and learn what exercises you can do from the comfort of your home to maintain range of motion and strength prior to knee replacement surgery. Click here for more details.

How to Prepare for Knee Replacement Surgery with Exercise

Seated Hamstring Curl with Band

What can you do pre operation waiting for a knee replacement?

There is so much emphasis and education on post operation knee replacement recovery that you may feel there is nothing you can do, but wait. Not only is there a lot you can do to relieve pain, maintain mobility, and recover stronger, but also you will improve how you feel and have a way more successful outcome post surgery. Many of you may be experiencing so much pain around your knee joint that it feels counter intuitive to exercise which is why you feel it is safer to wait. Let us just take a look first of all at what happens when you decrease or stop exercise.

Here are the changes that occur in your body and muscles when you stop moving or decrease your activity:

1) Muscles tighten and tight muscles can increase pain
2) Range of Motion around your joints decreases which limits function
3) Muscle strength deteriorates causing weakness and inability
4) Your cardiovascular or heart health and stamina decrease
5) Lack of use reduces ones ability to balance and your coordination
6) Every day activities become difficult and independence is challenged

You can limit the impact your knee arthritis has on your overall health by engaging in some simple targeted exercises. It is important to select the right exercises that will not cause pain or increase inflammation. The good news is there are a lot of exercise options available to you that will benefit you pre knee replacement surgery.

What are the benefits you will gain by exercising pre knee replacement surgery?

1) Maintain or increase range of motion around your knee

2) Maintain or gain strength in muscles that stabilize the knee

*Muscles can absorb shock lessening the stress of loads placed on the knee joint. Also, it is well documented that people who have good quadriceps strength will recover better post knee replacement surgery.

3) Exercise and stretching eases tight muscles which can lead to a
decrease in pain. It has been noted that a large portion of the pain
associated with knee arthritis can be attributed to tight muscles.

4) You will prevent a serious decline in cardiovascular health

5) You will boost energy, mood, and your confidence

6) You will limit the deterioration of your balance and coordination

7) You will drastically improve your ability to recover stronger and
faster than those who do not exercise pre operation

Now that you grasp the importance and benefits of why exercise is essential pre knee replacement surgery, where do you proceed from here? When selecting a type of exercise that is good for your knee having arthritis and possibly pain as well, follow these three guiding principles:

Non Weight Bearing

Most likely you are at the stage where you experience pain upon walking or weight bearing whether it is with every step or only after a specified time on your feet. If you fit into this category then you will want to select non weight bearing exercise options such as stationary cycling and swimming. Most importantly, you need to know that there are a lot of non weight bearing strength exercises you can choose from as well.

Range of Motion

The very nature of osteoarthritis is the deterioration of range of motion at your joint. The deterioration occurs due to a breakdown in cartilage between your bones leaving the point of friction at your joint bone on bone. This breakdown in the joint structure and the subsequent pain lead to a decrease in range of motion at your knee. Therefore, it is extremely important to do knee range of motion exercises including flexion and extension pre operation. There are non weight bearing range of motion exercises you can do that will help you maintain flexibility at your knee joint.

Quadriceps Strength – Especially VMO Strength

Now do not go shying away at the mention of the word strength because it does not involve heavy weights or fancy equipment. There are simple at home strength exercises you can do with little or minimal aids that will strengthen your quadriceps muscle. This muscle is the most important muscle you want to target keeping strong before you go in for surgery. Even just learning how to fire or contract this muscle and hold the contraction for a few seconds will help you recover strong post knee replacement surgery.

Your VMO muscle or Vastus Medialis Obliques, thank goodness for abbreviations, is one of the four quadriceps muscles that sits on the medial or inside of your knee closest to the joint. Having the ability to strengthen and contract this muscle is extremely important for knee rehabiliation and it also aids in extension of your knee. There are numerous exercises you can do at home to strengthen this muscle with little or no equipment.

These 3 guiding principles need to be the cornerstone of your exercise selection as you prepare for your new knee. If you could only see the results and know the comparisons I have witnessed by my clients who did exercise pre surgery in relation to those who do not, you would begin exercising today. Often my clients would report less pain post exercise, feel they loosened up, experience greater confidence in their physical ability, and also have a boost in mood and energy. Need I say more? The evidence is clear, the results are incredible, and now it is all up to you.

Where to begin Your Pre Op Knee Replacement Exercise Program – Getting Started!

If you prefer one on one attention, seek out the help of a qualified personal trainer or physiotherapist who will design a safe, effective exercise program for you. You also have the option of learning in the comfort of your home from an exercise specialist who has helped hundreds of joint replacement clients prepare for and recover from surgery. She led a community joint replacement class for over a decade that helped people pre and post knee replacement operation. All of her knowledge and experience is compiled in a user friendly guide in the format of an E-book and Video which you can view at www.kneereplacementexercises.net.

 

Knee Arthritis – Top 10 Tips To Improve Mobility

Did you know that by being an active participant in the management of your arthritis, you can improve your overall mobility, decrease pain, and maintain a better quality of life?  Now, the stiffness and pain you feel in your knee joint may actually tell you otherwise and make you feel you should rest, do less, and avoid exercise.  Well, the good news is that you have the ability through exercise to increase your range of motion, improve your strength, and gain functional ability; these will all allow you to perform daily activities with confidence and independence.  Through my years of experience as an exercise specialist training individuals with knee arthritis and knee replacements, I have learned what the most important exercise goals are to improve quality of life.  To assist you on what is best to focus on and what will help you with your knee arthritis or knee replacement, here is a list of exercises to improve your mobility:

  1. Lubricate and loosen your joint with range of motion exercises using the stationary bicycle or participating in an aqua fit class.  The range of motion exercise form you select should be non weight bearing if you have pain or experience pain and swelling with weight bearing activities.  However, if you are post knee replacement or do not have pain, then walking is a great choice to keep your joint lubricated.
  2. Strengthen your muscles around your knee and in particular the quadriceps muscle.  The gluteus medius hip muscle and the adductor muscle group on the inside of your thigh are also important to keep strong.
  3. Stretch your tight muscles and the muscles which may limit your range of motion at the knee and thereby your functional ability.  These muscles include the hamstring, quadriceps, calf, illiotibial band, and possibly your gluteal muscles as well.
  4. Limit and monitor swelling and/or heat in your knee joint. Sometimes arthritis sufferers become so accustomed to swelling or the feeling of heat in their joint that they ignore it and persist through this.  If the activity you are doing is causing swelling or heat in your joint, it is either too much, too soon, or the wrong exercise.  Please use these symptoms as a gauge to what you should be doing and always ice.  Your first goal is to bring the swelling down and minimize heat in your joint.
  5. Do specific exercises targeted to knee flexion and extension. A physiotherapist or exercise specialist will be able to identify for you whether you need to focus on flexion or extension exercises.  Having good flexion and extension at the knee is what gives you the ability to walk properly and perform daily tasks with ease such as climbing stairs.
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  7. Practice and be conscious about your gait mechanics. Pain, change of range of motion at the knee, and structural abnormalities caused by arthritis can alter your gait.  Have someone teach you how to walk with good technique and then implement this into your daily exercise regime.
  8. Know the right volume of activity for you! Often my arthritic clients would be going along steadily progressing well and then they would get a flare up of pain all of a sudden.  Upon further discussion, we would realize together that the activity they did over the weekend, or on their holiday, or with their grand kids was too much.  The volume of activity relates to the accumulated amount of walking, exercising, being on your feet that you do in one day.  A lot of arthritic participants find that they can walk for 30 to 60 minutes, but any amount above that threshold will set them into pain.
  9. Keep your body weight healthy to reduce the load/stress on your joints. If you are overweight, you will want to focus on cardiovascular exercise on a minimum of 3 days a week, preferably 5 days so that you can lose weight and reduce the load of stress on your knee joints.  Nutrition and eating habits play a huge role if not the most important role in weight loss; therefore it is highly recommended to combine both diet modifications and exercise to maintain a healthy body weight.
  10. Seek out medical professionals who can help you. Physiotherapists are an excellent resource prior to surgery and immediately post operation.  Massage therapists are terrific at all stages as they can help loosen all the tight muscles that form around your painful knee joint.  A registered dietician can assist everyone pre surgery and also help individuals who need to lose weight.  Personal trainers and kinesiologists are fantastic at helping design a strength program for you both pre and post surgery.
  11. Rest! Make sure you have rest days from exercise and allow your body to recover. I cannot tell you how many people have been so dedicated to their exercise program and healing fast that they never take a day off and hence end out setting their recovery back.  You should never do more than two days of exercise in a row and ideally it is best to do exercise every other day unless it is a very gentle form of exercise.

You are an integral player in the daily management of your arthritis and your recovery from surgery.  Exercise in the form of range of motion, stretching, strength, and cardiovascular conditioning will hugely impact your independence, confidence, and overall feeling of wellbeing.  I wish you all the best to building  strong, supple, well functioning knee joints.

Knee Replacement Surgery Recovery part-2

How to Gain Strength & Function Post Knee Replacement

This article is continued from part 1

Remember from Part 1 of this article that if you answer ‘Yes’ to just one of these questions, then you will need to continue your strength exercises.  Quite honestly, if you have stopped your strength exercises prior to the year anniversary of your surgery date, then you definitely need to jump back in to your strength program.

  1. Are you still walking with a limp or does your gait continue to feel unnatural?  Has someone else noticed your gait is different?
  2. Is your strength in the operated leg still weaker than the non operated leg?
  3. Do you have difficulty doing any of your regular daily activities of living?
  4. Are you still working on obtaining the desired range of motion targets set forth by your surgeon and physiotherapist?
  5. Do you play sports that you want to return to?
  6. Did you have complications with your surgery?
  7. Would you say you are overweight where that extra weight is a stress on your joint or did your doctor advise you to lose weight for joint health?
  8. Does your knee replacement leg feel weak, unstable or cause you lack of confidence?

The Goals of Your Post Operation Exercise Program

The goal of continuing your knee replacement exercises for a year post operation is to build muscular endurance and assist in a strong recovery for good overall function in all your regular activities.  Often the exercises you are given initially post operation are extremely light, easy exercises that just begin the rehabilitation process.  These initial exercises help the muscles begin to contract again after surgery and ease the muscle back into working.  However, these exercises do not usually provide enough strength or muscular endurance to help you return to all the loads and demands placed on your knee throughout your daily routine.  When you continue muscular endurance exercises for longer than three months after surgery, you will be able to add progression exercises that will gradually increase the load and stamina your muscles can endure.  This is the crucial reason why it is so important to perform consistent strength exercises for at least a year post knee replacement.

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A few of the exercise goals you will want to target after your knee replacement surgery are: quadriceps strength, knee flexion and extension, functional exercises for activities of daily living, balance, gait, cardiovascular endurance, and life/work/sport specific exercises to help you return to your normal routine.

So many of our participants who stayed with our joint replacement program for a year would say they gained huge improvements in joint function and strength at the year mark that they did not even have at the six or nine month mark.  They would then go on to make a statement of how glad they were they stuck with it as long as they did so that they could see how much more ability and function was possible for them.  Lastly, there hope was that other prospective knee replacement candidates would be told the importance of sticking with their exercise program for a year in order to benefit from a full recovery.

Knee Replacement Surgery Recovery part-1

How to Gain Strength & Function Post Knee Replacement Surgery

One of the biggest questions everyone has pre operation is, “How will my knee function post knee replacement surgery?”  The answer to that question depends on a multitude of factors including the following:  the extent of wear and tear pre surgery, individual genetics and lifestyle, body weight, and patient adherence to consistent strength exercises post surgery.

If you would like to optimize your chance of having a successful knee replacement recovery, you must do exercises both pre and post operation.  The biggest misconception and mistake people make is stopping their rehabilitation and strength exercises at three months post operation.  In order for you to gain optimal strength, range of motion, and function back in your knee after knee replacement surgery, you need to continue your exercises for at least one year post operation.

Immediately post operation, it is recommended to work under the supervision of a physiotherapist for six to eight weeks.  If your local hospital does not offer a rehabilitation program, seek out private physiotherapy either in home or at a clinic for this same time period.  At two to three months post operation, you will be ready to progress to the next stage of strength exercises.  In fact, your physiotherapist may graduate you from their care and refer you on to a community joint replacement program or a personal trainer.

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This is the crucial transition point where so many people stop their exercises not realizing how much better function they will receive if they continue.  Now a lot of people assume once the swelling goes down and they can do daily tasks with ease, that they are fully rehabilitated.  What we have seen is that the people who stop their knee exercises prematurely do not gain anywhere near the strength and flexibility that those who do continue their exercise program for a year obtain.  What ends out happening is the people who stopped their exercises realize at a later time that they do not have the strength, balance, gait, and endurance they need in their daily life.  Their lack of functional ability begins to pop up as a problem here and there in their every day movement and they become physically aware of it.  So the question you may be wondering is, “If I feel pretty good, how would I know if I need to continue exercising or if I can stop?”

If you answer, ‘Yes’, to just one of the following questions, you must continue your post knee replacement exercises:

  1. Are you still walking with a limp or does your gait continue to feel unnatural?  Has someone else noticed your gait is different?
  2. Is your strength in the operated leg still weaker than the non operated leg?
  3. Do you have difficulty doing any of your regular daily activities of living?
  4. Are you still working on obtaining the desired range of motion targets set forth by your surgeon and physiotherapist?
  5. Do you play sports that you want to return to?
  6. Did you have complications with your surgery?
  7. Would you say you are overweight where that extra weight is a stress on your joint or did your doctor advise you to lose weight for joint health?
  8. Does your knee replacement leg feel weak, unstable or cause you lack of confidence?

Read part 2…

How To Improve Your Gait Post Knee Replacement–Part 2

Knee Gait – Part 2

The second exercise goal to improve your gait post operation is going to be targeting specific strength exercises.  Strength exercises post knee replacement surgery need to focus on where you will have lost strength and where you need strength to execute proper gait mechanics.  Some of the most important muscle groups that need to be strengthened post surgery are  your quadriceps, gluteus medius, gluteus maximus, illipsoas, tibialis anterior, and gastrocnemius.  When you build strength in these muscles and incorporate functional strength exercises into your exercise routine specific to walking, your gait will improve.

The last, but by far the most crucial element you need to have in your exercise program to promote the return to a normal gait pattern, are balance exercises and specifically one leg balance exercises.  You will need clearance from your physiotherapist or surgeon advising you when it is safe to fully weight bear on your new knee joint.  Do not attempt the one leg balance too soon as your soft tissue needs time to heal before it will support your full body weight.  For people who have a larger body mass, you may have to wait longer before engaging in one leg balance exercises so that the muscles are strong enough to support the joint.  It is not recommended to perform the one leg balance prior to six weeks post operation unless advised by your physiotherapist.  Building your endurance on the one leg balance should be the first goal and that is by holding it for five then ten seconds plus.  Balancing on one leg must be done properly to support good gait mechanics.  When you stand on one leg, you need to ensure your pelvis stays level and that you are holding your trunk or torso tall with good posture.

There is just one more essential element you should add in to your exercise program to support the development of a strong gait post knee replacement.  You must walk regularly where you are gradually building distance and time.  The increase in duration and mileage should be solely dependent on how your joint is responding to the progressions.  If you experience any pain or swelling, your walking distance, speed, terrain or route may need to be adjusted.  It seems common sense to suggest walking to improve gait, but what we have found is that if all your rehabilitation is in a weight room setting, some people get comfortable on the bicycle or elliptical; gait will only improve if you are walking and doing exercises where you have to transfer your wait from one leg to the other.  Backward walking on the ground near something to hold or with a spotter is also another great option which will improve your gait.

In summary, you will be able to return to normal gait by doing consistent, specific knee replacement exercises that focus on range of motion, strength, and balance.  Gradually increase your walking time and walking with a frequency of at least three times a week focussing on good form.  Have a physiotherapist, personal trainer, or kinesiologist watch your gait and instruct you on how to perform good gait mechanics.  You will walk strong again and feel confident with your gait.  All it takes is some strength and balance exercises, walking, and good range of motion.

How To Improve Your Gait Post Knee Replacement – Part 1

Knee Gait – Part 1

Total-Knee-Replacement Osteoarthritis in the knees causes pain which then leads to gait changes and weak muscles.  Your body will unconsciously, automatically protect the painful knee by transferring more load to the other knee.  If you now look at how many months you waited for surgery and how long you may have been favouring that joint, it is no wonder your gait may still feel awkward or unnatural.  The good news is that there are specific knee replacement exercises you can do post operation to improve your gait.

In addition, after your knee replacement surgery, you will most likely have swelling around the knee joint for a month or two which limits range of motion.  When your knee range of motion is compromised, it impacts your ability to walk with a normal gait.  Furthermore, your muscles may have become even weaker immediately post operation due to the trauma of surgery and the reduction in weight bearing.  Therefore, it is extremely important you do exercises post  surgery to regain range of motion, strength, and foster a strong gait.

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The first exercise goal you will want to target post operation to improve your gait will be range of motion.  Initially, you will need to focus on decreasing the swelling in your knee joint because it will limit your range of motion.  Consistent icing, physiotherapy supervision, and avoiding too much too soon will help reduce the swelling and keep it to a minimum.

Along with monitoring swelling to assist in facilitating healthy joint range of motion, you will want to begin non weight bearing knee flexion and extension exercises.  Healthy knee flexion and extension are required as the first element to being able to improve your gait post knee replacement surgery.  Ultimately, the minimum knee flexion required for gait and daily activities is 90 degrees, but achieving 100 to 120 degrees is optimal. Extension of your knee joint is your ability to straighten your knee.  A negative knee extension measurement of -3 or -5 means your knee is staying flexed or bent and not extending fully to a straight alignment.  It is really important to note that tight muscles are a huge factor in limited range of motion; therefore, stretching your quadriceps and hamstring muscles can help increase knee flexion and extension leading to better gait.

Knee Gait – part 2

The Importance Of Selecting The Right Exercises Pre & Post Knee Replacement Surgery

Rehabilitation_knee_extensionHaving knee osteoarthritis entirely changes the dynamics of how your joint functions and how your muscles operate.  What this means is that both pre surgery and post operation your muscles and joint will not be responding to strength exercises as they once would have.  It is really important to understand this difference so that you will take a very specific, careful, and systematic approach to your exercise program.  Choosing not only the right knee replacement exercises, but also understanding what your joint and muscles require to build back strength, is crucial to a successful recovery.  Having a trained professional create a safe, effective exercise program for you will guide you to doing the right exercises to rehabilitate your joint.

There are a number of elements that contribute to the need for a very specific exercise program pre and post knee replacement.  The first factor is the presence of pain in the joint which must be listened to and worked around when selecting exercises.  The second element is the instability of the joint due to deterioration of the cartilage and subsequent misalignment.  With both pain and instability present in the joint, the surrounding muscles begin to weaken and atrophy due to disuse.  When this happens the muscle can forget how to contract or start to only contract at a very weak level.  Now that there is pain, instability, and weakness present in the knee, performing any exercise means there is going to be a lot of compensation and probably poor form.

Building Strength With Isometric Exercises

However, you will be able to build strength back up in your joint if you follow a specific progression plan and understand the concepts of where and how you should begin to build strength.  Whether you are pre or post operation, you will want to begin your strength program with isometric exercises.  Isometric exercises build strength by contracting muscles where you would not have to flex your knee.  What this means is that for a knee which is sore to bend, you can still build strength without causing pain.  Isometric exercises also offer the chance to feel and improve the intensity of contraction in your muscles for a muscle that may have become weak or deconditioned.  The most important isometric exercise for a knee replacement candidate to do is the quadriceps.  Isometrics can be done non weight bearing which again offers the best place to begin strength for both pre operation and immediate post operation.

Single Joint or Isolated Quadricep Strengthening

The next progression you would want to introduce in to your exercise program after isometrics would be single joint or isolated quadriceps strengthening.  What this translates to is selecting exercises that only require the movement of the knee rather than both the knee and hip as well as exercises that isolate building quadriceps strength.  The reason you want to start here is due to simplicity, stability and to ensure the quadriceps will be strengthened without other muscles taking over.  The supine knee extension over a circle foam or the prone knee extensions are both great examples of an isolated quadriceps single joint exercise.

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Multi Joint Weight Bearing Exercise

Once you no longer have pain with range of motion, have an increase in the quadriceps muscle strength and a good contraction, you are ready to advance to multi joint weight bearing exercises.  Multi joint weight bearing exercises allow you to enter into performing more functional strength exercises that relate to every day life demands.  However, if you jump into these too soon without doing isometric and isolated single joint strength exercises first, you risk not having adequate quadriceps strength.   Being able to add multi joint weight bearing strength exercises into your routine may be reserved only for your post operation rehabilitation; it is entirely dependent on whether you feel pain in your joint during or after doing these specific exercises.

The Goal of Progressive Exercise

The goal of this progression in the types of exercises you select  is to ensure you have both strength and stability in your joint and that your quadriceps muscle contracts as it should when performing certain exercises.  What can happen if you progress too quickly is that you will be able to do the multi joint exercises, but other muscles will allow the movement.  This could then lead to other musculoskeletal problems and imbalances possibly causing  pain down the road.

Therefore, start your exercise program with isometrics progressing to single joint isolated quadriceps strength, and then to the multi joint exercises.  Following a specific routine of knee replacement exercises will greatly enhance your recovery post knee replacement surgery.  Have a physiotherapist or personal trainer show you what exercises to do and watch your form as it will contribute to a strong, confident return to good function.