Having 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.