How to prepare for joint replacment surgery (Or any other surgery)

(And how I ended up knowing that exercises will prepare you and help you recover faster)

Never rely solely on this to recover from Total Knee Replacement Surgery

In the summer of 1996 my Dad had a Total Knee Replacement (TKR) done at DePaul Hospital. Little did I know that my working as a Rehab Tech a couple of years before this would help him recover from this surgery.

This was a familiar site to me. (Pic not my Dad's knee)

Having work with many patients who had had joint replacements, I had my Dad PREPARE his body for this surgery. Mostly simple exercises such as: GLUTE SETS, QUAD SETS, HEEL SLIDES. (Today I would have him use more complicated exercises as tolerated like: SQUATS, LUNGES, STEPS UPS, HIP HINGES, ETC.) He was also doing a fair amount of upper body strengthening which also made it much easier to recover from the TKR. Think about getting out of bed with plenty of upper body strength verses needing help to get out. 

The best part of his PRE-SURGERY exercise program was the look on the Surgeon’s face when I went with my Dad for his 1^st POST-OP visit. At the time normal recovery included using a walker for a month and then a cane for a month. My Dad walked into the office on his own after two weeks. They couldn’t believe it. He was a rare patient that PREPARED his body before surgery so that his recovery was much quicker than normal. I wasn’t even a NSCA –CPT yet. (Although I was in the middle of studying for the certification exam.)

Today I would have had a talk with the surgeon about adding PRE-HAB work to his patient’s joint replacement programs. 

HOW DID I DEVELOP THIS KNOWLEDGE?

 

They say timing is everything. (If I had started showing up at Barnes West a year sooner, I probably wouldn’t have gotten a job there.)

In 1993 I started volunteering at Barnes-West  Hospital’s Sports Medicine Center in Creve Coeur Missouri.  Little did I know where this would take me.

A few weeks after I starting hanging around there, the Head of the Physical Therapy Department (Mark) started to take an interest in my being there. (The reason I was there was to observe the Athletic Trainers) You know how some times when you meet someone, your personality’s just click. Ours did. (The other interesting thing about my time there was my personality DID NOT click with most of the Athletic trainers there. The Head Athletic Trainer and I got along pretty well.

Little did I know that Mark had plans to hire me to work at the Hospital.  Missouri Bone & Joint had just decided to move from DePaul to Barnes- West. Barnes-West needed a Rehab-Tech to work with the inpatients. Mark had decided I was a perfect fit for the job. 

I still remember my first morning on the job. I felt like a fish out of water, but Mark was a great person to train me and work for. One of the first things he taught me was how to bend the patients’ knees the first day after surgery. I took a while to get comfortable causing that much pain, but Mark had taught me that no one under our care would leave with a stiff knee(s). I knew where Mark was by listening for the patients’ screams and soon enough I would be causing screams. He wanted at least 90 degrees of bend that day and at least 120 degrees before they left for home.  (Unless the Surgeon had given us different orders.)

It use to bother us when we would hear one of the surgeon’s telling the patients before surgery to not work the joint if they were having pain. You shouldn’t have to worry about damaging a joint ANYMORE if it going to be replaced soon. Exercising around that joint can lead to better recovery and less post- surgical pain. 

Another way we could tell how well the patient’s joint would do after surgery was how much they were willing to go through after surgery. Some patients refused to bend their knees on their own since the knee was in a CPM machine. (Continuous Passive Motion) Active exercise (Bending and straightening the knee using your muscles) will always give better results than passively letting a machine do all the work. What happens when you can no longer rely on the machine? You have to try getting the muscles working again anyway and you get better results the quicker you rely on the muscles. I can still picture one Hip Replacement Patient being wheeled to their room from recover doing ankle pumps, and my first thought was; There is a patient that is going to do well after surgery. (and they did)

My lesson for anyone going if for Joint Replacement (or any other) surgery: the better your body is prepared before it, the quicker and better the recovery will be. I.E. BE AN ACTIVE PARTICIPANT IN YOUR HEALTH INSTEAD OF A PASSIVE ONE.

Stair Climbing for Balance (and Strength too)

The older you get the scarier these get!

Ask older adults about what they fear most about getting older and one of the most common answers you will hear is losing their independence. Ask them what part of their homes in the scariest any many will mention the stairs. I have relatives that live in two story houses that have talked about moving before they get too old to go up and down the stairs.

What can you do to make the stairs a less scary place in your home? You have two ways of approaching the problem.

Will this make your stronger (or WEAKER) around your stairs?

1.  You can accept getting weaker and eventually look for a way to get up and down the stairs with the help of something like a lift. Remember the phrase use it or lose it. Quit using your legs to get up and down the stairs and your legs will lose the ability to help you go up or down the stairs.

2.  You can prepare ahead of time by getting stronger around the stairs.

Anyone that knows me realizes I don't want anyone to settle for option number one unless absolutely necessary. I realize that some people will have to give up their ability to go up and down the stairs under their own power. What can you do to minimize the chance of that happening to you?

Exercise of course!

If you are unstable around the stairs, you should work on your overall strength level (Squat, Lunge, Deadlift, Hip Hinge, etc.) before attempting any of the following exercises.

My favorite exercise to teach clients body control around stairs is call the

Step Down/Step Up.

The up portion

I begin by teaching my clients how to control the step down portion of the movement. 
Stand facing a sturdy step at least 8 inches high.
Step up onto the step with both feet. I spot my clients by standing behind them and having my hands on their hips in case they lose control of the movement.
I have my clients begin using their weaker leg first. Slowly lower one foot back onto the ground focusing on using as much muscle tension on the leg that is still on the step. Repeat on one side until that leg begins to get tired. Rest for a couple of minutes. Repeat with the other side.

If you can't control the down portion of the movement, I recommend facing the kitchen sink. Place your hands on the edge of the sink and use your arms to help control the movement. As you gain strength, you will be able to perform this movement without using the hands.

The goal is to be able to take between 6 and 10 seconds to lower your body down till one leg is touching the floor. As you gain strength, the height of the step can be increased until it is about the length on your lower leg.

Once you have step downs/step ups mastered you can begin working around a staircase. 

Taking Steps Two at a time:

Version #1

Taking the steps two at time while using the same leg to lead:

Start at the bottom of a staircase.

Place the lead foot on the second stair.

Like this except don't use your hands to help.

Lift up using that leg until it is straight and the trailing sides foot is on the same step.
Use this pattern until you reach the top of the stairs.
Take your time going back down the stairs one at a time, alternating legs as usual.

Repeat using the opposite leg as the lead leg until you reach the top of the stairs.

Once you feel that you have mastered these versions, you are ready for the more challenging version.

Alternating the lead legs while taking the steps two at a time.

Begin at the bottom of the stairs.

Place the lead foot on the second stair.

As you use the lead leg to go up the stairs, lift your trail leg until it's foot is on the forth step.

Lift your body using the lead leg and lift your trail leg until it's foot is on the sixth step.

Repeat this sequence until you reach the top of the stairs.

Once you have mastered these you can add more of a challenge by holding weights in your hands by your sides, at chest level and even overhead if your are ready. The higher the weights, the more challenging.