Part 1 of 2
Ted Schoch, PIAA football official from NEPA, has spent the past 9 months preparing for the high school football season with the same vigor and passion as a young athlete. You may have seen him biking through Dalton or running drills on the sports facilities at Abington Heights High School. He has been recovering from a total knee replacement and met his goal of returning to work as a football official in this year’s Dream Game. He is more excited than usual to officiate this football season. He, like many others, learned that it takes much more than traditional home exercises to “get the most out of your knee replacement” and get back in the game!
Total knee replacement surgery is a very successful orthopedic surgery as more than 600,000 are performed in the United States each year. More than 95% of patients with TKR are satisfied with the outcome one year later according to the American Association of Orthopaedic Surgeons. Pain relief with daily activities was the most important factor for most patients. Those dissatisfied are often younger and tended to have a long history of an active lifestyle. Many of these patients may have unrealistic goals and expectations. It is recommended that these patients have better preoperative counseling and longer, more aggressive rehab to meet the goals of a more active lifestyle after surgery. The purpose of this column is to present a more advanced rehab program for “fine tuning” in order to make a full recovery for those hoping to hike, ski, play tennis, golf, etc. AND for those who seek better function in daily activities with their new knee.
Despite advances in knee joint implants (e.g. more durable materials, improved simulation of anatomical knee joint movement), some patients continue to report dissatisfaction with their post-operative function! Patients often complain about difficulty; entering or exiting a car, descending stairs, bending to the floor, and rising from a commode. All of these activities have one thing in common…they require the ability to perform a partial squat: controlled lowering of the body weight against gravity, not any easy task! The partial squat maneuver requires not only adequate mobility and strength at the hip, knee, and ankle but also equal weight bearing on both legs. The more advanced activity of descending stairs in a step over step manner requires even more effort as the leg muscles and joints must be strong and mobile enough, to support the body’s weight independently!
Studies show that even after two months of rehabilitation following knee replacement surgery, patients continued to place more body weight over their non-operative limb! This problem occurs for several reasons: (1) Continuation of a habit of walking in a manner to avoid a knee pain before surgery (compensating to avoid pain from the arthritic knee), (2) Continuation of a the “learned” compensation following knee replacement (compensating to avoid knee pain from surgery), and (3) reflex muscle inhibition (when the body experiences pain, the muscles are inhibited to contract in order to avoid pain). If not corrected, these three behaviors, whether acquired, learned, or automatic, will continue for a long time following knee replacement surgery and prevent the best possible outcome for the individual.
In order to perform the functional squat maneuver necessary for the functional, daily activities individuals must possess adequate mobility at their hips, knees, and ankles.
Functional Squat
Hips must bend > 90°, knees must bend at least to 90°, and ankles must bend to approximately 12° to 15°
Note: Ted Schoch, PIAA Football Official from NEPA demonstrates a functional squat with slight compensation in his right knee replacement due to lack of range of motion in right hip and ankle.
In addition to adequate leg joint flexibility, a proper squat requires strength of several key muscles: gluteus (buttocks), hamstrings (back of the thigh), quadriceps (front of the thigh), and the gastroc (calf).
During rehabilitation following knee replacement, even though knee function is paramount, failure to address hip/ankle mobility/strength may interfere with the restoration of important, daily tasks. In order for a replaced knee to perform optimally, the hip and ankle must be challenged with exercises similar to the following:
Calf Stretching
Calf Strengthening
MODELS: Ted Schoch; Vanessa Borgia
Next week read Part 2 for more advanced exercises to get the most out of your new knee…don’t settle for less
Guest Columnist: Janet Caputo, PT, DPT, OCS is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune Part 2 of 2 entitled, “Get The Most Out of Your New Knee.”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.
