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Health & Exercise Forum

Get the Most Out of Your New Knee - Part 1 of 2

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Sep 2, 2013

Dr. Mackarey's Health & Exercise ForumPart 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.

Fine Tune Your New Knee

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

  • Place hands on wall & put uninvolved foot forward.
  • Keep knees straight and involved heel on floor.
  • Lean body towards wall. Hold 30 seconds Repeat 3x

Calf Strengthening

  • Heel Raise Both Ankles
    • While standing, raise heels up & down. May hold onto object for stability. Perform 3 sets of  5 reps. Advance to 3 sets of 10 to 15 reps.
  • One-Ankle Lowering - Eccentric
    • While standing, raise up on toes. Bend uninvolved knee to raise foot off floor. With body weight on involved leg, slowly lower involved heel back to floor. May hold onto object for stability. Perform 3 sets of 5 reps. Advance to 3 sets of 10 to 15 reps.

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:

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.