Have Fun and Get in Shape!
Memorial Day is the unofficial kickoff to summer…outdoor furniture is out, the grill is fired up and the pool is open! This summer try to think of your pleasure puddle in different light…a health spa! It may very well be the exercise of choice for many people. Many have discovered the benefits of moving their limbs in the warm water of a home pool following knee or shoulder surgery. Also, long distance runners who often look for cross training methods without joint compression and arthritis sufferers who are often limited in exercise choices by joint pain from compressive forces when bearing weight, can enjoy the buoyancy effects of water. These are good examples of the benefits or water exercise…aerobic and resistive exercise without joint compression.
Exercise and Arthritis
Most doctors recommend some form of exercise with arthritis. Pain and fatigue are the most limiting factors for the person with arthritis. Pool exercise may be the answer. With proper technique, adequate rest periods, appropriate resistance and repetitions, water exercise can be very effective.
Benefits
The following are some of the benefits of water exercise:
- Decreased Risk of Cardiovascular Disease
- Improved Endurance
- Improved Strength – with resistance of water to exercise muscles
- Improved Flexibility and Range of Motion – with less pain
- Improved Function in Daily Activities
- Maintain Mobility
- Improved Balance
- Slow Down Osteoporosis
- Weight Control – which leads to less stress on joints
- Improved Mood and Attitude – release of endorphins and serotonin
- Improved Circulation – especially in warm water
- Decreased Muscle Spasm and Tension – especially in warm water
- Decreased Stress on Joints – Buoyancy effect of water
Getting Started
- Medical Clearance – see your family physician for clearance especially if you have a cardiac history or joint replacements. Do not use pool if you have surgical sutures or an open wound.
- Warm Pool - 83-88 degrees Fahrenheit
- Water Walking Exercise– begin in shallow end
- Water Running Exercise– with buoyancy vest in deep end
- Water Aerobics Exercise– using arms and legs as in regular aerobic exercise but in the water
- Strength & Flexibility Exercise – just as on land but in water
- Start Slowly – Don’t Overdo it
- 5-10 minutes and repetitions first time and add 2-3 minutes/repetitions each week
- Long Term Goal: 20 – 40 minutes per session - 3-4 times per week
- Submerge The Body Part - That you want to exercise into the water and move it slowly
- Complete The Range of Motion - Initially 5 times, then 10-15-20-30 times
- Assess - Determine if you have pain 3-4 hours after you exercise or into the next day. If so you overdid it and make adjustments next time by decreasing repetitions, speed, amount and intensity of exercise.
- Warm-Up - Make sure you warm up slowly before the exercise with slow and easy Movements
- Advance Slowly - By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
- Exercises – standing in shallow end of pool
- Heel Raises - push toes down and heel up
- Toe Raises – lift toes up and heel down
- Leg Kicks – extend leg up and down
- Hip Hike – raise knee up 4-6 inches and down
- Leg Squeeze – squeeze knees together and apart
- Leg Curl – bend knee
- Torso Twist – slowly turn arms/torso to right, then to left
- Shoulder Forward and Backward – like paddling a boat
- Shoulder Out and In – like a bird flying
- Bend Elbow Up and Down
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
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 GCSOM. For all of Dr. Mackarey's articles, visit our Health and Exercise Forum!
Don’t Forget to Prehab!
Rehabilitation is defined as the process of restoring something that has been damaged to its former condition. Recovering from joint replacement surgery involves intensive rehabilitation to attain full recovery. In recent years, however, the concept of rehabilitation “before” surgery or “prehabilitation” has been encouraged by most physical therapists and other rehab professionals as an opportunity to expedite the post operative rehabilitation process.
A recent study revealed that strength training before a surgical procedure can counteract muscle wasting associated with bed rest and limited mobility after a procedure. Two systematic reviews revealed that “prehab” exercise decreased pain and complication after the surgery and improved rehabilitation following the procedure. The studies also noted that individuals rehabilitated and attained goals faster, saving time and money. Due to these findings it is our opinion that prehab is an essential part of a comprehensive rehabilitation program for total knee (TKR) or total hip replacement (THR) surgery.
Therefore, it is important to plan ahead and discuss the best “prehab” program for you with your orthopedic surgeon and physical therapist.
Pre-habilitation – Pre-Operative Exercise Program.
Performing two or three sets of 10, two times daily is recommended:
- Ankle Pumps/Circles: While lying/sitting, move ankles up/down or in circles. This helps to reduce swelling and pain in the knee or ankle.
- Quad Sets: Lie on back, place a rolled up hand towel under your knee, squeeze the thigh muscle and press back of knee toward bed, tightening thigh muscle.
- Straight Leg Raise : Lie on back, bend on knee and keep other straight. Lightly engage belly to protect the spine. Lift the straight leg up ~12 inches up. Making sure to keep the leg completely straight throughout the motion.
- Gluteal Sets: Lie on back, squeeze butt cheeks together. Hold 5 seconds
- Bridges: Lie on back, lift hips off the table squeezing butt cheeks. Hold for 3-5 seconds.
- Heel-slide: Lie on back. Slide heel halfway towards buttocks or in a pain free range.
- Short Arc Quad: Begin laying down with a pillow folded under your knees. While keeping your thigh down, squeeze your quad muscles and straighten your knee. Hold for 3 seconds than slowly lower knee back to the starting position.
- Long Arc Quad: Begin seated on an elevated chair or mattress. Squeeze your quad muscles and straighten your knee as far as you can. Hold for 3 seconds than slowly lower your knee back to the starting position.
- Hip Adduction: Begin laying down, feet flat, knees bent, and pillow folded between your knees. Squeeze your legs together squishing the pillow. Hold for 5 seconds than slowly relax your legs without dropping the pillow
- Hamstring Curls: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Slowly bent your knee as far as you can. Hold for 3 seconds than slowly lower your knee back to the starting position
- Standing Abduction: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Lift your leg forward, like taking a step, hold for 3 seconds than slowly lower your leg back to the starting position
- Standing Extension: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support, maintain a straight back and leg. Lift your leg backward, like beginning to kick a ball, hold for 3 seconds than slowly lower your leg back to the starting position
- Static Squat - 30 degrees: Begin standing, facing a hard surface about waist height, like a counter. Have your hands on the surface for support and maintain a straight back. Slightly bend your knees, without your knees moving past your toes. Hold for 5 seconds than slowly straighten your knees back to the starting position.
“Prehabilitation” enables individuals preparing for a total joint replacement to maintain or improve range of motion, strength, and endurance prior to going for a surgical procedure. We recommend doing at least 4-6 of these exercises 2 times a day to help improve the conditioning of the body prior to surgery and the overall recovery and rehabilitation process following. When completing these exercises, it is important that the movements are symptom and pain free. Should you experience any pain or discomfort with an exercise, you should not continue to perform that exercise. The goal of “prehabilitation” is to prepare the body for your surgical procedure and improve the outcomes and success of the surgery, not further injure or hurt yourself in the process. Therefore, you may not be able to complete all the exercises listed, which is okay, just do your best and what you can! In conclusion, performing exercises prior to having a total joint replacement can enhance your recovery and post-op rehabilitation, so put your best foot forward and take the right steps toward a better total joint replacement with “prehabilitation!”
More Information: For a complete list of these exercises, visit our website at www.mackareyphysicaltherapy.com or call to see how Mackarey Physical Therapy can help you!
Guest Authors: Paul Mackarey, Jr, PT, DPT, clinic director at Mackarey & Mackarey Physical Therapy and Andrea Molitoris, PT, DPT, associate at Mackarey & Mackarey Physical Therapy.
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday
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 GCSOM.
