total knee Archives - Mackarey & Mackarey PT

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.