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Getting into a routine of daily exercise is crucial to guarantee an optimal outcome with your new hip or knee. The following exercises should be done before your surgery to familiarize you with contracting different groups of muscles in order to make the postoperative exercises much easier.
Most sessions of the Board of Directors, whether regular or special, are open to the public. Public notices of the time, place, and agenda of each meeting can be found here. Find a provider that's right for you. Click to Learn More. Your physical therapist may add agility exercises such as turning and changing direction while walking, or making quick stops and starts and balance board activities that challenge your balance and knee control once you can put your full weight on your knee without pain.
Your treatment plan will be determined by the physical therapist's examination of your knee, your goals, and your level of activity, and overall health. Functional training. Your physical therapist may begin to add activities that you were doing before your knee pain started to limit you once you can walk freely without pain.
These could include actions performed in the community, such as crossing a busy street or boarding and disembarking from an escalator. Returning to leisure or sports activities takes a different amount of time for each person; your physical therapist will be able to give you an estimate based on your specific condition. Activity-specific training. Depending on the demands placed on your knee by your job or the sports you participate in, you may require additional rehabilitation that is tailored to your job activities such as climbing a ladder or sports activities such as swinging a golf club.
Your physical therapist can create an individualized rehabilitation plan for you that takes into account all of these factors. If you have knee pain, working with a physical therapist to improve the strength and flexibility of the muscles that support and move the knee may help you avoid surgery.
This training may even enable you to avoid surgery entirely. Participating in a physical therapist-designed exercise program can be one of your best defenses against knee injury.
Additionally, staying physically active in moderately intense physical activities and maintaining a healthy weight through proper nutrition may help to reduce the risk of osteoarthritis of the knee worsening.
Although all physical therapists are trained and experienced to treat people who have a TKR, you may want to consider:. Prepare to describe your symptoms in as much detail as possible during your first visit with the physical therapist, as well as what makes them worse. Total knee replacement surgery is typically performed when a person suffers from one of the following conditions: Osteoarthritis, rheumatoid arthritis, other bone diseases, or a fracture that has not responded to more conservative treatment options Knee pain or leg alignment issues that make walking or performing daily activities difficult, despite more conservative treatment options Physical therapists are movement experts who use hands-on care, patient education, and prescribed movement to improve people's quality of life.
How Can a Physical Therapist Help? Acetaminophen Tylenol and Non-Steroidal Anti-Inflammatory Drugs NSAIDS like ibuprofen and naproxen can be bought at local drug stores to be used for pain relief; however, please talk to your physician before using these. Pain reduction as swelling improves and range of motion improves.
Return to your prior functional level or better. Day Of Surgery Day 0 Perform deep breathing exercises:. Follow their instructions closely regarding how and when to begin putting any form of weight on your knee. Criteria for Progression to the Next Phase of Knee Rehabilitation You are able to contract your quadriceps and perform straight leg raises with minimal pain.
You gain reasonable range of motion with your new knee. You can bear weight and walk at least ft with assistance. Training Phase Day 4 — Week 16 During this time period after your hospital stay, you will most likely be going to outpatient Physical Therapy and Occupational Therapy to continue your rehabilitation after surgery.
In addition to the above exercises, below are some exercises you can do at home to continue helping your therapy. Remember to ice your knee 20 minutes before and after therapy sessions or performing exercises. The goal of occupational therapy is to improve function in activities of daily living for example, learning how to move yourself around your house, your bathroom, getting into and out of a car, etc. Petterson et al. An intensive functional rehabilitation protocol produced better outcomes than a standard rehabilitation protocol 4 months and 6 months after TKA for the 6MW 8.
Evgeniadis et al. In contrast with these results, Levine et al. Valtonen et al. However, only knee extensor and flexor power remained significantly different between groups months after TKA.
Piva et al. Similarly, Liao et al. In contrast to these findings, Fung et al. Rajan et al. Furthermore, Mockford et al. Other authors have found that home-based and clinic-based rehabilitation protocols generated similar improvements in WOMAC score, knee rating scale, second stair test, 6MW, and knee flexion room 12 weeks and 12 months following TKA.
Similarly, subjects enrolled in a telerehabilitation program that was remotely supervised by a physical therapist obtained similar improvements in WOMAC, 22 , 24 knee ROM, 22 , 24 Berg balance scale, 24 second chair rise test, 24 TUG, 22 , 24 and the Tinetti test 24 compared to a group that attended standard rehabilitation.
These results were maintained 4 months after discharge from physical therapy. Although quadriceps weakness is a hallmark characteristic of OA, there is a precipitous decline in strength the first few weeks after surgery.
This was highlighted in the report by Petterson et al. ROM in subjects in both progressive strengthening arms was excellent and three months after TKA, subjects had degrees of knee flexion and nearly full extension.
TUG times were approximately 8 seconds. There was no difference between progressive strengthening and standard of care groups in self-reported functional ability or knee ROM, suggesting that self-reported measures capture different domains of disability than do performance-based tests.
This discrepancy has been substantiated by several others who have found that performance-based tests are driven by muscle strength and self-report questionnaires are driven by pain.
Johnson et al. The control group received progressive strengthening exercises based on the protocol published by Stevens et al. To ensure progression, exercise and vibration amplitude and duration were systematically increased. Similar improvements of extensor strength, pain level, and TUG time were found between groups after 4 weeks of treatment and subjects in the experimental group did not report any adverse effect of vibration exercises.
The vibration group had degrees of total range of knee motion, which was 10 degrees more than the exercise group, but neither group demonstrated significant improvements relative to pre-operative values. The authors suggest that whole body vibration may provide a valid alternative to traditional strengthening exercises after TKA, but these findings must be substantiated in larger trials with longer-term follow-up.
The accuracy of equivocal or non-superior findings from a study with such a small sample size 16 subjects , no long-term follow-up, and no a priori power analyses is questionable until corroborated by additional evidence. Moffet et al. The protocol involved 12 therapist-supervised sessions duration of minutes with individualized home exercises executed on the days without supervised treatment. The IFR included a warm-up, specific strengthening exercises, functional task-oriented exercises, endurance exercises, and cool-down period.
Seventy-seven subjects were randomized to either receive IFR or usual care. The authors only reported that 10 subjects in the control group received home rehabilitation services after TKA, but did not describe the exercises or progression that occurred in that group. One year after surgery, there were no significant differences between the groups and only All subjects were enrolled in standard inpatient rehabilitation that lasted days, but one group underwent a home-based exercise program for three weeks prior to surgery that focused on strengthening the trunk and upper body.
The control group received no additional therapy, while the third group underwent eight weeks of home-supervised exercises to strengthen the lower extremity.
Active ROM of the knee and functional ability measured using the Iowa Level of Assistance Scale were collected during the 10 th and 14 th weeks after the surgery. Ten weeks after surgery, patients enrolled in the postoperative exercise program presented with greater range of motion both flexion and extension and better functional ability compared to the preoperative exercise and control groups. Fourteen weeks after surgery, the postoperative exercise group had significantly greater knee ROM compared to the other two groups.
At this time point, knee ROM values were: The authors concluded that only a postoperative exercise program is effective at restoring knee ROM after surgery, although no group in this study averaged more than degrees of knee flexion 14 weeks after TKA. In a non-inferiority randomized trial of 70 subjects, Levine et al.
Subjects were randomized to receive supervised physical therapy that included range of motion ROM and strengthening exercises or home-based treatment that included NMES and ROM exercises. No cost analysis was performed. Six months following surgery, the Get Up and Go times of both the experimental and control groups were These values were greater took longer to complete the task than other published reports examining NMES.
At the same time point, the experimental and control groups of the study by Stevens-Lapsley et al. Experimental and control groups of the study of Petterson et al. These slower times from the subjects by Levine et al.
Quadriceps strength, the impairment targeted by NMES, was not evaluated. Post-operative, progressive exercise programs improve outcomes to a greater extent than postoperative care that does not include elements of muscle strengthening. The results from both randomized arms of the study by Petterson et al. Subjects in the study by Moffet et al. Although subjects in exercise group in the study by Evgeniadis et al.
Although the post-operative group was supervised, it was performed at home. It is possible that the poor outcomes in the exercise group are a consequence of the environment in which the rehabilitation was performed. Without use of resistive equipment and modalities that are commonplace in a physical therapy facility, at-home exercise programs may not provide optimal outcomes.
The studies by Petterson et al. Proponents of water-based rehabilitation protocols argue that exercising in warm water may reduce the stress on the joint and allow the individual to strengthen their lower extremity using water as resistance while taking advantage of the weight reducing effects of buoyancy.
However, water-based rehabilitation may increase the per-session cost and there have been few cost-effectiveness or comparative effectiveness studies assessing aquatic therapy in a post-surgical TKA population. Using principles of buoyancy may be most effective in the early stages after TKA when pain or muscle impairments limit the ability to perform resistance exercises in weight bearing positions.
Liebs et al. These authors also revealed that subjects randomized to start water-based therapy on the 6 th postoperative day had better WOMAC, SF, and Lequense Knee scores 12 and 24 months after TKA compared to subjects who were randomized to start aquatic therapy on the 14 th postoperative day. While these results were not statistically different between group, the effect size of the intervention on WOMAC score range 0.
The change in WOMAC score also exceeded the minimal clinical important difference cut-off 24 months following surgery. However, these authors used only self-reported measure of function and did not compare the outcomes of aquatic based therapy to other land-based rehabilitation paradigms.
Fifty subjects were randomized to either an aquatic program in which progressive strengthening exercises were performed in the pool or were advised to maintain their usual physical activity level. At the end 12 weeks of training, subjects in the experimental group had better knee flexion and extension power, greater cross sectional area, faster self-selected walking speed, and faster stair ascent time compared to control subjects.
No differences between groups were detected in relation to cross sectional area, walking speed, and stair ascent time at the one year follow-up.
This exercise program may expedite recovery and be more advantageous to subjects early after TKA, although future work should be conducted to explore this possibility. In contrast, Harmer et al. Both groups attended therapy twice a week for 6 weeks and each session lasted for 60 minutes. The same therapist supervised both water- and land-based treatment and the exercise prescription was highly standardized to ensure that the only difference between treatment groups was the medium water versus land.
Subjects were evaluated 8 and 26 weeks after TKA and there were no differences between groups for WOMAC score, knee range of motion, 6MW, and stair climbing power, although both groups demonstrated significant improvement compared to baseline.
The authors concluded that water-based therapy was not particularly advantageous with respect to functional outcome or clinical metrics, although it may be a valid alternative treatment for rehabilitation after TKA.
Balance is a critical impairment in patients with TKA and persistent muscle weakness.
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