Fresh Double Knee Replacement

[ivey]

I have a lady coming in on Friday who had a double knee replacement about 7 weeks ago. I talked with her last night, and her doctor has released her from therapy because she has full range of motion, or at least as much as they want them to have. I tested her on a leg press that we have that has a pretty light leverage, and she did okay. She was able to press at decent depth with both legs and singly without much problem.

I'm just curious if anyone has some ideas for exercises that I should be working on with her. I was thinking of using the press, shallow step-ups for now, and light leg extensions.

And also for after training therapy...should she ice, NSAIDs, etc?

[kuri]

Has she gone through PT? Talk with her therapist and they will give you suggestions on what is appropriate - and find out what kind of knees she got as it does make a difference as to range of motion.

Some newer models have a near 130 degree range while some have less.

I'm working with a dbl knee replacement person now (had it done 6 months ago) and have her doing low step downs (was doing this in PT), glute bridging variations, ball squats, band extensions but am staying away from machines.

[UConnJulie]

Yea ... I'd avoid machines ... but you can do all the things you would do with a regular client with modifications. For example, RDLs, bodyweight squats to parallel (if able) - single and double leg, step ups (start with 4" and progress upward), step downs (eccentric control is very important and often very weak), hill walking up and down forward and backward, sidestepping or really any resisted gait. If you have access to a cable machine with adjustable height and a waist belt, have them walk forward, backward, and both sides against resistance. Lunge progression (focus on dipping down not forward and might only start with partial range). Basically anything that the person is going to need to do in "life". Lots of single leg balance stuff too as balance is often off after surgery due to replacement of the joint surfaces and thus loss of sensory input. Find out what activities they want to get back to and work from there.

Another thing you can do is call the surgeon and ask if he has a protocol for that far out from surgery. Some do, some don't.

Most likely, they will not be able to kneel and will otherwise only be limited by motor control (the ability of them to consciously control their muscles) and range of motion.

Hope that helps.

[ivey]

Originally Posted by kuri

Has she gone through PT? Talk with her therapist and they will give you suggestions on what is appropriate - and find out what kind of knees she got as it does make a difference as to range of motion.

Some newer models have a near 130 degree range while some have less.

I'm working with a dbl knee replacement person now (had it done 6 months ago) and have her doing low step downs (was doing this in PT), glute bridging variations, ball squats, band extensions but am staying away from machines.

Yeah..she did therapy, but they released her when she reached the range of motion they wanted her to reach. She said their standard was 110 degrees, and she reached 130 on one knee and 125 on the other.

Thanks for the input, guys...it definitely helps. I've worked with knee replacements before, but nothing this fresh. She's very leery of movement right now, and I had to talk her into trying the step-ups. Anything where she's not seated makes her nervous. She said that her left knee feels "looser" and not as stable. I'll just have to work on building her confidence.

[UConnJulie]

If her knee feels unstable the thing that will fix that is increased strength.
Explain to her that low step ups are no different than climbing stairs. RDLs are no different than bending to pick up her newspaper/laundry/dropped pen. Make that functional connection for her and it should help alleviate her fears. Also, back wayyyyy off on intensity. Make it easy for her at first to build confidence. Then progress to more difficult. Always start with something she CAN do. Even if it is machines. But don't base her workout solely around machines. And build that bridge for her so she can see functionally where she is and where she needs to be.

[ivey]

Okay...so my lady is doing really well. Her strength is increasing as is her range of motion. She went back for a follow up with a PA and told him that she was working with me and described some of the stuff she was doing, and he told her it was good, but to make sure that her knee doesn't pass the line of her toe.

Now...I know this is bad information for a normally functioning knee, but what about for someone with a knee replacement? My instinct is that this is the same bad information applied by a PA that doesn't know any better and that he'd give that info to someone with normal knees as well. But I wanted to make sure that we're okay here.

[UConnJulie]

Could be, but also the knee coming in front of the toes does put increased compressive forces through the patellofemoral joint. If that component was replaced during her surgery, it would make sense that they would want to minimize that.