Needing a Knee Replacement? What to expect…

After knee replacement - physical therapy at Hampton PTby KRISTIN KEAFER DPT, Hampton Physical Therapy

Osteoarthritis is a degenerative process over time where the cartilage at the ends of your bones starts to “wear and tear”. Many different joints throughout your body may be affected with age related changes and the knee joint is commonly a symptomatic area. This involves the break down of cartilage at the end of the femur (thigh bone) and the end of the tibia (shin bone). Typically, an x-ray and a severe decline of your daily function will determine if you are in need of a joint replacement surgery. In the United States alone, 4.7 million individuals (3.0 million women and 1.7 million men) were with a total knee replacement in 2010.2 Signs that you may be ready for a knee replacement are significant swelling around the knee, tenderness, stiffness, pain with inability to straighten knee, deformities such as knock- knee or bow legged, and severe functional limitations. Physical therapy is the first line of defense to address pain and function, however if conservative methods are not working, it may be time for a joint replacement. All non-surgical treatments will be exhausted before moving forward with a surgical intervention. This can be discussed with both your physical therapist and your doctor.

What is a knee replacement?

The worn cartilage at the ends of the bones are surgically removed and replaced with a combination of metal and plastic implants. Typically, a knee replacement will last up to 20 years, however this can vary based on wear and tear of the components placed. In some cases, the doctor will only replace one side of the joint called a uni-compartmental replacement because the other side of the joint is still healthy. In these cases, the surgery is quicker, hospital stay is shorter, and rehabilitation process is faster.

Pre-Operative Treatment

Pre-op knee replacement - physical therapy at Hampton PT

Usually, your surgeon will refer you to physical therapy for pre-operative treatment prior to your knee replacement. Research indicates that it can improve early post-operative pain and function.1 A physical therapist will evaluate your range of motion at your knee, your strength, and your overall function with daily activities. This will further justify need for the surgery to your insurance company and will allow the therapist to work with you to increase strength and range of motion as much as possible to improve your post-operative outcome.

Pre-operative treatment is unique in the fact that you can meet with your therapist prior to undergoing your surgery to ask any additional questions and learn more about the rehabilitation part of this journey. Many of the range of motion and strength exercises that are prescribed to you before surgery will be similar to those after surgery. This always helps to make you feel more comfortable with what to expect.

Post- Operative Treatment

After surgery, typically you will spend 1-2 days in the hospital. You will work with a physical therapist in the hospital who will help you out of bed and start moving. They will show you how to use a walker or crutches and they will give you some exercises to work on while you are in bed. It is important to move after surgery to avoid a DVT (blood clot). Your plan for discharge depends on how functionally limited you are and what your home situation is like. Sometimes you will be discharged directly to home, and other times you may go to a skilled nursing facility if you need more help after surgery. Once at home, a physical therapist will come to your home to help you. As soon as you are able to safely leave your home, you will transition to outpatient physical therapy for continued rehab.

Outpatient rehab… this is where Hampton Physical Therapists’ are essential in this process!

Post-op knee replacement - outpatient physical therapy at Hampton PT

You should expect your therapist to be working hands on to reduce swelling and pain in the early stages. We also help to properly transition you off of a walker, crutches, and/or a cane to return you to normal walking mechanics. Manual stretching is implemented to improve your range of motion into flexion (bending the knee) and extension (straightening the knee). You will be given exercises to work on in the clinic and at home. It is imperative that you work as a team with your therapist to reach the best outcome. Gradually the focus will transition from range of motion exercises to strengthening exercises to improve all of your functional activities.

Post-op knee replacement - outpatient physical therapy at Hampton PT, Hampton NHBelow are guidelines for reaching functional goals post operatively to get you back to living a normal life!

Reaching Your Goals!

Day 1- 2 weeks
0 degrees of extension and 65-90 degrees of knee flexion. You will be able to stand, walk, go up and down stairs with assistance. Decrease swelling and keep pain under control!

2- 6 weeks
0 degrees of extension and greater than 90 degrees of flexion. You will be able to walk without an assistive device, sit and stand more comfortably, and do stairs with minimal support.

6-12 weeks
0 degrees of extension and 115 degrees of flexion or better. You should be able to move around normally, bend down to pick things up, sit comfortably, stand for longer periods, and tie your shoe laces.

12+ weeks
0 degrees of extension and 115-135 degrees of flexion. The first 90 days are definitive in your recovery. You should have little pain and be able to do most daily activities with ease. You will be working towards walking longer distances and getting back to normal life.

Range of Motion Milestones

0 degrees of extension to walk normal without a limp
65 degrees of flexion to walk on even surfaces
70 degrees of flexion to lift an object from the floor
85 degrees of flexion to climb stairs
95 degrees of flexion to sit comfortably and to stand up from being seated
105 degrees of flexion to tie shoe laces comfortably
115 degrees of flexion to squat or sit cross legged comfortably
135 degrees of flexion to get into and out of a bath tub without limitation

Hampton Physical Therapy is here to help with your journey before and after joint replacement surgery! Please contact us at either our Hampton or Seabrook office with any additional questions or to schedule a FREE discovery visit!

Resources

    • Li Wang, et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016; 6(2): e009857. Published online 2016 Feb 2. doi: 1136/bmjopen-2015-009857
    • Maradit Kremers H, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am.2015 Sep 2;97(17):1386-97. doi: 10.2106/JBJS.N.01141.
    • Rowe PJ, et al. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture.2000 Oct;12(2):143-55.

Is losing your balance normal as you age?

By ALLISON GARVIN, DPT

At some point we start to notice things are not quite as easy as they used to be. Reactions feel slower, standing on one foot feels like an acrobatic trick, and changing positions requires a moment to regain our orientation. There are multiple reasons for these changes, and we have the opportunity to get ahead of them right now! Our body’s balance is determined by three systems, the vestibular system, the visual system, and somatosensory system. Throughout our lives our body relies on different systems to create stability. Here’s why.

From infancy to approximately 3-6 years of age, we depend highly on vision, as this system develops and matures first.1 Our eyes have the goal of staying in line with the horizon, and if our vision doesn’t show us this, we know something is “not right” and our body will physically try to correct to reorient the image.

Children learn and gain stability and strength in their environment by exploring, sometimes falling, and making mistakes. What may seem clumsy in young age between the ages of 4 and 7 is actually a developing proprioception system. 2 Proprioception is the feeling in your joints. They tell us if we are in alignment, if there is abnormal pressure, or if we are in need of stepping to regain our balance. By 7 years old this proprioceptive system is most dominantly relied upon.2 However, at this young age, if we are to challenge ourselves with uneven surfaces or a narrow base of support, vision is again depended upon.

The last component of our balance system, the vestibular system, matures between the ages of 15 and 16.3,4 Our vestibular system is made up of a series of small bones and organs in our inner ear that tells via the movement of fluid in the inner ear where we are in space with relation to gravity. The vestibular system is very important, as when we experience a conflict in information (such as when your car is not moving, but the car next to you starts pulling forward or backwards), this is the system that corrects our experience and tells us what movement is truly happening.

As we age, neurons in our brains used to communicate information about our body’s special position lose dendrites (communicating branches), myelin sheaths (nerve coating that increases signal speed) degrade, cilia in the ear become damaged, and different pathologies including diabetes, neuropathies, unilateral vestibular hypo function, etc. can exponentially negatively impact all 3 systems.

The good news is, we are not helpless in this scenario! Numerous studieshave demonstrated the benefits of staying physically active as we age to improve our central nervous system (brain and nerves) as well as our muscle spindle function. In fact, a study by Duke- NUS Medical demonstrated that a tailored physical therapy routine for balance and gait challenges reduced patients’ risk of falls by 50%.6 What we can learn from this is that YOU have control over your balance and safety, and physical therapy has been scientifically proven to help you achieve reduced fall risk and improved mobility.

If you are concerned about your balance, Hampton Physical Therapy is here to help. Call for an evaluation. We can get you scheduled ASAP!

  1. REFERENCES
  2. 1 Lear S. Pediatric Balance Assessment. BA Audiology.org. https://www.baaudiology.org/files/2114/5796/1722/1430_Samantha_Lear.pdf. Accessed January 4, 2020.

2 Sá CDSCde, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study. Brazilian journal of physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816079/. Published 2018. Accessed February 10, 2020.

3 Cherng RJ, Chen JJ, Su FC. Vestibular System in Performance of Standing Balance of Children and Young Adults under Altered Sensory Conditions – R. J. Cherng, J.J. Chen, F. C. Su, 2001. SAGE Journals. https://journals.sagepub.com/doi/10.2466/pms.2001.92.3c.1167. Accessed February 10, 2020

4 Ralli G. Maturation and evolution of the vestibular system. GiovanniRalli. http://giovanniralli.it/allegati/108/aging .compressed.pdf.

5 Ribeiro F, Oliveira J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity. 2007;4(2):71-76. doi:10.1007/s11556-007-0026-x.

6 Keeping the Elderly Safe. Science Daily. March 2017. https://www.sciencedaily.com/releases/2017/03/170316093025.htm.

Sitting for long periods of time during Covid-19?

<a href="https://www.freepik.com/free-photos-vectors/people">sitting image above by freepik - www.freepik.com</a>by KATE SERODIO, DPT

Does Pre-Covid-19 seem like forever ago?  We’re now in week 4 and many of us are feeling like it’s been an eternity.  We no longer have our luxury at work desks, chairs, and routines.  But instead we’re left in our personal homes with our new work stations consisting of high top stools, a recliner, the couch, kitchen table, or your home office chair which you’re sure is the reason you’re now having some weird pain/sensation on the outside of your leg.  To make our working conditions even more complicated many of us have children that interrupt you with every other thought.  In fact, this tiny paragraph took me an hour to write secondary to the constant interruption and demands of the children’s online learning and my newly appointed position of Head of Homeschooling.  I miss the day when I had no idea what a zoom meeting was! 🙂

We are all on the struggle bus together!  We have no idea how long this ride will be but hopefully we can get off at the next stop, May 4th, right?  In the meantime, I’d like to help you with a simple adjustment you can make to help you get rid of your back or leg pain and or prevent it from ever happening.

Many of us, including myself, are experiencing sciatic pain.  Sciatic pain can present itself in many ways.  You could have pain anywhere from localized to your back to all the way down your leg to your foot.  The pain could be mild to severe and present itself as numbness, tingliness, burning or a pulling/tight feeling.  Nerves are complicated and don’t always make sense.  But if they’re starting to talk to you it’s very important that you don’t ignore them as they will soon become very angry and make sure you have no choice but to listen.  Anyone that has had a severe case of sciatica knows what I’m talking about.

So, what can you do to keep your back and sciatic nerve happy?

Above is a video I made, showing you 3 tIps on things you can change immediately in your home office or living room! (ALSO EXPLAINED BELOW)

TIP #1 Sit on a wedge or pillow: this increases the angle at your hips and decreases the neural tension on your sciatic nerve.  Sitting at a 90deg will actually put more pull/strain on the nerve.  The goal is to have your knees lower than your waist putting you more into a standing position vs sitting.  You should feel an immediate relief in your back and if you have any leg symptoms going on they should also be reduced or completely eliminated.

TIP #2  Don’t sit so long!  Set a timer for 20minutes.  Or drink so much water that your bladder puts you on a timer.  Your body isn’t meant to be in any one position for longer than 20minutes.  You’re asking for trouble if you go beyond this time.   Get up and move/change positions or how about you stretch!

TIP #3  stretch? Yes, one the best things you could do for your back to prevent constant disc bulging from sitting is to do the opposite of what you’ve been doing for the past 20+minutes.  Yes, stand up and simply arch backwards.  Repeat 20x

STAY SAFE & HAPPY!  We are open if you need us… just call!

(image of woman sitting image above by freepik – www.freepik.com)