TKA - Prehab
You are scheduled to have your total knee replacement (TKA) but you have to wait a month or so before you can have it. If you’re like me, you’ve already begun to plan and are wondering what you can do to “stack the deck of cards in your favor”. According to the most recent physical therapy clinical practice guidelines published by the APTA, it is strongly recommended that patients begin a preoperative exercise program with both strengthening and flexibility based exercises. They found improved knee flexion (bending) and extension (straightening) values at 1 to 3 months post op. Furthermore, gains in functional measures used to determine your overall recovery were also improved as compared to patients that did not have preoperative therapy.
There are some basic strengthening and flexibility exercises you can do from the comfort of your bed to begin to achieve exactly what many studies have proven beneficial. Not only will you improve your odds of a successful recovery but you will improve your overall physical condition, muscle function/awareness, and you will be aware of some exercises you will be required to do following surgery. I will list the exercises below, but for even further detail you can follow this link: my-exercise-code.com and enter this code: 8L26H5V
A quadset is the foundation of regaining control of your leg. It is one of the first exercises you will do after surgery and an important one to master to advance with the rehab process. In order to perform a quadset, your leg should be in a neutral/straight position while laying on your back. The goal of the exercise is to squeeze your thigh muscles on the top of your leg and hold for a few seconds. No actual movement should occur with this exercise and you should see your thigh muscles tighten up. As always, this exercise should be performed in a pain free manner and discontinued if you are unable to perform it without pain.
Short Arc Quad
A short arc quad (SAQ) is another basic exercise that you will likely perform directly after surgery. This exercise again focuses on quadriceps strengthening but allows for movement. To perform a SAQ, you will again lay on your back but you will need a rolled up pillow/towel or a bolster placed under your knee. To perform this exercise, you again tighten the top of your thigh but then lift your heel off of the ground. The back of your knee should remain in contact with your rolled up pillow/towel at all times. As always, this exercise should be performed with minimal pain and discontinued if it makes your knee pain worse.
Heel slides are another common exercise that will help you maintain or improve your ability to bend your knee. This exercise may be difficult due to general stiffness that has been caused by either arthritic changes or swelling/pain. Again only perform this exercise to your tolerance and do not cause additional pain. To perform this exercise, you will lay flat on your back and use a belt or piece of rope to assist with bending your knee. You should place the belt/rope just under your toes and keep your heel in contact with the ground at all times. Further be sure to keep your leg in a straight line as you bend your knee (do not allow for your knee to move inward or outward as you bend). A gentle stretch is usually felt at the knee joint and relieved once you return your leg to a rested/straight position.
Straight Leg Raise
A straight leg raise is another exercise that will help to prepare you for a total knee replacement. Again this exercise focuses on quadriceps strength but is a little more intense than the exercises above. Be sure to only perform this exercise if able to do so with minimal-no pain. To perform this exercise you will lay flat on your back with the opposite knee bent allowing your foot to be rested on the ground. You will start by tightening the front of your thigh (performing a quadset) and then lifting your whole leg upward to the level of your opposite bent knee. It is important to maintain a straight leg throughout the whole lifting motion. Also be sure to slowly lower your leg in a controlled manner to the starting position with every repetition.
The above exercises are only the beginning with regards to exercise prior to surgery. A good rule of thumb is to monitor your symptoms throughout independent exercise and perform each exercise with minimal to no pain. Other tools may also be used to assist with pain during the "prehab" period such as Kinesio Tape. Again I encourage everyone that reads this post to seek additional information and guidance from a physical therapist to perfectly prescribe exercises/treatments to your needs. In the next blog post we will discuss TKA outcomes and expectations. Stay tuned!
Jake Miller, PTA