3. Physical Therapy

 
“Opportunities don’t last forever - start preparing for your recovery now”
 

Prehab and Why It Matters

Exercising the knee joint before surgery, is referred to as prehab in contrast to exercising the knee after surgery, which is known as rehab. Prehab is important for two reasons. First, the quality of the knee before surgery is the best predictor of the quality of the knee after surgery. The more you can do to improve the state of the knee and surrounding tissue before undergoing TKR, the more you will be helping yourself to a successful recovery. Second, because healing begins immediately after surgery, it is important to start exercising the tissue that has been impacted by surgery as soon as possible. Knowing what to do and how to do it makes it easier to begin your rehab routine. While you might not have the endurance you had pre-surgery, you’ve already climbed that learning curve.  Furthermore, stronger muscles can exercise longer without fatigue, increasing the benefits of exercise during this critical early period of recovery.

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Don’t let current demands on your time become an obstacle to preparing for your recovery

 
 

The recommendation that you need TKR is not a surprise in most cases, since your uncooperative knee has probably been a limiting factor in your life for some time. Do not expect, however, that a trip to the hospital to replace the knee will, in and of itself, solve all your problems. As stated throughout this article, “knees are not plug and play”. The decline in the condition of the knees over time created additional stresses on tendons, ligaments, muscles and fascia surrounding the knee joint. This increase in pressures and subsequent decrease in movement likely resulted in the formation of restrictions and adhesions in leg tissues. Unless treated during prehab, these legacy restrictions could cause you additional pain and discomfort during rehab and impact your recovery. Since you will be visiting a PT on an out-patient basis after surgery, it would be well to establish that relationship before surgery. Ask your PT to evaluate the state of your leg and advise on how best to prepare for what lies ahead. Just be mindful of the fact that you may only have a limited number of visits covered by your insurance and act accordingly.

Prehab goals include selecting a PT, treating legacy adhesions that may have developed due to trauma or stress, stretching and strengthening leg muscles and arranging for a period of limited mobility. The first set of prehab exercises that I’ve described in Prehab Exercises prepares patients to deal with the limited mobility that will follow surgery. In addition to practicing with crutches (to insure the patient has sufficient upper body strength to use them), the patient should anticipate the need for changes in how he/she will get dressed, sit down and stand up, get into and out of cars, lie down, take a shower and go up and down stairs. The exercises below will help the patient prepare for other adaptations.