Knee replacement: Getting back to pain-free living

I see a lot of post-surgical knee replacements in my practice and wanted to write on a blog on what you can expect before and after surgery.  I also wanted to set you up with a few exercises that you can immediately start doing the day after surgery to begin restoring you knee mobility. 

Sometimes prior to surgery doctors will have you do “Prehab”- rehab before surgery.  This can be beneficial as it can prep you with exercises to do on you own before your surgery. If tolerated, it can help build your strength, which may make recovery easier.  You are also going to have to do several pre op visits that may include blood work, going over meds or possibly changing meds and tests to make sure that you are healthy and can tolerate a major surgery.  If you are having issues stabilizing your blood pressure for example, they may not want to perform surgery until this is stabilized.  Once you have been cleared, your doctor will recommend filling your prescriptions and having those available immediately after your surgery.  It is important that you take your medications as prescribed.  Your surgeon will want you to stay on top of your pain-meaning you are able to keep it under control. They absolutely do not want you to ever have to chase your pain. Chasing your pain is when your pain becomes severe and you are having a hard time getting it to come down.  People often overmedicate when this happens and doctors do not want you taking higher doses than they recommended.

Your doctor will also want you to arrange transportation to and from surgery.  Before your surgery, they will discuss how long you will be staying in the hospital. Some surgeons keep you over night, while others discharge you the same day. 

They day of surgery, you will be taken back. Before the surgery, you will meet with your doctor, nurses and your anesthesiologist.  Next thing you know, you are waking in up recovery and surgery is all over with.  If you aren’t released the same day, they will likely have a nurse or physical therapist come into and show you how to walk with a walker.  Once it’s time go home, they will typically wheel you out to your car in a wheelchair and help you get into the car.  Many surgeons also send you home with an ice machine that you will be using regularly the first week or two after surgery.

Once home, you are going to want to find the most comfortable place for you. I’ve found that people tend to prefer the couch or recliner vs their bed.  The first day or two you are going to take it easy. I’ve had patient start therapy as soon as 2 days after surgery. Some surgeons have patients wait a week or two.  From my experience, the sooner you get moving the better off you are.  Getting your knee moving sooner will not only help with mobility and inflammation, but it will help with the pain. 

What makes recovery from a total knee challenging is the pain and stiffness that comes with surgery.  A knee replacement is a major surgery. There is a lot of trauma that happens to the joint as a result of the surgery.  Inflammation, swelling and pain are all expected from the surgery.

When a person feels pain that’s usually our brains way of telling us to stop what we are doing.  People tend to be guarded, fearful and hesitant to move and do exercises because they can be painful.  I can assure you that you are not causing damage to your new knee by moving it.

This is where you have to trust your doctor and therapist when they say it’s okay to experience some pain and discomfort.  When you are restoring range of motion on a joint, it is going to be painful and stiff to push it. If it was easy, you wouldn’t have a medical professional guiding you along the way. Everything should be done in moderation which is why you have a therapist there to guide you through the process.  While some pain is expected, it should never be debilitating pain that lingers for days. Pain meds are going to be a great tool to help with pain in the early stages of rehab and they will allow you to push your knee a little more without suffering significantly afterword. 

To sum it all up, restoring your knee as soon possible will help kick start your recovery and get you one step closer to living a painfree life doing the things you love to do. 

Below are 3 exercises that you can start within days of your surgery.

Seated Heel Prop

This is going to be the best exercise you can do restore your knee flexion. You are going to be spending a large portion of your first few days seated with your leg elevated.  Whether you do this laying down or in sitting, make sure there is nothing direction under the knee to allow gravity to pull the knee into full extension.  You should do this in 3 minute bouts or longer up to 1hour a day. Yes, a cumulative time of 60 minutes.

Seated Knee Flexion

While in a seated position, slide your foot back to a bent knee position. Keep your foot planted on the ground and scoot forward until a stretch is felt at the knee.  You can cross over your opposite leg and push the knee and leg further back.  This will initially be very uncomfortable.  2-3 minute bouts are recommended for 1 hour a day.  60 cumulative minutes as well. 

Bike partial and full revolutions

Bike partial and full revolutions.  I cannot stress how valuable a stationary bike will be with your recovery, not only early on but during your entire recovery and even after. A small desk bike is a good option but a recumbent bike is even better.  This will help aid in restoring knee flexion. You may have to start off doing partial revolutions, using the good leg to push the operated leg into flexion and just going backward to forward until you are able to make a full revolution.  I recommend doing this 10 minutes a day working to two 10 minutes bouts twice a day. 

These exercises are what I do with my patients to help restore mobility along with other variations, ultimately progressing to strengthening and functional movements.  Total knee replacements are one of the most frequently treated areas that Torrez Physical Therapy and Wellness treats.  We deliver your entire course of treatment in your home, one on one with a doctor of physical therapy.  Never worry about being passed off to a less qualified tech to do exercises or splitting therapists time due to other patients being treated at the same time.  Get results faster and get back to doing what you love doing. Give us a call or text at 575-499-4249 to get your therapy scheduled if you are having a knee replacement or knee surgery. 

Yours Truly,

Savannah Torrez, PT, DPT, COMT

“Make progress, not excuses”