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This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2022. For the original video go to https://www.youtube.com/watch?v=joOKmnXdMrg&t=365s
Bob: Okay Brad and I have worked with thousands of knee replacement patients over the years and I have found that they tend to make three big mistakes. We're going to talk to you about those.
Brad: Getting the knee replacement isn’t one of them.
Bob: Okay this first mistake Brad, my mother-in-law did this, she went from the walker to the cane, and then to no cane too rapidly. Her knee flared up and she lost motion.
Brad: I'm assuming increased pain with it?
Bob: Right. So, we really want you to be careful in transitioning.
Brad: So oftentimes you'll be with a therapist, and they'll help and guide you, and you say, "Am I ready to go?" And they'll do some balance testing.
Bob: I would err on the side of staying with it longer.
Brad: Right, yep, yep. Be safe.
Bob: Then try it for 15 minutes and see how it is the next day. But don't make the knee worse.
Brad: And of course, it's quite a jump from the walker to the cane and even a bigger jump from the cane to nothing at all. It's a good thing to be cautious with. Before we get going on the three mistakes, we want to let people know that the vast majority of knee replacements do very well. I would say at least 95%.
Bob: Yes, I've seen that stat.
Brad: Yeah, and so we're going through the mistakes. It's going to help you through it. It's not to scare anyone, just to make your positive experience more positive.
Bob: All right the second mistake people make is they are given a whole load of exercises and they don't know where to focus but I tell them to focus on bending the knee and straightening the knee. It's going to get strong; I'm not worried about that. I am worried you might be lacking the straightening, or you might be lacking the bending. So those are the things you want to focus on.
Brad: Right. The first week or two is really important. And that's why we're showing it in bed. Sometimes it's easiest to start here because that's where you are.
Bob: We're using the knee glide here because we think it works really well. And Brad's going to show a flexion on it.
Brad: Right. So, the idea is, you can do it on your bed, you can put something on your bed so that your heel doesn't stick.
Bob: Like a cookie sheet.
Brad: Yeah. Anything to reduce the friction because it doesn’t move as easily without anything. You need something to allow it to move freely. I've got a belt here or a strap, and what I'm going to do is just put it around the shin or if it's long enough to wrap around your foot. And then you can pull. The one thing with a knee replacement is when you're bending it or straightening, that is one-time the pain is okay. You need to break up that scar tissue.
Bob: And I think it helps when you are in control.
Brad: Right. As opposed to being pushed.
Bob: If I'm pushing, they don't let me go as far as when they do it.
Brad: Yeah, you just cannot relax when someone else is inflicting pain on you. That’s true. It's a direct way to say it. So again, we're going to bend it as far as you can stretch it. Then let it go back down. Some therapists will say you need to hold it and stretch it in pain for 30 seconds. I've always had good luck going pressure on, pressure off.
Bob: Yeah, exactly. Now we can roll a towel up and do an extension right here too.
Brad: So, in other words, getting the knee straight. And a lot of people think just bending the knee is important which it is, but getting it straight is equally or sometimes more important. Especially for walking. So, let's say I can't get the knee completely straight. Bob rolled up the towel and put it under my ankle and there's an air gap, and just sometimes relaxing and letting gravity pull the knee down is enough.
Bob: You could sit up too if you want.
Brad: Yeah, if you have a bed that goes up or you're comfortable sitting up that’s fine.
Bob: It will put a little more stretch on the hamstring.
Brad: Then I am going to put a little pressure above the kneecap, you know because you're going to have an incision here. You must be careful and mindful of that particularly early on. And stretch, stretch, stretch. This one's good to put the cold pack on there.
Bob: If you don't have the knee glide, you can just put a towel roll under the ankle.
Brad: Or any kind of comfortable cushion that creates the gap. And then put that pressure down.
Bob: Brad is also going to be doing these same exercises in a seated position.
Brad: Yeah. So, what we need is a slippery surface. You can have a shiny floor with a sock on and you can start to do motion forward and back.
Bob: A lot of people do floor scrubs. If you're on a tile floor, then put a towel down and then slide back and forth.
Brad: If you're on carpet you can use a plastic clipboard or cookie sheet, anything to make it slippery and slide forward and back easier. But we find what works the best is a knee glide again. That's what it is made for and that's why it works well, with very little friction. You can use your other foot to help push.
Bob: That's where it really pays off.
Brad: The unique thing about the knee glide is you can change the angle and that's one thing you cannot do with the towel.
Bob: Right. This could be a lot more comfortable on your ankle and it's going to give a little more resistance to the quadriceps.
Brad: Yep, so you're going downhill here, and as your range of motion gets better it's oftentimes helpful to strengthen that hamstring by turning it around.
Bob: All right, the third piece of advice I like to give to my patients is don't listen to other people, especially other patients. You know, everybody has a Mildred in their life, right?
Brad: Mildred? Who's Mildred?
Bob: Mildred is always the lady who knows a lot more than you. And she’s going to say, well my knee got better in two weeks or whatever. You know, first off that's not true. I mean it probably took a month or two months, but she remembers it that way.
Brad: Some people do really excel fast, but it really doesn't matter.
Bob: Exactly. It's just going to throw you off. I mean if you have two knees done, one is going to be way different than the other. It's always different. You can't predict how it's going to go. It's going to end up good, just give it time.
Brad: Yep, some people get to walking without their cane or their walker within three weeks, others will take four or five or six weeks, and they all end up in the same place in three months.
Bob: Right, they're all happy.
Brad: Absolutely. So really, it's important to stay positive with your rehab.
Bob: Good luck!
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