Recovering Faster After a Total Knee Replacement
As a Physical Therapist, I hear it all the time. “My friend Jim got a total knee replacement and is already back playing golf in a month.” So, you decide to get the surgery. Immediately afterwards you are feeling sore, stiff and having a difficult time moving around, getting out of bed, and just walking in general. You are surprised that it’s this difficult after the surgery. Your friend made such a quick recovery. “Why am I in so much pain? Why am I having such a hard time moving around?”
In my professional career, I try to educate first. Yes, you can make a speedy recovery! However, there are controllable and uncontrollable factors involved. Let’s talk about the uncontrollable factors first.
You can’t control your doctor’s performance during surgery so it’s best to spend some due diligence asking the right questions. Does this physician do several knee replacements? What are their results like? In this technology age, you can also Google your Doctor and see what Healthgrades ranks him or her. From there, meet with the Doctor and hopefully he or she educates you on what to expect during the surgery. More importantly, they should inform you on the steps needed for a fast recovery after surgery. Make sure you are comfortable with the doctor you choose. Don’t ever be afraid to get a second opinion on surgery. Also, make sure you research where you will be going for Physical Therapy. As a patient, you have many options on where you would like to go for therapy, taking into consideration your insurance, location and reputation of the clinic. Most importantly, it is critical to have a Physical Therapist rehabilitate your knee who has manual therapy training.
Another uncontrollable factor is your current health status. How healthy are you? Do you have a heart condition? Are you active? Are you in good shape physically? Do you have any other medical conditions that can slow your recovery? Examples include diabetes, autoimmune disease, respiratory problems, other orthopedic surgeries previously like total hip replacement or arthritis in your other knee. These are all important factors to consider and ultimately will affect your timeline of recovery. Once a patient sees me after having surgery, I can determine typically how quickly this patient will recover in the first visit.
There are also many controllable factors that contribute to the recovery time after surgery. A patient’s family or social support system is extremely important for recovery. Also, how motivated a patient is to get better, can move recovery time up significantly. I always explain to a patient on the first visit, “If you want to recover quickly, it is imperative that you are motivated to do what it takes. That means work hard and do your HEP (home exercise program).” This is crucial. If the patient is motivated enough and does what they are told by the Therapist, then that is a giant step to getting better quickly.
So, what kind of exercises are common? We will do specific stretches like heel slides. Also, we will do knee flexion stretches over the table assisted by the opposite extremity. Another important one is key strengthening exercises like quad sets, straight leg raises and short arc quads. In Physical Therapy, I believe it is important to have a hands on approach that is critical to reducing scar adhesions and soft tissue restrictions which will free up the knee and allow it to move with more ease and less stiffness. If the patient is compliant with attendance and comes 3x/week while also doing the HEP at home at least 2x/day, then a fast recovery is more likely.
WIth a knee replacement, Physical Therapists perform aggressive stretching and myofascial release and scar mobilizations which is when the Therapist tries to break up scar adhesions. This is usually very uncomfortable for the patient, but also necessary to restore full motion in the knee. During a first visit, it is important for patients to be educated that they may feel an uncomfortable sensation when doing Physical Therapy after a knee replacement but it is so critical for a quick recovery.
As cliche as it may sound, “Short-term pain for long term gain.” This is one of the few times I use this phrase with patients when considering all the various diagnoses and medical conditions I have treated over the years. So, when you hear about a friend’s recovery time following knee surgery, please consider there are so many factors that go into a speedy recovery.
Author: Avi Bregman, PT, MPT