Is your knee giving you problems?
Total knee replacement is an orthopaedic surgery that involves removing a problematic joint and replacing it with an artificial joint. Problematic joints include joints that are painful, swollen and stiff especially in the mornings and after you have been sitting for a while.
These symptoms usually arise because of osteoarthritis in the knee, which is inflammation in the joint. When you feel these symptoms, it is a normal response to try and avoid it by not moving. So you stop moving over a prolonged period, your muscles get lazy and consequently there is a reduced muscle strength in your leg muscles.
Along with decreases in your muscle strength, swelling and stiffness in the knee further drastically reduces the ability to perform the tasks that you enjoy or that are required in your daily life to remain independent.
To read more on osteoarthritis and pain management provided by Cilliers & Swart Physiotherapy click here.
Why you need a Biokineticist
Exercise, if applied in the right manner can prevent osteoarthritis and delay total knee replacement surgery. Additionally corrective exercises strengthen the joint before you go for your scheduled surgery and it also helps to rehabilitate the knee joint after your knee replacement surgery.
We know that you are struggling to walk up and down the stairs, struggling to sit down and stand up from the chair, you might even struggle to just get out of bed. Stop limiting those activities you love to do like hiking, running, cycling, gardening, playing with your kids or grandchildren. We can and want to help you! Our biokinetics practice is here to assist and guide you in dealing with your daily knee struggles.
Our aim is to prevent you from having a possible knee replacement. We can still assist you even if your doctor told you that you have to go for a total knee replacement.
How do we do this?
Biokineticists evaluate your pain level, strength, movement ability, balance, quality of movement and possible weakness in your joints and muscles. We take your results and we give you exercises specifically to strengthen the muscles around your knees, hips and ankles to improve your movement ability and quality.
The exercises will be adapted to you to minimize the pain you experience. These exercises form part of your ‘prehab’ treatment and will not be normal gym exercises but rather specific movements done in a specific manner to bring about healing, stronger muscles and improved movement abilities.
We are with you every step of the way, testing your physical abilities and showing you your progressions. The exercises are adapted to your limitations, needs, pain and preferences. Additionally, we liaise with your orthopaedic surgeon and other healthcare providers to ensure we provide a holistic approach to your healing.
How can you avoid osteoarthritis?
Osteoarthritis is inflammation in the bone and joint cartilage. It is known as a “wear & tear” condition where the joint experiences degeneration over the years. However, there are many risk factors that may lead to a person developing osteoarthritis:
- Joint injuries
- Mechanical stress
- Neurological conditions
- Other inflammatory conditions
- Sometimes even certain medications
The symptoms related to knee osteoarthritis cause us to avoid using and moving the knee. Which results in your leg muscles becoming weaker and weaker as time goes by and daily tasks just seem unbearable. Eventually, all of this together leads to knee replacement surgery.
The way to combat this loss of muscle strength and ability to do daily tasks is to engage in something called prehabilitation. Prehabilitation, or prehab refers to when someone engages in an exercise treatment program. Prehab aims to prevent injuries before the actual occurrence, reduce the risk factors of osteoarthritis as well as strengthen the knee joint and muscles around the joint. And ultimately prevent the diagnosis of osteoarthritis.
We focus on your muscles and bones and look at how they are functioning. You receive exercises and goals and we work together so that you can enjoy your life without osteoarthritis. Our medical background allows us to see beyond just exercising but to also guide you in everyday activities and lifestyle behaviours so that you can have the life you want to have. Maybe you think you are too young to start preventing osteoarthritis. But research shows that by the age of 35 our muscles and bones start to get weaker. Weaker bones and muscles increases your chances of having osteoarthritis. So, it can never be too early to see your Biokineticist for the prevention of osteoarthritis.
What if you already have knee osteoarthritis?
This is where we assist you! We can and want to help and guide you to deal with your pain and struggles. The answer is to intervene with a prehab exercise treatment program. Our biokineticist evaluate the severity of your osteoarthritis and give you guidelines on how to do certain activities that you need to do on a daily basis.
We show you ways that make it easier and less painful to do daily or sport specific activities. Our focus will be on helping you use the right muscles for the right tasks. You will know what movements to avoid so that you prevent pain from increasing.
The goal is to strengthen the muscles around your knee joint to reduce the stress you experience on the knee. By strengthening your knee joint you will prevent further damage and degeneration. Which will ultimately reduce your risk of having to go for a knee replacement surgery. Why wouldn’t you try a conservative approach for your knee health before spending a great deal of money. We want you to have a normal, healthy and functional knee!
How to prevent or delay a knee replacement surgery?
The main reason for knee replacement surgery is osteoarthritis. So, the primary way to prevent a knee replacement is to prevent knee osteoarthritis. However, a secondary way to prevent or delay a knee replacement surgery is by managing your risk factors and taking part in a prehab program.
Already have a knee replacement in mind or scheduled?
Prehab can also be a form of conservative treatment. When a patient engages in an exercise treatment program before they undergo an anticipated orthopaedic procedure such as the total knee replacement.
The prehab exercise programs focus on improving the strength in your leg muscles. Which will assist you when completing daily tasks such as climbing stairs, gardening, cleaning the house and shopping. Additionally prehab can be implemented in people who participate in sport and has experienced many injuries. It also focuses on correcting poor movement habits, balance, preventing falls, walking and freedom of movement in the joint.
This is important to know. Because the physical limitations you have now – will not be completely resolved after your total knee replacement. The surgery replaces only the painful joint and not the working muscles surrounding the joint.
We need these muscles and other soft tissue structures in and around our knee joint. They need to function optimally so that we can move pain free, with confidence and with as little physical limitations as possible. Therefore stronger, better-conditioned muscles, tendons and ligaments will reduce and better distribute the joint forces during movement. And ultimately reduce the pain in the knee joint. You will have improved functioning of the knee during everyday tasks as well as activities you love to do.
Prehab allows you to go into the surgery with increased leg muscle strength and improved capabilities of completing daily and sport activities, so that you will be able to come out of surgery – A step above the rest! Your treatment is not only limited to better physical outcomes but also translates to greater psychological readiness to get back to movement as there is greater confidence in the ability of your knee.
Benefits of prehab
Prior to surgery
- Improved leg strength of up to 50%
- Greater ability to perform functional tasks of up to 30%
- Improved post-operative recovery, as research shows performance before surgery is a significant predictor of performance after surgery
- Better range of motion / flexibility & mobility
- Building the confidence you need to use the replacement joint properly when learning to walk and move again
- Reduced costs
- Less recovery rate & time
- Improved physical functioning / functional task performance
- Improvements in walking speed, sitting down and standing up form a chair, stair climbing
- Prehab exercise programs improve the initial post-operative outcomes
- Reduced postoperative pain
- Improved strength in leg muscles
- Decreased length of hospital stay and a faster recovery
- Meet your outcome expectations after surgery
- Likelihood of discharge to a long-term rehab facility decreased
How long does the rehabilitation process take after your surgery?
This is a very good question but one that does not have a definite answer as it differs from person to person. Generally you will receive physiotherapy after your surgery. This is to assist in the initial pain management and to restore your range of movement. About week 12 post surgery, you should be referred to a biokineticist.
Most people who have to go for a total knee replacement are either scared of the surgery or the recovery process. And end up not going for the surgery. If they do go for the surgery, they do not complete the rehabilitation process. However, we know that those who complete their rehabilitation exercises heals much quicker than those who do not. Not doing your exercises would be a really silly thing to do after all.
But I have a new knee..
You might think you do not need these rehabilitation exercises because you have a new knee. Well, this new knee is only a new joint, but you still have the same muscles and movement patterns that you had prior to your knee surgery. Remember that your muscles are always weaker after your surgery so you need to do those rehab exercises. We also know that those who participate in prehab treatment – exercise prior to their surgery have even better results after their surgery. Their recovery process is quicker and yields much more benefits than those who did not participate in prehab.
But I can walk..
Walking is an achievement after your surgery but it is not the only exercise you should be doing. Also, doing too much walking can cause your knee to swell, increase your pain and even slow down your recovery. That is why we are here to guide you and show you to do the right exercises and amount of exercise. Biokineticists are exercise scientists so we show you exactly what exercises to do. We start with the easy ones at first and as soon as you show progression we guide you on how to progress these exercises at the right time.
But I still have pain..
We also know that you might have some pain because of the surgical procedure and you should be taking your prescribed medicine during your rehabilitation period. Not taking your medicine as prescribed can result in you having more pain than you should have. More pain results in less movement which ultimately slows down your recovery process. You need to move and exercise those muscles if you want to get back to living your life to the fullest.
Frequently Asked Questions
Before we start with your prehab exercise program, you come in for an orthopaedic evaluation at the biokinetics practice.
This is essential in order to get your medical history and to evaluate your knee’s flexibility, mobility, strength, functionality and movement quality.
A safe prehab exercise program is prescribed and tailored based on your unique needs, evaluation results and any other medical condition or medication that must be considered.
As soon as possible. If you want to prevent osteoarthritis or if you already have osteoarthritis. And at least 6-8 weeks prior to a scheduled orthopaedic surgery.
The prehab program structure depends if you are preventing or managing osteoarthritis and may include:
- Easy warm-up
- Cardiovascular component (exercise that increases breathing & heart rate)
- Strengthening exercises
- Sport specific activities (accelerating, decelerating, jumping, turning, landing etc.)
- Functional tasks (sitting down on a chair, standing up from a chair, climbing up and down stairs, gardening and cleaning the house)
- Balance exercises and
- Stretching exercises, appropriate for the individual and their medical history.
It is advised that you complete at least one of the prehab exercise program sessions at the biokinetics practice. This will be in the form of a one on one session. The supervised one on one session allows the biokineticist to ensure that you are completing the exercises in a safe and correct manner. It allows for adaptation or alteration during the session to ensure that you have as little pain as possible.
The prehab exercise program can be adapted to a home or gym based program if you cannot do the supervised one on one sessions at the biokinetics practice.
Working with a Biokineticist during this time is key as each patient can express any concerns or questions regarding their rehabilitation and may assist in improving motivation and program adherence to the ultimate benefit of the patient.
Generally, the prehab exercise program needs to be completed three times per week. But this may vary between patients and the severity of osteoarthritis.
The length of the prehab period is very important as the longer you engage in the prehab program, the better your chances are of achieving success. Again, the length of the entire program varies between patients and the severity of osteoarthritis.
Our treatment exercises are not aimed at increasing the pain you already have. With our knowledge base in exercise medicine, we can tailor the prehab exercises to your unique needs in order to reduce your knee pain while still acquiring gains in strength, flexibility and ability to do tasks.
You will not be expected to engage in any exercises that elicit more pain. And you will not be expected to lift any heavy weights or run! We will continue to communicate pain levels during the prehab exercise session to ensure that you are experiencing as little pain as possible.
Our prescribed exercises are guided by medical research and will assist you with your pain and difficulty moving. There are a few ways that we can assist you so that you will still be able to engage in the prehab exercise program even if you have knee pain.
We adapt the amount and frequency of the prehab exercise program. Although the amount and frequency will be low initially, it will be sufficient for making your muscles stronger and help you move better.
You may continue with your prescribed medication during the prehab period. You will need to inform your biokineticist of your medication and the manner in which it is prescribed for you. Taking the medication is important for pain management and we will not ask you to stop taking it.
Individuals with this severe form of osteoarthritis may decide to go for a total knee replacement if they have no significant relief provided by at least 6 months of conservative exercise treatment in combination with medication or if their day to day activities just seem impossible to do anymore.
The final decision to undergo this procedure should be a cooperative one between you, your family and the multidisciplinary team. This includes your orthopaedic surgeon, physiotherapist, biokineticist and other healthcare specialists.
- Severe osteoarthritis diagnosis
- Failed rehabilitation of at least 6 months of conservative treatment in addition to medication
- Severe knee pain or stiffness that limits your everyday activities such as walking, climbing stairs, and getting in and out of chairs
- Severe knee pain while resting during the day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications, cortisone injections, lubricating injections or other surgeries
- Knee deformity such as bowing in or out of your knee
- History of repetitive injuries at the knee joint
- Long distance runners and other athletes struggling with knee problems
- Rheumatoid arthritis