In part 1 of my prehab blog series I will discuss what I think is the most important things to consider and what has brought me to that conclusion. I will then follow that up in subsequent blog posts with specific exercise suggestions. In the final part, I will discuss what challenges I faced in relation to all this, and what I did to combat that and stay mobile / prepare for surgery.
Maintain Range of movement
I put this at the top of the list because my consultant surgeon, his assistant and the hospital based physiotherapists all told me that you never get back more ROM than you have before your surgery. Therefore, it’s important to keep as much flexion as you can.
I didn’t lose all that much in all honesty, probably because I am hypermobile anyway and my joints already flex more than they should! This looks comical now when I straighten both legs! The left still hyper-extends whereas the right extends to zero degrees, like it should, and cannot go any further due to the design of the implant!
Maintain strength
This can be the most challenging one of all. Pain can prevent some types of exercise most traditionally used to strengthen quads and ham strings (the two muscle groups most affected by total knee replacement surgery). However, quad strength is of major importance post surgery as this muscle is usually partially cut in order to get to the knee joint, therefore takes some trauma and is still required for you to be able to lift your leg and do your flexion exercises (which, if missed run you the risk of losing ROM permanently).
On the flip side, ham strings tend to suffer major bruising post total knee replacement because the route of the lymphatic system, which is responsible for removing waste fluids from the muscles, are at the back of the knee.
These two muscle groups work in conjunction with each other, to flex and extend the knee. They are the two that will cause you most pain post op, so keep them as strong as you can pre-op.
Develop good balance
I found after the op that the other leg was doing SO much work to not only hold me up, but prevent me from falling back down again that balance as well as strength was incredibly advantageous for me. I have always had good balance and flexibility, but as the right knee worsened this clearly got worse on my right side. So, as a personal trainer I would demonstrate everything with the other side. I used to take flexibility classes and we included balance in those. I could balance / pose in ways many found super hard, as long as I was doing it on my left leg!
Then I thanked my lucky stars that I could do this after the op because I honestly think it majorly helped my mobility in those early weeks.
Improve upper body strength
Because, quite frankly, those arms / shoulders will be holding / levering you up and around for quite some time post op! You will need to be able to lift yourself up from a multitude of surfaces using your arms and just one of your legs! I still need both arms to get up from my sofa, because its quite squishy and low, and I am now almost 3 months post op!
You might want to assess the seated surfaces in your house at this stage, some people say a recliner is helpful. I didn’t buy anything extra, I just used additional cushions so I was sitting higher, used crutch handles and a multitude of other surfaces as levers and of course, my strong, nimble well balances other leg!
Get regular massage
This might seem unconventional but seriously, it kept me nimble and walking in straight lines until my op date. I was getting them 2 weekly, then as things worsened, I increased them to 1 weekly. I honestly do not think I could have carried on working right up till my op if it was not for the massage. Make sure it is deep tissue massage and make sure that the therapist is qualified and knows that you are having a knee replacement.
At 3 months post op, the difference is incredible. While I was limping, I was getting regular massage as it was causing me back pain, but 3 months out I am now all good and back to 1 x monthly maintenance massages!
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**Coming up in part 2: specific exercise suggestions based on my personal experiences of what a pre surgery knee feels like and what I found possible.**
Knee Replacement Resource 