Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 99: Returning to the Gym After Knee Replacement (How to Rebuild Strength Without Guessing What Is Safe)

Transcript

Episode 99: Returning to the Gym After Knee Replacement (How to Rebuild Strength Without Guessing What Is Safe) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Your old program, if you had one, was built for
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  an earlier version of your body. Your starting
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  point now should reflect what you can control
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  today. Are you ready to get back to what you
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  love after knee replacement? The Total Knee Success
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  podcast is your trusted guide with practical
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  tips, evidence -based strategies, and no fluff.
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  It's not personal medical advice, just solid
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  education to help you manage pain, regain mobility,
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  and get back to living the life you love. Let's
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  dive in. Welcome back to the Total Knee Success
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  podcast. I'm Michelle. Returning to the gym after
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  knee replacement can bring a new set of questions.
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  You may have finished formal physical therapy
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  or you may be close to finishing and the familiar
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  structure is changing. In therapy, someone selected
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  the exercises, watched your form, adjusted the
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  load, and helped you decide when you were ready
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  for the next step. At the gym, you're surrounded
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  by machines, benches, weights, and bicycles,
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  but choosing where to begin is now up to you.
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  By the end of this episode, you'll have a general
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  framework for returning to gym training. We'll
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  look at how exercise choice, load, and range
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  can change at exercise. how symptoms may guide
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  adjustments, and questions that may help you
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  choose an appropriate starting point. This episode
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  provides general education, not an individualized
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  gym program. If you have restrictions, complications,
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  significant balance concerns, or questions about
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  whether an exercise fits your situation, check
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  with your surgeon or physical therapist before
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  using it. Rehabilitation and independent training
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  serve different purposes. Rehab is designed around
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  specific impairments and functional goals. Your
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  physical therapist may be training you or helping
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  you improve knee bend, quadriceps activation,
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  walking, stairs, balance, or movement that might
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  be limiting you. Independent gym training has
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  a broader purpose. It helps you continue developing
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  strength, endurance, balance, and physical capacity
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  after the most supervised phase of your rehab
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  has ended. Many people return to the gym before
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  their knee or operated leg feels completely normal.
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  Many people return to the gym while their knee
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  still feels stiff at times. Their operated leg
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  remains weaker or certain movements are not yet
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  smooth. Current research shows that people often
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  report meaningful improvement in the first few
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  months after total knee replacement, while performance
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  -based function and strength may follow a slower
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  or more variable course. That's one reason continuing
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  to train can be extremely useful. The surgery
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  changes the joint. It doesn't automatically rebuild
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  every muscle or restore every physical skill.
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  If you've reached the point where returning to
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  the gym is an option, great job. Getting this
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  far took time and effort, and you can continue
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  building from here without rushing the next step.
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  Kudos to you for making this excellent health
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  decision. Remember, your starting point may need
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  to be modified after a complication with another
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  joint problem at the heart or lung condition
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  when balance is limited or while post -operative
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  restrictions remain. Permission to return to
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  the gym does not mean every machine, movement,
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  range, or load is appropriate for you. Any remaining
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  restrictions should guide the movements, machines,
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  ranges, and loads you first use. When you first
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  walk back into the gym, resist the urge to recreate
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  the workout you used years ago. Your old program,
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  if you had one, was built for an earlier version
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  of your body. Your starting point now should
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  reflect what you can control today. That may
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  mean fewer exercises, less resistance, a smaller
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  range, and longer rests than you remember. None
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  of these choices make the session less valuable.
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  They make the information from the session easier
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  for you to interpret and make a change for the
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  next session. Machines and free weights can both
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  be useful. A machine guides the path of the movement
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  and often provides a stable seat or vac support.
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  That can make it easier to focus on one pattern
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  without also managing a weight through space.
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  Machines can be especially helpful when you're
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  rebuilding confidence, or working one leg at
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  a time, or learning how your knee responds to
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  resistance. The limitation is that the machine
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  decides much of the path. Its seat, pivot point,
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  and range may not fit everyone's body. A machine
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  can feel awkward even when the exercise itself
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  is appropriate. Many machines allow the seat
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  and starting position to be adjusted before resistance
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  is added. Because the fit varies by person and
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  by machine, An awkward or forced position is
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  a reason to stop and ask a trained gym staff
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  member for help, rather than pushing through
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  it and causing pain. Free weights allow more
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  freedom and can resemble daily tasks, but they
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  also require more balanced coordination and control.
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  Holding dumbbells during a squat, split stance,
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  or step up changes the task immediately. You're
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  not only moving your legs, you're controlling
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  the weight, your trunk, and your position in
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  space. Free weights may be a later progression
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  for some people and an early option for others
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  who already move confidently. Proteovascular
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  equipment can provide a useful entry point. A
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  stationary bicycle may be quite familiar from
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  the rehab visit and allows repeated knee motion
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  without the impact of walking. Seat height changes
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  how much your knee bends. A higher seat usually
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  requires less bend, while a lower or closer seat
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  requires more. For many people, a seat position
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  that promotes smooth revolutions without lifting
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  the hip or forcing your knee is a useful starting
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  point. Resistance is often kept light during
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  the initial trial so you can observe the movement
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  and symptom response before considering progression.
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  A recumbent bicycle offers a wider seat and back
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  support. A lot of times it's more comfortable.
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  Some people feel more secure there, especially
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  when balance or standing endurance is limited,
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  and if you're sitting on a tall seat of an upright
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  bike, can feel a little bit like you're up high
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  and sort of out there. The position may also
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  make getting on and off a little bit easier.
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  I know sometimes I'll have someone step up on
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  a stool before they get onto a regular stationary
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  bike, and that's not always available at a gym.
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  Treadmill walking can be useful when you already
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  walk safely on level ground. Many people use
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  a slower pace while becoming familiar with the
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  moving belt. For some people, a treadmill can
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  increase fall risk and it can be especially challenging
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  when the moving belt is unfamiliar. For this
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  reason, I usually recommend walking on a track
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  or predictable outdoor surface for most people
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  early on, unless the treadmill is their regular
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  exercise of choice and they were quite used to
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  it before surgery. The rails can help with getting
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  on and off and using them during walk for a little
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  bit of balance. But if you're blocking and relying
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  heavily on the rails, that may change your posture
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  and make it harder to judge whether the speed
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  is actually manageable for you. If you're unsure
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  whether treadmill walking is appropriate for
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  you, I encourage you to talk with your physical
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  therapist for this one. An elliptical reduces
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  the repeated foot strike of walking, but it requires
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  balance, coordination, and enough heat and hip
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  motion to follow the machine's path. It is not
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  automatically easier because it feels smooth.
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  In fact, it can be a surprisingly challenging
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  cardiovascular workout for many. Begin only when
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  you can on and off it safely and choose a short
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  trial before increasing resistance or duration.
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  A rowing machine combines knee bend, hip motion,
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  trunk control, and some pulling exercise with
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  the arms. The sliding seat can require more deflection
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  than you'd expect, and fatigue may lead you to
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  push too far forward. Now, rowing can be appropriate
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  for some people, but it's not a required part
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  of a successful program. Foot position and slide
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  lengths change the amount of knee bend required,
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  and many people begin with a shorter, controlled
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  slide and adjust it as their emotion and comfort
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  allow. Be careful when getting off the machine.
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  The dismount may require a significant loaded
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  knee bend at a time when the soft tissues around
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  your knee have already been stressed by the exercise.
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  I know someone who injured their knee this way
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  after knee replacement, so the dismount deserves
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  as much attention as the exercise itself. Strength
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  training is where many people become unsure,
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  especially around the leg press and the extension
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  machine. The leg press trains the hips and knees
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  together. It can be a useful way to practice
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  producing force through your legs while the seat
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  is supporting your body. Your foot position,
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  seat angle, depth, and resistance all change
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  the demand. Many people begin with a range in
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  which their pelvis, knee, and ankle remain controlled
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  and their heel stays in contact with the platform.
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  Depth and resistance can change the demand considerably
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  and a deeper press is not automatically more
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  useful initially. A gradual progression also
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  makes it easier to judge how your knee is responding
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  to each exercise session. The knee extension
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  machine trains the quadriceps more directly.
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  Some people have heard that this machine should
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  never be used after knee replacement, and that's
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  a bit too broad. Knee extension exercise is used
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  in rehab and research because the quadriceps
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  are central to walking, rising from a chair,
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  and controlling stairs. The important questions
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  are whether knee extension exercise fits your
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  current stage and any restrictions, what range
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  and resistance are appropriate, and how your
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  symptoms respond. The hamstring curl works the
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  muscles behind the thigh. It may be performed
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  seated, lying down, or standing, depending on
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  the equipment. Machined fit and movement control
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  can change how a hamstring curl feels. The pad
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  and pivot often need to be adjusted before resistance
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  is added. Calf raises support walking and push
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  -off. Many people begin with both feet and stable
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  hand support. As strength improves, the range
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  can increase or more of the work can shift to
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  one leg. Squats do not have to begin deep or
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  with a barbell. A sit to stand from a firm bench
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  is one functional example of a squat pattern.
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  A higher surface reduces the amount of knee bend
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  and force required. Possible progressions include
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  changing the surface height, slowing the lowering
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  phase, adding resistance, or shifting more work
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  toward one leg. Changing only one variable at
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  a time makes the effect easier to observe and
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  adjust. Lunges and split stance exercises ask
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  each leg to work differently. They can help with
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  stair function, getting down toward the floor,
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  and controlling forward movement, but they also
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  require balance and knee control. For some people,
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  a supported split squat is a more manageable
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  start option than a walking lunge, which can
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  be quite challenging after knee replacement.
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  Stable hand support, assure stance in a smaller
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  movement range, can reduce the balance and control
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  demands while performing the exercise. Step ups
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  are another practical choice because they connect
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  strength to steer function. Step height, foot
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  placement, direction, and repetitions all change
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  the demand of a step up. Many people begin with
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  a lower step and focus on a controlled ascent
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  and return. Changing only one variable at a time,
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  again, makes it easier to identify which changed
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  caused the response, as you have after the exercise.
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  Hip strengthening is often included in exercise
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  programs after total knee because your hips help
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  control your pelvis and leg during walking, stairs,
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  and balance tasks. Depending on your current
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  ability, that may include standing hip abduction
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  with a band, sidestepping, bridges, or machine
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  -based hip work. Balance practice may be as simple
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  as standing on one leg, your stable support,
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  practicing controlled weight shifts, or using
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  a split stance. Unstable surfaces are not required
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  to make balance training useful. When starting
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  a gym exercise program, choosing the starting
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  load is less dramatic than many people expect.
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  Many people begin with resistance that allows
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  a consistent movement pattern from the first
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  repetition to the last. Breath holding, jerking
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  the weight, unexpected shortening the movement
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  or shifting most of the effort to the other leg
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  can indicate that the resistance that's chosen
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  or the exercise setup needs to be adjusted. A
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  load that looks light can still be appropriate
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  when the muscle is working hard. It can be hard
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  to stay patient when the weight looks light,
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  but control gives you a better foundation for
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  the next progression. Range of motion is another
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  training variable. Many people do not use a machine's
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  full available range on the first day. A controlled
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  starting range may gradually increase as knee
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  bend, confidence, and strength improve. Forcing
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  a larger range while the rest of your body twists
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  around it doesn't create a better movement at
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  all. Speed changes the exercise too. A slower,
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  smooth pace can make it easier to feel the path
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  of the movement and control both the lifting
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  and lowering phases. Moving extremely slowly
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  is not required and not recommended. It may make
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  the exercise unnecessarily demanding and it may
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  be a little more stressful on your joints. Faster
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  movement may have a place later, but momentum
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  and jerking motions can reduce control and shift
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  the work away from the muscles you intend to
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  train. Early on, a deliberate, comfortable, and
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  smooth pace often makes the movement the safest
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  and most effective. So what should your first
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  program include? Rather than choosing a long
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  list of exercises for one session, it can be
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  useful to organize the week around general training
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  categories. Some people strengthen the full lower
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  body twice a week, with at least one to two days
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  of rest between those sessions. People who prefer
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  shorter, more varied workouts may alternate a
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  push day, a pull day, and a rest day. A push
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  day might include a leg press, sit to stand,
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  and calf raises. A pull day might include a hamstring
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  curl, hip hinge exercise, or a rowing machine.
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  The exact exercises can vary, but the categories
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  make the week easier to organize. The exact selection
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  should reflect your goals, your current abilities,
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  and the work you've already done. If you're transitioning
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  out of your formal physical therapy, use your
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  final sessions to work with your therapist on
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  a long -term program. When you're getting into
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  your program, adding every machine at once might
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  muddy the water. If your knee becomes more swollen
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  in the evening after a workout, you will not
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  know whether the problem was the leg press depth,
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  the treadmill duration, the lunges, the extra
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  sets, or the total volume of the session. A smaller
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  program gives you a more useful signal. Once
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  the response is acceptable, add one variable
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  and then observe again. During exercise, many
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  people notice muscle fatigue, warts, or effort.
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  Some may also notice mild discomfort, but its
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  meat depends on the person, the exercise, the
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  time since surgery, and the clinical situation.
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  New, char, increasing, or unfamiliar symptoms
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  should not be dismissed as ordinary exertion.
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  An excessive response may include sharp pain,
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  increasing pain with each repetition, loss of
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  control, new buckling, or a movement that becomes
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  progressively more uneven. Afterward, pay attention
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  to swelling, stiffness, walking quality, and
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  how your knee behaves later that day and the
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  following morning. A mild temporary response
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  doesn't automatically establish whether an exercise
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  was appropriate or inappropriate. It may indicate
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  that the weight, range, repetition, sets, total
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  session volume, or another variable needs to
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  be adjusted. If you're unsure what caused the
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  response or how to change the exercise, talk
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  with your trainer or physical therapist instead
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  of guessing. Repeating an exercise with improper
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  technique can lead to injury. Remember that persistent
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  or increasing swelling, worsening pain, a new
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  loss of motion, repeated instability, or symptoms
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  that do not settle deserve discussion with your
• 16:02
  healthcare team. Sudden chest pain or shortness
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  of breath, requires emergency care, call 911
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  rather than driving yourself. Sudden severe knee
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  pain, inability to bear weight, marked or rapidly
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  increasing swelling, half -pain or swelling,
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  fever, spreading redness, or a new wound drainage
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  also require prompt medical evaluation. Help
• 16:24
  from an exercise specialist can be useful when
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  you're unsure how to adjust equipment, when your
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  operated leg avoids work, when balance limits
• 16:32
  your choices, or when you keep provoking the
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  same response. A physical therapist is an excellent
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  resource for questions about pain, swelling,
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  restrictions, and whether an exercise is appropriate
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  after surgery. A trader with experience working
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  with people after knee replacement can help you
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  learn the equipment and organize your workouts.
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  If walking still feels awkward, uneven, or tiring,
• 16:53
  my intentionally concise book, Walking Like Yourself
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  Again After Knee Replacement, may help you understand
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  why. The link is in the show notes, and you can
• 17:01
  also join the free Total Knee Success Insider
• 17:04
  for practical education and updates. The most
• 17:08
  useful gym program is not the one with the most
• 17:11
  exercises or the heaviest weight. It's the one
• 17:13
  you can repeat, understand, and progress. Keep
• 17:17
  the beginning simple. Let your technique and
• 17:19
  your knees response guide your next step. Over
• 17:22
  time, those sessions can build the strength you
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  need for fall prevention, travel, hiking, cycling,
• 17:28
  and all the activities that make the training
• 17:31
  worthwhile. Next in episode 100, We'll talk about
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  getting back to golf after knee replacement.
• 17:37
  We'll look at putting, chipping, partial and
• 17:39
  full swings, walking versus using a cart, uneven
• 17:43
  ground, fatigue, and how to return to the course
• 17:45
  as a progression rather than one fixed date.
• 17:49
  Thanks for joining me. I'm Michelle, and this
• 17:51
  has been the Totally Success podcast. This podcast
• 17:58
  is for educational purposes only. Discover more
• 18:01
  at TotalMeSuccess .com and be sure to subscribe
• 18:05
  and share because every step forward takes you
• 18:08
  closer to living the life you love.