Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 90: Months 4 to 12 After Knee Replacement: What Nobody Tells You (The Months That Surprise Almost Everyone)

Transcript

Episode 90: Months 4 to 12 After Knee Replacement: What Nobody Tells You (The Months That Surprise Almost Everyone) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  If the thought, I guess this is good as it's
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  going to get, starts showing up, it may help
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  to ask whether the specific ability you want
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  has actually been trained. That distinction can
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  point to a next step without assuming that every
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  symptom can or should be fixed through more exercise.
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  Are you ready to get back to what you love after
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  knee replacement? The Total Knee Success podcast
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  is your trusted guide with practical tips, evidence
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  -based strategies, and no fluff. It's not personal
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  medical advice, just solid education to help
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  you manage pain, regain mobility, and get back
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  to living the life you love. Let's dive in. Welcome
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  back to the Total Knee Success podcast. I'm Michelle.
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  If you're somewhere between four months and a
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  year after your knee replacement, this episode
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  is for you. By the end, you'll have a clearer
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  picture of what can still change during this
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  stage. What may still need your attention and
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  why being past the operation doesn't tell you
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  whether you've reached the strength and activity
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  level you want. The first few months after surgery
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  usually have a clear purpose. You're working
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  through swelling, regaining motion, rebuilding
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  enough strength for daily activities, and becoming
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  more independent. Appointments, exercises, and
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  visible milestones give the process structure.
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  Then that structure begins to fade. You may finish
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  physical therapy. See your surgeon less often,
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  and notice that people have stopped asking you
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  how your knee is doing. Life starts looking more
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  familiar again. That return to a more familiar
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  routine is welcome, but it can leave you unsure
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  of what comes next. You may be driving, shopping,
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  working, and moving around your home without
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  thinking about every step, while stairs still
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  take more effort than you expected. Your operated
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  leg may tire sooner than your other leg, and
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  longer walks may still feel awkward. From the
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  outside, you may appear to be doing very well,
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  while a few important activities still feel unfinished.
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  As daily life becomes more normal, the question
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  becomes less about getting through surgery and
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  more about what you'd still like your operated
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  leg to help you do. For one person, basic errands
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  may be enough. Someone else may want to work
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  a full shift, walk through an airport, handle
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  stairs more easily, return to the garden or get
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  back on the golf course. There's no single goal
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  that fits everyone. Total knee surgery can reduce
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  arthritis pain and create the conditions for
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  better function, but it doesn't automatically
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  rebuild strength, balance, or endurance. You
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  now have an opportunity to continue building
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  strength, function, and capacity around your
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  new joint over the next several months. After
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  preparing for surgery and working through the
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  demanding early weeks, it's easy to ease off
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  just as the next phase begins. The work you've
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  already done still counts. and the next phase
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  can focus on the activities you want your leg
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  to handle after your total knee surgery. Instead
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  of thinking, am I finished? A more useful question
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  may be, what do I still want my leg to be able
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  to do? The answer may involve walking farther,
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  managing stairs with less effort, returning to
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  work, travel, or getting back to an activity
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  that you enjoy. Once you identify a specific
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  activity, your strengthening and activity program
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  has a reason to keep evolving. And this is often
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  the point when the challenge begins to drop.
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  You may finish physical therapy and become less
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  consistent with the exercises because walking
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  around the house feels fairly easy. Ordinary
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  daily activity may be enough for the life you
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  want, but when the activities you value require
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  more strength, endurance, balance, or control
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  on uneven ground, those abilities may still need
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  focused work. Time allows your knee and symptoms
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  to continue changing, but time alone does not
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  progressively strengthen your quadriceps. Strength
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  develops when your muscles are asked to handle
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  an appropriate challenge, while endurance builds
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  as activity increases in manageable steps. Balance
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  can also improve through practice that's appropriate
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  for your current ability and safety needs. Your
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  program also does not need to stay frozen at
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  the exercises you were given during the first
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  six weeks. Early on, getting your knee moving,
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  standing safely, and walking through the house
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  may be major accomplishments. During months 4
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  through 12, exercise choices are often more useful
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  when they address whatever still limits the activities
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  you want to do. Strength may still be limiting
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  you if stairs or rising from a lower chair take
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  considerable effort, or if your other leg continues
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  to do more of the work during a sit -to -stand
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  movement or stepping up the stairs. You may walk
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  a reasonable distance and still feel weak when
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  your operated leg has to control more of your
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  body weight, because level walking and higher
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  demand tasks do not require the same amount of
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  strength. Walking can look fairly good before
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  strength fully catches up. On level ground, your
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  body can use rhythm, momentum, shorter steps,
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  and compensation strategies to keep you moving.
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  But stairs, curbs, low chairs, and controlled
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  lowering ask more from your quadriceps. Going
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  downstairs can be especially revealing because
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  your quadriceps must control your body weight
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  while your knee bends. That's why you may walk
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  through the grocery store fairly well. and still
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  feel shaky stepping down from a curb after a
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  long bout at the store. That difference can simply
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  mean you've not built the next layer of strength
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  yet. Endurance may be a bigger limitation for
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  someone else. Your knee can feel reasonably good
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  for the first 20 or 30 minutes on your feet,
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  but then your whole leg becomes tired and your
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  steps shorten. In that situation, focusing only
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  on knee motion or repetitions in one exercise
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  may miss the larger problem. A gradual plan for
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  longer periods on your feet or farther walking
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  may be more relevant, provided the increase does
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  not cause a large or lasting rise in symptoms.
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  Balance or uncertainty may be the main issue
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  instead. You can cross your living room without
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  thinking about it, yet grass, gravel, crowded
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  places, and quick changes of direction still
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  make you feel cautious. For pickleball, hiking,
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  dancing, or walking heavy vacations, You may
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  need gradual practice with the specific conditions
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  that still feel difficult. Use appropriate support
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  or professional guidance, for example, a physical
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  therapist, when needed. A date on the calendar
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  is not a functional finish line. Four months
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  does not automatically mean you should be able
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  to do everything. Six months does not automatically
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  mean improvement is over. And one year does not
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  automatically tell you how strong, active, or
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  capable you can become. The calendar tells you
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  how much time has passed. It cannot measure how
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  much capacity you've built or what may still
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  be possible with appropriate work. This is really
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  an opportunity to go the distance and to get
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  even stronger so you can get back to doing the
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  things you want to do. Research shows that people
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  follow different paths after total knee replacement.
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  What someone reports about their function also
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  does not always match how they perform on walking
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  tests, stair, or chair tests. and higher demand
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  activities may continue to expose weakness, endurance
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  limits, or movement strategies after basic walking
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  has improved. And that's okay. That variation
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  is another reason your month six cannot be judged
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  by someone else's month six. The point is not
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  that everyone should keep pushing harder. It's
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  that your activity has to give your body a reason
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  to adapt if you want it to progress. If your
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  routine stays exactly the same every day, your
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  body becomes more efficient at that routine.
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  And that's great. It has no reason to build significantly
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  more strength or endurance than the routine requires.
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  And you don't need dramatic workouts or hours
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  in the gym. The challenge simply needs to match
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  the activity you want. Easier stairs may require
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  more leg strength and step control, while an
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  hour of walking on vacation calls for gradually
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  increasing walking tolerance. Returning to golf,
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  gardening, hiking, pickleball, or a physically
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  demanding job may require practice that begins
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  to resemble the actual demands of that activity.
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  I commonly talk to people about when they're
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  returning to work that they progressively increase
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  their activities at home before that first day
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  begins and I've had people report back to me
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  that that really made a difference for them.
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  The key word though is gradually. More is not
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  automatically better and one exhausting day is
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  not the same as progressive training. The human
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  body usually responds better to repeated manageable
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  challenges than to random bursts that leave you
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  significantly more swollen, sore, or tired for
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  several days. And useful work is work you can
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  repeat. A few well -chosen exercises performed
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  regularly may do more for you than a long list
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  that is rarely completed. And a walking program
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  that increases intolerable steps is generally
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  more useful than repeatedly testing the farthest
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  distance you can manage. The examples that follow
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  are general education, not a personal exercise
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  prescription, and I'm not your physical therapist.
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  A podcast can't determine which exercises or
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  activity levels are appropriate for your knee,
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  your health history, or your current abilities.
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  Your surgeon or physical therapist can certainly
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  help you make those decisions if you'd like help
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  with them. Strength is one area that may still
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  deserve attention. Quadriceps weakness can remain
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  after walking looks fairly normal and may show
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  up on stairs, curbs, lower chairs, or controlled
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  lowering. Progressive resistance could include
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  sit to stands, step -ups, controlled step -downs,
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  leg press, knee extension, or other exercises
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  selected and progressed for your needs and abilities.
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  The name of the exercise is less useful than
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  knowing whether it is appropriate for you and
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  provides enough challenge to support change.
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  Walking is useful, but walking and strengthening
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  are not interchangeable. Walking can build endurance
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  and general activity tolerance, yet it may not
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  provide enough resistance by itself for more
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  demanding tasks. If walking is part of your plan,
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  consider whether the distance, pace, surface,
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  and duration still match what you want to prepare
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  for. Changes should be gradual and tolerable
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  rather than based on proving how much you can
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  do in one day. That might be fun, but usually
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  the next day is not so fun. Your balance may
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  deserve direct attention as well. Practice could
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  begin near a stable support and might include
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  a narrower stance. Supported single -leg balance?
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  stepping over small obstacles, changing direction
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  or walking on different surfaces. The challenge
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  needs to match your current ability and safety
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  needs. Always be safe with this. If you feel
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  unsteady or have a history of falls, get individualized
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  guidance instead of experimenting alone. It's
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  always great to have someone there when you're
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  working on your balance too. As those abilities
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  improve, the way you perform a task can reveal
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  whether your other leg is still taking over.
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  You may shift away from your operated leg when
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  you stand from a chair. pull heavily with your
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  arms on stairs, or turn your body when stepping
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  down. And those strategies can be useful early.
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  If they continue, a physical therapist can help
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  determine whether strength, motion, pain, balance,
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  or habit, among other things, is driving the
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  pattern and whether it's appropriate to change
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  it. Connecting exercise to an activity you care
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  about can help you choose what to train. Walking
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  through the zoo with your grandchildren, standing
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  long enough to cook a holiday meal, returning
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  to work, gardening, traveling through an airport,
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  playing nine holes of golf or 18, or attending
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  a concert, all place different demands on your
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  operated leg. The activity itself can point toward
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  a need for more walking tolerance, stair strength,
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  balance, or practice with a particular movement.
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  Day -to -day symptoms can still vary with sleep,
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  swelling, activity, stress, and fatigue. A difficult
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  day doesn't erase the ability you've built so
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  far. Sometimes that's hard for people to conceptualize.
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  A difficult day does not erase the ability you've
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  already built. The larger pattern is more useful.
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  Tasks may require less effort. You may need less
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  support or you may stay active longer before
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  fatigue changes the way you move. Those changes
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  can be gradual, but they count. In fact, I would
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  argue that they tend to count more. New or rapidly
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  worsening symptoms deserve medical attention.
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  Still, contact your surgeon or another appropriate
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  medical professional promptly for a sudden major
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  decline, a new inability to bear weight, significant
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  instability, or signs that might indicate infection
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  like increasing redness or warmth, new drainage,
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  persistent fever, and seek medical attention
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  for new calf pain or a large unexplained increase
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  in swelling. Seek emergency care for new shortness
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  of breath or sudden chest pain. If a persistent
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  limitation is not changing, despite a reasonable
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  plan, an individualized evaluation can help identify
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  what's driving it. Between months 4 and 12, the
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  work often changes from doing exercises because
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  you had surgery to building abilities that support
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  the life you want to live. You can finish formal
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  physical therapy while continuing to work on
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  strength, balance, and endurance. In fact, ask
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  your therapist for how to progress your program.
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  One or two activities may still need focused
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  attention even when you're doing well overall,
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  and that's not evidence that you're behind. It
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  may simply show that basic daily function returned
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  before your higher demand abilities did, and
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  that's usually how it happens. The early phase
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  gave you a foundation. What you build on it can
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  be connected to your priorities, whether that
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  means easier daily activities, a return to work,
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  more family time, more travel, recreation, or
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  something entirely different. It's really up
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  to you. If the thought, I guess this is good
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  as it's going to get, starts showing up, it may
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  help to ask whether the specific ability you
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  want has actually been trained. That distinction
• 13:54
  can point to a next step without assuming that
• 13:57
  every symptom can or should be fixed through
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  more exercise. Your next step does not have to
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  be dramatic and it does not require hours of
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  exercise every day. It rarely requires all of
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  that. It may mean gradually asking a little more
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  from your muscles. a little more balanced exercise
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  or endurance at a level your body can tolerate
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  rather than waiting for the calendar to do the
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  work. If you're already doing that great job,
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  keep going. The work may look less dramatic than
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  it did during the first few weeks, but it can
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  still support the activities you want your operated
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  leg to handle. For more practical guidance during
• 14:34
  this stage, join the Total Knee Success Insider
• 14:37
  newsletter. Each week I share new podcast episodes,
• 14:40
  clear explanations, and additional resources
• 14:43
  to help you understand what you're experiencing
• 14:45
  after knee replacement. You can sign up through
• 14:47
  the link in today's show notes. And if walking
• 14:50
  still feels awkward or less natural than you
• 14:52
  expected, my book Walking Like Yourself Again
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  After Knee Replacement may help. It explains
• 14:57
  why walking can continue to feel different after
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  the early months and offers practical strategies
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  you can discuss with your physical therapist
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  or use when appropriate for you. You can find
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  the book through the link in the show notes.
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  In the next episode, we're going to talk about
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  something that catches a lot of people a little
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  off guard, having a bad day after you thought
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  things were going well. We'll discuss why those
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  days can happen, what they may mean, and when
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  a change puts the usual ups and downs versus
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  when it may deserve a closer look. Thanks for
• 15:28
  joining me. I'm Michelle, and this has been the
• 15:30
  Total Knee Success Podcast. This podcast is for
• 15:37
  educational purposes only discover more at total
• 15:40
  me success calm and be sure to subscribe and
• 15:43
  share Because every step forward takes you closer
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  to living the life you love