Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 118: Exercise After Knee Replacement: Building a Long-Term Routine (Strength, Walking, Balance, and a Plan You Can Keep Using)

Transcript

Episode 118: Exercise After Knee Replacement: Building a Long-Term Routine (Strength, Walking, Balance, and a Plan You Can Keep Using) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  Walking can overlap with aerobic exercise, but
• 0:02
  it's not automatically an aerobic workout. Pace,
• 0:06
  duration, and effort influence how much it challenges
• 0:09
  your heart and lungs. You can work on walking
• 0:11
  as a useful activity without assuming it replaces
• 0:14
  strength or balance practice. Are you ready to
• 0:18
  get back to what you love after knee replacement?
• 0:21
  The Total Knee Success podcast is your trusted
• 0:24
  guide with practical tips, evidence -based strategies,
• 0:27
  and no fluff. It's not personal medical advice,
• 0:31
  just solid education to help you manage pain,
• 0:34
  regain mobility, and get back to living the life
• 0:36
  you love. Let's dive in. Welcome back to the
• 0:42
  Total Knee Success podcast. I'm Michelle. When
• 0:45
  you're going to physical therapy, your physical
• 0:47
  therapist helped organize your program. You had
• 0:50
  appointments, a plan, and a reason for each activity.
• 0:53
  Then those appointments ended. Maybe you still
• 0:56
  have a stack of handouts on the kitchen counter.
• 0:58
  Maybe you remember three exercises really well,
• 1:01
  and the rest have become a blur. When you finish
• 1:04
  physical therapy, your therapist will often give
• 1:06
  you guidance on how to progress as you get stronger
• 1:09
  and more active. That's an important part of
• 1:11
  your plan, but it doesn't always happen. If you're
• 1:14
  getting close to your last therapy appointment,
• 1:16
  ask your physical therapist what progressions
• 1:19
  would be appropriate for you. They know your
• 1:21
  knee, your current abilities, and what you're
• 1:23
  working toward. So what should you actually keep
• 1:26
  doing after knee replacement? You probably don't
• 1:29
  need to repeat every exercise you did during
• 1:32
  the first few weeks after surgery for the rest
• 1:34
  of your life. But you do want to keep working
• 1:37
  on the physical abilities that help you do the
• 1:39
  things you enjoy. By the end of this episode,
• 1:42
  you'll have a better idea of how knee motion,
• 1:44
  strength work, walking, balance, and aerobic
• 1:47
  exercise can fit into a routine you can keep
• 1:50
  using. This is the second episode in our Protecting
• 1:53
  Your Progress for the Long -Term Series. In episode
• 1:56
  117, we talked about choosing the things that
• 1:58
  you want to be able to do. Today, we're putting
• 2:00
  some structure around your routine. This episode
• 2:03
  provides general education, not individualized
• 2:06
  medical advice. Follow your own clinician's guidance
• 2:10
  about movement choices and restrictions. Let
• 2:13
  me introduce Fiona, a fictional listener who's
• 2:16
  had any replacement. Fiona enjoys exploring botanical
• 2:19
  gardens, wants to dance at her granddaughter's
• 2:21
  wedding, and loves browsing outdoor arts festivals.
• 2:25
  She finished her scheduled therapy visits. But
• 2:27
  when she looks at everything she's accumulated
• 2:29
  throughout physical therapy, she wonders how
• 2:31
  she could possibly fit it into her day. Is she
• 2:34
  supposed to do everything every day? That's where
• 2:38
  we'll begin. Think about what you want your body
• 2:40
  to be able to do. Your routine can help you maintain
• 2:43
  and build the physical abilities you need. Strength
• 2:46
  work helps your muscles produce force. You use
• 2:49
  that strength when you climb into a boat, get
• 2:51
  up from a picnic blanket, carry a suitcase up
• 2:54
  a flight of stairs, or walk uphill to a scenic
• 2:57
  overlook. Walking helps you practice moving through
• 3:00
  everyday environments and can also build endurance
• 3:02
  when the pace and duration provide enough challenge.
• 3:06
  Balance practice helps you manage your position
• 3:08
  as you stand and move. That becomes useful when
• 3:10
  you turn, reach, or navigate everyday environments.
• 3:14
  These categories overlap. Walking uses muscle
• 3:17
  strength and balance, and many strengthening
• 3:19
  exercises involve knee motion. But walking alone
• 3:23
  may not provide enough challenge to maintain
• 3:26
  every aspect of strength or balance. That's why
• 3:28
  including different types of exercise in your
• 3:30
  long -term program can help you maintain and
• 3:33
  build your strength, balance, and mobility. That
• 3:36
  variety can fit into a short routine with familiar
• 3:39
  equipment. Before we get into the choices, I
• 3:42
  want to mention the Total Knee Success Insider
• 3:44
  newsletter. It's where I share additional education
• 3:46
  and resources for people navigating knee replacement.
• 3:50
  You can find the sign of information in the show
• 3:52
  notes. Let's begin with knee motion. Your knee
• 3:55
  needs enough bending and straightening for the
• 3:57
  tasks you want to perform. You use that motion
• 4:00
  when you sit, walk, and climb steps. You may
• 4:03
  already get some movement throughout your day,
• 4:05
  but some people benefit from continuing specific
• 4:08
  movement exercises recommended by their therapist.
• 4:11
  Getting your knee fully straight is especially
• 4:14
  important for walking. Full knee extension helps
• 4:17
  Fiona achieve a more normal walking pattern.
• 4:20
  That's not a competition to achieve the largest
• 4:22
  possible number on a measuring device. The question
• 4:25
  is whether you have enough motion for what you
• 4:27
  want to do and whether a change is affecting
• 4:30
  those activities. If you notice a meaningful
• 4:32
  loss of motion, increasing swelling or a new
• 4:35
  limitation, it's worth mentioning to your clinician
• 4:37
  rather than simply forcing your knee harder.
• 4:41
  Now let's talk about strength because it affects
• 4:43
  so many daily tasks. Think about getting out
• 4:46
  of a chair. Your legs and hips have to do the
• 4:48
  work of lifting your body. Now think about going
• 4:50
  down a flight of stairs. Your muscles also have
• 4:53
  to control how quickly you lower yourself. Those
• 4:57
  are different demands and both are worth considering.
• 4:59
  A strengthening routine can include movements
• 5:01
  that resemble sitting and standing, stepping,
• 5:03
  lifting, and controlled lowering. Depending on
• 5:06
  your ability and your clinician's recommendations,
• 5:08
  the resistance might come from your body weight,
• 5:11
  a resistance band, a weight, or a machine. There
• 5:15
  isn't one exercise that everyone must do. A person
• 5:18
  who wants to garden may benefit from working
• 5:20
  toward getting down and up from lower positions.
• 5:23
  Someone who enjoys traveling may want to build
• 5:25
  the leg strength and endurance needed for stairs
• 5:27
  and longer days on their feet. Remember that
• 5:30
  your knee does not work in isolation. Muscles
• 5:33
  around your hips and ankles help support movement
• 5:35
  and control. Include both legs in your strengthening
• 5:38
  work as long as you don't have an injury or another
• 5:41
  medical restriction that prevents you from doing
• 5:43
  so. After surgery, people sometimes become so
• 5:47
  focused on their surgical leg that they overlook
• 5:50
  the rest of their body. Strength work needs to
• 5:53
  be appropriate. Strength work needs both an appropriate
• 5:58
  challenge and time between demanding sessions.
• 6:01
  If you have an individualized program for your
• 6:03
  physical therapist, use that guidance as your
• 6:06
  starting point, particularly if you have another
• 6:08
  medical condition or restriction. Fiona realizes
• 6:12
  that strength work can help her spend more time
• 6:13
  on her feet at an outdoor arts festival and move
• 6:16
  comfortably when she dances at her granddaughter's
• 6:19
  wedding. That gives her a reason to choose her
• 6:21
  strengthening exercises instead of simply trying
• 6:24
  to complete every exercise on an old handout.
• 6:28
  Walking is a part of everyday life, and you can
• 6:31
  also set aside time for it. Think about the distances,
• 6:34
  surfaces, and situations you want to manage.
• 6:37
  Walking through a botanical garden may support
• 6:39
  a different goal than spending an afternoon navigating
• 6:41
  crowded booths at an outdoor arts fest. Walking
• 6:45
  can overlap with aerobic exercise, but it's not
• 6:48
  automatically an aerobic workout. Pace, duration,
• 6:52
  and effort influence how much it challenges your
• 6:54
  heart and lungs. You can work on walking as a
• 6:57
  useful activity without assuming it replaces
• 6:59
  strength or balance practice. So that brings
• 7:03
  us to balance. Balance is involved when you turn
• 7:05
  to talk to somebody, reach for something, step
• 7:08
  around an obstacle, or move from one surface
• 7:10
  to another. It depends on several systems working
• 7:13
  together including strength, sensation, vision,
• 7:16
  and coordination. Balance practice might involve
• 7:20
  changing your stance, shifting your weight, or
• 7:22
  practicing a movement with greater control. The
• 7:25
  appropriate challenge varies widely. Some people
• 7:28
  need a stable countertop within reach. Others
• 7:31
  may already be ready for advanced tasks as long
• 7:34
  as they're staying safe. Support is part of good
• 7:37
  planning. If you're doing standing balance work,
• 7:39
  choose a safe environment and keep reliable support
• 7:42
  available. You don't prove anything by practicing
• 7:46
  a difficult balance task where you could fall
• 7:48
  and sustain an injury. Tai Chi or a suitable
• 7:52
  group balance class may be another way to include
• 7:54
  balance work. as long as the instructor can adapt
• 7:57
  the movements to your needs. Aerobic exercise
• 8:00
  can include cycling, pool exercise, and walking
• 8:03
  when your pace and effort challenge your heart
• 8:05
  and lungs. Maybe you enjoy walking outdoors.
• 8:09
  Maybe you prefer a stationary bicycle because
• 8:11
  the weather is unpredictable. Maybe you like
• 8:13
  exercising in a pool. Maybe you feel more motivated
• 8:16
  when you go somewhere at a set time and other
• 8:19
  people are expecting you. Those are all considerations
• 8:22
  when you're choosing an activity. An activity
• 8:25
  you enjoy and can access regularly is more likely
• 8:28
  to become part of your life than one you dread.
• 8:32
  Let's talk about classes for a minute because
• 8:34
  I don't want anyone to think that the only choices
• 8:36
  are walking alone or following a program at home.
• 8:40
  Your local YMCA, community center, or gym may
• 8:43
  offer aquatic exercise, group strengthening,
• 8:45
  or general fitness classes. Some places also
• 8:48
  offer Tai Chi, which combines controlled movement,
• 8:51
  coordination, and balance challenges. These can
• 8:55
  be long -term options after formal physical therapy,
• 8:58
  provided they fit your current abilities and
• 9:00
  any instructions from your surgical or medical
• 9:02
  team. An aquatic class may appeal to some who
• 9:06
  like moving in the pool. Before entering a pool
• 9:09
  after surgery, your incision needs sufficient
• 9:11
  healing and your clinician's approval. Tai Chi
• 9:15
  may appeal to someone who enjoys slower, deliberate
• 9:17
  movements and wants to practice coordination
• 9:19
  and balance. A general fitness class might combine
• 9:23
  strength, endurance, and balance all in one session.
• 9:27
  Another option is working with a personal trainer.
• 9:29
  A qualified trainer can help you develop a strengthening
• 9:32
  routine. You can learn how to use gym equipment
• 9:34
  and gradually increase the challenge as you get
• 9:37
  stronger. Look for someone who has experience
• 9:39
  working with people who have had joint replacements
• 9:42
  and who can follow any recommendations from your
• 9:44
  physical therapist. There's another advantage
• 9:47
  to classes that has nothing to do with a particular
• 9:49
  muscle. People often enjoy the social side. Seeing
• 9:53
  familiar faces, having an instructor, and knowing
• 9:55
  the class meets on Tuesday can make it easier
• 9:58
  to attend regularly. The classes vary considerably.
• 10:02
  Two classes with the same name may have very
• 10:04
  different movements and levels of difficulty.
• 10:07
  Ask what the class includes. Let the instructor
• 10:09
  know you've had a knee replacement, and ask whether
• 10:11
  movements can be modified. A class that works
• 10:14
  well for your neighbor may not be the right starting
• 10:17
  point for you. If you're unsure whether a particular
• 10:20
  class or exercise is appropriate, especially
• 10:22
  if it involves jumping, twisting, or higher impact
• 10:25
  movements, check with your surgeon or physical
• 10:28
  therapist. Implant -specific guidance and your
• 10:31
  personal circumstances take priority over a general
• 10:34
  podcast recommendation. Public health physical
• 10:37
  activity recommendations describe broad goals
• 10:40
  for adults, but those general goals are not a
• 10:43
  personalized prescription for someone after surgery.
• 10:46
  Your current fitness, other health conditions,
• 10:48
  and surgical guidance all influence where to
• 10:51
  begin. Fiona enjoys walking through botanical
• 10:54
  gardens, so she keeps that as part of her routine.
• 10:57
  She also discovers an aquatic class at the Y
• 11:00
  that she enjoys. Suddenly, her week has some
• 11:03
  variety, and she no longer feels as though every
• 11:05
  workout must look like a physical therapy appointment.
• 11:09
  Here's where all the pieces come together. Even
• 11:11
  a well -designed plan can be difficult to follow
• 11:14
  if it doesn't fit your life. A sustainable routine
• 11:17
  needs room for your schedule, your interests,
• 11:19
  and the other demands on your energy. Start by
• 11:22
  asking what you already do. Perhaps you walk
• 11:25
  the dog most mornings. Maybe you attend an aquatic
• 11:27
  class twice a week. Maybe you have a strength
• 11:30
  class at the gym or prefer strength work at home.
• 11:33
  Then look at what might be missing. If your week
• 11:35
  includes plenty of walking but no meaningful
• 11:37
  strengthening, you may want to make room for
• 11:39
  strength work. If you focus on resistance exercise
• 11:42
  but rarely do anything that challenges endurance,
• 11:45
  You might want to add an aerobic activity you
• 11:47
  enjoy. It can help to think of a usual week and
• 11:51
  a busy week. In a usual week, Fiona might take
• 11:54
  walks to prepare for her Botanical Garden outings,
• 11:57
  attend her aquatic class, and make time for strength
• 12:00
  and balance exercise that support dancing and
• 12:02
  navigating an outdoor arts festival. In a busy
• 12:05
  week, she might shorten a walk, choose a brief
• 12:08
  strengthening session, and return to a regular
• 12:10
  class when her schedule settles down. And that's
• 12:13
  an illustration, not a schedule I'm prescribing.
• 12:16
  The right amount and combination depend on you,
• 12:20
  the individual. There's no prize for having the
• 12:22
  longest routine. The purpose is to keep doing
• 12:25
  the things that support your goals. Even a routine
• 12:28
  you enjoy needs occasional adjustments. As an
• 12:31
  activity becomes easier, you may be ready to
• 12:34
  increase the challenge with strength work that
• 12:36
  could involve a little more resistance or a more
• 12:38
  demanding version of a familiar movement. To
• 12:41
  build endurance, you might gradually increase
• 12:43
  the duration or intensity. With balance, it could
• 12:46
  mean a task that requires more control while
• 12:49
  keeping the appropriate support available. Change
• 12:52
  one element at a time when possible. That makes
• 12:54
  it easier to recognize how your body responds.
• 12:58
  A sun muscle effort is expected during exercise,
• 13:01
  but pain, swelling, and changes in function are
• 13:03
  worth discussing with your clinician, especially
• 13:06
  if they're increasing or making everyday tasks
• 13:09
  harder. New chest pain or sudden shortness of
• 13:11
  breath requires emergency medical evaluation.
• 13:15
  There are also times when life interrupts a routine.
• 13:18
  You get sick, you travel, family responsibilities
• 13:20
  take over. You miss your class for a few weeks.
• 13:23
  When you return, it may make sense to start below
• 13:26
  the level you were doing before the break. See
• 13:28
  how you respond and build back gradually. That
• 13:31
  is especially important after an illness or a
• 13:34
  substantial change in how much you've been doing.
• 13:38
  Let's return to Fiona. Fiona now has a more focused
• 13:42
  plan. She walks because she enjoys exploring
• 13:44
  botanical gardens. She goes to a class because
• 13:47
  she enjoys the people and the structure. She
• 13:49
  includes strength activities to help her spend
• 13:51
  an afternoon browsing outdoor festivals and dancing
• 13:54
  at her granddaughter's wedding. Her plan may
• 13:57
  change. If she plans a visit to a larger botanical
• 13:59
  garden, she may work toward longer walks and
• 14:02
  varied paths. As her granddaughter's wedding
• 14:04
  approaches, she may practice the movements and
• 14:06
  endurance she wants for dancing. If a class closes,
• 14:10
  she can look for another option that serves a
• 14:12
  similar purpose. That flexibility is one of the
• 14:15
  strengths of a long -term routine. Keep challenging
• 14:18
  your body so you can maintain the abilities you
• 14:20
  use and continue building strength, balance,
• 14:23
  and endurance. Finishing formal physical therapy
• 14:25
  doesn't mean you're finished improving. Your
• 14:28
  therapist's guidance can help you take a more
• 14:30
  active role in progressing your program. As you
• 14:33
  think about your own week, consider five questions.
• 14:36
  Am I maintaining and improving the knee movement
• 14:38
  I need? Where am I working on strength? How am
• 14:42
  I including walking? How am I including balance?
• 14:45
  And what am I doing for aerobic endurance? And
• 14:48
  you can revisit those answers as your interests
• 14:51
  and abilities change. Before we finish, one more
• 14:54
  resource. If you're still dealing with pain after
• 14:57
  knee replacement and want to help understand
• 14:59
  what you're experiencing and what you can do
• 15:01
  about it, my book, Making Sense of Pain After
• 15:04
  Knee Replacement, explores pain in plain language.
• 15:07
  You'll find information about the book in the
• 15:10
  episode notes. In episode 19, we'll talk about
• 15:13
  maintaining your knee replacement for the long
• 15:15
  term, including staying active, follow -up care,
• 15:19
  and changes that may need medical attention.
• 15:21
  Thanks for joining me. I'm Michelle, and this
• 15:23
  has been the Total Knee Success podcast. This
• 15:29
  podcast is for educational purposes only. Discover
• 15:33
  more at TotalKneeSuccess .com, and be sure to
• 15:36
  subscribe and share. because every step forward
• 15:39
  takes you closer to living the life you love.