Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 95: Getting In and Out of a Low Car (Why This Feels So Awkward and How to Make It Easier)

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Episode 95: Getting In and Out of a Low Car (Why This Feels So Awkward and How to Make It Easier) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  The seat was low, the roof line was close to
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  her head, the door didn't open as wide as she
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  had expected, and there was very little room
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  between the edge of the seat and the glove box
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  for her legs. She was trying to protect her surgical
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  knee while lowering her body, turning her hips,
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  clearing her foot, and avoiding the door frame
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  at the same time. It just was not working. Why
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  hadn't she practiced this before surgery? Are
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  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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  After leaving the hospital, Linda walked toward
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  the passenger side of her daughter's sedan. She
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  had already practiced walking with her walker,
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  standing from a chair and going up a few steps.
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  Then she opened the car door and realized that
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  none of those activities looked quite like the
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  challenge in front of her. The seat was low,
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  the roof line was close to her head, the door
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  didn't open as wide as she had expected, and
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  there was very little room between the edge of
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  the seat and the glove box for her legs. She
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  was trying to protect her surgical knee while
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  lowering her body, turning her hips, clearing
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  her foot, and avoiding the door frame at the
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  same time. It just was not working. Why hadn't
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  she practiced this before surgery? By the end
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  of this episode, you'll understand why getting
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  in and out of a low car feels so awkward after
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  knee replacement, how seat height and vehicle
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  design change the movement, and several ways
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  to make the transfer more controlled and comfortable.
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  Car transfers receive surprisingly little attention
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  compared with walking, stairs, and getting out
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  of a chair. Yet this is one of the first real
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  -world tasks many people face after surgery.
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  You need a car to leave the hospital or surgical
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  center, attend appointments, and gradually return
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  to the activities that connect you with other
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  people. There's a practical reason this feels
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  difficult. A car transfer combines several movements
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  that are challenging after knee replacement.
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  low surface, bending your hip and knee, rotating
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  your body in a confined space, lifting your leg
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  over the door opening, and then reversing the
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  entire sequence when you get out of the vehicle.
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  When you sit in a regular chair, you can approach
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  from the front. You stand with your back to the
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  chair directly in front of it, reach for the
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  armrests if they're available, and sit straight
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  down and back. A car does not offer that arrangement.
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  The seat faces forward, but you enter through
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  an opening at the side. Many people instinctively
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  try to get into the car the way they have for
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  years, stand on one leg, place the other foot
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  inside, and lower onto the outer edge of the
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  seat with only part of their pelvis supported
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  before bringing the rest of their body in. That
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  familiar method may still work for some people,
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  but right after knee replacement, it often does
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  not work as smoothly as expected. It's requiring
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  some single leg balance, controlled lowering,
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  enough hip and knee motion to clear the doorway,
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  and the ability to turn while only partly supported
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  by the seat. Early after surgery, that combination
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  can feel extremely difficult and maybe unsteady
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  or unsafe. Separating the task into smaller steps
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  usually gives you more control. Sit fully on
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  the seat first, then turn and bring your legs
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  inside. Vehicle ergonomics research involving
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  older adults has found that people use several
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  different movement strategies during vehicle
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  entry and exit. Comfort depends on the combined
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  demands of trunk bending, foot placement, rotation,
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  and the amount of space available. Seat height
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  is important, but the shape of the seat, the
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  door opening, and the room for your legs can
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  change the transfer just as much. The height
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  of the seat is one of the biggest variables.
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  When a seat is high enough that your hips remain
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  near the level of your knees, you don't have
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  to lower your body very far. When seat height
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  is low, your hips travel farther downward, you
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  need to bend your knees more, and your thigh
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  muscles must control more of your body weight.
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  Research on sit -to -stand movement has consistently
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  shown that lower seats increase the demands of
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  the task. Rising from a lower surface generally
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  requires more strength, greater joint motion
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  and more forward movement of the trunk. Getting
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  into a lower vehicle presents the same challenge
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  in reverse to the sit -to -stand transfer we
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  were just talking about. Your quadriceps and
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  hip muscles control your descent. while you manage
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  your knee, which may still be swollen, stiff
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  or reluctant to bend. Getting back out of the
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  vehicle may feel even harder. Now you're starting
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  from the bottom of the movement. Your feet may
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  be positioned below or in front of you. The door
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  opening limits where you can place them, and
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  the car may not offer a secure handhold where
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  it's useful. The depth of the seat also changes
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  the task. Some vehicle seats slope downward toward
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  the back. Once you're sitting, your hips may
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  be lower than your knees. That position can increase
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  the effort required to stand back up. Also, a
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  deeply contoured seat may hold your pelvis in
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  place, making it harder to turn toward the open
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  door. The height of the door opening is another
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  factor. A sedan may have a low seat and a low
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  roof. You need to lower yourself enough to clear
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  the roof with your head while also keeping control
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  of your knee. A taller crossover or SUV often
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  provides more headroom and a seat that's closer
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  to standing height. But a very tall vehicle creates
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  a different problem because you have to step
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  upward to enter. The easiest vehicle is usually
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  not the lowest or the highest. It's the one that
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  allows you to sit without dropping low or climbing
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  high and stand without pulling up or jumping
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  down. Let's look more closely at what your hip
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  and knee are doing. As you lower toward the seat,
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  both joints bend. Your trunk usually leans forward
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  to keep your balance over your feet. Your quadriceps
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  control your knee as it bends, while your hip
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  muscles control your pelvis. Once you make contact
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  with the seat, you shift your weight away from
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  your legs, but the movement's not finished. You
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  still need to bring your legs into the vehicle.
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  Bringing your legs into the vehicle is often
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  the part that feels the hardest. Your hip and
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  knee need to bend, your foot has to clear the
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  doorway, and your surgical leg may feel unusually
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  heavy. Swelling and reduced quadriceps activation
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  can make lifting it surprisingly difficult. Instead
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  of planting your foot and twisting your body
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  around it, sit first. Turn your trunk, hips,
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  and legs together in a smaller movement. Ask
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  your physical or occupational therapist whether
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  this general approach fits your situation. Although
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  the movement can look complicated at first, it's
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  usually very doable once you separate it into
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  a few smaller steps. Start by sliding the passenger
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  seat back to give yourself room and make sure
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  the floor area and seatbelt are out of your way.
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  Back up toward the open doorway until you feel
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  the seat behind your legs, keeping your assistive
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  device close until you're steady and using a
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  stable surface for support. This can be challenging
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  because the door can be in the way. Resist the
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  urge to grab the door. You might start closing
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  it on yourself, and that never ends well. As
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  you lower yourself, keep your surgical leg slightly
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  forward if deeper bending feels uncomfortable
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  and likely it will for your first car transfer.
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  Lean forward from your hips and ease down with
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  control. Once you're seated, slide your hips
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  back as needed, then turn your hips and legs
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  together in small controlled movements so your
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  body faces forward. Avoid any twisting on a planted
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  foot. Some people use their hands to guide their
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  surgical leg. A leg lifter is another option
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  when a therapist has suggested it. The loop is
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  placed around the foot or lower leg so your hands
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  can help guide your leg as you turn in or out
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  of the vehicle. It should assist the movement
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  rather than pull on your incision or force your
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  knee to bend. A portable car assist handle is
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  another optional tool. It fits into a compatible
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  door latch receiver and provides an extra handhold
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  while you lower to or rise from the seat. It
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  needs to fit your vehicle securely and be used
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  according to the manufacturer's instructions.
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  I'll link examples of both a leg lifter and a
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  car assist handle in the show notes so you can
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  review them and discuss them with your therapist.
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  There's not one perfect sequence for everyone.
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  Some people bring their non -operated leg in
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  first. Others move both legs together. The best
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  approach is the one that lets you stay in control
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  and avoid forcing your knee or twisting on a
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  planted foot. Getting out of the car is essentially
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  the same process in reverse. Before you start,
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  make sure the seat is in a good position, the
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  seat belt is off, of course, and the door is
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  fully open. Turn toward the doorway as you bring
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  your legs out, then slide forward until your
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  feet can reach the ground. Try to bring your
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  feet back underneath you to help you stand without
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  pushing your knee into a position that doesn't
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  feel right. Lean forward from your hips and use
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  your legs and a stable handhold and come up in
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  a controlled fashion. A common issue is starting
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  to stand before you've turned enough toward the
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  door. And that can leave your feet pointing forward
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  while your body is still trying to rise, which
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  creates a twist and makes things harder. Another
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  is having your feet too far out in front of you,
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  which reduces your leverage. Small adjustments
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  can make a noticeable difference. You may hear
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  this described as a sit -first transfer. Sit
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  on the seat while you're facing out of the vehicle,
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  then turn your body to bring the legs inside,
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  and then reverse it on the way out. The sit -first
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  approach can be useful early on. It separates
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  standing, lowering, turning, and moving your
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  legs instead of asking you to manage them all
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  at once and risk twisting on a very sore leg.
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  The type of vehicle can make a difference, but
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  it's not always as simple as saying one category
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  is easier than another. Rather than relying on
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  the vehicle label, look at the actual transfer.
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  Can you sit without dropping down too low? Can
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  you clear the roof without excessive bending?
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  Place both feet on the ground when you exit and
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  find a secure place for your hands? Those details
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  are more useful than whether the vehicle is called
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  a sedan, crossover, SUV, or minivan. Driving
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  is a separate decision from riding as a passenger.
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  Being able to get in the driver's seat doesn't
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  mean you're ready to drive. Safe driving depends
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  on surgical clearance, reaction time, medication
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  use, and the ability to perform an emergency
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  stop with adequate strength and control. So check
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  with your surgeon on when you're clear to drive.
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  It's useful to practice the parts of a car transfer
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  outside the car. You might be given the firm
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  chair that's slightly higher than your vehicle
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  seat, practicing backing up to the chair, lowering
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  with control, and keeping one leg slightly forward
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  if needed. From there, you can rehearse moving
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  your leg sideways while seated so the turning
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  motion becomes more familiar. As that becomes
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  easier, you can progress to a lower chair that
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  more closely matches your vehicle and then practice
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  the full transfer in the actual car with supervision
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  or assistance as appropriate. You can also practice
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  the car transfer before you have your surgery,
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  find out which car you're going to be going home
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  in, and then practice on the passenger side before
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  the surgery happens. One study of older adults
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  entering and exiting passenger vehicles found
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  that only a small number of underlying movement
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  patterns describe the strategies people used
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  across different cars. That supports something
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  we see regularly. There's no single perfect movement
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  for everyone. The most useful transfer is the
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  one that lets you control the lowering and rising
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  portions, use the available space, and avoid
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  unnecessary twisting. If the transfer repeatedly
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  causes sharp pain, feels unstable, or requires
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  someone to pull you from the vehicle, stop practicing
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  it on your own and ask your physical or occupational
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  therapist to assess the task. One awkward attempt
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  doesn't necessarily mean something's wrong. It
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  may simply mean the setup, technique, or level
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  of assistance needs a little adjustment. Functional
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  progress after knee replacement doesn't occur
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  at the same speed for every activity. Research
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  shows that self -reported function often improves
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  substantially during the first three to six months,
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  while more demanding tasks may continue to change
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  over a longer period. A car transfer can remain
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  awkward after ordinary walking has become comfortable,
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  because it requires a deeper and more complex
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  combination of movements. If you'd like more
• 12:29
  practical education for the stage of knee replacement
• 12:32
  you're in, join the free Total Knee Success Insider
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  through the link in the show notes. It's designed
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  to help you understand where you are in the process
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  and what may be useful to discuss with your healthcare
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  team. Okay, let's wrap this up. Getting into
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  and out of a low car is difficult because the
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  transfer is requiring you to bend farther, and
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  lower and turn within a small space, and lift
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  your leg through a side opening. Moving the seat
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  back, sitting before bringing your legs inside,
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  turning in smaller steps, and choosing a vehicle
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  with a useful seat height can make the task much
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  more manageable. The car itself is part of the
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  equation. A sedan may be too low. A large SUV
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  may be quite high. A crossover minivan or another
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  vehicle with a seat near hip height may provide
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  an easier middle ground. Test the actual transfer.
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  rather than judging only by the type of vehicle.
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  In episode 96, we'll talk about getting down
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  on the floor and back up again. We'll look at
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  why floor transfers are valuable for gardening,
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  exercise, time with grandchildren, and getting
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  up after a fall, along with a few methods that
• 13:38
  can be adapted to different levels of strength
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  and flexibility. Thanks for joining me. I'm Michelle,
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  and this has been the Total Knee Success Podcast.
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  This podcast is for educational purposes only
• 13:54
  discover more at total me success calm and be
• 13:57
  sure to subscribe and share Because every step
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  forward takes you closer to living the life you
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