Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 96: Getting Down on the Floor and Back Up Again (One of the Most Important Skills Nobody Teaches)

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Episode 96: Getting Down on the Floor and Back Up Again (One of the Most Important Skills Nobody Teaches) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Know how you plan to come back up before you
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  go down to the floor. Reaching the floor does
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  not guarantee that the return will be manageable.
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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
• 0:33
  back to the Total Knee Success podcast. I'm Michelle.
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  Susie was visiting her daughter when her grandson's
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  toy rolled under the coffee table. Without thinking,
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  she started to lower herself to reach it. Halfway
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  down, she stopped. She was not sure how to continue
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  safely, and she had no clear plan for getting
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  back up. She could walk, manage stairs, and get
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  out of a chair, but the floor required an entirely
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  different movement. Suzy's not a real patient
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  or listener. Her story combines situations that
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  many people encounter after knee replacement.
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  And that's why we're talking about floor transfers
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  on the Total Knee Success podcast. They may not
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  appear on the usual first list of goals after
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  knee replacement, yet they're part of gardening,
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  exercising on the floor on a mat. sitting beside
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  a grandchild, reaching a low space, and many
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  other ordinary activities. There are three broad
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  techniques people commonly use, a kneeling -based
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  technique, a non -kneeling technique, and a supported
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  or modified technique for floor transfers. By
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  the end of this episode, you'll understand what
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  separates those three techniques, what your physical
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  therapist may consider when choosing among them,
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  and why practicing the movement in smaller parts
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  can make it feel much more manageable. First,
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  we need to separate a planned floor transfer
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  from getting up after a fall. When you choose
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  to go to the floor, you can prepare the area,
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  arrange support, and decide how you will come
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  back up before you begin. A fall is unexpected
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  and may involve an injury or medical event. Episode
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  107 will cover fall prevention and getting up
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  after a fall in detail, so check that out if
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  I've published it already. Today, our main focus
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  is education on the planned floor transfer. Moving
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  from standing to the floor requires you to travel
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  a long distance downward and then raise your
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  body through that same distance again when you
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  want to stand back up. Your knee is involved,
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  but the movement also depends on your hips, ankles,
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  trunk, arms, balance and coordination. That's
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  why you may walk well and climb stairs but still
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  find getting to the floor and back up again surprisingly
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  difficult. Sitting in a chair gives you a fixed
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  target and a familiar starting point. Near the
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  floor, your support changes several times. You
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  may move from two feet to one knee and one foot,
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  then to your hands and knees or toward one hip.
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  You have to control each position and know where
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  the next support will come from. Before I describe
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  the three techniques, I'd like to remind you
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  that this is general education. not a set of
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  instructions for you to follow on your own. Your
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  surgeon should address any procedure -specific
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  precautions, and your physical or occupational
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  therapist should determine whether floor practice
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  is appropriate for you at this time, which technique
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  fits you, and what support or supervision or
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  assistance you might need. The first technique
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  uses kneeling. A common position within this
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  technique is half -kneeling. Half -kneeling means
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  one knee is supported on the floor or on a firm
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  pad while the opposite foot is planted in front,
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  similar to the bottom of a small lunge, or the
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  position a football player may take when they
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  take a knee. Physical therapists often use half
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  kneeling because it connects the floor to standing.
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  The front foot provides a base to move over while
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  the knee on the floor provides another point
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  of support. From this position, a therapist can
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  see how comfortably you tolerate pressure. whether
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  you can bring one foot forward, how well you
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  control your trunk, and how effectively your
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  arms and legs work together. Some people move
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  through both hands and knees before turning toward
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  one hip to sit. When returning to standing, they
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  may move back through the hands and knees, bring
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  one foot forward into half kneeling, and use
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  a stable support as they rise, something like
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  a chair or the side of a couch. The exact order
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  the knee that goes down, the direction you turn,
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  and how much you use your hands need to fit your
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  body and your home setup. Kneeling comfort varies
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  widely after knee replacement. The front of your
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  knee may feel sensitive, numb, or sore when pressed
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  against a hard surface, even after your surgeon
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  has permitted kneeling. In episode 93, I talk
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  about kneeling tolerance in detail, including
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  why permission, comfort, and confidence are separate
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  questions. Research also shows that difficulty
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  kneeling is common after knee replacement. and
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  can be influenced by discomfort, altered sensation,
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  fear, and other joint problems. A recent incision,
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  wound concern, revision procedure, tendon repair,
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  fracture, infection concern, or a restriction
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  from your surgeon may rule out kneeling for now.
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  Your other knee also counts. Arthritis or pain
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  on that side may affect which leg, if either,
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  can be placed on the floor. There's no automatic
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  rule that your replaced knee should always be
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  the knee on the floor or always be the leg in
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  front. The more comfortable arrangement may depend
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  on kneeling sensitivity, knee bend, leg strength,
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  the condition of your other knee, and the direction
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  you need to turn. A physical or occupational
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  therapist can compare both sides instead of assuming
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  one setup will be best. The second technique
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  avoids direct kneeling. One common version uses
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  side sitting. Side sitting means your pelvis
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  rests on the floor while your legs angle toward
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  one side rather than folding directly underneath
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  you. One leg may remain farther forward or less
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  bent. This technique may reduce pressure on the
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  front of your knee and may require less knee
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  bending than a full kneeling position. In exchange,
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  it may ask more from your hips, your trunk, your
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  shoulders, wrists, and balance. A painful hip,
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  limited hip rotation, or difficulty supporting
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  weight through your arms can make side sitting
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  a poor fit. A non -kneeling technique may also
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  use a controlled turn toward a low firm surface
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  rather than taking you directly toward the floor.
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  The key question is whether avoiding kneeling
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  creates a more manageable movement without shifting
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  too much demand to another joint or to your balance.
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  The third technique is supported or modified,
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  and this approach adds a stable support, divides
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  the distance into smaller levels, or changes
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  the activity so you don't need to go all the
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  way to the floor. A firm couch, fixed rail, heavy
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  bench, raised mat, or professionally selected
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  intermediate surface may be useful. I use this
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  a lot in the clinic. I tend to go from a chair
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  down to a stool and then eventually down to the
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  floor. An intermediate surface could allow you
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  to move from standing to a low but firm level
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  before continuing. For gardening, a raised bed,
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  stable garden stool, or kneeling bench may let
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  you work comfortably without sitting on the ground.
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  For time with a grandchild, a firm cushion beside
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  a stable couch may create a better setup than
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  the middle of an open room. For a mat exercise
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  class, choosing a position near a fixed support
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  can give you a planned way back up. The word
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  stable is really important in this case. A lightweight
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  chair can tip. A wheeled stool can roll. Stacked
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  cushions can slide and a towel bar can pull away
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  from the wall. So be careful. The support needs
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  to remain steady while you place meaningful body
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  weight through it. The goal of a supported technique
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  is not necessarily to progress all the way to
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  the floor. Sometimes the best solution is to
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  change the activity. Reaching a raised gardening
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  bed, sitting on a low firm bench, or exercising
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  on an elevated mat may give you the experience
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  you want without requiring a full floor transfer.
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  That's a practical adaptation, not a lesser accomplishment.
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  Help from another person also requires some planning.
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  Pulling you upward by the arms can strain your
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  shoulders and disturb both people's balance.
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  A family member can be nearby for reassurance
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  and assistance, but your therapist can show that
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  person where to stand and how to help without
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  pulling or lifting in an unsafe way. So how does
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  the therapist choose among these techniques?
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  It usually comes down to four questions. Can
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  you bend your knees enough for the positions
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  to be considered? Can you tolerate pressure through
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  one or both knees? Can your arms and legs control
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  your body close to the floor? And is your balance
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  and the environment appropriate for the technique
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  that you're choosing? A therapist may begin with
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  a chair rather than the floor. Standing from
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  a firm chair provides information about leg strength,
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  forward weight shift, balance, and how much you
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  rely on your hands. Research involving older
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  adults has found a relationship between chair
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  -rise performance and floor transferability,
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  although they're not the same task. The therapist
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  may then test one small part of the transfer.
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  That might be controlling a staggered stance,
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  moving toward a raised padded surface, turning
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  from sitting toward one side, bringing one foot
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  forward from kneeling, or practicing the final
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  rise from a low, supported position. This is
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  where the task often becomes less intimidating.
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  You're not being asked to solve the whole transfer
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  all at once. You and your therapist can identify
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  the specific part that's limiting you and work
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  from there. It's also nice to split it up because
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  working on transferring to and from the floor
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  can be pretty exhausting. So sometimes we split
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  this up into parts during a therapy session.
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  One teaching method is called backward chaining.
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  It begins with the final portion of the movement
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  and adds earlier portions later. You might practice
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  only the last transition from a low supported
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  position to standing. Once that's controlled,
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  the starting position can gradually move lower.
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  Research involving older adults suggests that
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  practicing floor -rise skills can improve parts
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  of the task, although the evidence is not specific
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  to people after knee replacement, and the results
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  across studies are mixed. The useful principle
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  is to practice the actual skill in careful chosen
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  pieces rather than assuming general exercise
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  will automatically teach the sequence. Strength
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  still contributes. Chair rises, step work, and
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  exercises selected for your hips, thighs, trunk,
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  and arms may build the capacity you need, but
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  strength alone doesn't tell you where to place
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  your hands, which foot to move, or how to organize
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  your body close to the floor. For a first attempt,
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  use a controlled environment and work with your
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  physical therapist or another qualified clinician.
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  Choose a firm surface with enough padding for
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  comfort but not so much that your hands or feet
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  sink or slide. Clear loose rugs, pets, cords,
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  and hard edges. Use secure footwear when the
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  technique begins or ends in standing. Please
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  do not practice when you're dizzy and usually
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  tired, ill, or affected by medication. And very
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  importantly, know how you plan to come back up
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  before you go down. Reaching the floor does not
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  guarantee that the return will be manageable.
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  Now let's briefly return to falls. After a fall,
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  pause before trying to stand. A head impact,
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  loss of consciousness, severe or increasing pain,
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  significant bleeding, a visibly changed limb,
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  chest pain or symptoms, New weakness or confusion
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  or an inability to move or bear weight are reasons
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  to seek emergency assistance. When you're uncertain
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  whether an injury occurred or cannot move safely,
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  call emergency services or use an emergency alert
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  system rather than making repeated attempts to
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  stand. Episode 107 will provide a more full discussion
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  on fall prevention and what to consider after
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  a fall. The point for today is simple. A planned
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  floor transfer is a skill you can prepare and
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  practice, and it's wise to do so if you're capable.
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  A fall requires an injury and medical safety
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  decision first. A successful floor transfer plan
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  allows you to reach the level you need and return
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  with control using the support that's appropriate
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  for you. That may include your hands, a couch,
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  a firm pad, an intermediate surface, supervision,
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  or choosing to remain above floor level for now.
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  Your preferred technique may change. Early after
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  surgery, a supported or modified approach may
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  be the most reasonable option. Later, changes
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  in strength, motion, or kneeling comfort may
• 13:16
  make another technique quite possible for you.
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  The choice can also change with the activity.
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  For gardening, you may not need to reach the
• 13:25
  ground. In episode 97, we'll explore raised beds,
• 13:29
  garden stools, kneeling options, lifting, carrying,
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  and pacing. For sitting with a grandchild, complete
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  your transfer before holding your child so that
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  your balance is not changing while you're managing
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  someone who's moving around in your arms. For
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  a mat class, decide how you will leave the floor
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  before the class begins and position yourself
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  near the support you plan to use. You do not
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  need to match the speed of the group. The three
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  techniques give you a simple way to organize
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  the possibilities, kneeling -based, non -kneeling,
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  and supported or modified. You don't need to
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  memorize every variation. You need a technique
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  that fits your motion, strength, comfort, balance,
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  and environment. And you need to talk to your
• 14:16
  therapist, because this podcast is for education
• 14:19
  only. Consider signing up for the Total Knee
• 14:22
  Success Insider for practical education that
• 14:25
  helps you understand where you are in the knee
• 14:27
  replacement process. The link is in the show
• 14:29
  notes if you'd like to check it out. It's totally
• 14:31
  free. My intentionally concise book, Walking
• 14:34
  Like Yourself Again After Knee Replacement, explains
• 14:37
  the factors that influence natural, controlled
• 14:40
  movement in daily life, and it's specific to
• 14:43
  walking. I'll also link the book in the show
• 14:46
  notes. Next, in episode 97, we're going to talk
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  about returning to gardening after knee replacement.
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  including using raised beds, garden stools, kneeling
• 14:55
  alternatives, lifting, carrying, pacing, and
• 14:58
  ways to enjoy the work without trying to do everything
• 15:01
  in one afternoon. For now, remember that a floor
• 15:05
  transfer is a skill, not a test. You can begin
• 15:08
  with one supervised piece of the movement and
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  build from there. Thanks for joining me. I'm
• 15:14
  Michelle, and this has been the Total Knee Success
• 15:16
  Podcast. This podcast is for educational purposes
• 15:23
  only. Discover more at TotalMeSuccess .com and
• 15:27
  be sure to subscribe and share because every
• 15:30
  step forward takes you closer to living the life
• 15:33
  you love.