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Josephine

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In the UK, it is not common practice for surgeons to send their patients to physio after a joint replacement. This can result in people feeling a bit lost when they read on BoneSmart of all the intensive PT (physical therapy) that our US members discuss. Please be assured that this is not essential. Each country gets good results from their procedures. However, to overdo exercises is never a good idea as it can lead to chronic (i.e. longlasting) inflammation and similar problems. And exercises should never ever cause pain in any way whatsoever for the same reason.

Hips actually don't need much exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

But after the first 2-3 weeks of rest and recuperation, normal activities of daily living (ADLs) can be quite adequate for that rehab/PT

ADLs include:
~ Personal hygiene and grooming
~ Dressing and undressing
~ Functional transfers, e.g. Getting out of bed
~ Voluntarily controlling bladder and bowel elimination
~ Ambulation (Walking or using a wheelchair)
~ Housework
~ Meal Preparation
~ Care of pets
~ Meal preparation and clean-up



Walking and other activity
Hip or knee, walking is about the best exercise you can do but again, you need to moderate your time and distance.
Always use your walker, crutches or canes as appropriate, only moving from one to the other as you gain confidence. Your goal is a full stride in your walk and the use of an aid in the early stages of recovery helps you balance and stretch out your steps as you walk. If you have any signs of a limp as you walk, it's an indication that you need to go back to an aid that provides a bit more support for a while.

I would suggest the following regime and please note the key point is never cause yourself pain

Week 1 and 2
Walking around the house as normal - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it.
A 5 minute walk every one to two hours is plenty.
No other activity, no house work or anything like, just rest, rest, rest

Week 2 and 3
Start on a plan of walks around the house lasting longer than 5 minutes but don't
a) get into too much pain and
b) get too tired. Stop before you get to that point​

Activity: for these two weeks nothing but rest, occasional trips to the kitchen to get a snack or a drink and to the bathroom for potty and showers!
Week 3
Take short walks outside the house in the garden, driveway or road for about 5-10 minutes maximum, once a day

Activity: prepare yourself a meal or help prepare a family meal - but just peeling the potatoes or similar​

Weeks 4 and 5
Lengthen the walks to about 10-15 minutes once a day, maybe twice a day if it doesn't cause your knee/hip to swell or be painful.

Activity: now you can do some dusting and push a vacuum round the middle of the living room; do more meal prep and maybe fill and empty the washing machine
Weeks 6 and onward
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes Take at least one 5 minute rest while you are out.

Activity: ironing, washing, meal prep but get someone else to clear up after, wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, not you!!
Bed making and changing sheets, cleaning bedrooms etc., can wait until about week 8!​
 
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Josephine

Josephine

NURSE DIRECTOR EMERITUS
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Ankle Pumps and foot rotations (Both Legs)



These are simple exercises and can be done any time you are resting with your leg elevated or not, doesn't matter. It's something you should be doing from the moment you get back to the ward after your surgery.

It generally doesn't cause any pain in your knee and it will be very good for keeping your circulation going and preventing things like DVT or blood clots which is their primary function. Do them as often as you feel able for the first couple of weeks but once you are ambulant, they are no longer necessary.
 
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Josephine

Josephine

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exercise bikes

TKR: Using an exercise bike requires restraint at the start and - as ever - patience! Start with very short sessions, about 3mins. And only rock back and forth. Do that for many days until you feel brave enough and free enough to try a full rotation - but at first do it backwards!

When you've done a number of those, try one or two forward rotations. Do not, under any circumstances, let it be painful! If you find it is painful going 'over the top' stop at once and try again the next day. Although to be absolutely truthful, the first time is always somewhat painful but it shouldn't be excruciating! Take it slowly, v-e-r-y s-l-o-w-l-y!

It's a frequently asked question on this forum: which is best, upright or recumbent?

Simple answer is that it's a matter of choice. Hip patients feel more comfortable in a recumbent while knee patients might feel an upright has more ability to adjust and test the joint. Whatever suits you is the right one to use.

This is a recumbent bike

recumbent bike.jpg



Make sure you don't slouch, that your posture is upright and your rear pushed well into the back of the seat. Have the seat setting as far back to begin with so your joint (hip ior knee) isn't stressed too much, moving it forward a bit as you feel able. Also have the resistance on zero to begin and slowly increase as you recover. Under no circumstances rush this. Spend at least one, probably two weeks on the lowest settings.

This is an upright bike

upright bike.jpg


You may find it helpful to have a step stool to assist mounting the bike.
To start with, have the seat as high as you can get it and still reach the pedals and set the resistance set at zero.

For TKRs, do not attempt to do full rotations, just rock the pedals back and forth. It may take you two weeks to manage a full rotation but don't worry if it takes you longer.

Once you have managed that, you can begin to lower the seat a notch at a time. When you feel up to it, also begin increasing the resistance.

Under no circumstances rush this.
If you are a hip patient, spend at least 1, probably 2 weeks on the lowest settings.
If you are a knee, double that time - as a minimum! So 2-4 weeks on lowest setting.

However, once the first early weeks of recovery are over, a stationary bike is one of the very best modes of exercise you can undertake!

On the other hand - if you can't run to or don't have the space for either of those, consider a peddler instead.
Some even have tensioners and on-board computers! Such a device would really be worth its weight in gold so far as your recovery is concerned. And when you're done you can always sell it on in Ebay! :wink:
(Prices added 16th January 2012)

UK version
Pedex Deluxe Fitness Pedal Cycle Exerciser
Amazon.co.uk £44.95

aecx.images_amazon.com_images_I_31CP6_iKDuL._SL500_AA300_.jpg


US version
Sunny Health & Fitness Mini Cycle
Amazon.com $58.

aecx.images_amazon.com_images_I_41reiTyS3lL._SL500_AA300_.jpg
 

Jamie

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If you can't get your exercise bike seat low enough to get a good testing for your knee, then a crank shortener might be the answer.

Here is one I found at tandemseast.com :

awww.tandemseast.com_parts_cranks_09.jpg

$118 per pair


Here is another at adaptivemall.com that is quite inexpensive compared to the first one:

aep_yimg_com_ca_I_am_2272_98409004_.gif


Regular price: $44.00
(Sale price today: $39.60)
 

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