Quad question

[beachy]

In reading many recovery threads I see a lot of talk about quads being weak and not working.

Is that because of the damage done during surgery. I picture the quads being pulled and stretched.

I’m doing a lot of quad strengthening and stretching in prep for surgery. And it helps with standing and walking pre op. Does this help recovery or are the quads pulled so much that it doesn’t help? Do you just start all over with the quads in PT?

 

[Hood1980]

Good questions @beachy. I’d like to know that too and I have another one. Do they have to “snip” your quad if you have a revision? I understand that getting the current implant out is the hardest part and I can see them having to snip the quad to gain better access to your current joint. Does anyone know? @Josephine?


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[Roy Gardiner]

The key IMO is to wait for healing to be complete before doing any strength training, so yes they will weaken. But muscles are good at regaining strength!

 

[Jockette]

Your quad will take a beating in the surgery and it will take a while to recover. Relax and let it. It will recover better if you don’t try to hurry it along.

PTs are all about strengthening things but don’t give a thought about the fact that we need to heal first.

Some people feel that strengthening the quad before surgery helps. The quad will lose temporary strength due to surgery, so maybe the stronger it is going in, the better level you will be at when you lose some of that strength. (I’m not sure if I’m saying this right)

Anyway, I did not do any quad strengthening before surgery and mine came back. The body is an amazing thing and does recover. But it will recover on its own timeframe, not yours, not your PT’s and not even your surgeon’s. Don’t worry about it. Your knee will be the boss, it’s best to let it and not fight it.

 

[beachy]

@Roy Gardiner
Totally agree about waiting for healing. I’m wondering if my pre hab strengthening and stretching will help post op. No weights just swimming and quad exercises. No lunges.
Your thoughts? It seems that you were in great shape from cycling pre op. Do you think that helped in your recovery?

@Jockette
I’m all about the Bonesmart PT way.

I’m wondering if working these quads (and other muscle groups) pre TKR is going to help with recovery. I’ve watched the surgery on YouTube several times.
At my age I’m hoping being in good condition before TKR helps.

 

[Jockette]

Personally I’m not totally convinced that pre-hab does a lot for recovery, but some people feel it helps.

The surgery is going to take a major toll on the body and everybody’s body reacts and heals at different rates, no matter what our age is or how fit we are. We had a member a while back who was a Marine and had a tough time. I mean, seriously, he had to be pretty fit to be a Marine!

 

[Mutti3]

Just to add my experience to this discussion. I did upper and lower body strength exercises before surgery. Of course what I could manage at my age. I worked out daily until the weekend before surgery. I believe it helped me in my recovery. I didn’t join bonesmart until I was 3 1/2 post op, so I don’t have documentation.
I felt all the exercises helped me, but it is a choice.

 

[beachy]

@Mutti3
Upper body for sure! I’ve been using hand weights. The best is doing dips on the steps of the pool! It hurts my knees to do dips on a chair.

 

[Roy Gardiner]

I’m wondering if my pre hab strengthening and stretching will help post op.

Well at worst (a) it can't hurt (b) it's you taking charge and taking action, which is good. At best it'll give you a head start. So yes there are no negatives.

It seems that you were in great shape from cycling pre op. Do you think that helped in your recovery?

I'd cycled for 30 years prior to surgery, but very little leading up to it. Yes, I think it helped. But not as much as following the BoneSmart way for recovery.

 

[Laurenkate]

Arm and core strength might be more important. For the first few days after surgery, it's important to be able to pull yourself up and to lift or push off the toilet seat handles if necessary. I don't know if the medication or surgery itself can make things like sitting up seem like climbing Mt. Everest. It doesn't last long but I've managed to pull a few muscles after both of my tkrs.

 

[lovetocookandsew]

I wasn't able to do any quad or leg strengthening before my revision for obvious reasons, but I had excellent upper body and arm strength as I had to use my arms to do things my leg could no longer support, such as getting back up from the floor, out of a bathtub only using my arms instead of my legs or knee. etc.

As a result my arms and upper body are very strong, while my legs and thighs, which while not totally weak, do need some strengthening. I think it can't hurt to go into this surgery as fit as we are able in any part of our bodies we are still able to work on, knowing that afterwards there will be a period of time where we are unable to use our quads no matter how fit they were (mine were frozen for exactly a week, then magically woke up).

I don't personally know how much of a difference it makes to be as fit as possible before the surgery, but I do know it doesn't hurt to be in good shape at any point. I also know having bad knees makes it impossible for many of us to get them strong and fit in preparation for a TKR, but many people I know, or know of, are able to eventually get their legs fit and strong again after they recover, and go on to do the things they used to do before their knees gave out.

I'd do whatever you are able to do before the surgery to strengthen your legs and body without hurting yourself more, and then after you recover finish the process to your own liking.

 

[DIYSteve]

I am one month after LTKR surgery w/patella button. My quads were wiped out by surgery. Now my quad strength feels good, nearly like pre-surgery. Surgery certainly beat up quads: Among other things, patella button installation requires patella to be lifted and twisted such that it can be sawed and drilled. That stretches the quad a bunch. Some OS (e.g., mine) place a tourniquet around the upper thigh during surgery, and that further damages the quads.

Also, surgery damages motor nerves, moreso with some people than others. My quad motor nerves did not want to fire the first few days, then gradually started to fire. Now I seem to have full quad function. (ROM is my limiting factor).

I went into surgery with strong quads. I skied (mix of downhill, touring and XC) 3X/week (w/ much pain) and bicycled the other days, until my OA got so bad by mid-March that I was unable to do either. After that, I walked and hit the pool to maintain strength as much as possible. I cannot be certain whether going into surgery with strong quads helped, but it seems so.

Of course, each person's recovery experience is different, so YMMV. Good luck

 

[Celle]

At my age I’m hoping being in good condition before TKR helps.

@beachy, you didn't fill in your date of birth when you registered, so we don't know what your age is.

 

[Jajakio]

I did a good six months of preop exercise that my PT helped design. . I was pretty bad off before surgery but found I could bicycle in the hot tub among other things. Hot water loosened things up and reduced pain. I believe exercise before surgery helped me post op. It is still tough after surgery and how well you do may also be influenced by how good your surgeon was, how extensive the repairs needed were and your general health and tolerance for pain. But i was able to make a full rotation on the bike 10 days after surgery and only needed a leg lifter for 3 or 4 days before I could swing my leg into bed by myself. I'm just over a year out from surgery and am basically happy with the outcome. I'm able to bike for real now and hope it helps with the eventual next knee.

 

[Laurenkate]

@Jajakio....the things you learn here! Bicycling in a hot tub!? That's interesting....

 

[beachy]

Thank you all for sharing!
Looks like I’m on the right path. Quads, upper body and core. Just what I’ve been doing. It helps when you all share your experiences. Everyone is different in their recover. I want to know that I did everything in my power to have the best recovery I can have. After that let the chips fall where they may.

@Celle
I went back and added my birth year. Overlooked it when I registered. Thanks for the reminder!
65 yrs young 9 days after my TKR.

 

[Celle]

Thank you for adding your birth date.

 

[Jajakio]

@Laurenkate, I didn't have a bike, i just leaned back and pedaled in the water. It worked. After a few months, I could see muscles developing just below my knee on the inside. It helped to compensate afterwards when the quads were weak. It a long haul recovery no later what you do beforehand but for me it makes sense to go into surgery as fit as you can. Many of us are going to have limitations and some kinds of exercising isn't going to be possible, but where there a will, there's a way. Upper body is good unless youve got other limitations like shoulders, stretches are good. If you can barely walk, like me before surgery, there may be seated work you can do like leg lifts or ankle rolls. There are plenty of preop exercises on the web. Search and adapt what can work for you. Do what you can and don't worry about whay you can't.

 

[Jockette]

I didn't have a bike, i just leaned back and pedaled in the water.

Haha, I thought the same thing @Laurenkate did, that there was actually some kind of bike in the water!

 

[SusieShoes]

I too thought you had some kind of water bike!