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[TKR] ROM and Extension stretches

Discussion in 'Knee Replacement Recovery Area' started by Roy Gardiner, Feb 8, 2012.

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  1. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    Extension stretches

    Extension exercises are those which stretch the calf and the hamstrings to allow the leg to straighten (0 degrees extension) or the knee to bend slightly backwards (e.g. -1 degree extension, backward bending is measured in minus numbers).

    There's loads, but I like to keep it simple and easy. Sit on a chair, rest your heel on something a little higher up. Press down on your thigh, you will feel the stretch through the back of your leg. Alternatively, lean forwards, that will really put the pressure on. No need to make it hurt, and you can do it loads of times a day.

    awww.roygardiner.com_images_legext01.jpg





    Extension stretch with a partner

    Caveat: In general, BoneSmart does not recommend using weight on the leg, or having a partner press down on your leg, for extension stretching. However, we also say: 'whatever works for you', and 'no pain, more gain'. And this exercise did work for me; so, if you think it may help you, please try. Gently!

    Sit on the floor with your leg outstretched, as straight as it will go. Your partner is going to help straighten your leg by pressing down above and below the knee, NOT on the knee itself, see 1st pic below.
    awww.roygardiner.com_bonesmart_ext01.jpg

    (The odd gear I'm wearing is cos I've just finished a bike ride and it was a quick opportunity to get a partner demonstrator and a photographer).

    If your leg won't go straight, as shown above, you don't need the book under your heel; it's only when the stretch really starts to work you need it.

    Partner presses down VERY GENTLY and increases the pressure; you will feel a fairly sharp pain all along your calf and behind your thighs.

    You will (eventually, maybe after weeks and months) get your leg straight, see next picture.

    awww.roygardiner.com_bonesmart_ext02.jpg

    It's not obvious from the pic, but my leg is clear of the carpet for its full length. My exercise partner (daughter, in fact) is pressing gently on the knees. You see here one hand slightly above the knee, one well below it. One hand each side of the kneecap is needed, distance to suit you.

    The next pic illustrates negative bend (extension is quoted in degrees, +n degrees is for forward bend, like the 1st pic; 0 degrees is straight; -n degrees is backward bend, the third pic)

    awww.roygardiner.com_bonesmart_ext03.jpg

    Compare pics 2 and 3; look how the ankle is raised by the book, the calf angles downwards, the thigh is flat on the floor. You don't need to do the same, but a backward bend is good, it helps you to be able to 'lock' the knee when standing.

    You don't have to have your partner lean right over your other leg, either, we've just done it that way so it's easier to photograph.


    Flexion stretch

    Loads of ROM (flexion) stretches seem to me to put force through the knee, not what's needed. So I have started doing this one using my son's skateboard (there must be one of those in any house that's had children about!), the beauty being that I use my arms to pull the legs gently backwards, no force going through the knee.

    awww.roygardiner.com_images_rom01.jpg

    When ROM (flexion) gets good, actually sit on the skateboard, feet either side of course, and put hands on the floor to rock you backwards and forwards.


    Extra information. It occurs to me that not everyone might know how to do stretching exercises properly.

    First, no pain. Discomfort just to the point of pain is OK.

    Extension: Press down/lean forward until you don't want to go any further, hold for about 10 secs, gently release. Swap legs and repeat. Repeat this set maybe 5 times.

    ROM (flexion): Pull forward until you don't want to go any further, hold 10 secs, relax. Wait 10-20 secs and repeat. Repeat the set maybe 5 times.

    Repeat this extension/ROM (flexion) set every hour, or even more often if it suits.

    Swelling won't notice until the next day, if any. If there's none, repeat the sets; if there is some, back off to even more gentle, or have a rest day.

    Quad strengthening

    And now, laydeez'n'genlmen, my latest idea in a new super high technology approach to quad strengthening. Be prepared to be amazed, stunned and all kinds of stuff. First, examine the detailed picture below:


    awww.roygardiner.com_images_squat01.jpg


    A fireplace with two piles of books, you think. Ha! You're right! But not any old books, oh no, Encyclopedia Britannica, bitta respect please.

    On top of them some copies of classic Winning magazine, cycling from the 80s, and an old bit of shelving.

    Top stuff.

    The idea is that I sit on the bit of shelving and and stand up again, getting a nice pull in the quads without upsetting the knees. The number of books used makes it the right height, wizard innit!

    Heels are close up to the books for maximum effect.

    The key to the hi-tech aspect is that every so often I take 2 magazines away (one from each side, you can't fool me!), to lower the height a tiny bit. When they're all gone I remove an encyclopedia from each side and put the magazines back. Slowly getting more strength-bearing range of motion.

    Look upon my works ye mighty and despair!

    And a close up.

    awww.roygardiner.com_images_squat03.jpg

    The wee doggy is called 'Bones', belongs to my eldest daughter, and is good at supervising.
     
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    Last edited: Nov 11, 2017
  2. Mimi

    Mimi Sr Bonesmartie

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    I really like that first one. Where were you 8 months ago:loll: I really had a time with extension. It finally came around after I did the bed hang for a few months. I would have preferred to do yours though. The skate board looks good too. My at home PT had me put my leg as far back as possible when I sat on a rocker and then gently rock. It helped me a lot.:biggrin:
     
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  3. Campervan

    Campervan Sr Bonesmartie

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    Hiya, I went and bought a cheap skateboard from a discount warehouse, but the wheels wouldn't go straight. We thought it was me at first, but hubbie couldn't make it go straight either. GRRR.... so we got our money back
     
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  4. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    what cos of my idea... surely not, it'd be a couple of hours after I posted??
     
  5. Campervan

    Campervan Sr Bonesmartie

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    Hi Roy, nooooo, surgeon told me to get one.
     
  6. Randi

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    Roy - you can get UP from sitting on the skateboard ? I don't think I'd ever get up !
     
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  7. referee54

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    One exercise that helped me with extension was to lie face down on the bed, with my feet hanging over the sides. I would use small ankle weights at first, and dangle my legs over the edge of the bed, gently bringing my legs to a straghter position. as the need arose, I would use slightly larger ankle weights.

    Since I was one of the rare ones with adhesions, I also used the ankle weights and sat on the edge of the bed and hung my knees over the edge that way, and let the ankle weights and gravity pop those little stinkers...
     
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  8. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    Not just using my legs! I reach behind and use my arms on the stool, or a couch, or something, to take most of the weight.
     
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  9. Randi

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    Okay ...maybe I could do that. I actually pulled a muscle in my shoulder in the early post-op days trying to maneuver my unwilling body parts !
     
  10. RunA42K

    RunA42K post-grad

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    Great exercises Roy! Although I never had a problem with extension I had to work for my ROM. I like the skate board idea. Humm, why didn't my OS ever tell me about that one? Maybe I should tell him next visit! :thumb:
     
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  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    For the heel slides, that's pretty much what I did except my brother made me a little wheelie board with some wood and a set of castors I had in my tool room! It's being used as a plant stand now! But pulling on the shins with the hands beat making your leg do it hands down! Nice one, Roy! It will probably end up in the Library when I get the time!
     
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  12. Campervan

    Campervan Sr Bonesmartie

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    Amazing the different things we're all "invented" to do the heel slides. Physio in hospital gave me a stiff plastic bin bag, but that got soft and started puckering. So I use a shiny magazine. And I use by other leg to push on the shin.
     
  13. Randi

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    My Mom's PT had her put a towel on the floor and slide every time she sat on the 'throne" .
     
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  14. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    Extra information. It occurs to me that not everyone might know how to do stretching exercises properly.

    First, no pain. Discomfort just to the point of pain is OK.

    Extension: Press down/lean forward until you don't want to go any further, hold for about 10 secs, gently release. Swap legs and repeat. Repeat this set maybe 5 times.

    ROM: Pull forward until you don't want to go any further, hold 10secs, relax. Wait 10-20 secs and repeat. Repeat the set maybe 5 times.

    Repeat this extension/ROM set every hour, or even more often if it suits.

    Swelling won't notice until the next day, if any. If there's none, repeat the sets; if there is some, back off to even more gentle, or have a rest day.


     
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  15. bottomshollow

    bottomshollow ADMINISTRATOR Administrator

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    Your advice is so "right on", Roy. :thumb: I knew that my extension in my right knee was not at "0"-- almost but not quite. I tried your stretch--and my left felt perfectly normal, but my right could feel the stretch without even pressing down on my thigh. But it was not painful, just slightly uncomfortable. So I will be doing this off and on several times a day until I know I'm where I need to be. The pics really brought it all home.

    I loved the skate board, but I think I'll go with a plastic bag---I have plenty of them at no additional cost. And what would I ever do with a skate board after I don't need it for flexion any more? :what:

    I always enjoy your posts and frequently learn something new. Thanks for all you do. Judy
     
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  16. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    Hi, Judy B, glad you like my stuff, I do try.

    The extension exercises you can do as much as you like until it starts to hurt then - surprise! - stop.

    Plastic bags are free it's true and you can slide them about no bother, but you can't sit on one and scoot backwards and forwards. And a skateboard ain't about to break the bank - well not for me, I found my son's in the shed :th_heehee:
     
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  17. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I like your stuff too, Roy! :wink1:
     
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  18. CLaudia

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    Hi Roy, I found that my granddaughters have a skateboard so I borrowed it. I did the stretches as you suggested and it felt really good. By the 5th one my knee was going back further than it's gone before with no pain I can see how beneficial it's going to be. Thanks for the great info!
     
  19. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor
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    Glad it's working for you!

    I think the key is that no force is going through the knee, the quads are not working, the only discomfort is the actual stretch itself.
     
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  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's why, when I did my heel slides, I only took it back so far and then, because I was sitting on the edge of the seat, was able to lean into the bend to increase it. I could get an extra 10-15 degrees doing that. Much more valuable, productive and lasting ROM than having a PT leaning on your leg!
     
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