• REGISTER for Joint Replacement Awareness Day on May 9th, 2020!

    Surgeons, patients, and other medical professionals will talk about topics you've told are important to you. You can ask questions LIVE of the participants. Please "like" and "share" our JRAD notice on your Facebook page too!

    Register and learn more in this announcement:

Watch 2019 JRAD Videos

TKR ROM and Extension stretches

Status
Not open for further replies.

mojo1180

new member
Joined
May 29, 2012
Messages
7
Age
66
Location
United States
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.
thanks I will try this and see if it helps allready doing the hanging off bed 10 minutes twice daily my surgeon seems to think that since I waited 10 years to have tkr done I did A lot of damage surgerory lasted 3 hours
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
You can use a static bicycle to help with flexion exercises. Here is what I have just started (March 2013) to use

awww.roygardiner.com_images_bcellar01.jpg


Yes it's a child's bike, set up in my cellar on a static trainer (called a 'turbotrainer' in UK for no reason I can understand). The trainer can provide resistance, obv, but I have set it up with none at all.


The reason for using a child's bike is that the saddle can be set pretty low. At the early stage of recovery an adult's bike would be better, with the saddle set very high.

awww.roygardiner.com_images_bcellar02.jpg



To start with you can set the pedals horizontal and just rock backwards and forwards if you can't make a full rotation.

awww.roygardiner.com_images_bcellar04.jpg


Then as things progress you do a full rotation, nice and gentle, then keep going until you can easily turn the pedals at maybe 50-60rpm for 20sec or so. Remember, no resistance, this is a stretching exercise not a training one.

You can see below that using a child's bike that there is a huge amount of scope to lower the saddle more and more to get the level of flexion you require. I expect to lower the saddle by tiny amounts, just a couple of mm at a time, maybe once a week or less often. It doesn't really matter; as long as the exercise is done several times a day (it takes 30sec or so each time) then progress will come.

awww.roygardiner.com_images_bcellar03.jpg
 
Last edited by a moderator:

10squeen

new member
Joined
Mar 19, 2013
Messages
7
Age
63
Gender
Female
Love the skateboard idea. My PT has me in a rocking chair with leg on a step stool and rock into the leg to get ROM.

Surgery Jan. 8 2013
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
I reckon that in the early stages that would be better than either skateboard or static bike because of the gentleness and level of control it gives you. And you can watch telly at the same time :)
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
I am now using the kiddie bike for flexion exercise and my proper bike on the same machine for a bit of training. I can't go out as of now (March) because my collar bone hasn't healed properly yet.

I find that if I do the big-bike training followed by the flexion exercise, the legs are warmed up and it's much easier. Most of you on here won't have the variety of bikes I have :) but you might find using an exercise bike you can raise and lower the saddle to get the same effect I get, maybe.
 

gami

senior
Joined
Jan 30, 2013
Messages
364
Age
72
Location
New South Wales
Gender
Female
Country
Australia Australia
:goodpost: Hi Roy I've been going to the gym 3 times a week and using a stationary bike there...but I might get my husband...who's a real handy man to have a go at setting p my bike at home like this...then i can as you said just do a little bit each day at home.

thanks again Gami :flwrysmile:
 

marty1227

junior member
Joined
Jan 28, 2013
Messages
22
Age
65
Location
US
Gender
Female
I am so glad I found this thread...my PT is a firm believer in "No Pain, No Gain". I will be having a talk with them tomorrow, and if I can't convince them to back off, I am not returning there. The information you have provided in this thread has given me hope that I can achieve extension on my own...no need to be going through the pain that I have been at PT.

My husband looked at me like I was crazy when I said I wanted to get a skateboard:)
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
Marty, if this thread helps you then it's fulfilled my objective and I'm happy, thanks for posting and letting me know.

As to the skateboard, you give him That Look (the good one, I mean), tap the side of your nose with your forefinger in that 'I know something you don't' way and say, 'Yes, I've been doing some reading up, there's something I want to try." That should set him off...:)
 

LinZee77

junior member
Joined
May 3, 2011
Messages
58
Age
62
Location
Long Island, NY
Gender
Female
Hi Roy
Thanx for the timely article! I was just considering in the past two weeks to purchase a bike trainer to set up with my "female" mountain bike so that I could easier transition to using it outdoors, and I wasn't sure if it was a good idea for tkr recovery or not rather than just getting a stationary bike. My question to you is, if I don't have one of those rear wheels that can pop off easily, what models can you get without needing an adapter? Should I bother getting the ones that also have "resistance" devices built in?
I live in a very hilly neighborhood, so that is why I am terrified to ride my bike around yet. (I am about 10 weeks post op for the newest right knee, and 2 years post op on my left) I have also just started using my home elliptical trainer, which I couldn't manage until just last week ( yers, I am on the "slow healer" curve ). I have been going to PT mainly for aqua therapy and find that I am still having trouble with using the pedals even on the PT stationary bike :headbang: and possibly this could be the solution for me.
Your great humor and confidence are an inspiration for sure.
Best, Lin Z
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
The thing I use is a 'static trainer' (aka a 'turbotrainer' in UK) which, in short, simply clamps onto the rear wheel of the bike, lifting the bike from the ground. You don't need to remove the rear wheel at any time.

Resistance is provided by a roller that presses against the rear wheel and then turns as you pedal. To eliminate resistance one simply adjusts the roller to be not in contact with the wheel! AFAIK it's not possible to buy a static trainer without such a resistance device, they are after all originally intended as training aids.

This is a cost effective option if one already has a bike.

Your local bike shop will be able to provide help.
 

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States
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


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.






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.
Thank you so much for rewriting the link to these wonderful exercises. As you suggest, I am taking a week off from exercising until my tendon feels less tight and sore, but will be using your gentle exercises for sure. Thank you again, much appreciated.
Susan
 

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States
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...
 

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States
I have been doing the leg hang with weights to achieve extension but I think that is how I injured my hamstring tendon. I'm taking a break from that stretch but might try the other position you mention (also hanging).

Susan
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
Susan, I would believe that easily. I have always hated the idea of that hanging-weight exercise, it is contrary to everything I've heard from coaches and experts on stretching. I advise that you never do it again -- bear in mind, though (disclaimer follows!) that I'm not a qualified coach or physio, it's just IMO.
 

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States
Susan, I would believe that easily. I have always hated the idea of that hanging-weight exercise, it is contrary to everything I've heard from coaches and experts on stretching. I advise that you never do it again -- bear in mind, though (disclaimer follows!) that I'm not a qualified coach or physio, it's just IMO.

Roy, how far along are you and do you still do your exercises?
Susan
 
OP
OP
Roy Gardiner

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,831
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
Extension probably -1 or summat around there, I don't do extension exercises any more.

Flexion probably 135+. I should do flexion stretches but rarely do so :blush:

Being bone idle is a real :thumb: in the early days of recovery as you need no encouragement to do the right thing, nothing. It's, as you now see, a handicap later.
 

nicolse

junior member
Joined
May 28, 2013
Messages
31
Age
70
Location
Franklin, MA USA
Gender
Female
Country
United States United States
Extension probably -1 or summat around there, I don't do extension exercises any more.

Flexion probably 135+. I should do flexion stretches but rarely do so :blush:

Being bone idle is a real :thumb: in the early days of recovery as you need no encouragement to do the right thing, nothing. It's, as you now see, a handicap later.

My extension is around -5 (down from -15); I'm wondering if there is a time no more extension can be achieved; I'm starting to think that exercising in real life (walking, bike riding) is just as beneficial as quad sets and leg lifts. My TKR surgery was on May 6 of this year. Any thoughts about when one has reached the peak of extension? In other words, is there a window that shuts after x months?
 
Status
Not open for further replies.

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
50,109
Messages
1,360,068
BoneSmarties
31,525
Latest member
Leec
Recent bookmarks
0

Top Bottom