ROM and Extension stretches

[Roy Gardiner]

Do you mean +5? That is, your leg can't go quite straight? I write -1 for myself to mean my leg bends very slightly backwards, i.e. the knee can 'lock' when standing.

I am firmly of the opinion that there are no absolute limits and quite certain that there's no 'window' that closes; but it all takes time. From -15 to -5 since May I think is excellent progress.

 

[nicolse]

Do you mean +5? That is, your leg can't go quite straight? I write -1 for myself to mean my leg bends very slightly backwards, i.e. the knee can 'lock' when standing.

I am firmly of the opinion that there are no absolute limits and quite certain that there's no 'window' that closes; but it all takes time. From -15 to -5 since May I think is excellent progress.

In the US they use negative numbers through 0 to describe how far away from a straight leg you are so, yes, I did mean -5. But that aside I thank you for the validation of my progress and confirmation that there is no window that closes!

Susan

 

[Roy Gardiner]

Ah shoot I didn't know that... OK now I understand how the numbers differ.

 

[nicolse]

So, Roy, you can imagine my gait with -15!

 

[Roy Gardiner]

Extension stretch with a partner

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.

(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.

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)

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.

 

[chestnc]

Thank you Roy, you guys have a plethora of information that is so so helpful. My PT has been working on straightening my leg using the partner assisted method that you showed. PT suggested that I keep something under my heel at home which for a while I admit I had forgotten that part. But actually the method you show with pushing on the thigh seems to be effective. I have started using that method today.

 

[RunA42K]

Extension stretch with a partner
(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).

Ah Roy, you are not wearing odd gear, as soon as I saw this I thought oh they wear Pearl Izumi too in the UK. I have lots of their gear too and can't wait to use it again.

As far as extension goes, my first TKR, I never had a problem with it -0- but with this revision I know right now I have work to do on it. As I write this now, I have foot propped up on pillow with two zip loc bags of frozen peas atop my knee pressing down. I've always known extension as a+ (plus) number, have never heard of it referred to as a - (minus) perhaps it is different Physical Therapists in different parts of the USA. If I had to guess since I've not been measured yet I'd say that I am a +5. This is uncharted territory for me because my trouble has always been with flexion. I will see my Physical Therapist on Monday.

 

[Roy Gardiner]

Not chosen by brand, I didn't know what the symbol meant 'til just now. Assos, now, that is by choice.

Josephine gave the explanation on this on another thread; extension of 0 (zero) is when your leg is straight. +n is when your leg is bent to n degrees, see 1st photo above, -n is when your leg is bent backward (see last photo above, thigh and knee are on the carpet, heel raised on the book, so obviously leg is bent backwards). You only get -1 or -2 really, not much more is necessary or desirable.

 

[Nana moon 27]

Hi @Roy Gardiner

Just want to thank you for information for straightening the knee. It's so useful. I'm doing one similar to what @referee54 was on about with the weights on my ankles with my legs draped over the end of the bed. I only knew about that because I paid privately for a physio. The NHS gave me some bog standard exercises that were ok but not enough. I've been getting back and hip ache. I do not normally have this. When I saw the private physio he told me it's all down to the bend in my knee making me walk down slightly on one side. He said if it's not sorted I will have long term musculoskeletal problems. Finally, once my GP got this information he's referred me back to my OS. I am 11 weeks in and still on morphine for pain relief. That is not right. He's given me four more weeks off work and I have to try and get well, stop having pain and swelling and get off the morphine because one of my jobs involves a lot of driving. I can't drive still due to the morphine. Once more Roy. Thank you.

Nana moon 27

 

[Roy Gardiner]

You are most welcome.

weights on my ankles with my legs draped over the end of the bed.

I don't like this because I think that (a) it's too aggressive and causes pain (b) it lasts too long; a 30-sec stretch lots of times a day is better than minutes at a time. Just my opinion, though, I have no qualifications.

 

[Nana moon 27]

Happy Birthday Roy,
Have a great day
Love Nana moon 27 x

 

[oldrugbyprop]

Great post Roy. I will be picking up a cheap skate board tomorrow. My extension is good but I want to really work on my flexion still stiff legging it coming downstairs. Partly due to over doing it with four blizzards in a row and having to snow blow the driveway. But I'm whining. But I'm not complaining about my knees anymore.

 

[Fancypants]

Just found this thread with such excellent exercises.....will put all into action....

 

[Angel1978]

I have try them. And just not doing the trick. See have big problem. When I do the extension. The back of my knee start to burn. And it goes down leg. Take it down for while and repeat. Thanks for all the advice. Xxx


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015

 

[Roy Gardiner]

@Angel1978 you will get discomfort down the back of the leg, that's the stretching working. It takes time. Hold the stretch for 20sec or less, repeated many times a day. It DOES work, just takes time. Walking with a long stride has a similar effect.

 

[referee54]

@Angel1978 you will get discomfort down the back of the leg, that's the stretching working. It takes time. Hold the stretch for 20sec or less, repeated many times a day. It DOES work, just takes time. Walking with a long stride has a similar effect.

I agree--stretching is a slow process. Can you heat your hamstring muscle---the back of your leg---prior to stretching? Hold the stretches for 30 seconds, then repeat. After you are done stretching, ice your muscle. Try this four or five times a day.

 

[javaev]

Awesome discussion...!
Fantastic suggestions for ROM and extension..

 

[shrdlu]

Great ideas Roy.

I don't know if this was mentioned before, but for those who don't have access to a skateboard, you might instead try a furniture dolly (aka movers dolly) as a cheap alternative. I got some for less than $15 each at Harbor Freight (in the U.S.). Northern Tool also carries them, as well as big box stores. The dolly serves the same purpose as the skateboard, except that you can later use it as a plant stand or to move furniture later on. If you need more foot room, just cut a board to fit in the center. (Bring your measurements to your local Lowes or Home Depot, and they will cut down boards that you purchase from them.)

 

[Suzibelle]

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...

@referee54 : did the ankle weights over the bed resolve the adhesions and eliminate the need for MUA? How often and for how long before you saw your extension issues resolve?

 

[Roy Gardiner]

At the top of this thread you will see my daughter demonstrating partner-aided extension stretches. I much prefer these to leg-over-the-bed, because

1. Pressure can be much better controlled
2. You can easily do the recommended 30-secs and relax, then repeat, method.

Stretching shouldn't be for extended periods, 20-30secs only. This is because the body starts to resist them, which is counter-productive.