♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the Internet ♪
- Well, hi there, folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our own opinion, of course, Bob.
- Title of today's program is Knee Replacement Exercises,
Less Pain and Less Pain Meds with Faster Rehab.
So we're gonna show you some techniques today
to try to get you more movement with less pain.
- Exactly, which is everybody wants for the total knee.
- Right.
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- Ah, yes.
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- Yeah, 60 seconds version.
We are giving away a TENS unit today,
and that's what we're gonna be talkin' about
for pain control.
We're givin' away a couple of these, I believe.
Very good unit, one of our favorites,
really good instructions.
- Right.
- Comes with quite a bit of pads, too.
- Right. - And it just--
- Everything you need.
It's one of the options for pain control, Bob.
- Right. - We've got something else--
- We've got some other ones, too.
- Yep. - All right, Brad.
- All right, so, total knee replacements,
Bob and I have been in this practice for 30 years plus each.
Well, I'm not quite as much as you.
- You're not as much as me, no.
- Anyway, we've done thousands of total knee replacements.
- Yes, we have.
- And we've learned a lot of things.
- Rehabbed thousands.
We didn't do the knee replacements.
- Right, yeah, we rehabbed 'em,
got people back into the game of life again.
And there's some techniques here
that we wanna share with you to accelerate your program,
so that you can get your knee moving, walking,
and back to normal again.
- Are you saying we learned a few tricks
over the years, Brad?
- Yeah, we certainly have. - Okay.
- So, let's get right to it. - Right.
- One of the things I do wanna mention
before we get into it is just the use of cold packs.
- Sure.
- And most everyone that does a knee replacement
is introduced to cold packs and the use of 'em.
- Yes.
- But they've done some studies on it
and there's one done in 2017,
and actually proved, in this study,
significant decrease in opioid pain meds, which--
- By using the--
- Just the cold pack.
- Cold pack, yeah. - Exactly.
We're also gonna talk about
integrating the use of a TENS unit with this.
But, typically, let's start out with how people normally
get out of surgery, and they're in the hospital bed.
- Right.
- One of the first things you can do,
why don't you lay down, Bob, as if you're the knee patient.
- All right.
- We're gonna pretend this is a hospital bed.
And they want you to get the knee moving
as soon as possible.
And this is one thing that has just come out
and it's called a Knee Glide.
And while you're in there,
they used to have a CPM, Continuous Passive Motion machine,
which not too many surgeons use 'em anymore.
- I'm just gonna show, this is a very lightweight, very--
- Right.
- Less than five pounds. - Right.
- So. - He interrupted me.
- I'm sorry, go ahead, man.
- That's all right.
But this is much easier.
A CPM machine's got electric motor, it's heavy,
you gotta set it up, it's awkward.
And the benefit from this is
this allows your muscles to do the work.
So, you're starting muscle reintegration already with this.
So go ahead and show how it works.
- Yeah, I put a little towel on there
just to make my heel a little more comfortable.
- Right.
- We won't need the towel when you're sitting.
- Right.
- But this is just a real easy way to start.
Let's say your knee's like this,
'cause you might maybe can't straighten all the way.
- Right. - If you can just--
- Rest up.
- You can start just small little oscillation movements,
and then hopefully work up to some larger movements.
- Right.
- But this is just a great way
to start gettin' some movement
while you're already in the hospital bed,
get things rollin'.
- Right, this is one of the things
probably the therapist is gonna help you with to get goin',
and then you can get on to doin' it by yourself.
- Right.
- So you can feel comfortable with it.
The next thing is, in the chair,
typically you're in a wheelchair right out of surgery.
And I don't know about other therapists out there,
other people, but years past,
they'd say you gotta wax the floor.
So the idea is that you put a towel down,
and hopefully you got a nice shiny floor.
And then you move your foot back and forth
as the towel reduces the friction,
and you can do it.
Now this floor is an exercise floor.
It's rubber and it doesn't work at all.
- And it wouldn't work on carpet either.
- And it does not work on carpet either.
That's the other thing with a Knee Glide,
which is a really nice tool for this.
You can use this, and all of a sudden,
you have very little friction at all.
It works out really nice.
And the other benefit of the Knee Glide
is you can put it up on the stilt and we have an incline.
And so now, we're actually going downhill.
It's not a big difference,
but it reduces the friction because you're going downhill,
plus the ankle is now more dorsiflexed
or up at an angle this way.
- It's more comfortable. - Right.
- Yeah, my wife, when I was havin' her use this,
she was having knee problems, and we started with it flat,
she goes, "Oh, that's hard on my ankle."
- Right.
- So, it's not a minor thing.
- So, when she put it up, it was--
- It was more comfortable, right.
- And we find that with knee patients as well.
- Right. - You start it out here,
and you start working it back and forth in that manner.
And then, they get more range of motion
'cause you wanna break up that scar tissue from surgery
as soon as you can.
You're actually gonna wanna push it a little harder
and it's gonna be a little painful at that point.
And the therapist is gonna say,
we've gotta push into that pain, break up the scar tissue,
it's gonna hurt, you're not gonna tear the surgery apart.
That's not an issue.
So, I usually do, instead of me pushing on the person's leg,
as a therapist, I'll say take your other leg,
put it over on your heel or up on the Knee Glide,
and use your good leg to help push it
to give it a good stretch.
It's gonna be a little painful, but you have to do that.
And if you had a knee replacement,
you know exactly what I'm talking about.
Now, if we can break up that scar tissue a little more
with less pain, everyone's happier.
- Right.
- So that's where we're going to use a TENS unit.
And that's, Bob?
- [Bob] Just assuming you probably did some ice already,
and now we're gonna go ahead and, in between,
since you can't ice all the time--
- [Brad] Well, we're gonna ice at the end of this, Bob.
- [Bob] Sure.
- [Brad] So we're gonna incorporate that.
- But you can use the TENS Unit
while you're actually working out.
- Yep.
- Or you can use it before you're working out, too.
- Exactly, and the reason I like to put it
while the person's doing it, because it hurts the most
when you're doin' the passive range of motion.
And I put the patches on,
you know you have to learn how to use the TENS unit.
Your therapist will show you.
And that will make less pain
when you're doing the passive, the stretch,
the breaking up of that scar tissue,
you can get a little bit further.
And if you can get a few degrees further each day,
it's all gonna add up
so that you're gonna have a faster rehab.
So that TENS unit is good.
And there's been studies showin'
that TENS units are effective for reducing pain,
particularly in a situation like this.
- Well, in some surgeries, Brad,
they actually implant the electrodes.
They actually implant them, implant the TENS.
- But not in a knee replacement.
- Not in a knee replacement, no.
- Right, in a pain situation, sure.
- They've done it, yeah.
- In chronic back pain-- - Right.
- Is probably a good example of that.
- No, I had a neighbor girl that had it implanted,
because she had some chronic pain.
- Okay, yes.
Because, yeah, TENS units do work.
- Right.
- So, what we're gonna do is work with that.
And once you get done, you're only gonna do this for about
maybe five to 10 minutes.
- Right.
- And you're gonna have enough.
You got the knee bending.
But we also need to work on getting the knees straight.
- Right.
- We're gonna leave the TENS unit on.
The Knee Glide we'll set off to the side.
And this is what I usually do, Bob,
and I think most therapists do,
is you put the knee up like this
and oftentimes it doesn't go totally straight.
- Right.
- It's still contracted a little bit in a bent position.
And we're gonna actually push down.
And I'll have the patient go above the knee
and push down and stretch.
- Initially, gravity might be enough.
- Exactly, yeah.
- When you start off with that.
In fact, I often like the stool like this,
'cause I go, let gravity do its thing for awhile.
Then if it hurts too much, give it a little break.
- Right.
- You know, and bend it,
and then let gravity jump in there again.
- So when you come up like this, oh, it feels good,
let it go down and stretch, oh, that's painful,
the TENS is gonna help.
- Right, help blunt the pain.
- Exactly.
So sometimes a little on and off motion will work good.
It depends on the patient,
the patient knows we're gonna do it.
Sure, a little oscillation there.
- Some people, if the pain isn't too bad,
then I'll have 'em push gently to get that stretch out.
And then to finish off, what I usually do, Bob,
is I'll have the person go to that position.
So we got a stretch,
and the intensity of the stretch will vary.
If I go like this, it's pretty aggressive.
- Right.
- If you put it up in here
so the pad or the stool is under the calf, not so bad.
- Not nearly as bad.
- Yep. - Right.
- And also, for pain and swelling management,
I'm gonna take the cold pack, which I have right here,
I'm gonna leave the TENS unit on,
so everything is still working, I'm gonna put the cold pack.
So now we have not only the TENS managing the pain,
but the cold pack's gonna help the pain and the swelling.
And the weight of the cold pack gives you more of a stretch.
So, it all varies.
You might, when you put that on,
it might be too much of a stretch.
Then you'll bring it in closer, so that it's not so bad.
- You wanna experiment around with it.
- Yeah, and you'll learn this very quickly.
- You figure out what works for you and what doesn't.
- Right, exactly.
15 minutes of the cold pack
and then you're gonna take things off,
take the TENS unit off,
and then it's nice to go for a little walk.
- You know, sometimes you can have patients
work on the extension laying down, too, Brad.
- Yeah.
- You can take the Knee Glide, put the towel on here,
and you're like this, and you can even sit up like this.
And you can work on tryin' to straighten here
right while you're in bed.
- Right.
- Givin' a little push like this.
- Exactly, yep.
- This is kind of a nice, comfortable way.
Hamstrings are a little bit tighter in this position.
I guess if you lay down like this it'll be a little less.
- Right.
- And you can work on straightening that way, too.
We like to go at it from a lot of different angles
when you have trouble straightening it out.
- Exactly.
So bendin' it straight,
all these little things are gonna increase your rehab time,
get you back on your feet again,
feeling good and comfortable.
And, Bob, I don't know, what more can we say, except for--
- You can fix just about anything.
- Except for--
- A broken heart.
- Right, and knees are a lot easier than a heart.
- Yeah, they are. - I can tell ya that.
- We'll get to it someday, though.
- Exactly.
(cheerful electronic chords snippet)