♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- This video today was put together
by Mike and Alex
of the Bob & Brad Crew.
- Mhmm.
- Both are physical therapist assistants
and both have been providing treatments
to our patients for years.
They do...
- Fantastic work.
- We're very happy with all the work with their patients.
We have reviewed and approved
all of their material that they're bringing up.
So they're showing you our treatment
through them with their experience.
- And it's been... - Exactly.
- Wonderful.
- So make sure you subscribe to the Bob & Brad Crew channel
in which they do reviews of products that keep you
healthy, fit, and pain free.
They handle all of our new products now.
Enjoy the video.
- Good luck.
- Welcome folks to the
total knee replacement fitness program.
I'm Alex, physical therapist assistant.
- I'm Mike, physical therapist assistant.
- And this is higher level exercises, four to eight weeks,
once your range of motion and walking quality is improved.
So we're talking, this might not make sense right now,
your range of motion needs,
your straightening needs to be at zero.
That's absolutely straight.
And your bending should be around 90 degrees,
which is just,
a right angle there, right?
- A right angle in your knee with your hip.
- Yep. If you're still not at totally straight in your knee
keep working on it.
We're not saying advance to these
if you're not ready, but this is...
- Yes.
- A guideline.
- Figure out which ones seem comfortable to you
and try these.
If you're behind stick to the range of motion
and phase one of the program or the earlier exercises
till you feel more comfortable and then progress to these.
Some people will be ready for these a little early,
some people a little later, it kind of varies.
- Yep. Everybody's different.
The goals of this phase here,
number one: Max knee bending.
So you should be at about 90 right now.
We wanna get you to all the way back to about...
everybody's different,
120, 125.
Some people maybe 130.
- Yeah. And like 100 and 110 are functional.
Your surgeon will tell you ahead of time
what their goal is for you.
- Yep.
- It kind of depends upon your knee
and how damaged it was prior to this.
- Yeah.
- So not everyone's gonna get 120
but we'll progress towards what you can get functionally.
- Yeah.
- Goal number two is to progress your surgery side.
So if my right one was my surgery
to try to equal the strength of my non-surgical side.
If this knee's bad too, you might actually surpass it.
- Sure. - But...
- And a lot of people surpass it really early on, so.
- Yes, but the goal is to get both legs in this phase
to be about equal strength or closer to.
- Yep. And number three:
Determine your appropriate assistive device, if any.
You're probably using a cane at this point,
determine should I still be using a cane?
Or should I ditch the cane? Get rid of it.
Or some people even,
if they're not doing well,
they'll even grab the walker again for a while.
So gotta determine what you want.
- Yeah and if you've been using a walker for years,
'cause you have bad balance and you had a knee replacement,
you're probably still gonna be on a walker.
I mean, if your balance is poor, it might be different.
But we're talking about for the average person
that wasn't using the assistive device before this.
- A lot of people in this stage
get rid of the cane here now.
Or they're still working with the cane.
Everybody's different.
- Yep.
- And note: if it hurts, don't do it.
You gotta know the difference from pain versus stretch.
You're still gonna be stretching.
It's still gonna be a stretching pain,
but those sharp 'pain' pains, those you have to avoid.
- Yep. So don't push it.
Just do what is gonna be kind of painful,
but not agonizing,
like 'this is getting worse' type feeling.
- Yep. Yep. You shouldn't digress in this stage.
- Yep.
- The exercises: I'm gonna demonstrate number one,
is that okay?
- I suppose I'll allow it today.
- Don't get mad.
All right,
so you're gonna have to use your imagination here
a little bit.
Number one of this is called a step flexion stretch,
or a step knee bending stretch.
So that's the goal here.
So imagine these are my hand rails on some stairs,
and my right knee, this is the affected knee.
So all I'm gonna do is put my foot up on the step.
Probably an eight inch to 12 inch step I would say.
And I'm gonna bend forward.
See how my knee is bending.
Go as far as you can, until you can't go any farther
and then hold it for about five seconds.
- [Mike] And then... - And then back off slowly
- [Mike] Make sure you have sturdy handrails
before you do this.
- Yep. Yep.
- [Mike] And some people just do one step.
Some people will go up like two steps.
Depends on your flexibility and how much
range of motion you have in your knee at this point in time.
- And some people will go as far as they can.
And then they'll kind of drop their butt down
to sneak a little more motion in there.
- [Mike] This is more of a range of motion
stretching exercise versus a strengthening builder.
- Yep. This is range of motion.
That's goal number one.
Number two...
- Is sit to stands
after I just moved the chairs.
- Michael.
- Sit to stands.
Try to go without your arms.
If you need momentum
you can kind of keep 'em here to rock up and push.
If you're not quite there,
start with using your hands.
If you need one hand,
then you can try two hands on lap, maybe.
- Yep.
- Pushing up.
The goal is if one side is weaker than the other,
say this is my strong side,
you're gonna see people getting up like this.
- Yep. And this is a big one.
The pain versus a stretch.
If it's really hurting your knee
when you're trying to get up use your hands.
- Yeah. - Use your hands.
You gotta work up to that.
- Sit with arm rests on your chair.
- This is strengthening and range of motion.
That's what I like about this one.
You're bending your knee as you're sitting down
and you're also getting some strengthening out of it.
- Oh, this is another one.
I remember what I was gonna say.
- Finally.
- If you're early on, you're probably kicking your leg out.
By this time, you should try and get both your feet
equal with each other when you stand.
- Yep.
- It's gonna engage the muscles equally.
- Yep. Equal strengthening from side to side.
- Yep.
- All right.
Number three.
These are called standing exercises.
There's five of 'em.
I'm gonna run through 'em quickly here.
You're gonna want something to balance.
So you could either hold your steps in the house.
You could go behind a chair.
- [Mike] Countertop.
- Countertop, walker,
the sink works real well
'cause you can actually grab a hold
- [Mike] You can do the dishes.
- No, that's not an option.
- [Mike] Oh.
- All right.
So I'm gonna go behind the chair.
I'm gonna kick out to the side.
My toe is pointing straight forward.
I'm going out to the side.
- If I'm giving a front view
he's just kicking
out to the side like this.
- We're working this muscle here.
And then you're gonna kick backwards.
Now we're working your glute max,
your big butt muscle.
- [Mike] These ones, shouldn't be very hard.
You're gonna do these on both legs.
- Yep.
- [Mike] So you're gonna do a set of 10 reps
on the right leg.
And then you're gonna switch
and do a set of 10 on the left leg.
- That's a good point,
'cause you wanna get that weight bearing
on your bad knee as well as it moving.
And then you're gonna do marching in place.
I turned to the side
because I'd run into the chair
and I have good enough balance at this point.
- [Mike] You do?
- Well, sometimes.
- [Mike] You're working on it.
- I'm working on it.
- [Mike] You can also do these at a walk or two.
If you want.
If you don't need balance
then you don't have to hold on.
- And number four of these is mini squats.
I'm not expecting you to get to 90 degrees.
Just use good form.
Get your butt back
like you're gonna sit in a chair.
- [Mike] Yep.
- And then back up slowly.
- Just a slight knee bend.
You don't wanna bring your knee way forward.
Do a bad one once.
Yeah.
Don't do that.
If your heels are popping up, you're probably going too far.
You're going in the wrong place.
Pretend you're just sitting in a chair.
If you want, put a chair behind you.
It's kind of like doing the sit to stands.
- Yep. And then the last one.
We call these calf and toe raises.
You're just gonna go up on your toes
and then lift your toes.
All your muscles in your legs get weak
when you have a knee surgery,
'cause you're favoring those muscles.
So we have to strengthen 'em all back up.
- [Mike] Yep. Just do both of these together.
If you get stronger eventually over time you
can try doing single leg.
But right now just stick to double.
- [Alex] Yep. - It's just gonna be easier.
These are a smaller muscle group,
your calves are, so.
- Yep. Good for your balance too.
- Yeah. If you have poor balance, do these as well.
- Yep.
- Number four.
I can't really demonstrate this
'cause we don't have a stationary bike.
- We'll just talk about it.
- A stationary bike or a new step machine
or something like that,
it's just gonna get more endurance and muscle built up
in your leg, doing the revolutions like that.
- Yeah.
- You could just shoot for five minutes to start,
if you can handle it.
Increase your workload, so the amount of resistance,
as you feel comfortable.
Start with zero or one, whatever the lowest setting is.
Don't put any inclines or variations.
Over time you can build up what level you're doing
and just kind of take it easy.
You might start further back from the bike,
if it's a recumbent style.
Or higher up,
if you're doing more of the vertical style bike.
We'll show some pictures here
of the two different types you can use.
- [Alex] Yep.
But it's just a good exercise.
Build up some strength and endurance.
Helps with your walking and everything else.
- [Alex] More of a dynamic exercise.
Maybe break up a little scar tissue
that still remains there.
- [Mike] Yeah.
- You know, get yourself back to functioning and moving
like a normal person.
All right.
Number five, single leg stance progression.
So I'm gonna start with both hands on the chair.
I'm standing on my bad side.
We want this side to be able to equal the other side.
That's the ultimate goal.
- [Mike] Yep.
- So then I'm gonna drop a hand if I'm feeling comfortable,
and if I'm feeling really good
I'm gonna drop the other hand.
- [Mike] Or you go to fingertips.
- Or fingertips. Yep.
You go to fingertips.
Drop the other hand,
and then I'm really feeling good,
I'm gonna close the eyes a little bit.
- [Mike] Uh oh, it's getting crazy now.
- So you wanna build up to being able to do that
for 30 seconds.
- [Mike] And try that on both legs as well
because you'll see if one side is worse than the other.
Maybe your other side is poor balance too.
It's just something to work on.
- Yep. We wanna equal out the right side and your left side.
- If you're prone to falls in the past,
maybe have someone hold on you for this one.
- Yep.
- Like use a gait belt or just a normal belt.
Just grab on.
- Yep. Good spot to be at that kitchen corner.
So you don't fall.
- Yeah. If you don't feel safe,
but hold on if you feel comfortable.
- Yep.
- Number six is step ups and step downs.
So unlike our other video,
showing you how to do stairs without pain,
this is to strengthen your leg.
So you'll use a step.
It can be a four inch step.
It could be eight inch, 12.
Whatever you have at the house.
- [Alex] Yep. Start with four I would say.
Always start low.
- [Mike] Use the railings to start, if you need them.
I would recommend them.
So if my left side is my surgery leg,
you're gonna actually use that one to go up with.
So if I'm doing a forward step up,
I'm just gonna go up
and I'm trying to use this leg,
bring your other foot,
and you can just keep it here and go back down.
We have people hold onto the railings.
Now, once you start to get stronger
try not to hold on and try to control it.
'Cause what happens is people will pull.
- [Alex] Momentum.
- And then they'll go
like this.
Try to control it, as your pain subsides more
and you feel stronger, to try to go up.
Then try to control it on the way down.
- [Alex] Almost picture your quad muscle
contracting to lift you up.
- Down is a lot harder
than controlling it then just going up.
Try not to push too much with your good leg either.
'Cause if I'm just pushing,
this leg is not doing a thing.
So think about this leg engaging
and using these muscles and your quads and your hamstrings.
- Yep. And same idea as squats.
Don't let your knee go past your toes.
You want 'em to stay in line.
- Yep. Don't go all the way up.
Just keep 'em nice and up.
And then for step down,
you're gonna actually start going down
with your good side first
because that's gonna make your bad side bend and control.
Once you get to a point your heel's gonna pop up.
This.
But just try to control it.
Use the railings initially.
Try to control the downward steps.
- [Alex] And this one,
make sure you have good range of motion
the first time you try this.
Good bending. Good bending.
- [Mike] Yeah. If you don't have a good bend to this
you're gonna get to here and you're gonna go "ow!"
And you're gonna go down. Flop down.
- [Alex] And you could be in for a world of hurt.
- [Mike] Yes. - All right.
That's four to eight weeks,
once range of motion is improved.
Anything else you wanna say?
- Check out all the other programs
at bobandbrad.com/programs
and you could check out other ones related
to the total knee replacement fitness program.
- Well said, thank you.