- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most
famous physical therapist on the internet, Brad.
- Well, in our opinion of course, Bob.
- I'm trying to convince ourselves.
Okay, today we're gonna talk about top three
advanced total knee replacement exercises,
- Right.
Strengthening exercises, strengthening.
- So these are, you know,
after you've been done, you know,
the surgery's been done for quite a while,
and now you want to make sure,
cause I read that actually
a lot of people, a year later,
that knee is still like 20 to 30% weaker than the right.
The other knee.
- Not my patients.
- No, not your patients.
(Brad laughs lightly)
Right? So what we're gonna do today, Brad,
we're gonna do three exercises
without equipment and three exercises
with equipment.
- Right.
- So let's start off with number one.
You want me to do it?
- You bet.
- All right, we'll do mini squats.
Now you can do this one of two ways.
One, you can grab the side of a chair
like this, and you're just gonna go ahead
and just what it sounds like.
Just you're doing mini squats, right?
Not going down very far.
Just a good way to get some
strengthening in that end range.
- And you're gonna do about 10 to 15 of these.
- 10 to 15, the alternative would be to go ahead
and do sit to stands,
and you might be in a chair with armrest
to help you get up.
- Right.
- And if not, eventually you wanna progress
to the point where you don't use the armrest.
- Right.
- But you're gonna go ahead and stand up,
sit down again.
You're probably gonna need the armrest to start
off with.
- Right.
- Stand up, sit down again. 10 to 15.
These are hard work.
- Right.
- So you're gonna gonna
get your nose over the toes.
And, I think eventually what you'll find is
that you can do it without the arm rest,
- Right.
- is what I'd like to see.
- This really depends on the function,
the prior function of the individual.
- Right.
- I mean, they're doing knees so young now.
If you got an 80 year old person,
and they were not that, you know,
high level, right?
- Right, before, this might be difficult.
- Right, and the other one
is if it is an older person
or someone that is not that strong
and their primary goal is to walk,
just squat like this, you may have to maybe go
to a sink and put your hands around the sink,
so you have something solid,
- [Together] To hold on to.
So use your judgment.
- Good point. All right, Brad, lateral step ups.
So this you could do on a stairs.
- Okay.
- On a step.
- And hopefully, I have a rail there
to grab onto the hand-rail to step.
And if this you know,
this would be the first step to hand-rail.
- The other way around, actually,
cause this one goes up first.
- Oh, this is my involved knee.
- Yeah.
- All right.
Use your imagination here.
So you can do it on a stool like this,
but you need something to hold onto.
- Yeah.
- This is pretty aggressive on this knee.
And this is a high step here.
- This is the knee knee that was replaced.
- That's the red tape,
matching my red Garcia tie.
Okay.
- Yeah.
And you're gonna go up like this,
and you're gonna go down like this.
It's a lot harder than it looks,
if you do it right,
now, common mistakes are people
go like this and then
they'll go up, and then
they'll bend forward and
touch with their toe and go down.
But you want to keep good, tall posture.
You're gonna push straight up.
If you look at my left foot,
I'm gonna go up.
If you can, without pushing with your toes,
it's okay if you do.
But as it gets stronger,
you're gonna go up and come down
and it's even harder
if your heel touches first,
and then let your foot go down.
The other thing is, look at my knee.
If you find that your knee is going in like this,
and I'm exaggerating a little bit.
you don't want that, you want to keep it in line.
So it stays good, proper alignment.
And you'll find, that if you do up to 10 of those
with good body mechanics,
that's as much as they're gonna do.
- This is gonna help you on stairs too.
- Right, exactly.
- This is gonna help you with that,
that final issue a lot of times
people have is with stairs.
All right, Brad.
Let's, I'm gonna go ahead
and do clamshells.
- All right.
- Now this one's really not
strengthening of the knee per se,
it's strengthening of the hip,
maybe a little bit of the knee.
It gets the I.T band going all the way down.
- Yeah.
- But it's, it's strengthening the hip abductors,
and external rotators, and you'll find
out it's just important muscles to help
with your overall walking.
So this is the replaced knee.
- Yeah, right there.
Let's give them a little tape to, to see that.
- And you're gonna start off,
gonna put your feet on top of each other,
your ankles on top of each other
and the knees are together.
- Right.
- Knees, slightly bent.
- Here is lined up.
- And it's just like a clam shell would be,
right Brad? You're opening the clam shell.
- Right.
(growling noises)
- Hello, Mr. Brad.
- Yep.
- Now this is one,
Brad and I just had this discussion.
It's harder than it looks.
- Yeah.
- Because these are not very big muscles.
- Right.
They're small muscles and they start to hurt.
I mean, they start to burn after a bit.
- Right, you're gonna feel right
where his hand is, right there.
And do 'em slow like this,
hold it up for a second and come down.
Good controlled motion.
- Yeah.
- You can do this on your bed.
You're probably not gonna be able to get
on the floor too easily.
So just go ahead and do it
on your bed and you'll get that muscle.
- Good 10 to 15.
You may not even be able
to do that many the first time.
- Right.
- But you're gonna find
out it's gonna give you
more control when you're walking.
- Yep.
- And such.
So now we did three exercises without equipment.
Now we're gonna do three exercises with equipment.
Let's do the first one.
You're gonna need some Thera Tubing,
or Thera band or stretch tubing.
Just, if you Google it, you'll find
that it's pretty easy to find.
- It's very popular on the internet
as well as in stores now.
- Yeah. So what are we're gonna do is,
- Oh, all right.
- So you're gonna attach this somewhere,
to something solid.
Yeah, I doubt that you're gonna have a Brad
in your home helping you out.
- You might.
- So you're standing with the knee like this,
here's the involved leg,
and this is just a great for terminal knee extension.
So you're gonna go ahead and pull back like this
- As far back as you can.
- Yep.
- And with weight on the leg.
- Yep.
- And this is an important one
for that full extension on heel strike
when you're walking.
- Yeah, but it helps to get
the VMO, Vastus Medialis Oblique's.
- We gotta get that speech therapist going.
And 10 to 15 as well.
- 10 to 15 again, on that.
- And it should get you tired.
So you just have step back
if it's not tight enough.
- All right, Brad, if you wanna jump right
into hip abduction with those.
- Okay.
- So with the same band,
you can do some hip abduction.
- This is really nice if you have the handles,
you can grab onto.
And if you're just starting this one,
it's a good idea to have someone alongside you,
cause it could,
you could lose your balance with this.
- That's why these are advanced, Brad.
- Yeah.
- These are not, these are not for the beginner.
- Exactly. And you're gonna go here.
This one is much harder than it looks.
I'm gonna pull here,
and I'm gonna step out, and in here.
So you're working your balance,
as well as the muscles
on the sides of your hip,
the hip abductor muscles.
- And again, the I.T bend
that you're strengthening,
actually goes all the way down to the knees.
- Right.
- So it stabilizes the knee a bit, too.
- Yep.
And you know, depending on your level,
if you have something to hold onto,
(chair scrapes)
you could add a little hip abduction as well,
but make sure you have something to hold onto.
- And you could walk along by a countertop, too.
In case you feel like you're gonna
lose your balance and you know, hold on.
So you're not gonna do any much good.
(both laugh together)
- I guess, if you don't feel steady, you shouldn't do it.
- Yeah. That's a good point.
- Have someone behind you
holding onto your belt or something
of that nature.
Again, advanced exercises for that
higher level rehab.
- Lonnie, you wanna throw us a ball?
We're gonna have a ball, Brad.
- Oh, it's a red ball.
- Okay. Brad's gonna show the final exercise,
This is hamstring strengthening.
- Now this one,
you can do on on a bed with the ball.
It's gotta be a firmer bed,
but even a soft one would work.
I'm gonna do it on the floor here,
cause it is probably the easiest
to do it on a firm surface.
The nice thing I really like about this
for a total knee is when you're laying down,
you can you get your feet up on here
and you can simply do this to range it out.
Just get warmed up.
It's not hard.
The strong leg helps the involved one,
stretches it out.
And then once you do that 10 or 15 times,
hamstring strengthening, and we want
these muscles back here to get stronger.
To do that, you're gonna lift up your butt.
The beauty about this exercise,
it works the core, the hip and the hamstring,
so it's a triple duo there.
Up like this,
Now you probably won't be able to do this,
If you haven't done it before, you're probably
gonna just lift your butt up a little bit,
pull the ball towards you and then away.
And after you get used to it,
it may take about five or 10 sessions
before you get up to here.
But that really works the hamstrings in the core.
And again, 10 to 15 reps.
If you're getting stronger and you wanna do more,
you can do 10 or 15 reps
and lay here and just relax.
Maybe do a little more stretching,
and then do another set of 10.
All right.
- You wanna show the ultimate Brad.
- Oh
- One leg, or do you think that's too much?
- Well, for those people who are way up there,
probably just some, some men who've got big egos
and you really want to get stronger.
- Some women too, Brad.
- Well, that's possible, I mean there's no doubt.
The next step up is you cross your foot like this,
the involved ones on the bottom.
And that makes it a little bit harder on that hamstring.
And then it's really,
this is really advanced.
And if you're doing that, you're probably out,
well you can't run with that.
- Yeah.
- With a replaced knee,
but you're really you're up there.
There's not gonna many people, gonna do that.
- As an alternative to the ball, Brad,
if you have an office chair at home like this,
- Sure, yep
- You can work on wheeling yourself
around like this.
- Right.
- I don't know if you're catching me, Lonnie.
but I'm pulling myself with my heels
and that's working the hamstrings here.
- Yep. Yeah. Just make sure you've got good wheels,
and you don't pull yourself off the chair.
(Brad laughs)
- That's right.
All right, that's it, Brad.
Just remember, we're not just pretty.
- We're pretty ugly.
- [Together] No.
- No. We're pretty old,
cause today is Brad's birthday,
and he's getting older all the time.
- 53, I believe.
- 53, wow.
- So, oh yeah, there we go.
- That's an old man's hat.
(laughs lightly together)