♪ Bob and Brad ♪
♪ The two most famous ♪
♪ physical therapists ♪
♪ on the internet ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- 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 and Brad crew.
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 and 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.
- Hi folks. I'm Alex, physical therapist assistant.
- I'm Mike, physical therapist assistant.
- And this is the total knee replacement fitness program.
This is your guide to achieve maximal knee bending.
- Bring it to the max.
- Is that a song?
- You would know better than me.
(Mike laughs) You're the music guy.
- Anyway
- Two things to note here.
Number one. I'll do number one.
- Okay.
- Pain control is very important.
Practice your deep breathing.
You might have to refer to previous videos;
we did these things.
Practice your deep breathing,
and use your pain meds
at least one hour prior to doing your exercises.
And you should be staying on your scheduled routine
for pain meds, especially early on.
- Yep. Number two is swelling management.
So it's very important working towards your range of motion
of your knee bending.
If you have more swelling in your leg,
it's gonna be harder to bend the knee.
So practice RICE.
Rest, ice, compression, elevation are all important things.
- Yep.
- Remember you could do numerous ones at once.
Lay on your back.
Watch some previous videos we have.
Elevate your feet up above your heart.
Put some ice pack on there.
- Make sure to have a layer
between the ice and your knee skin.
- Yeah.
- And yeah, just try to get the swelling out of there.
- And get moving. Activity.
- Yep.
- Functional range of motion norms.
Now these are norms,
so, if you're not in these categories yet,
don't be, you know, don't be nervous.
- Don't be discouraged.
You will get there.
Everyone's different.
These are just recommendations.
- Yep. They say zero to two weeks you're bending.
Your flexion range of motion should be 65 to 90 degrees.
So, 90 degrees is that right angle.
- If you're not there at two weeks at 90 degrees,
don't force it.
- Yeah.
- Just take your time.
These are just norms.
- Yep.
Two to six weeks they say you should be about 115 degrees.
Mike and I have worked with a lot of older people.
- Yep.
- And they, you know, sometimes 115 is what they get to
by the end, and that's great for them.
- Yeah. It's all gonna depend.
Your surgeon will tell you
if they don't expect you to get full range of motion back.
It depends on how long you waited to get the knee replaced
and what damage was done, basically.
- Yep. Yep.
And 12 weeks.
I mean, if you're probably a younger person, very active,
125 to 135 degrees, 135 is all the way heel to butt.
- Yeah. I don't honestly see that range-
- No, I don't. - a whole lot.
Most of the time, we're looking for 120.
- I don't think I've ever seen 135. I'm gonna be honest.
- No, not a knee replacement.
- Some functional things, you know,
just to put in perspective
why you need to get your knee bending.
Walking takes 65 degrees of bending
- Picking up an object takes 70 degrees of bending.
- Yeah. They say climbing steps.
This is one step after another, you know.
Normal stair climbing is 85 degrees of bending
of your affected leg.
- Going from standing to sitting.
No, I said that backwards.
Standing to sitting.
(Mike laughs) - Yeah.
- You need 95 degrees of bending-
- Yeah. - at least.
- And they say squatting. I thought this one was surprising.
Hundred fifty...
Squatting or sitting cross-legged, 115 degrees of bending.
Squatting, I don't know why that was-
- Ask your surgeon if you can cross your legs-
- Yeah.
- Not all of them like that, but a hundred...
Yeah. I guess if you-
- Maybe.
- squat decently.
- Yep.
- And in and out of the car or the bathtub
you commonly need 125 degrees of bending.
- Yep.
- That can vary depending upon your vehicle
or if you have a seat in your bathtub or not.
- Or how much you can compensate
with other muscles, techniques.
- Yeah.
- All right.
On to the exercises.
Now we're gonna go phase by phase.
Zero weeks to six weeks plus.
So we're gonna start.
- We'll specify, exercises just to focus on knee bending.
- Just to focus on knee bending.
Yes. This is zero to one week.
So that first week after surgery, we're gonna start.
There's two exercises here.
We're gonna keep it simple.
Number one.
Do you wanna demonstrate, or do you want me to?
- Supine heel slides.
I'll demonstrate.
- Okay.
So basically what he means is laying on your back
getting your knee bending.
- You don't need a knee glide if you don't have one.
You can just use your sock.
- All right.
We're using knee glide.
It does work a lot better with the knee glide I will say.
- Yeah, bit smoother.
- Yep.
So all Mike is doing, he's laying flat.
You know, this is early on where you, you know,
you might not wanna get out of bed.
You know, you might be in a lot of pain,
but you gotta get it moving.
- Zero to two weeks,
you're probably gonna bend it like this far.
I'm exaggerating-
- Yep - how much.
That's full range of motion.
- And you might need to use your leg lifter for a while too.
- Yeah.
- You might refer to previous videos. A leg lifter.
- You can also use your other foot if you can reach.
- Yeah.
- And help push a little bit, if that's comfortable.
If that bothers your back, don't do that.
- Sure.
Okay.
So that's laying on your back, getting your knee bending.
You're not probably gonna get a lot of motion,
but it's a starting point.
- Yep. - All right.
You wanna hand me the knee glide?
- No.
- Thank you. (laughs)
- Toss it at ya.
- All right.
So we're gonna say my right knee I had replaced.
So we're gonna get in the seated position, you know,
to start.
You're not gonna go for a long duration.
I'd say three to five minutes is gonna be plenty
that first week.
- Yep.
- So you might, you know, you might have to
bring the knee glide out like this.
Your knee's not bending much.
You might just start going this far
- And every so often, like every 30 seconds or minute,
just try to bring it back-
- Yep - a little more.
Hold it for like 10 seconds.
- Yeah.
- Just so you feel a stretch, just touching the pain,
not forcefully bending it where it hurts.
- Yep. It's not about speed, as Mike says.
It's about getting your foot
to come back further underneath you.
- Yep.
- That's zero to one week.
Those two exercises, that's it.
- Yep.
- One to three weeks.
We want you to do this three times daily.
Increase the duration a little bit
Maybe 10 to 15 minutes per session.
- Yep. Just take a little bit longer.
You're probably feeling a little better.
- Yep.
- The first exercise is gonna be
just continuing the knee glide.
- Yep.
- This is one of the optimal things.
Focus on that range of motion
and getting the knee flexion back.
- So as it bends more,
you might be able to bring the knee glide
back a little further.
But same concept.
Go slow. Pull it back underneath you.
At this point, you might be able to push a little bit
with your uninvolved leg and really stretch it out.
But, you know, let pain be your guide.
Don't try to-
- You don't-
- get it all.
- have a knee glide,
just use a towel on the floor.
- Yeah.
- Works pretty similar.
This is just a little easier-
- Yeah - on all surfaces.
- Our patients have never regretted getting
the knee glide though, so I-
- Yeah, we send them home with them,
and then they just bring it back when we're done.
And they've all thoroughly enjoyed using it.
- Yeah.
Number two, this is an easy one, but very, very effective.
I love this one.
(Mike laughs)
All you're gonna do is your feet are gonna be flat
on the ground.
- Just imagining him like the knee patients
complaining at him after-
- Oh yeah. - doing this one.
- Yep.
Yep. - It works.
- It works.
- It won't hurt.
Just, it stretches.
- Oh yeah.
It might hurt a little bit.
Don't lie to them.
(Mike laughs)
All right.
So your feet are flat on the ground.
All you do is you scoot your butt forward.
And do you see how my knee is bending a little more?
And then I'm just gonna hold it for 10 seconds or so.
- Yep. So the goal is keep your feet planted.
You probably have to have shoes on
or grippy slippers or grippy socks.
If you're just in bare feet, it's gonna slide too much.
- Yeah.
- We also have people do this in a wheelchair too-
- That's right. - if they're more
- wheelchair-bound in the facilities.
But this is just a good way.
You're in control of how much pressure you're doing.
No one else is pushing the pressure.
- Yeah.
- Again, don't forcefully get it
because you want a better number.
Just do what you can do for that day.
- I think we can both agree,
when the patient's in control of the situation early on,
they do a lot better.
- Yeah.
Otherwise, if we force them back,
they yell at us a little more.
- Yep.
- In a nice way.
- So start with maybe five repetitions.
You know, move up to 10 as you feel comfortable,
and really try to get your butt to the edge of that chair.
You know, make a goal of it.
Number three.
This is sit to stands with your knee bending.
I like this one.
It's functional.
You know, you get a little strengthening in there too.
So, this chair probably should have armrests
at this point.
But, you're gonna stand up.
And then most people wanna, you know,
kick their bad leg out and sit down,
but that's not doing anything for your bending.
So, early on, you know, I'm not expecting you to
keep your foot all the way back,
but try to get it back as far as possible.
Reach for those armrests.
Sit real slow.
See how the knee is bending, bending, bending.
And if that's too much,
then kind of stop yourself and bring your foot forward.
- This is a good test to do week by week two, early on.
You'll see how far your foot is out.
And then as time goes on, like a couple months,
you'll probably start noticing they're more even.
- Yep. Yep.
- So, just another way to see progress.
- That's the goal, is equal weight-bearing,
equal bending of your knees when you're standing, sitting.
Number four. You wanna take this one?
- No.
- Yeah, you do.
- Yeah, I do. Where is it?
Number four. Walking with focus on knee bending.
So while you're walking,
you just wanna make sure your knees are actually bending.
- I'm gonna get outta the way here.
- You don't wanna do the old peg leg
and, like, whip your leg straight,
'cause it hurts, like this.
You want to allow it to go forward
and then bend as it's going back.
- Yep.
And then when you're lifting it off the ground,
bend it too.
- Yep.
So just focusing on trying to get
a normalized gate pattern.
You might still be using a walker
at this point in time
or a cane depending upon your mobility.
Keep using it as long as you need, and then eventually,
you know, wean off if it's appropriate for you.
- Yep. Yep.
All right.
Then we're moving on to four to six weeks.
This is where we're gonna get a little more aggressive.
Three times daily again.
Maybe bump it up to 15 to 20 minutes of exercise
per session.
- Yes.
- I don't need to show it again. Do I?
Continue with the knee glide.
- Yeah. The knee glide is in every phase of this.
Keep working at it.
You probably have it closer to the chair now
'cause you're bending a little more.
- Yep.
- Range of motion is, should be your number one priority
these first six weeks.
Strength will come back later.
- Yep.
- Just keep focusing on the bending-
- Yep. - if that's your issue.
Straightening will be a whole other video.
But... - Yeah
The knee glide, I would say, you know,
bump it up to doing eight to 10 minutes now.
You know, don't do your, you know,
three to five minutes.
Bump it up to eight to 10.
- And you don't just have to sit there and do that.
You can breathe while doing it or watch TV or-
- Yeah.
- something to get your mind off of it
'cause it's gonna be a bit of discomfort-
- Yeah.
- while you're doing it.
So, just try to breathe through it.
You know, watch some TV, distract yourself.
- Yep.
- Just enjoy your time with the knee glide.
- Number two.
We just did it in the one to three week phase two.
The scooting forward in the chair stretch.
But try to get that foot underneath you now.
You know, equal with the other foot.
- Yep, just progression more and more
just to try to get a little more knee flexion
as long as it's tolerable for you.
- Yep.
- Number three is a different one.
It is in some of our other videos.
It's called a step stretch.
- Sure.
- So, Alex will show here.
We're using a chair.
This would be like your handrail.
- Yeah.
- Do not go...
This would be like two steps up.
You don't have to go this high right away.
I would just start with a normal step height-
- Sure - like this.
But he's just gonna put his surgical knee up on there.
- I'm tall, so I can get away with doing this.
Not many people will be able to.
Use your imagination here.
This is a railing on steps.
- Yep. Hold on and lean forward into it.
Obviously Alex is exaggerating-
- Yeah.
- Because most patients will not be able to bend that far.
- No.
- Most will start way back.
- Yep. Sure.
- And then they'll try to bend into it.
- Right about here maybe.
- Yep.
And right when you start to feel the pressure,
just stop there.
Do not forcefully bend it even more.
- Yeah.
- You're in control of it again.
- And a little trick when you get to the end,
try dropping your butt down.
You get a few sneaky degrees there.
- It's the very similar concept to the chair scoots.
It's the exact same thing.
Your foot is planted.
You're just in a standing position now,
and you have a little more leverage-
- Yeah. - to stretch a little more.
Typically wait a little longer to start this one
because it is more aggressive than the other ones
and we don't always wanna be real aggressive right away-
- Right - with this.
- Yep.
And we don't wanna put you at risk for falling.
So we like to wait on that one a little bit.
- Yep.
- And then, again, the walking with the emphasis
on bending the knee.
I even tell people to exaggerate
when they're walking.
You know, act like you're gonna kick your butt
when you're-
- Isn't that how you walk all the time?
- Well kind of, but, at bar time.
Well, we can't throw that in there,
Bob and Brad said.
(Mike laughs)
- Number five is functional knee bending with ADLs,
activities of daily living.
So, just try to go about your day.
Try to think about letting your leg work like the other leg.
Just let it bend.
If you're picking up something low, try to use it.
Don't baby it as much anymore.
- Yeah.
Getting in and out of a car, you know, anything like that.
- Yeah.
Do the stairs again if you're comfortable with them.
There's other videos how to do stairs correctly.
Maybe use that leg to lead going up the stairs now.
- Yep.
- It all just takes time, but these are all tips
to help get your knee bending a little easier.
- Yep.
When you're getting dressed in the morning,
You know, bend your knee, you know,
to get your socks and stuff on.
Don't, you know, don't be-
- Yep. Try to maybe-
- Compensating. - get rid of some of those
sock aids and other things you've been using early on.
- That's right.
So this leads us to six weeks plus.
You know, at six weeks we expect your range of motion
to really be improved.
You're feeling good.
Now at this point, I would continue
with the step-bending stretch, you know,
on your stool or your chair.
I would do that once or twice a day.
I'd say for 15 reps.
- Yeah.
You still wanna keep some bending focus.
Depends on your range and how comfortable it is.
Sometimes, like, your knee bending might be far
if you're stretching it,
but just in normal, like,
if you're not stretched or warmed up,
it might not be as far.
So still focus on it if that's an issue.
- Yep.
- You will know eventually over time
when you can stop focusing on it.
- Yep.
But the main thing in this phase is to, you know,
again, bend your knee functionally
with everything you do at six weeks plus.
I mean, you should be trying to bend that knee
like you were before surgery.
You know, it's probably not there yet, but...
- Might be even better than-
- Probably better... - before surgery depending...
- That's a very good point.
- Yeah. Some people, it's pretty bad before surgery.
- Yep.
- All right.
This is your guide to get max knee bending.
You have no excuse.
- Check out all our other videos related
to total knee fitness program.
You can find it on bobandbrad.com/programs.
- Thank you.
- Thanks.