- 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 our physical therapist assistants
and both have been providing treatments
to our patients for years.
They do fantastic work. - 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 wonderful. - Exactly.
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.
- Welcome folks. I'm Alex, physical therapist assistant.
- I'm Mike, physical therapist assistant.
- And this is the total knee replacement program.
- Yes. And this video is called exercises prior to surgery.
- Or pre-op exercises. - Yes.
So let's get into it.
We just wanna give a couple tips
for getting in pre-surgery shape.
And I took this from fitnessandwellnessnews.com.
You always gotta cite your sources, right, Mike?
- You did research?
I did a little research.
- Wow. I'm proud of you.
Yep.
- So number one, you want to start
your pre-surgery exercises at least six weeks
prior to surgery.
- Yeah. So month and a half before,
just write it on the calendar
and start doing some of these.
- Yep. The earlier the better.
If you're new to exercises, start slowly.
You don't wanna get into something
you haven't been doing and then injure yourself
or cause more pain, 'cause you're
probably in pain already from your bad knee.
Your bone on bone knee. - Your arthritic knee.
Yeah. So don't do anything crazy.
Start slow, build up over time basically.
- If you're an exercise buff,
you're in pretty good shape, then they say
to kind of train like you're training for a race.
Increase the intensity, the duration,
and the frequency of your regular routine.
- I will say, from people we've seen treated
with knee replacements, the more in shape
that person is before surgery,
they typically recover faster.
- Absolutely.
- Would you agree? - Yeah. Yeah.
And you can kind of tell by seeing somebody
before therapy, how they're gonna do
with their therapy. And number three,
if you're really painful, aquatic therapy
would be great for you. - Yep.
- Get in the pool.
- Take some pressure and weight off your joints.
If you have a warm pool in your area,
that's also beneficial, kind of warming up the joint
prior to it. - Yep, that's a good point.
They're non-impact or low impact exercises.
You can do some of these things we show here kind of
in the pool, you can't do the laying down ones, I guess.
- No, no.
Some of those, you might have to look up
some pool exercises for those. - Yeah.
And then number four, diet.
We're not gonna get into it, 'cause this isn't
what this is about. So.
- Yeah. Do your own research,
anything your surgeon tells you
before the surgery, kind of take that into account.
- And I thought this was interesting.
The medical studies out of the
University of Boston said pre-surgery participants
reduce their chance of needing inpatient rehab
by 73% with the appropriate pre-op exercise
and conditioning program. So.
- Yeah. A lot of these exercises are things
you're gonna get after your surgery
and you can do at home.
Obviously inpatient is you rehabilitating in the
hospital or going to a skilled nursing
facility to do your rehab.
- And decreased hospital time equals
improved quality of sleep and rest at home.
- Yeah, a lot of our patients
we saw at skilled nerve seeing facilities,
it's usually rough sleep. - Yeah.
People making noises at night,
nurses checking in, giving pills, doing stuff.
If you can do this at home to recoup,
you're better off.
- Yeah. All right.
We're gonna get into the exercises right now.
- Okay. (laughs)
- All right. We don't wanna do a program
that we don't think people can do,
so we recommend 15 to 20 minutes,
two times a day. And if you do it one time a day,
whatever. That's better than...
- Yeah. It's better than nothing.
Just do what you can.
If you can't do all these exercises
or they increase pain, just don't do those ones.
Do the ones that work for you
and you feel like are helping.
- Yep. But these exercises are kind of made for
being able to get through them,
because we suspect you are in a lot of pain,
being you're gonna have your knee replacement.
So let's start. Number one,
we're gonna start with an exercise called quad sets. So.
- Quad sets.
Mike's gonna kind of demonstrate,
I'm gonna get out of the way here.
- I'll lay on the plinth here.
- Sure. So the green tape kind of shows
this is his bad knee.
- This is my bad knee.
- Really arthritic, bone on bone.
- You gonna give me a little towel there?
- Sure. Do you want it under your heel?
- Sure.
Okay. So all he's gonna do is
he's gonna tighten his quad muscle here
and he's gonna push it down into the mat in this.
When he does this exercise,
you can tell you're doing it right.
Your kneecap will slide up. You know,
you won't be able to see a big difference,
but your kneecap will move up,
and you should be able to see a little bit
of a quad muscle there, so.
- If you have bad knee straightening,
you might not be able to get flat.
I actually hyper extend a little bit when I'm doing it.
I mean, if you can only do this, that's fine.
If you don't know if you're doing it right,
you can put your hand down here.
Or you can put a towel or some type of
really soft foam ball,
anything, and just try to push into it.
- Yep. And there, you know, there probably is
gonna be a little more pain when you do this,
but it's kind of a low level strengthening exercise
and it's very important you do it right.
- Make sure to breathe.
Don't hold your breath, and try to go for like,
hold it for three to five seconds.
- Yep. 10 reps.
And then see how you feel.
- One one thousand, two one thousand,
three one thousand. And relax.
- So simple off, that's number one.
- Yes. - Number two,
we're gonna do three-way hip kicks.
So you might as well stay in this position here.
I'll get rid of the towel roll.
- Okay. - All right.
- So we're gonna start with straight leg raise.
- So you do a quad set first.
- Quad set.
- This is what we just covered. Quad set first,
keep the knee straight, and then Mike's gonna lift.
- Keep your toe pointed, neutral or straight, too.
Do not plant it.
- Yep. And don't lift too high.
Just lift kind up to my hand.
And then back down to start.
- Sometimes we say to have your other knee bent
and if you're strong enough, you can go up to here,
but you don't have to go
way up here. - Right.
- And try to control it both ways.
Do not like just kick around. - Yep.
And rest in between each repetition. Go down, rest.
- Yep. I disengage, quad set. Go up.
Go down. Relax.
- So that's one hip kick.
Mike's gonna roll onto his side here in a little bit.
- Would you say do 10 reps of each of these?
- I'd say 10 reps of each. Yep.
So now he's gonna, you know, when you have a bad knee,
your hips are gonna get weak. Everything's gonna get weak.
So you gotta strengthen your hips as well.
So this is an exercise for your hip abductor,
your glute media. So he's gonna lift,
and a lot of people like to bring their
leg forward when they lift,
but you wanna bring it straight up
or even a little bit backwards
to make sure you're doing it right.
- So don't try to shift forward.
Try to just keep it nice and at your side.
- Yep. Don't let your pelvis roll forward or back.
Right and neutral.
- Don't go over too much forward or backwards.
And try to control it again.
Try to keep your knee as straight as you can.
This one's a little harder for some people.
So you might have to go to the next exercise, clam shells.
But if you are able to do this,
just try to kick straight to side.
- So that's two of three on the hip kicks.
Mike's gonna roll onto his stomach.
I'm just gonna show the other way again.
Here's his left leg now on this side.
- Just trying to get off my mic here.
We'll say this is my bad side
so you can see it better on camera.
- All right. Sounds good.
- So we're just gonna go straight back?
- Yep.
- Okay. Try to keep your pelvis
against the mat when you do this.
- So he's still on glutes. Now
this is your glute max. Your big butt muscle.
- We're hitting hamstrings too.
There's a different way to isolate the glute max,
but you have to bend your knee more,
and probably your knee's already sore.
So we're not gonna show that one right now.
- Sure.
So three way hip kicks, 10 laying on your back,
10 on your side, and then 10 laying on your stomach.
- Yes.
- And go nice and slow and controlled.
- Next one.
- All right.
You already kind of hit on it.
If you were having trouble laying on your side,
doing the lift on your side,
then you might wanna start with.
- Some clamshells. - Clamshells.
Look at him rolling all over the place
and I'm just standing here. This is great.
- (Mike laughs)
- All right. So you gotta get on your side.
You have to have bent knees.
And you try to keep your pelvis in the same position.
See how my pelvis isn't rotating?
A lot of people do this.
Keep it same position, rotate.
- And it's a very subtle move. You're not,
there's not gonna be a lot of movement.
- I don't have, I mean,
I'm getting tight there and I'm younger,
and I don't have knee pain,
but this is another hip one, but yep.
Just kind of control it. I'm pointing in my knees.
If this is uncomfortable,
put a pillow in between your knees.
That's fine. Not too big, 'cause then
you're not gonna be able to go down as far.
- And always use a pillow, too.
Mike's holding his head up, but if you need
a pillow under your head for comfort.
- Yeah. A pillow under your head as well.
- Okay. So that's the clamshell.
That's number three. - Yes.
Now we're gonna do short arc quads.
Another one laying down. - Yep.
I gotta switch again so they can see my bad side.
- I'm gonna give you this towel roll here.
- So you could just roll up a towel,
put a pillow under your knee.
- Am I outta the way here, Tanner?
- We're just gonna activate the quads a little bit.
- Yep.
Like you're doing a quad set,
but your heel's gonna lift, you know.
- It's just a little motion.
Try to hold it for three seconds, if you can.
- The goal is that you straighten everything completely out.
Go ahead, Mike.
Everything is straight here. No lag,
they call it.
- No leg? I have legs. I have two of them.
- Lag.
- Oh. L-A-G.
- L-A-G, yep. - Oh.
- All right, so that's number four, short arc quads.
Now we're gonna get into long arc quads.
So we're gonna actually sit in a chair
or sit at the edge of the mat here.
- I'll sit at the edge of the mat
so we don't move as much stuff at the moment.
- I'll sit in a chair.
- That's a fancy chair. You gonna like read me a story?
- You like that? Yeah.
- Keep me by a fireplace or something.
- I should. All right. Long arc quads.
You can do it sitting on the edge of your bed,
a mat or whatever, sitting in a chair.
You just simply kick out, hold, down slow.
- You can hold this for three to five seconds.
Just like the other exercises. Like the quad sets.
If these are hard for you,
just stick to the short arc quads.
These are more advanced version.
- Yep. Might cause some pain.
Just go as high as you can.
- Yeah. And if you can't straighten all the way,
it's gonna be hard. Just do what you can.
- 10 reps of those.
- 10. We did 10 already? That was fast.
- Yep. 10 reps of those.
Now we're just gonna get into knee range of motion, so.
You're demonstrating. You might as well sit here.
I'm gonna get you the, should we go with the knee glide?
- Sure. We'll go with the knee glide.
- The Bob and Brad knee glide.
They'll be happy to see this.
And it really is a good product. It works well.
- Yes. We typically try to send one home with all our
knee replacement patients to use
and then they just bring it back when they're done.
And we keep some in the office too.
- So number six, we're working on range of motion.
This is flexion or bending.
You wanna have as much range of motion
before surgery as you can.
It's just gonna be that much easier after surgery.
- The closer the knee glide is to you or the more it goes
under your chair, the more your knee is gonna be bending.
- Sure. Yep.
- So if it feels comfortable, scoot your chair forward.
- Yep. - You can bend more.
- That's a good point. Yep.
- And also, we have it set at an incline right now.
That's gonna make it going down a little easier.
You can do it flat too, if that's more comfortable.
- Yep. I feel like my ankle
gets really tight if I keep it flat.
- Sure. - You can also reverse it,
but we don't worry about that for now.
- And do this one as tolerated. I mean,
you can work up to five, 10 minutes.
I mean, if you're feeling like you're
getting some benefit from it, so.
- Yeah. This is a good one just to do
if you're reading or watching TV or something.
Just put it down. If you don't have a knee glide,
you can put a towel on the wood floor
or you can wear socks on a carpeted floor
or something like that.
- All right. Moving on. So we worked on the
bending there with the knee glide.
Now we're gonna do a little bit of
straightening or extension. So, very simple.
You just prop it up on the stool there.
- Yep. And if you're tight, you know,
you can't straighten all the way,
if this hurts here, just leave it there.
- Yep. - Just try to let gravity,
try to go for time on this one.
Five to 10 minutes you can do.
- Yep. - Just let gravity kick in.
If your knee's really sore,
you can even put an ice pack on it.
- Yep. Keep those toes up, Mike.
- Oh, sorry. We have a low stool.
We typically start with a low stool, I say,
before surgery or right after.
As the patient progresses, we might
get a higher stool for them.
If you wanna use a taller stool,
typically don't do that right away.
You can do it later on after surgery if it feels good.
If you get too tall, sometimes
you get more of a hamstring stretch
than a knee joint stretch.
So always start with a lower stool.
If I lean forward, then I get more of a
hamstring stretch, actually.
- Yep. Very important to work on
your knee straightening, 'cause a lot of times
that's the hardest thing to get after surgery.
- And everyone has one way that's hard.
Some people have both ways that's hard,
but most people, either their bending
or their straightening is hard.
So the more you can get before surgery,
the better. - Yeah.
But the straightening, that's really crucial
for your walking later on.
We'll get into all that.
- Yeah, in other videos.
Keep watching which video relates to your
problem with knee surgery.
- Yep. The next one, we gotta get some arms
in there because your arms are gonna
carry you for a couple weeks after surgery, so.
- Yeah. A lot of times people have,
it depends on your age and your functional level,
but a lot of people have walkers right away.
- Mm-hmm. Oh yeah.
Just a front wheel walker or four wheel,
at least a cane, crutches once in a while.
- A lot of people think, "I won't have a walker,"
but then they say "Give me that walker."
- Yeah. It helps, yeah. Right away.
- All right. So chair pushups,
your legs are basically not doing any work,
you know, if you're strong enough to do so.
So Mike's gonna push himself up with his arms.
- Try to do this in a handled chair.
It's easier. If you don't have handles,
I guess you could put on your knees,
but it's a little harder. - Sure.
- So just push up.
- Yep. This is all triceps.
- Yep. - Yep.
And you're gonna need this because
you're gonna have, you know, a painful knee for
a couple weeks.
- If your arms are too weak, engage your legs.
I mean, if I engage my legs, I'm probably gonna
end up doing just a sit to stand.
- Yeah. We really focus on the arms doing the work.
- Yep.
- Okay. Number eight.
I think this one's really important for balance,
but you gotta make sure you're safe. You know,
there's something close to hold onto,
and this is single leg stance, we call it.
So just standing on one leg, you know,
working on your proprioception.
- This is hard. Hold onto a chair or a walker.
- It's a good strengthener too,
as well as balance, so.
- How long would you do this?
- I'd do this up to 30 seconds and I'd probably
do it two or three times.
If you need to start by holding on,
drop to two fingers. If you're really doing good,
then let go completely, but safety is key.
- If you have really, really poor balance
and you don't feel comfortable doing it
and your knee hurts too much, don't do this one.
- Right. - This is one we give a lot
to after surgery, like a month or two out.
- Yep. And the last one.
- Number nine.
- Well, I figured we'd end with something
real simple, but a very important exercise.
- Ankle pumps. - Ankle pumps.
So either do it sitting in your recliner,
you know, with your legs elevated
is kind of what we like to do.
- You could lay down and do it in bed, too.
Or if I was in a recliner, it's just
bringing your toes up and down.
That's all it is. Moving your ankles.
- You probably have some swelling
in your knee currently from all the arthritis,
the bone on bone. - Yep.
So pumping your ankle is gonna be very important.
- These are good to do in the morning
when you wake up or before you go to bed.
And a lot of these exercises, try to get in the routine.
Like pick a certain time of day you say
you're gonna do them,
like I'm gonna do them right away when I get up
and you'll just start doing them
every day or right before bed or
whatever timeframe works for you,
just setting a schedule and being consistent
with it will lead you to do these exercises more often.
And if you feel overwhelmed with this many,
just pick the best ones for you.
Pick two of them or three of them,
at least you're doing something.
- Yep. Couple strengthening, and for sure
the range of motion, I would say, so yep.
- Yep. - All right.
Yep. The routine, I think that's a big point.
Get in your routine,
stay in your routine, - Yep.
And you can go to bobandbrad.com/programs
in the knee replacement section
and watch all our other videos relating to this.
- All right. We'll talk to you after surgery.
- We will?
- Thanks. (both laugh)