♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- We're ready to go, I'm Brad Heineck, physical therapist.
- And we are the most famous
physical therapists on the internet.
- In our opinion of course, Bob.
- Today we're gonna talk about two key exercises
to rapid recovery for total knee replacement.
So Brad and I have seen what?
Maybe three patients between the two of us?
- Yeah like 3000, we've done thousands--
- We've done thousands of patients.
- Total knee we're talking about.
- Yeah, that have to had their knees replaced
and so we've seen it all.
- Right, and we feel real confident
in what we're saying here.
- What, aren't you gonna talk some more?
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- Yeah, that's nice. - [Brad] Nice consistency.
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Nobody liked us.
- Well, that's what Bob always says.
My mom liked me,
So anyways, Bob shall we talk.
- Yeah, let's talk.
- Knee, total knee replacement, we'll get serious here.
If you get your knee replaced
they may have a class for you to go to
before your-- - Before the surgery.
- Before surgery, and they'll give you more than these two,
but these are probably in our opinion,
the most important ones by far.
- Yeah, when I when I have a patient Brad,
I say you can do all the exercises they've shown you
and all the ones I'm gonna show you,
but I want these are the two you're gonna focus on,
and these are the ones like priority.
You make sure these two get done.
- Right, exactly.
And they're quite simple actually.
The first one is we call them long arc quads,
or I say kicks, you're gonna do your kicks.
So if this is my knee it's gonna be stiff,
that's why you're getting it replaced.
There's arthritis in there,
it's typically lacks range of motion and strength.
So we want to get, the big thing is range of motion,
and we're just gonna work like this.
And you need a firm chair to sit in.
And you want to start with the knee
at about a 90 degree angle,
you can see with the stripes there.
And we don't care if you pull it in this way,
'cause we're gonna work that later.
and you just simply go up,
sometimes I'll have people hold their knee right here
to stabilize that joint and kick up
as far as you can and back down.
And do that about 10 repetitions.
You can go more than that if you'd like.
Now, if you're unable to straighten it out straight
and it's just stiff and a little painful there,
then you do 10 or 15 of these.
- And it's kind of a warm-up almost.
- Yep, and before you finish
you're gonna get a stool out in front of you
and put your foot on there and if say it's tight here,
you're gonna actually gently push
and try and straighten the knee,
so you get full extension straight.
Now this may not happen the first day you do this,
but you're gonna start this,
this will be the prehab before surgery,
you're gonna start just a few weeks before surgery.
And hopefully by the time surgery comes
you have full extension,
and then you can do your kicks full range of motion.
- A little variation of that Brad,
do you mind if I have the stool?
Is actually if you're working on this,
you can actually turn the foot one way
and press it down. - Sure, yep.
- And turn the foot the other way and press it down, yeah.
- So you can see his toe is going one, right or left.
- And it's just gonna stretch different parts of the knee,
and you may find out you get a little more success that way.
- That's one of the tricks of the trade.
- That's right, one of those tricks
from seeing a couple thousand patients.
- So this again is a prehab,
you do your kicks first, 10 or 15,
do this stretching if you need to.
Then we need to get the knee to bend,
and what you're gonna do there
is go back and forth with your foot on the floor.
- Oh wait, yeah that was yours right, go on?
- Yeah, that doesn't work so well.
You can put a towel on the floor and that works.
If you wanna do it on carpeting and what not,
or use an angle like this has,
then we use the knee glide,
which actually we invented.
It works really well, is because we needed one. (laughing)
- Right, exactly.
- And a lot of therapists could use these
as well as at home.
And all's you're gonna do
is go back and forth.
Now you're gonna do this,
you can do as many reps as you'd like,
but at least probably 20 or 30.
But you could go two or three minutes on this, no problem.
But, after you get the knee loosened up,
then about every fifth or so repetition
pull it in as far as you can.
You can take your other foot,
and you want to get the bend as far as you can.
You know what, if you can get it up to here, that's great.
If not, that's not unusual.
Some people with arthritic knees
maybe only can get to here and it's tight.
But with repetition you can get it moving,
and you okay Liz?
She almost fell off of her stool.
- No, she's just waking up now.
- Yeah, so you're gonna do this secondly
and working on that bend.
- A nice feature to this, Brad,
is that the handle here, and I'll tell you why.
My wife was doing this after a knee problem that she had,
and the ankle gets uncomfortable
when you start getting out here.
You see how the ankle is really
plantar flexing there. - Right, plantar flexed, yep.
- So this keeps it a nice comfortable angle.
And plus you got the down hill,
so to help it now stretch and deflection a lot easier.
- So you can see it acts as a handle to carry it
as well as you can work it flat or get that incline,
which is really a nice benefit.
- Especially after the surgery, that's a huge factor.
I think that's where the patients really really dig this.
- So you go into surgery, by that time
you have good range of motion, the best that you can get.
After surgery--
- You got a little bit of strength from the quads.
- Exactly, you're ready for surgery.
After surgery the doctors are gonna say
"Get that knee moving."
You're more than likely gonna have therapy.
This is a really a benefit to have at home.
And that downhill benefit is really nice.
And see it slides down,
there's very little friction on that to begin with.
And then you can help here,
and you're gonna push and push and push.
And you wanna get after it right away after surgery.
- What's nice is you can start around by the ankle first,
and then when it gets too far,
where the ankle can't push as much,
then you can put your heel right on the toe of this,
and it really gives it a good push.
As a therapist, a lot of times what I do
is I can sit there and if I'm measuring somebody,
I can come up to them and yeah Brad'll be on there,
and I can actually use my foot to push it
while I'm taking the goniometer measurement.
- Yep, with both your hands,
and it's really handy dandy.
So you're gonna work that after surgery,
but also you're gonna do the same thing,
you're gonna work those kicks.
And typically after surgery, it's very common,
you're only gonna get maybe
about this much extension initially.
So you do your kicks, you can do 10 to 20 of 'em.
- Again, get's kind of a warmup,
and this is the actual exercise
though. - There you go.
And then of course you're gonna have a cold pack.
There's gonna be one of your friends to control the pain.
And you can put a cold pack over your knee
and let the weight of the cold
and the cold help you know mask the pain.
- Yeah, initially you may not even have to push at all.
I mean you may want to just let gravity,
first couple days or first week, let it do it's thing.
And these stools are nice for this,
because what happens is it'll start to hurt
and then you can bend it and give yourself a little relief.
And then you can go back into it again.
- So yeah, if you've got something like that.
And if you could put the cold pack on it,
you're not gonna leave it 30, 40 minutes to straighten out.
But usually I'll have someone five minutes,
it's getting pretty uncomfortable,
then you can take the stool and move it in here,
and it feels much nicer. - Right, there is that.
- You've gotta be nice to yourself, too,
when you're doing the pulls tab.
- And despite what people think,
physical therapists, PT does not stand for pain and torture.
We're nice people sometimes. - We are.
We're here to help you out,
but after a knee surgery there is a little discomfort.
- Yeah, unfortunately that's one of the few things we treat
where there is gonna be some pain involved
with the stretching part.
- But if you do the prehab, it's gonna be much better--
- Everything helps. - Pulls tab, after surgery.
So Bob, this is really a good segue
to get into our we can fix just about--
- Yeah, we can fix just about anything,
- [Both] Except for, a broken heart!
- Right, exactly,
if we could do broken hearts like we can do knees,
we would have no problem.
- We could fix thousands of them.
- Yeah, we could write books and everything else.
We would be. - We'd be like Dr. Phil.
- We would be in Tahiti every other weekend.
- Why Tahiti, I don't know? (laughing)
- Is there a Tahiti?
- Yeah. (laughing)
- Is it any fun? - Nah.
(upbeat electric piano)