We're here today to talk about the
exercises you can do
before and after you've had a total knee
or a unilateral knee replacement.
These exercises are designed to
strengthen the joint,
strengthen the muscles round about the
joint to help support and to get the
movement back
into your knee following this operation.
It's important to do these exercises
before and after the operation and to do
them regularly.
So are these going to hurt big man?
They're going to hurt a little bit after
the operation. Before the operation they
shouldn't hurt at all.
After the operation there will be a bit
of pain because you have had a major
operation but they're really important
to help
with the benefits we've already
spoken about so we'd always expect you
to be able to do them.
And when are you expecting me to start
doing these? So you can start these
exercises the day of surgery. As it's
been discussed before we can get you
up and about on the day of
surgery so it's important that we start
getting these muscles working on the day
of surgery and
the subsequent days after that. So
I've heard a lot of stuff about
physio-terrorists,
I'm not wanting to be too sore when
I'm doing this.
Not at all, hopefully you won't be
too sore. There obviously will be a bit
of pain but we'll work with the nursing
staff to make sure that you're getting
the pain
relief that you need and when you
go home it's important you do take pain
relief regularly so you're able to do
your exercises to get to get the best
result.
And if I'm really sore when I'm doing my
my physio,
I mean are you guys gonna listen to
me when I ask you? Yeah of course we will.
It's important that we we're
here to push you and to
try and get you to the kind of limits of
what you can do but we're obviously not
here to cause too much pain. So we will
listen to you and we'll
make sure that we're listening to
what you're telling us. All right I mean
it hurts a bit at the moment that's why
I'm having the operation. So
have I to do these before I go? Yeah, if
you can. Yeah it'll really help to
strengthen and actually what you might find
is actually some of your pain gets
better with doing these exercises
because the muscles are working a little
bit harder round about the joint.
Ah you would say that. Trust me I'm a
physio.
Okay. Okay, so we're gonna get started
with the exercises. So
the first exercise we're looking at the
knee joint here and we're looking at
pushing the knee joint into the bed. Okay
so if you just squeeze this muscle here
and you're squashing down. Lovely and you
can see that the heel has come off the bed
there a little bit and that shows that
the muscle's working really hard.
And relax, good. So we're pushing down.
Squeeze this muscle. Push down and
holding for about five seconds.
Lovely and relax. Good, do one more.
Push down, lovely and relax.
Good. For the purpose of the video we're
going to do two or three of each
exercise but when you're doing them at
home we'd expect you to do
up to a maximum of 10 once you're able
to manage that.
Okay, the next exercise we're going to
use this here. This is just a rolled up
towel
and at home you can use a rolled up
towel, a cushion, a pillow anything like
that, that is going to give you
a little bit of a lift.
So I'm going to ask Graeme if you can
bend your knees slightly. I'm going to
place this under the knee and we'll just
going to let that relax there. Okay
again you're squeezing this
muscle, you're pushing down into the
towel
and as you do that this heel will come
right off the bed there.
Lovely good and relax it back down.
Okay, so again we're squeezing down,
lifting up,
holding for five seconds. Good
and back down. So I'm going to be able to
do this
the day of the operation? Absolutely, yeah the
day of the operation. This is what we're
expecting. Some people will maybe
struggle with it initially
but that's what we are there to do. My
neighbour said that they
couldn't move their leg for two
days like after.
Usually people are able to move straight
away. Usually people we can get them to
do this exercise
and if they're not able to manage it we
can work with them really hard to
try and get the muscle working harder.
He said something about a block,
something to do with a nerve?
So we would always wait. You will
have a nerve block, or some people will
have a nerve block,
so we'll always wait until that's worn
off before we start getting you
doing these exercises or getting you up
and about on your feet. Right.
Okay, so let's do two more two more of
these. So we're just squeezing down,
lifting, hold for two, three,
four, five, and relax. Good and one more
two, three, four, five and relax.
Lovely. Okay, so we'll just bring this out
of here.
Okay the next exercise. Again is working
on this muscle here. This is a
quadricep muscle.
So one for this one, we're going to keep
your knees straight as you can. You're
going to tighten this muscle.
Okay and you're going to lift your leg
just straight off the bed
about six inches and you're going to
hold it there for two,
three, four, five and back down.
That's a big six inches!
And lift again. Hold for
two, three, four, five and back down.
Lovely, one more lift and hold for
two, three, four, five.
Good and back down. Excellent, so that's
all the exercises we do for the
quadriceps when we're on the bed.
The next exercise we're looking at the
movement. Okay, now I've got a plastic
bag here.
Now this plastic bag is obviously here
just to reduce friction.
Okay so what I'm going to ask you to do
this time. So I'm going to ask you to
pull your heel
up towards your bottom. Okay so we're
going to bend the knee. Let it bend. Let
this slide, slide, slide, slide, slide.
Good and then let it slide back out nice
and slowly.
Good, now just put just put a plastic bag
in just to reduce friction if you're
doing this on your bed at home.
Okay, so again slide up towards you.
Good and then let it slide back out. Oh,
that's easy!
It's easy now, obviously after your operation
this is one of the exercises that's
really important. Okay it's really
important that we get this bend into
your knee.
So if I can't really bend it
what am I doing? So we'll give you
a few hints and tips and
it's really important that we keep
keep trying to push that movement. You
get it to a point where you feel it
can't really go any further,
hold it there and then you let it back
out and hopefully as time goes on that
movement will get bigger and bigger.
So I have to keep trying to push beyond
where I got to. Absolutely. Yeah really
important we're pushing this exercise.
Okay and how do I know when I'm
getting as good as it's going to be?
So for this for this exercise we're
looking at getting to 90 degrees of
flexion.
Now 90 degrees means that's a right
angle. So we're looking for that angle
there of your knee
before you leave
hospital or as close as we can to that.
About there? A little bit less. About
there is what we're looking for.
Okay, so we're looking for about 90
degrees and then we'd let that back
down.
So will you keep me in if I can't get
to that?
We'll have a look at it and we'll see
what movement you're getting to.
If you're getting close to that and
you're doing really well with your
exercises, no, there's no problem with
that. We'll get you home.
And if you're really struggling with the
movement we can get you some physio
follow-up
in an outpatient setting.
Right, so when I leave
there'll be more physiotherapy? For some
people. Not everyone needs physio
follow-up.
Some people need it some people don't,
we'll assess that on an individual basis
on the ward
and we'll get that referral done
if that's required.
Right so it's only going to be if I need
it then? If you need it yeah. Most people
do absolutely fine going away doing
their exercises themselves
and don't need that follow-up but as I
say if you need it there's no problem
with getting that.
Okay, so in summary the exercises that
we've got when you're lying down
are pushing your knee into the bed.
Lovely, good.
We've got the one with the with the
pillow or the cushion
Oh that's comfortable! You're squeezing
down, lifting up.
Excellent and relax. We've got the
exercise where you're lifting the leg
straight up keeping it as straight as you
can.
Gotta get it straight as I can? Yeah, lift and
hold. Good
back down and then you've got the last
one with the
plastic bag and
pulling up. Excellent, and back down.
Okay, so we'll just take this bag away.
Okay, so the last exercise
in lying is we're going to pop this
let's roll under here okay?
Now what this does this gets the
straightness into your knee.
Quite often when you've had an operation
and before you've had a knee replacement
sometimes your knee can have a bit of a
bend in it and it's actually kind of
stuck at that angle.
What you mean like? Yeah exactly. Some
people's knees can be stuck
at that angle and after they've had
their operation it's really important
that we aim to get the leg nice and
straight okay?
So this is a really nice rest position.
Okay, so you wouldn't want to rest in
this position
all day but holding it in this position
for maybe 10, 15 minutes.
Okay, just to really let that those
muscles relax at the back of the knee
and let the joint get used to being
straight again. Okay g 287 00:08:49,120 --> 00:08:52,560 in that position as an exercise you can
also just do a little push down so what
you were doing before.
Lovely, push and relax. Again push down
and that's sometimes one that does hurt
a bit at the back of the knee but again
it's really important that we're getting
that movement and we're getting that
knee
straight as it'll go.
So I've got to get it
completely straight and then I've got to
get it to bend as much as it will go?
That's what we're aiming for yeah so
we're aiming
to get that nice straightness which we
call zero degrees
and then, that's the straightness, and
then for the the bend we're looking for
that 90 degrees or as close as we can to
it.
Okay, but if I go over 90 is that a
problem? Absolutely no not a problem at
all. That's what we're looking for if you
can get over 90 that would be
great.
But 90 is what we're looking for
before you leave the leave the hospital.
Okay, so we'll take this away and the
last exercise is that is
important to do after your surgery, to
get your ankles moving. So just
pushing your ankles towards you and then
pushing them away. Lovely and just
pulling them back.
Excellent, now what that does is just
gets the muscle pump working up your
legs when you're not as mobile, when
you're not up on your feet as much.
Okay good okay. So in summary the
exercises that we've got:
You are pushing your knee down onto the
bed, squeezing that muscle.
Excellent and relax. Good. You are sliding
this
rolled up towel in and you're lifting up
here.
Good. You are lifting your leg straight
up off the bed keeping it as straight as
you can.
Good. You are using the
plastic bag to get the bend into your
knee. You're sliding all the way up
and then all the way back down.
You're using the roll again under your
heel this time
to get that nice straightness into your
knee and you can use that as either a
rest position
or using doing a bit of a squeeze to
get a little bit more
straightness into your knee. So this one
takes a bit longer to do?
Yeah, this one takes about 10 minutes.
This is the one that's for the rest
position. Okay.
Good and the last one is just the ankles
back and forward.
Good okay. Happy with those exercises?
Fine.
Good, excellent. Thank you.