♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet ♪
- Howdy, folks.
Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together, we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- So, we're going to talk about the mistakes
that we see people make after a total knee replacement.
Brad, you and I have probably seen,
maybe thousands of patients, right?
- Oh yeah, for sure.
Thousands.
And they're usually pretty fun to work with.
- Yes, they are.
- They get better and they have a high production and,
- Let's jump right into it Brad.
- Whatever, yeah.
- Yeah.
(Bob laughing)
- I couldn't think of what hell I wanted to say.
(Bob and Brad laughing)
We're a family show.
- So, number one,
they don't have a home plan
for after the operation.
So, like, they get home
and they suddenly realize,
I don't have any food.
I can't go out and drive,
and get some food.
I can't make it up the stairs.
- They don't put the hand.
- They don't have rails.
- Hand grab, or grab handles
that you can put on easily beforehand.
Makes a big difference just getting in the house.
- How are you going to shower?
(Brad groaning)
You know lots of things.
And you maybe even need to go
to a nursing home for a while.
- Sure.
- I mean, maybe if you are that dependent, so.
- Actually, we have a video of a woman
she was young at the time.
- Right, right.
- She went to a nursing home and she did.
- Did she have two of them done?
- Yeah.
She had both done,
and she owned a restaurant.
She went back and was completely active
with going up and downstairs,
carrying things, et cetera.
- Brad, we're eventually going to have a checklist here,
of things you should think about before you go home.
- Sure.
- So we'll have that in the,
- Yes.
- In the, actually in the PDF.
- [Brad] Oh, there's going to be a printout.
- [Bob] Yes.
- [Brad] And for free, you can print it out
and have a list of things you should do.
- [Bob] Go to bobandbrad.com and go to the program section
and look for knee replacement.
- [Brad] Right. And if you do this quick
and it's not there
it's because we haven't had time upload it yet,
but we're definitely working on it.
- All right. Number two.
They're not taking enough pain meds.
Everybody's worried about becoming dependent on narcotics.
- Right?
- So they,
- Which is understandable.
- Oh understandable.
But this is a painful surgery.
They're going they're hammering it.
They're cutting in there.
- Bob, you don't have to.
They're not going to be awake for that.
(Bob and Brad chuckling)
- So, anyway, you got to take the narcotics.
And the problem is Brad,
if you wait too long, like let's say,
you go, well I'm going to see how I do without them.
Then it gets really bad and you can't catch up.
- Yeah.
- So.
- So, yeah. Just do what the doctor prescribes.
- Right.
- They'll make adjustments.
You can report back to them.
They're very well in tune
and they do not want to over medicate you as well.
- Yeah.
- You'll be fine.
- Maybe when they come, take you off,
just depend on them.
All right.
Number three.
I see this one way too often, Brad.
Doing too much too soon.
That's your middle name.
(Brad gasping)
They progress to a cane too quickly
or they progress to no cane too quickly.
- Sure.
- And all of a sudden,
they find out their range of motion in their knee
gets worse and the pain of the knee gets worse.
- Yeah. You really need to take it step by step.
You usually have a therapist
that you're working with and follow their instructions.
They'll help you out.
- My mother-in-law was a good example of this.
She was doing great.
- Yup.
- And she started using the cane.
- Yeah.
- Went downhill.
- She didn't fall though?
- No, she didn't fall.
- Oh, good.
Goodness.
- All right.
Number four.
I tell, I don't know if you tell patients this one Brad
but they listened to other people too much.
- Oh, yes.
- To other patients.
They go, oh, my knee was going so much better
at this point already.
Or maybe it was worse at this point.
But the thing is they have a very poor memory.
(Bob and Brad chuckling)
And quite often it's not what they thought.
Or if you have two knees done, you're going to find one
goes way easier than the other.
- Typically, yeah.
- It's hard to predict.
- A matter of fact, Bob, I would go so far as
if I had two people,
two patients with a total knee replacement
and one was doing really well
and the other one was not, was having some problems
and maybe a week or two behind, which is no big deal.
- Yeah.
- I would never schedule them at the same time.
- Right.
- Because the one who was doing not,
- It would deflate them.
- Yeah. The one who wasn't doing so well would say
why am I not walking with a cane?
It's only, you know?
And so, you really, it's a lot of psychological.
- Yes.
- Yeah. Our therapists are psychologists.
- Psychological warfare.
(Bob and Brad chuckling)
- Whatever. There's a lot of positive attitude
that needs to be approached.
- All right.
Number five.
This is my opinion.
I don't know if you agree with Brad, but,
- Okay.
- You are given a whole bunch
of exercises to do after knee replacement
but there's two that I think are really important.
The ones that you should focus on.
And that is you want to bend the knee as far as you can.
- Yup.
- And you want to straighten the knee as far as you can.
- Right.
- [Bob] If, the strength will eventually come. I mean.
- Right.
Range of motion.
And that's why the therapists
are measuring it every time.
- Yeah. It's a race against scar tissue.
So, one thing that we have found, Brad.
- Yes.
- We'll do a little self-promotion now.
- That's all right.
- We have found the knee-glide
that we created to help with the bending
and the straightening, really helps along.
I've had people that were stuck
and actually got along further.
Brad, why don't you demonstrate
like how you can do assisted flexing.
- Right.
- With the knee-glide.
- I do want to say the therapist will probably
going to have you what they call wax the floor.
- Right.
- You got to have a sock on,
you need a shiny floor
and then you're going to go back and forth like this.
- Right.
- Works fine.
And you know, we've been, we did that for 15 years
and we decided something would be really helpful.
So, this works really nice.
Now you can assist like this to bend it more.
- [Bob] Right.
- [Brad] And then to straighten it
you could go like this and I'm going to, there we go.
And I'm going to just push down.
And the knee-glide really works well
because it's comfortable.
And the big benefit is sometimes putting it at the angle
like this makes a big difference.
- [Bob] It's a lot more comfortable on your ankle.
- [Brad] Yeah.
- [Bob] I think.
- [Brad] And a little incline can help you get
an extra five degrees without any issues.
And once your range of motion gets back
and then you can strengthen hamstrings
like this and it works quite well for you.
- [Bob] Brad, I want you to show real quickly in bed.
- [Brad] Ah,
- [Bob] Because I think it's a huge advantage
is that you could start exercising your knee in bed
before you even have the strength to get out bed.
- Right. So, though that first week of after surgery
in a first day or two, while you're laying there
you can actually get the knee moving like this.
- You might put a towel underneath the heel.
- Yep. You can.
There's a couple options you can do
to get it moving more.
Let's say, you just don't
have the strength, but you know, it's going to bend more.
- Right.
- You can take a towel roll and go under here
and that may help.
But it's even better yet
if you can get a belt or a strap.
Get a belt and get it around your foot.
- Right.
- All you have to do
you don't have to tie or anything
just right around there.
And now it's just like, reins on a horse.
You're going to just.
- Whoa.
- Whoa Betsy.
(Bob laughing)
But no, it really does.
- Works well.
- Yep. Gives you a lot more leverage.
So, you're not working.
You can relax.
And that's a key with range of motion. Learning to relax.
- Right. You've got to trust yourself.
- Yeah.
- I mean I find people do better themselves
than with me on them.
- Yeah, exactly.
I'd much rather have the patient put the force
on the leg because they trust themselves.
They don't trust the therapist.
- So, one of the big advantages of the knee-glide
is that the weight.
- Yeah.
- I mean I could carry it with one finger
and you can carry it from room to room.
- Yeah.
- Or you can transport it easily.
- Right. It's very easy to clean
if you have from one patient to the other.
We're happy with it
because it works and it fits a need
that has been out there
for years and now it's filled.
- So, another one is actually
if they don't do their pre-hab actually.
- Ah, yes.
- I know that's after.
I mean before, but if you do your pre-hab
your knee's going to be ready for the surgery.
- Right.
- Plus you know what is coming.
- As a matter of fact, this works nice.
Excellent for pre-hab to get your knee.
If your knee can straighten
and flex all the way before surgery
the chances of your rehab is going to be much better.
- Right. Right.
And the final thing, Brad, oh, go ahead.
- I was going to say there's a lot of hospitals that
offer a pre-hab course.
- Yeah.
- You go maybe hour or two long and typically
a therapist teaches it
and they'll give you some exercises to do before,
you know, a week or two before the treatment.
And they'll talk to you about things you do.
You'll get rid of your throw rugs at home.
Put hand, grab bars in the bathroom.
- A lot of hints that would be helpful.
- Yeah. It's really worth if they offer it.
Make sure you take that for sure.
- All right.
Number seven.
The final thing that we see quite often
is people try to go back to work too soon.
I know. For many of you, you can't take that long time off.
I mean, you don't have money coming in
but it's really good if you could do at least eight weeks.
You go back to work too soon
and you don't get the result that you want in the knee.
- Yeah.
- It's quite devastating to spend all the time
and money to have the knee done
and then not get the results you want.
- I know I've had people go back to work
that I remember one guy in particular
he was a carpenter.
So, he had to get down on his knees.
- Oh geez.
- And the doctor said, yes, you can,
but you need a knee pad.
You need to do it carefully.
So, we actually practiced getting up and down on the floor.
- Oh sure.
- So, that he was very well aware
and he would not damage his knee.
- So, again, at least eight weeks,
if possible 12 weeks is even better.
- Sure.
- So, take it for what it is worth our advice.
So, this is after seeing thousands of people.
- Yeah. Good luck with your knee and,
- Thanks.
- you're going to say why didn't I do it before?
- Yeah. Why did I take so long?
All right. Thanks.
(upbeat music playing)