If you found out your knee surgery is being postponed due to the COVID-19 world pandemic, you’re in the right place. You may have been struggling with pain and dysfunction from knee osteoarthritis and/or other knee injuries for years prior to being put on a list for a total knee replacement (or total knee arthroplasty), when suddenly a pandemic occurred which slowed the world to a halt.
There may be other reasons why your knee replacement has been cancelled or postponed. Maybe your health is not where it needs to be to undergo surgery. Or maybe you even had second thoughts about the surgery all together.
Now the question is… What the heck are you going to do for your knee instead?
Luckily for you, there are some simple tips and tricks that can help you manage pain and function, and possibly even set yourself up for BETTER success after your surgery… or even avoid surgery altogether.
I’m sure you’ve heard of rehab (short for rehabilitation – in our case, physical rehabilitation), but have you heard of prehab (short for prehabilitation)?
Prehab is a great way to make sure your knee is optimized for surgery, and help you bounce back faster.
Total knee replacement replaces the joint surfaces of the knee (and gets you that much closer to being Iron Man), but it doesn’t replace the MUSCLES around the knee joint!
Once you have a knee replacement surgery, not only do you have to recover from the surgery itself (which is hard and painful), but you have to build up your knee muscles so that you’re truly able to get back to what you want to do, with enough endurance and strength to do it.
That’s why you might as well get going on strengthening your knee muscles now, rather than waiting until after the surgery is done. You can’t go wrong getting strong!
I’ve had the opportunity to work with many clients immediately after their knee replacements in the hospital – when physiotherapists come in, make you bend your knee despite how painful it is, and get you up and walking ASAP. That’s because now that the knee joint is brand new, we have to get working on all the soft tissue around the knee joint to get it back up to snuff!
For most people, this soft tissue has had months, if not YEARS, of time to get more and more weak, and do less and less activity. This may be a conscious decision (“I stop these activities otherwise my knee will get worse”), or possibly an unconscious decision (slowly doing less activity over time, and occasional repetitive periods of rest when recovering from flare ups). You have to move it or lose it, and chances are, you’ve probably lost SOME of your strength.
Let’s pause for a minute to discuss some myths about knee osteoarthritis, a “diagnosis” that makes up a good portion of people getting knee replacements (even though only a very small fraction of people with knee OA will need a knee replacement in their lifetime!).
Exercise will make my osteoarthritis worse!
This is SO false! While some forms of exercise may be too much for you with where your symptoms are now, that doesn’t mean that ALL exercise is off the table.
The exercises I will go through with you in this blog are a great place to start if you don’t know what you can and can’t handle. It all comes down to your knee’s tolerance level – if you’re doing way too much activity in too short of a time, you may be blowing past your knee’s abilities, and then it may hurt more.
If you bring it down a notch, you may be able to tolerate your exercise activity better. If you do NO exercise, the muscles around the knee have no reason to get stronger – and if you don’t have a naturally active lifestyle, they may decrease the tolerance for exercise again.
But if you start an exercise program, you may find that you feel like you have more energy walking for longer distances and feel like stairs are getting easier and easier.
Your tolerance level can move in both directions (regardless of your age – it’s never too late to start!) based on your daily activities.
Everyone has a limit on the amount of exercise they can tolerate, and that limit can fluctuate over time. You can be sure that an Olympic athlete can push themselves 100x harder than I can prior to injury or pain, but that’s because it’s their one and only job to train their bodies to be more resilient and strong.
Pain during exercise means I’m hurting my knee.
This depends. Of course if you’re pushing yourself THROUGH pain, and pain is going up and up and up, and then you can’t walk for a full day after? That’s not great. That may start you on a cycle of overworking your knee, and then complete rest – which is not optimal for a daily routine of exercise to make your knee stronger.
HOWEVER, a little bit of pain during exercise is not a problem, and may even indicate that you are pushing yourself to a good level to make knee strengthening progress.
If your pain increases 2 points on a scale of 1 to 10 of pain or less, AND the pain goes back down to your baseline within 24 hours, then that’s perfectly safe. This is especially true for people that have constant knee pain – if it’s always painful anyways, then you might as well start making the muscles to work on managing and decreasing that pain long term!
Okay, now that we’ve got your myths addressed, here is your step by step guide to managing your knee pain while you’re waiting for surgery.
Start with steps 1, 2, and 3, and move on to 4 and 5 when you’re feeling confident you can work a little harder.
1. Pain relief
Most people are getting a knee replacement because of pain. There’s a few things that you can do that you may not be doing already to help pain relief.
- Heating pad – use it for 15 minutes on your knee in the area of the pain, AND over your quadriceps – the front part of your thigh – for muscle relaxation and to help your knee feel more flexible. Use on and off throughout the day if needed. Bonus points if you have a hot tub or use a hot bath to really relax your whole leg!
- Ice – If your knee is really painful, and you just need it to be numb for 10 minutes – try ice for 10 mins over your knee joint. Once your knee starts feeling better, switch back to the heating pad.
- Take a look at your aggravating activities – what REALLY bothers your knee the most? Can you make walking the dog last ½ the time but go twice instead? Can you plan your day more efficiently so you don’t have to do so many stairs? Do you need to set an alarm for every 20 minutes when you’re sitting at your desk to prevent the pain from increasing from prolonged sitting? Take a look at what makes your knee worse, and troubleshoot solutions to these problems. Look at times of the day that are TOO MUCH movement or loading, and things that are TOO LITTLE movement or loading, and bring both to a moderate level of movement.
- Self massage – you can use your own hands to massage the muscles on the front of your thigh above the knee cap (quadriceps femoris muscles!), OR you can use a baking rolling pin to slowly roll up and down the muscle on the front of your thigh while your leg is lying flat on the ground. Check out a video below. Make sure you don’t roll past the crease of your hip, or over the knee cap in your knee. Roll for 2-3 mins at a time.
- Over the counter (OTC) medication – many people find relief from oral OTC medication, or OTC creams and rubs. If you do find relief from these, great! Use these in ADDITION to all your other tips and tricks in this blog. You want to use these strategically to be able to move on to exercising your knee to make a long term difference in your pain.
2. Exercises to do starting today (almost) no matter what
Knee pumping with or without a strap
- Start in a comfortable seated position. Straighten out your knee as much as you can, then slowly lower back down to the starting position. If the end range extension (straightening) is really painful, consider starting with slightly less range of motion, and increasing the range of motion over time.
- If this is STILL too painful, or seems unmanageable, use a yoga strap (or bathrobe tie, belt, or a piece of rope – really anything that you have handy) to loop around your foot to give yourself some assistance with lifting your foot up, so that your quadriceps have to do less work. As you improve, you will be able to get rid of the yoga strap and just use your muscles to do this work. Repeat 10 slow and controlled repetitions, 5-10 times per day.
- This is a super effective exercise for pain relief, loosening your knee when it feels stiff, lubricating your joint, and getting your muscles used to contracting and stretching.
Quad set with pillow
- Start lying flat on your back, with a pillow under your knee. Push your knee slowly down into the pillow, while keeping your heel on the ground. This will engage your quadriceps on the front of your thigh. Hold for 5 seconds, and then relax. Repeat 10 times, 1-3 times per day.
- If this feels like it’s too much, don’t push down as hard – even a 10% contraction is beneficial if that’s where you have to start!
- If this feels easy peasy, feel free to push down as hard as you can (really squish that pillow!), which will result in an intense muscle contraction!
- This is a great exercise to make your quadriceps muscles start contracting again to get stronger, and is a good preparation exercise for all the harder stuff you’ll be doing later. Strengthening, as we’ve discussed before, is important for supporting your knee joint and helping increase your function/ease of movement.
3. Your desired full body movement/cardiovascular exercise
My favourite and “easy access” option is walking daily. If walking is already in your routine, try to do 30 minutes per day. If walking sounds really tough, start with a few minutes at a time, but do it 3 times per day. Then work on increasing your time walking a little each day.
If you still struggle with walking, and if you have access to your own swimming pool, then swimming is your next best option. Aquafit exercises decrease the load through your joints which can be very helpful when your joints are not feeling their best. Try it out and see if it’s for you! Typically your endurance for movement will be longer than if you did the same movements out of the water. You can try walking, calf raises, lungeing, squats, or any other exercise while you’re in the shallow end of the water (safety first!).
Cardiovascular exercise is important in terms of your overall health, but it also will get your knee joint moving – getting lubrication of the joint, blood flow supplying nutrition and oxygen to the area, and pain relief!
4. Exercises to do if all is going well, and you want to turn it up a notch
Active Straight Leg Raise
Start lying on your back, with one knee bent and the other straight. Raise the straight leg up into the air to about a 45 degree angle over a period of 3 seconds. Lower it back down over 3 seconds. Repeat 10 times. Perform on the other side.
Work up to doing 3 sets of 10 on each side, 1x/day.
Start lying on your back with your knees bent and your feet flat on the floor. Press your hips up to the ceiling, squeezing your buttocks. Hold for 5 seconds. Lower back down. Repeat 10 times.
Work up to doing 3 sets of 10, 1x/day.
Sidelying Hip Abduction
Start lying on your side with your legs out straight. Keep your hips stacked – don’t let your top hip roll back! Raise up your top leg towards the ceiling over 3 seconds. Ensure your top leg’s toes are facing the wall, and not the ceiling to ensure the muscle on the side of your hip is working. Lower down over 3 seconds. Repeat 10 times. Do it on the other side too!
5. Exercises to really make your knee work
Sit to stand
Start sitting on the edge of a stable chair (not an office chair on wheels!). Ensure your ankles are slightly behind your knee joint. Sit tall, lean ALL THE WAY forward and push your feet into the floor to push yourself into a standing position. To sit back down, think about reaching your buttocks back to the chair, attempting to land light as a feather. Make this movement last a few seconds on the way up, and a few seconds on the way down to ensure longer muscle contractions. Repeat 10 times.
Start standing tall, and then take one big step back with one foot, landing on your toes. Keep your front knee stacked over your ankle. Lower your back knee down to the floor. Step your back leg back in. Repeat 10 times. Switch to the other side. If needed, use a hand on a counter or a wall for extra balance.
Work up to doing 3 sets of 10, 1x/day.
There are many ways to make these exercises harder. You can add on weight (like holding dumbbells), or increase your number of repetitions/day. Once a strengthening exercise no longer feels hard, make sure you increase the intensity level to continue your progress.
What an amazing start to building your body up! But are you wondering what ELSE you could do to help you get ready for surgery?
Here it is :
- Learn more about the surgery and what you’re getting yourself into – see Tyler’s amazing blog post here
Anything else to improve your overall health. If you know you have a “weak area” in terms of your health, get it under control.
-Quit smoking. Seriously. Today.
-Eat well (well rounded nutrition)
-If overweight or obese, consider losing weight -speak with a dietician about how to manage your diet better to achieve these goals
-Manage stress as well as possible
-Relaxation strategies ie. Deep breathing, meditation, mindfulness
-Manage comorbidities (ie. manage diabetes, high blood pressure, etc)
There you have it! A very simple program for you to get going on getting stronger.
Keep in mind that every body, and and every knee, is different. I’ve met many people who have had a total knee replacement on both sides, and had two sets of different symptoms pre-surgery, and completely different recovery experiences. Your abilities, pain, and function may benefit from a more individualized program. But the principles of exercise and improving function will never change!
Do you think you need some personalized help for your prehab, or not sure what to do with your knee pain? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand what you can be doing to help your pain feel better.
Physiotherapist at Strive Physiotherapy and Performance