I spent 25 years as a kinesiologist. Now I write about it.
Surgery is easy; it’s recovery that’s hard. ― Alexis Dupree
On a recent writer getaway in the gorgeous state of Maine, I attended a dinner party one Friday night with old friends from my sports medicine days. The topic? Arthroplasty (joint replacement).
The hosts — both former physicians in the Army — served up fresh crab cakes and a killer tiramisu — in a cottage-style house on Damariscotta Lake.
Rich spent his entire career as a military orthopedist, sewing up Guantanamo prisoners and arriving at battle scenes to try and save feet and hands. And arms.
His clinic was on an enormous floating barge. The Military Sealift Command ships, literal floating hospitals, were often deployed on command, without notice to provide on-site emergency care for American combatant forces.
And the bad guys.
I’m Not a Doctor, But I Play One on TV
“I reattached arms, gave them new joints, did whatever it took, even though I knew most of the prisoners would die anyway,” Rich told me. “Those new joints wouldn’t get the rehab they needed — if they got any care at all.”
I asked him what joints were the worst to recover from.
“Feet and ankle, no doubt. All the weight and forces are transmitted there. You have to stand to walk. Boom.”
“I concur,” I said, in my best Marcus Welby voice (for those of you that didn’t grow up, um, back then, see Marcus Welby, MD).
Rich smiled. “Knees are a bitch, too. The arthroplasty procedures have improved — the incision is small now — but the rehabilitation is intensive. It sucks for most people, especially for overweight and out-of-shape people,” he said (Rich is a guy who does 100-mile bike races on weekends so he knows fit).
While partial and total knee replacement surgeries have improved (my own father’s scar from 20 years ago still looks like a 6-inch tire track), the rehabilitation remains intensive. In some, it can take more than a year to have “normal” movement, and even then it’s never the same as the original joint.
That said, typical rehabilitation with a physical therapist usually involves high-tech equipment and small pools for aqua-based therapy — all good. Water therapies are one of the most effective ways to rehab joints.
Yet there is no evidence that expensive equipment gets you any further in your recovery than common-sense applications (and trust me, those expensive options have medical codes that are Gold to the provider).
You can heal faster and get the maximum use out of your new joint by following a common protocol of “uncommon” routines.
And this advice is also prudent for basic knee health and overall optimal function (including muscle strains, cartilage tears, etc.)
This advice is not meant to replace your physician-recommended therapy but to consider it along with your therapy, and to keep your body performing to support the joints.
Train the Body for Surgery Using Uncommon Methods
The joints in the human body are the same in every person, but every person is unique to a surgical procedure. Chances are, your healthcare provider will never say, “You should prepare your body for surgery by training it.”
Women in good physical shape will have a better childbirth experience (since I am a man, and helped with my son’s birth, I say this with deep respect).
The more prepared you are for any surgery, the better you will do.
Surgery is trauma to the body that involves tissues, nerves, and emotions because everything is connected to the nervous system. Everything is connected.
Even a paper cut is traumatic. A nasty paper cut stings worse than a root canal on Tax Day. Yet these minor wounds, if frequent enough, are fatal.
In Ancient China, a torturous execution method called Death by 1,000 Cuts (paper cuts) was reserved for the most notorious criminals.
The body’s response to surgical trauma is a systemic chain reaction of hormonal, hematological, metabolic, and immunological explosions (and this begins before the incision).
Preparing (or training) the body months before your surgery is prudent and you’ll recover much faster. Consider this advice.
Lose excess weight.
This puts less stress on your “new” joints during rehabilitation and makes your body more agile. Too much adipose tissue slows your metabolism and your ability to heal.
2. Meditate and learn to relax the body.
Tension is our enemy. It’s why Bruce Lee said, ‘Be like water.’
Create a habit of mindfulness. Meditation is not always sitting on a mountain with your legs crossed. Sit or lie down and ease your mind and body. The less tension you have in your body the more powerful your intention becomes.
Relaxed tissues recover quicker and handle pain better (it’s why women are given epidurals during childbirth). If you are calm and relaxed the day of your procedure you will be happier after.
3. Strengthen tissues by performing uncommon opposite movements.
Do not wait for your rehabilitation to strengthen your body.
For a knee arthroplasty procedure, every muscle surrounding the major joints should be a focus — before surgery. This includes hip, back, and abdominal musculature.
Strengthening exercises should begin at least six months before your scheduled surgery. The stronger your body is, the better you will handle the surgery and the faster you will recover.
Most joints in the human body move in flexion, extension, rotation, and abduction/adduction. Flexion is our “default” movement. We are born in flexion, sleep in flexion (i.e., the fetal position) and our primary movements are flexion. We sit (flexion), we walk (flexion), and we hold a baby and embrace (flexion).
Flexion-centered workouts defeat the body.
Yes, it builds massive biceps and pectoralis and biceps femoris (hamstring) muscles, but it sends the body into a puffed up mess.
Ready? Here is perhaps the greatest secret.
Newton’s third law. Applied forces are equal in magnitude and opposite in direction.
Equal. In opposite. Direction.
Extension. Lateral movements. Retraction. Extension.
We must — must — train our tissues, joints, and body (and mind) with opposite and under-used movements.
We rarely walk sideways or backward. It’s an uncommon movement.
So do it.
How is this applied to the knee? The same way it should be applied to the entire body. Exercises must incorporate knee extension (opposite) and lateral movements two to three times more than flexion movements.
Here’s how.
Incorporate unusual movements into your life.
Walk Backward
Walk backward (extension) at least twice a week with your other rehab protocol. (No, do not walk backward in a street or in a dangerous place, but in a gym or your home.) Walk backward around your coffee table or chair or dog.
Before you do, move area rugs and other small items and keep your arms free just in case you stumble.
Walking backward helps strengthen the extensors and stabilizers behind the knee and hip. This will make your knee more stable post-surgery and is especially helpful in movements like descending stairs.
Lateral Movements
Walk laterally. Set a line on the floor with rope from wall to wall and move sideways along that line in 3 sets of 10 repetitions.
Shaking the Body
Shake. While most should modify this movement if you are headed for knee replacement surgery, gentle shaking is a powerful movement for the body.
In a relaxed, feet-apart posture, squat slightly and shake your entire body up and down — without tension. Later, you can try and jump lightly, and increase the velocity of the jumps.
Shaking stimulates the facia (tissue) and “shakes” the bones — applying a good impact force that helps strengthen bone tissue. It also increases circulation and lymph flow.
Calf Raises and Bent-Knee Calf Raises
Besides traditional calf raises, perform bent-knee calf raises. Stand facing a wall and use it for support if needed, but flex your knee by squatting, then perform calf raises with a bent knee, 3 sets of 10 repetitions.
This targets the small muscles behind the knee that are vital in stabilizing it (popliteus, etc.).
Dorsiflexion (front of tibia/lower leg)
Dorsiflexion start
With your back to the wall, lift the foot so you are on your heel. This trains the tibialis as a dorsiflexor that also stabilizes the knee. Lifting the toes (extension) trains the toe extensors as well.
Dorsiflexion end
Posterior Knee (extension)
A powerful way to strengthen the knee in extension is to use a small therapy ball (you can also use a pillow).
Knee extension
Stand on a wall and place the ball behind the knee. Imagine a line passing through the knee to the wall and extend your knee along that line into the ball’s resistance. 3 sets of 10 repetitions.
This same concept can be used for the lower back, placing the ball behind you and performing extension with your back.
While there are many other opposite movement exercises like rotation for the knee, by using this basic formula, the entire body is trained — and the same principles are applied to the lower back, shoulders, and neck.
Why? Extension. Retraction (shoulder blades), and opposite movements must counterbalance flexion, yet in most training protocols this is minimized. Walk into any gym and what are they doing? Flexion.
My bottom line? Train for your surgery and train the body for life by employing the rule of opposites.
Why?
A body in motion stays in motion. Keep it that way.
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