Healthy Cells, Healthy You with Janet Walker

PT for the Knee - Before and After Knee Replacement Surgery

• Janet Walker • Season 3 • Episode 3

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Understand the intricacies of managing knee pain with insights from expert physical therapist Shehla Rooney. Shehla unpacks the complexities of knee osteoarthritis, revealing its symptoms, risk factors, and the demographics most affected, emphasizing that while we can't halt time, proactive steps can significantly enhance knee health.

Shehla shares details about conservative treatments  while also clarifying the role of surgery and the crucial importance of physical therapy in knee replacement surgical success.

Our discussion about the post-surgery phase emphasizes the significance of tracking range of motion to ensure a smooth recovery. Learn why objective measurements are crucial, how they guide professionals, and what benchmarks indicate progress. We wrap up with practical advice on maintaining knee function through consistent exercise and engaging activities. Plus, stay tuned as we hint at a revolutionary device, the Go Knee, that promises to reshape recovery strategies. Don't miss this episode packed with expert tips and valuable advice for anyone navigating the challenges of knee pain or surgery preparation and recovery.

To connect with Shehla Rooney, PT, visit:  thegoknee.com
To connect with Dr. Timothy Kavanaugh, orthopedic surgeon and knee specialist, visit: azortho.com

Together, we'll build Healthy Cells, and a Healthy You!

Janet Walker:

Knee pain, whether it's from an injury, wear and tear, a chronic health condition or a cause unknown. You just want your knees to work again without pain. Sometimes, prevention and conservative treatments make all the difference. Other times, surgical intervention is the only solution is the only solution. In either case, physical therapy for the knees is a way to ease your muscle and joint pain, strengthen the muscles around your joint, increase your flexibility and get the best knees that your body can give you.

Janet Walker:

Welcome to Healthy Cells, healthy you. I'm your host, janet Walker. I've been working in the healthcare community for over 30 years and for 20 of those years I've also worked as a writer and producer for the Windsor Broadcasting award-winning national PBS, health information TV shows, american health journal and innovations in medicine. We've interviewed thousands of doctors, scientists and researchers on every topic related to health, medicine and medical technology. You can watch current episodes of Innovations in Medicine on your local PBS channel or you can stream our programs on the American Health Journal channel, the Better Health channel and TV Healthy Kids. I'm also a new host for Windsor's award-winning podcast entitled Better Wellness. Today we're talking to she, sheila Rooney, physical therapist and creator of a home physical therapy knee program that can help you in your quest for healthier knees. Welcome to the program Sheila.

Shehla Rooney, PT:

It's so nice to be here, Janet. I'm excited.

Janet Walker:

Let's first start talking about how you came to specialize in knee damage and recovery, because your practice is pretty much limited to that. Is that correct?

Shehla Rooney, PT:

It is correct and it was not intentional. I'm what's called GCS certified. I have a certification in geriatric physical therapy and I've been treating the older adult for like 26 years. So that's like heart conditions, lung conditions, you know, cancers, heart failures, diabetes, the whole thing, amputations. But about six years ago had a patient that was struggling after knee replacement surgery. He shouldn't have been meaning, he was healthy and motivated, he was doing everything right, but he just wasn't progressing and was told he needed another knee procedure and he just begged for a solution to avoid that second surgery. And as they say, you know, necessity is the mother of invention. We created something for him. It worked. We tried it on another patient and it worked. And I just realized, you know, that we had created something bigger and could have a bigger impact on a much larger scale. And knowing that you know that there's a possibility of helping millions of people all over the world, that we had to explore it. And so that's how I became the knee replacement guru, Not intentional, just by chance.

Janet Walker:

Wonderful. Well, we're going to talk a little bit more about what you created later, but first let's talk about osteoarthritis of the knees. What is it, who gets it, and what symptoms do patients experience?

Shehla Rooney, PT:

I feel like everybody kind of knows that osteoarthritis is the wear and tear arthritis. It's the shock absorbers in the knee wear down. Bones are not supposed to touch each other and so if your cartilage and your soft tissue wear down, well then instead of your bones moving smoothly and easily, with those absorbers in between, they start getting more rugged and rough, and what that does is it causes the bones to rub together, which causes pain, stiffness, you know, locking of your joints. So I would say the hallmark sign of knee osteoarthritis is pain. The pain is persistent. It develops gradually over time, like months and years. So if your pain just started, like two days ago in your knee, it's not likely osteoarthritis and most people describe it as like a dull ache. It gets worse if you're standing for a long time, walking for a long time, going up and down stairs, and then again people would say, in addition to pain, they have stiffness. Some swelling Patients will tell me you know, my knee buckles every now and then or it locks up when I'm walking. So all those symptoms combined really do affect the ability to move and do everyday tasks.

Shehla Rooney, PT:

Now, as for who gets knee osteoarthritis, there's a lot of research all over the place. I mean I call it an older adult issue, like mostly people over the age of 50, but it can occur in patients that are younger. It can happen in people who have, like, excess body weight so if you're overweight it does place extra stress on your joints but also those who have done like repetitive aggravating activities during their lifetime. You know, maybe they were runners, maybe there were factory workers that were standing on concrete, you know, for eight hours a day, you know 40 hours a week. Maybe it was people who did construction or climbed ladders over and over again. So any job that placed a lot of stress or activity that placed a lot of stress on their knees makes you a higher risk to kind of develop osteoarthritis.

Shehla Rooney, PT:

But honestly, since I've been doing all this knee stuff, the people that tend to need knee replacement surgery or have like severe osteoarthritis are those that had an injury in the past. So they'll tell me, like when I was 18, I played soccer and I had a knee injury, or I played college football and I blew my ACL out and you know they had to have a repair. Maybe a meniscus repair ACL, repair ACL out, and you know they had to have a repair. Maybe a meniscus repair, an ACL repair, so that surgery 30, 40, 50 years ago kind of started that trajectory of arthritis developing in that joint and kind of just worsens over time. So it's a wear and tear of your knee.

Janet Walker:

I recently spoke to orthopedic surgeon Timothy Cavanaugh, who does total knee replacements. Orthopedic surgeon Timothy Kavanaugh, who does total knee replacements. But certainly there are some preventative measures or treatments that patients can try first before they make that surgical leap. So what are some of the conservative treatments for pain related to osteoarthritis?

Shehla Rooney, PT:

As for preventative, I don't know that we can prevent osteoarthritis because I can't prevent myself from aging, I can't prevent myself from having the injury that I had when I was, you know, 20 years old. But, you know, maintaining a healthy weight can help you maybe prevent it from worsening. You know, there's like an additional 10 pounds of weight on our bodies puts an additional 40 pounds of stress on our knees. You know, also, activity modification If you love running, then maybe you need to look into your proper footwear, maybe get an assessment of how you're, how you're running. Maybe that needs to be modified or maybe running is not an option for you at this point because it does cause that high impact activity over and over again. And also, I think that the biggest thing that we don't do enough is like looking at our posture, you know, looking at our footwear. You know, are we flexible, are we strong, where we need to be? I think those basic things they're not like sexy and glamorous. You know, just like a warmup, warmup before activity. You know, I play pickleball and I find I'm the only one on the court and I'm one of the younger ones that is doing an elaborate warmup. They just kind of get on the court and start warming up with their paddles and their balls. But you know, I'm so aware, being a PT for 26 years you know injury prevention, warming up my joints, preparing them for activity, you know that can really, in essence again, not prevent arthritis but maybe slow down the occurrence of it or the rapid progression of it. As for other conservative measures knee braces, you know, or knee supports and I mean yes, they have been proven to help but nobody wears them, nobody likes them. You know they're bulky, they slide down, women don't like to wear them under their clothes. So I you know there's a compliance issue with knee braces. So, even though they've been proven to help reduce that pain associated with knee osteoarthritis, I just find if you don't wear them then it doesn't help.

Shehla Rooney, PT:

Orthotics, like again if you have, depending where your pain is or where your arthritis is in your knee sometimes it's on the inside of your knees, maybe you're a little bow-legged there's certain orthotics and inserts that can kind of help with that lower body alignment and help manage your pain a little longer. I like some soft wraps, like people kind of pull on those compression sleeves over their knees when they're doing activities that are aggravating, and then other conservative things. You know there's research out there that says some supplements like glucosamine and chondritin and again there's probably people listening that are like I don't know, the research is conflicting. But you know, depending on the quality of the supplement, depending on how long you've taken the supplement, there are research that says it has benefits to helping manage knee pain related to osteoarthritis.

Shehla Rooney, PT:

And then, as a PT, I strongly advocate like topical treatments, like there's things like BioFreeze or ointments that have capsaicin, cbd creams, voltaren, like there are topical agents that I'll just rub on my knee when I need to and it can help control the pain and allow me to do activities like going to the gym or walking to maintain a healthy weight, and these are ointments and creams that people can try.

Janet Walker:

if they help them, great. If they don't help them, there's no adverse effect.

Shehla Rooney, PT:

Correct, that's exactly right.

Shehla Rooney, PT:

Low risk but high value. And to me you start with things like a soft knee sleeve. You start with things like an ointment that you can rub on, and then you know, if those don't work, then you go to something more like over the counter, maybe a medication like a Tylenol or an ibuprofen. But I find sometimes people go to that first and I don't want to put something in my body. That's systemic and you know, again, the older adult might have stomach issues or ulcer issues and there's certain medications they can't take.

Shehla Rooney, PT:

So let's start with things that are a little more conservative, but yeah, ultimately you know, the most beneficial conservative treatment out there for the management of knee OA is exercise, and everybody hates hearing me say that because it requires effort. It's not a pill, it's not, you know, but ultimately the research out there, you know, is compelling on the benefits of exercise, and what physical therapy can do is we can teach you what exercises you need to do. That will help you very specifically. Now my pet peeve is, you know, you go to a physical therapist and they tell you to do all these like exercises that cause pain. But to me remember, as you said at the beginning, I'm known in my hometown as the knee lady and I have realized in my earlier career like I would tell people to do activities that literally increase their pain, which then reduce their compliance, and then they just didn't come back and see me and I thought they were healed but really they just kept living with their pain.

Shehla Rooney, PT:

So I think a very intentional exercise program that's specific to the knee, stretch the things that get tight around the knee, strengthen the muscles that get weak around the knee, I think those are really advantageous. And if you are going to go to the PT for conservative, there's tons of things nowadays that we do like dry needling and cupping and taping and scraping and massage techniques, and then we have all these modalities like electrical stimulation and shockwave and shortwave, diathermy and ultrasound. All of these things are kind of like the ointment, you know, kind of like the knee sleeve. They're not taking a pill, they're not having surgery, but they can just maybe help reduce your pain so that maybe you can go to water aerobics, so you can help, you know, do the motions and maybe help doing cardiovascular exercise. But I do think conservative treatments tend to for some reason not be done as early on in the arthritic journey as they should.

Janet Walker:

Some of those treatments sound really interesting. I'm going to have to have you back for another interview to talk about those things. You know, the cupping and the dry needling. These are all things that are popping up on our newsfeeds and our social media and I'd love to have our listeners learn more about them. So I'm going to tap you for an episode about those things. But let's talk a little bit about physical therapies, since that's what you specialize in and we've been talking about it a little bit. When should a patient seek help from a physical therapist, and can they go on their own, or do they need to get a doctor to refer them to a physical therapist?

Shehla Rooney, PT:

There's something called direct access in physical therapy and most of the states in the United States allow direct access, meaning if you think you need physical therapy you can walk into the therapy office, you know, make an appointment and go see them. The whole point is reimbursement right If you want insurance to pay for it. A lot of insurance requires you to go to the doctor first, get the order and then go to physical therapy, and a lot of therapists prefer that as well, just to always have a doctor involved. But it's easy to access physical therapy is my point either through direct access or through your primary care doctor. But as to when to go, what I find is people come to see therapists when their arthritis is severe like or moderate to severe, not when it's mild.

Shehla Rooney, PT:

I think there's a misnomer that as we age, pain is normal and that's a myth, like to me. There's something called normal aging and pathological aging, and pathological aging is that? Oh, because I'm this age, I should have aches and pains, like we've all read those articles of the centurions that are like 105, and they don't have knee pain and they're walking up and downstairs and living in Asia or whatever. So to me it's not true. So I sometimes think they don't come see me soon enough. But if I was talking to the audience about when should you go see a PT?

Shehla Rooney, PT:

When you have knee pain, you know when it starts impacting your everyday routine, when you start realizing that you're sitting down to put your shoes on or you're changing how you put your socks on, you know, maybe you're not playing pickleball as much. Maybe you're like, ah, maybe I won't golf 18. I'll golf nine. You know. So when you're I call it your life getting smaller, when you start making your life smaller because of your knee pain, go seek out assistance. And that's when I'd be like come see me. Because what if it's a matter of simply changing an insert in your shoe? You know that's not that evasive, right? Um, what if it's a postural thing? What if there's lots of therapists that specialize in golfing? Like, what if they can change the mechanic so you're not hurting that knee? So I think sometimes they don't come see us soon enough.

Janet Walker:

And is there ever a time when you've worked with a patient and then you've said you know what? I think it's time for you to have a surgical consult?

Shehla Rooney, PT:

100%. I mean, as we talked about all those conservative measures, I'm not going to do that for two years, three years, like the goal is the ones that you talked about having me come back, like the scraping, the taping, the dry needling, those are all modalities to help reduce pain so that we can get you to do something longer term. So you know, I'm not going to do that for months and months. I'm going to do it to control your pain, so I can then put you on the best exercise program to manage your knee pain and then that will control it until it doesn't. You know, again, it's a wear and tear. We're standing on our legs, we're bipedal, so we stand up. So once the conservative measures are no longer working, then I'm going to absolutely instruct the patient or tell them when they're discharged from therapy, like, do these techniques? But once your pain starts to get really bad and it's affecting your daily routine, it's time to go get an orthopedic consult.

Janet Walker:

So I don't know if you listened to my recent episode with Dr Kavanaugh? I did. My recent episode with Dr Kavanaugh I did. He's a big proponent of physical therapy. In fact, he said that physical therapy is probably 40% of the success of a knee replacement surgery. You've worked with a lot of knee replacement patients. Have you also found that successful patients are those who are really dedicated to their physical therapy?

Shehla Rooney, PT:

Yes, I feel like patients compare knee replacements to hip replacements. Hip replacements you don't have to do as much physical therapy to get the results you want, but with the knee joint it's very specific. Your knee needs to bend and straighten repeatedly every day, multiple times a day, in order to get this recovery. And I think without guided and again, I'm not saying it has to be a physical therapist, but there has to be somebody that establishes a very diligent exercise program in order to have the success. I did listen to Dr Kavanaugh's and I fully agree. Like you could have the best surgeon with the best implant, but if that patient goes home and just expects to rest for four to six weeks and assume that after that time that knee is going to work great because it's brand new, that's not how this works. Knee replacement recovery requires intentional, active involvement from the patient.

Janet Walker:

Yes, Should patients begin physical therapy before knee replacement surgery or is it strictly something that they want to do following knee replacement surgery?

Shehla Rooney, PT:

You know again, I've been doing this for 26 years there used to be a common thread that everybody went to a joint camp or a prehab program before surgery. And you know, I think the shift was that, you know, all of a sudden reimbursement wasn't paying for the prehab programs or the joint camps, and you know, everything, unfortunately, is a business, and so it kind of went away to the wayside that you'd scheduled a surgery. You were given a huge booklet that kind of had all the information in it and not everybody reads it, not everybody knows what to do with it, and so I feel like it became a passive process. But the answer to the question is should people do prehab or some kind of therapy before the surgery? To me, 100% yes.

Shehla Rooney, PT:

The research is clear that the more motion you have in your knee before surgery, the better the outcome. The stronger your quadricep muscle is before surgery, the better the recovery and the outcome. So to me those are two things that I am experts in. Like physical therapists know how to increase knee motion and we know how to strengthen muscles around the knee joint, and to me that soft tissue prep work really helps. When someone like Dr Kavanaugh goes in and replaces that joint he's doing a lot of bony changes. The surgical process involves a lot of bone replacing different things and implant replacing the bone so that soft tissue component is integral.

Shehla Rooney, PT:

So if you can do things before the surgery to prepare, not to mention the brain, you know I feel like people forget that with knee arthritis your brain's number one job is to protect your knee. So it almost in essence, like I said, when the person starts sitting down to put their socks on or they start avoiding stairs, maybe they stop walking as much. You know that's the brain kind of telling them that that's going to hurt, so let's avoid that activity. So part of doing prehab is reawakening the brain and connecting it to this arthritic knee and saying it's okay to do some activity with this knee. So that way when the surgery happens and there's a brand spanking new knee in there, it's not a shock to your brain Like whoa, we haven't done anything with this knee for months, maybe years, you know, you think it's just going to let you do things that inflict pain on yourself. It doesn't work that way. So yes, prehab, something before surgery, is crucial.

Janet Walker:

You know, it's interesting because in preparing for this series on total knee replacement, I've talked to a lot of knee replacement patients and the majority of them have said that their second knee was easier, they recovered faster, and I wonder if that's because they've been doing the rehab on their first surgical knee, which you know in turn gives them some exercise and prehab on the second.

Shehla Rooney, PT:

I think there's absolute truth in that. I think, in addition to them, like maybe walking more, because it takes two legs to walk, it takes two legs to stand up, it takes two legs, so all of a sudden they're doing more activity number one, but I think it's also expectations. I think it's like they realized how much work it took to get that knee moving, and so I think that the expectation is different for the second one, and when the expectation is different, you're going to have a different result.

Janet Walker:

Let's talk about that a little bit. What are some common misconceptions that patients have with total knee replacement?

Shehla Rooney, PT:

Well, we just I think the one we just talked about, where you know, doing physical therapy or exercise before surgery won't make a huge difference, you know. So they avoid activities, you know, which in essence results in them becoming weaker and tighter and more deconditioned leading up to the surgery. So I've heard many people say, yeah, I'm not going to go to therapy. The surgery has been scheduled, the surgeon's going to fix my knee, so I'm just going to wait it out. So that's one misconception is kind of sit tight and rest until the surgery because you might cause damage to that knee before. That's not true. I think another misconception is people get their hip done and then they think their knee, although listening to Facebook support groups I'm realizing people now realize there's a big difference between hips and knees. So definitely hips are not the same as knees. So that's a misconception. And I think another misconception is they think their knee is going to feel normal after the surgery.

Shehla Rooney, PT:

But you know, in essence you have put a brand new, you know, metal, plastic implant into your body. It can never feel the same as the one that God gave you at the beginning. And so I think people are like I thought it was going to feel normal, or I can kind of feel that in my knee, or my knee looks a little bigger than the other knee. When's it going to feel normal? I think that that's a misconception. I think they don't understand the pain will go away or reduce and they'll be able to do things they didn't do before that pain was inhibiting them from. But I don't know that it ever fully feels normal per se.

Shehla Rooney, PT:

And then I think also the misconception that I hear all the time is underestimating how long the recovery actually takes. I think people are like you know, four to six weeks, and I should feel normal. Four to six weeks, why is my knee still hurting and stiff? Or even eight weeks. So I think there's a misconception that you know the recovery should be faster than it is, and so that causes a whole slew of. You know, if your expectations are in six weeks, I should feel so much better. Or maybe they're going back to work in six weeks and they realize they're not ready right. So there's a misconception. I don't think people plan long enough for how long the recovery takes.

Janet Walker:

What is the typical recovery time, like what's normal, for saying, okay, I'm this many months past surgery but you averages, but I've had all spectrums, but you know it depends on what their therapy looked like.

Shehla Rooney, PT:

It depends what their pre-surgical status looked like. It looked, it depends on their comorbidities, it depends on their motivation level, it depends on their financial situation. You know, even where they are in the United States can make a difference in terms of what insurance covers or doesn't cover. So, you know, I will give you the generic response that I think all surgeons would agree with me is you know, give it a full year before you make a decision on whether you regret having the surgery. Now, I don't like that. So that's my, that's my general response that I should give. But if you're asking me specific, which I shoot it straight, I'm going to say you know, most people regret having that surgery the first seven to 10 days, you know for sure. You know, because it's a very painful recovery. But by two weeks and three weeks, I mean, you know this surgery, you're walking independently the day of yes, you're using a walker, but you're walking independently. You know, within a week you're getting yourself dressed and taking yourself to the bathroom and you're, you know, walking around in your house. Again, it doesn't feel great, but you're doing all those things, um, you know. So I would say, by four weeks your knee is moving better, so you're able to get up and down better and again get in and out of a car. You might be able to resume driving at that point.

Shehla Rooney, PT:

Um, but yeah, I would say eight weeks is when you're like yep, I can dress myself, yep, I can drive, yes, I can walk and move around. Uh, maybe stairs are still a little tweaky and you feel like I don't like how my knee feels when I go upstairs or walk long distances. But really for three months you're, it takes like three months for your bone to even grow into that implant. So to expect in less than three months you're not going to have pain or swelling or discomfort, I think is unreasonable. But I think you'll be very functional well before the three month mark, meaning very independent, like if somebody watched you, it looks like you're resuming normal life, but you personally are like I still feel my knee. It reminds me if I do too little or too much. You know you can't forget it for those first three months.

Janet Walker:

Are there any common mistakes that patients make that can inhibit their recovery? So many, so many so many.

Shehla Rooney, PT:

So one that a patient just told me a couple of days ago was he took it as a badge of honor that he was off all the pain medications that the doctor had prescribed and he was only like six days after surgery. So I think that's a mistake patients make, is they think it's a badge of honor to wean off the heavy pain meds because of the fear of addiction and narcotics and all that stuff. So unless there is a history of addiction in your life or you're having a major side effect to the heavy pain meds, I suggest you really do take those, especially for the first two weeks, because if it allows you to work your knee harder, then you're going to reap the benefits of gaining that knee motion faster, trying to get that quadricep muscle to activate sooner. So common mistake is weaning off the pain meds too soon. I think another one is doing too much of the wrong stuff. Again, I had a patient this past week who was telling me that he was adding like I don't know something like 500 to a thousand steps every hour. That he was awake and he's right, and he still hadn't met his range of motion goals. So you know. And then he was saying that his leg would swell up at the end of the day. So part of me was like you're doing too much of the wrong stuff.

Shehla Rooney, PT:

After knee replacement surgery we already know you can walk. You can walk the day of surgery. I think the thing you can't do is bend and straighten your knee easily. So, to me, doing too much walking or doing too much riding a bike even I like riding a bike. It loosens the knee up and helps reduce stiffness. But the bike should be in not 30 minutes of riding a bike, it should be five minutes so that you can then do some active exercise to increase your bending and your straightening.

Shehla Rooney, PT:

So doing too much of the wrong stuff I think is a mistake people make. They think because I'm walking, I'm exercising, but not all exercises are created equal after knee replacement. I think also a mistake patients make is they defer to the physical therapist too much about their recovery, meaning what I do two or three times a week when I go see Shella trumps anything that I do at home. And that is not true. I think that what you do at home every day is going to trump whatever I do in the clinic. So what we do seven days a week is going to make a bigger difference than what you do at home every day is going to trump whatever I do in the clinic. So you know what we do seven days a week is going to make a bigger difference than what you do two or three times a week. So a lot of patients are kind of like they pass the buck to the physical therapist, to kind of be reliant on gaining the knee motion or getting the leg straight. I think that's a big mistake PTs make. And then another one is that because of the pain after the surgery they don't push themselves. I think a huge mistake.

Shehla Rooney, PT:

Patients don't realize and this is specific only to knee replacements. I'm not saying this to everything. So if your listeners are like whoa, I had pain and I tore something, no, no, no For knee replacement recovery, a lot of patients will say it's hurting so bad so I'm going to stop the activity. But I think that there's a neurological component they're not aware of that your brain says it hurts so you should stop doing it. But in actuality there's no tissue damage occurring and so there's a disclaimer, meaning pain with tissue damage means don't do something, but pain with no tissue damage means just proceed with caution, and so a common mistake I see is my knee hurt too bad. I couldn't do the exercises, and that is not negotiable in knee replacement recovery. Pain is just a reminder that your brain doesn't like what you're doing with knee replacement, but it doesn't mean to stop doing what you're doing. So again, people will walk because it feels better than bending the knee. But bending the knee is the key to the recovery, more than walking is.

Janet Walker:

What is normal range of motion? I assume that's the bending and straightening you're talking about.

Shehla Rooney, PT:

Yes.

Janet Walker:

What is normal for a knee replacement patient and when do they want to question the fact that they're not where they should be and take the next step?

Shehla Rooney, PT:

Okay, so normal range of motion. You'll hear a therapist say like zero to 135 or zero to 140. Zero means your knee is fully straight. So zero is a straight knee. 140, 145 is like my heel to my bottom, like it's all the way back. Think of like a, you know a hamstring curl thing. Your, your, your heel is touching your bottom. So that's normal range of motion. Some people have 150, 155. It depends on your soft tissue restriction. But you know, as far as your knee can bend After surgery, obviously the biggest thing that happens is you wake from surgery after anesthesia and your leg just balloons up, it swells up, it stiffens up and you know, motion is very restricted.

Shehla Rooney, PT:

So what normally happens is people lose that knee straightening ability. So instead of that number being zero, sometimes therapists will say minus 15. That means you're lacking 15 degrees from straight. Okay, um, and then they'll say 90 degrees. Well, 90 degrees is you know me sitting in my desk chair right now with my you know hip parallel to the floor and my ankle directly underneath my knee. So those are kind of norms, like 90 is, you know, just sitting regularly in a chair.

Shehla Rooney, PT:

But as for norms after knee replacement surgery, again it's going to depend on how hard did you work? What was your pre-surgical range of motion? How hard did you push yourself? What are your goals? You know, if you only had a hundred degrees before, you know, research says that you're going to be lucky to get to maybe 105, 110, you know, maybe more. That's why it's so important to do that prehab.

Shehla Rooney, PT:

But for me, and what I do every day, my I'm going to throw out numbers that some people are going to be like whoa, but to me I want my patients at one week to be at, like, you know, zero, meaning they can get to fully straight to about 110 degrees. You know, by two weeks I want them to get as close to zero to 120 degrees. You know, by three weeks I want them to be at 120 plus and everything after that is icing on the cake. But again, that's my goals for them. I think it's reasonable and obtainable. I think that that's not always the norm because patients, you know the pain makes them inhibit. They don't want to do as much. Maybe they have weaned their pain medicines.

Shehla Rooney, PT:

But the range of motion numbers, I like objective numbers. Some patients hate it, but my thing is you have to know the numbers because the number tells me something. If they say I'm off the walker in the cane, I'm like what's your straightening number? And they're like minus eight. I'm like, oh so you're walking with a limp. And they're like, oh so you know, it tells me you shouldn't be off the walker in the cane, like put that cane back in, because we don't want to walk with a limp and reinforce a habit that will be hard to break.

Shehla Rooney, PT:

So the range of motion numbers are important because they tell health professionals you know what is normal, what is not normal. And when you asked about when should you worry, if you go back to your follow-up appointment with your surgeon at the 30-day mark and they look at your range of motion and it's between like 85 and even 95 degrees of motion, they're going to start to get concerned because it's been four weeks. They're probably going to have a conversation with you that hey, if you don't get that knee bending more, we're going to have to discuss on your next visit, maybe at the two month mark, that you need a manipulation under anesthesia because your knee is not moving as well as they think it should. So that's kind of a staple across the board that if you're still kind of stuck at 90 degrees at four weeks in. You're kind of behind the eight ball.

Janet Walker:

So we've talked about how important physical therapy following surgery at home is. How long should patients do physical therapy or exercises for their surgical knee for, you know, a few weeks after the release from physical therapy, a few months, a few years or forever?

Shehla Rooney, PT:

Great question. So it kind of depends on the individual's goals and how fast they recover. So you know you could have patient A who gets their range of motion to like zero to 130 in the first month. But if you let up too soon, I mentioned that it takes three months for that bone and that implant to kind of grow together. So I find people who gain motion really quickly kind of back off because their knee is doing so well and then they'll lose some. So you'll lose like 10 degrees of range of motion in those first three months if you let up.

Shehla Rooney, PT:

So the answer to your question is for those first four to six weeks you were doing exercises like three to five times a day every day. After the first four to six weeks, if you're meeting your range of motion goals, you could probably ease up on that to maybe three times a day every day. You know, for the next few weeks, till you're yeah, till you're like at the eight week mark, nine week mark. But you know to me even that last you know the second month to the third month, you should be doing something still every day that bends and straightens that knee because you can lose it. So I've seen people at three and four months that had done really well beginning. You know they're like why am I walking with a limp? And they're they lost a little bit of their knee straightening? Or they're like my. You know, my knee used to be easy to bend and now it's like I feel like I've lost about 15 degrees. Or the PT measured it from last week to this week and I've lost seven degrees. Why would that be? And it's because they eased up on the exercises.

Shehla Rooney, PT:

So my answer to people is how often should you do it? It depends. I mean, ease back off on your exercises and then if you feel the tightness starting to come back, then you have to increase that back up. But it's a fluctuating game that if you do too little you lose it, if you do too much you can cause some increased discomfort. So it's a balancing act.

Shehla Rooney, PT:

But it is very individual because some people they get that motion back and then they resume activities they like, which also puts their knee through a full motion and that's great. I would rather you be outside doing something to bend your knee than sitting in a chair doing a standard exercise. Overall, you should still be doing some sort of knee exercise program within the first three months, and from three to six months you should be doing something, albeit at a maybe reduced frequency. Maybe it's three times a week, but I will also say that even at a year mark you got to be doing something that keeps that knee active. But I hope it's, like you know, a fun activity that you enjoy doing, instead of these seated exercises or bed exercises that you've been doing the first three months.

Janet Walker:

Now, I know you created a device and protocol that's proving to be a great help to knee patients, but I was hoping that I can talk to you about that a little bit when you come back, because we're out of time right now. So would you come back to talk to us about the Go Knee?

Shehla Rooney, PT:

Oh, it would be, my pleasure.

Janet Walker:

Well, shella, thank you so much for being with us today and educating us Listeners. You can connect with Shella at thegonicom that's wwwthegonicom. And thank you so much, everyone for listening to the Healthy Cells Healthy you podcast with me, your host, janet Walker. You can find us on Apple Podcasts, google Podcasts, iheartradio, spotify or wherever you get your podcasts. Subscribe and tell your friends. We'll help you find solutions and together we'll build healthy cells and a healthy you.

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