In trying to build back atrophied muscles and regain muscle endurance after total knee replacement (TKR) surgery, it can be easy to forget about range of motion (ROM) once you reach a certain level of flexibility. To be able to do things like walk down steps or pedal a bike, I've read that you need to be able to bend the knee joint about 110 degrees backward.
I'm now about eight months out from TKR on my left knee, and achieved that 110 degree ROM a few months back. Since then, I've had the tendency to forget about pushing my ROM, since my knee joint bends just fine for most activities. But that's a big mistake in terms of rehabilitating the knee for a fuller, more active life. I'm finding that the more ROM I have, the more normal the joint feels, and the more power and snap I have to my leg. So I've placed a renewed focus on ROM in hopes of getting my ROM back to where it was before the surgery, and perhaps even beyond that.
One step was to purchase a goniometer to measure the maximum bend in my artificial knee joint. The video below explains this device. I'm also doing some stretches. The most useful ones for me include:
- Lie face down on bed, pad, or carpeted floor, and bend your heel back toward your glutes. You can hook your other foot around the back of the leg/foot you are bending to gain more leverage, but ideally, have someone help you push your foot back to gain more flex in the joint. This can hurt, so the person helping you should exert steady pressure, rather than a jerking motion. If you start pounding on the floor for mercy like an old fashioned TV wrestler, then perhaps you are overdoing it. Once it gets to the maximum bend you can tolerate, hold it there for few seconds.
- Simply sitting back on a chair or bench, tuck one knee in and pull back on the shin with your hands to achieve a good bend. You can also use the back of your ankle on the bent leg to pull back with added pressure. I find this stretch works great in a whirlpool, especially after the warm water heats up the joint. Once again, don't jerk back, apply steady, strong pressure, and then hold for a couple of seconds.
- Try doing a deep knee bend while holding onto a chair or railing, and crouch till you reach the maximum flex. A variation on this is to do a controlled lunge/knee bend into a set of steps, putting the foot for the knee you are working two or three steps up, and keeping your other on the floor or landing.
- I'm Catholic, and I found that while kneeling in the Church pew, if I keep the balls/soles of my shoes on the floor, then let my weight sink back until my rear end rests on the front edge of the pew, I get an excellent flex in my knee joint. This was difficult when I first tried it at the start of Lent, but was easier by Easter. I felt a bit guilty at first about using a church pew as a physical therapy device, but I was praying for quick recovery anyway, so I figure it's OK, as long as I'm still paying attention to the Mass.
Those are a few stretches that have worked for me. Please keep in mind that I'm not a physical therapist, or in the case of the pew-stretch, not a theologian, so it's best to consult an expert for the best stretches for you.
My bigger point is that ROM is something that needs to be kept after, even after you've achieved a base, functional level. Right now, I'm close to a 122 degree bend, which is where I was at before the TKR last October 7. As I review the video of the "Goni" self measurement, it seems I didn't have it aligned quite properly, so perhaps I was a bit shy of 122. But I'm damn close, which is great. I need to keep working at this while the joint is still healing and adjusting to the surgery. A few more months from now, it may be too late to gain additional ROM!