My client is 45 years old and has had total knee replacement. I've been seeing her three times a week for two months now. She has had limited knee flexion (15 degrees) for over 25 years. Surgery was done in a last ditch attempt to improve function. We are achieving 40 degrees of knee flexion now with assisted/PNF stretching on quads. The surgeon wants to continue this work with a view to doing a quadsplasty next year. This lady is highly motivated but is overweight and limited in her ability to do cardio. Any ideas for increasing cardio? Any other ideas to improve knee flexion?
Sounds like you have your hands full. As we always point out, you should always follow medical advice first. However, there is nothing wrong with adding a function “twist” so to speak to your client’s rehab. Based on the information given, my first thought is to concentrate on your client’s hip and ankle. In other words, surround the problem. I often work with people immediately post surgical (following doctor's orders, of course) by using a whole body approach. Point, most of the post surgical recommendations are isolated to the problem area; yet in life, we function as a whole. For example, the muscles that control the knee also control the ankle and hip. Therefore, condition the whole, taking into account the “problem part.”
Solution: Increase hip and ankle soft tissue extensibility in attempts to free up unnecessary tension in the knee. If I were a betting man, the reason for her knee replacement is because her hip and/or ankle are not functioning correctly. Remember, the knee is a simple hinge joint between two more complex joints (hip and ankle). Unfortunately, if the above and below joints are not working well, the knee takes on all the stress!
Depending on your background, I would perform soft tissue therapy — more specifically Active Release Techniques (see activerelease.com for a provider in your area if you are not qualified). You will be amazed with the results, and it will create a great network opportunity for you seeing as most ART practitioners do not condition people like yourself. As for cardio, if she walked into your facility, then forms of walking will work. See Gary Gray's Functional Video Digest on Walking. You will find great ideas and plenty of assessment examples of how to “tweak” for each individual. Your immediate options while you wait for an ART session: water aerobics or an Ergometer, which allows just upper body movement to take place.
Last but not least, be sure to combine your aerobic work with proprioceptive conditioning (i.e., standing on an Airex Pad barefoot to challenge the sensory organs in an unexpected environment). This reflex stimulating exercise will create a better environment then any traditional post surgical exercise! At first, you may have to add outside support like a dowel rod or your assistance, but the effort will lead to faster rehab and a much better functioning client.
I hope this helps. Good luck!