Research Corner - Q&A Total Knee Replacement by Steve Rhyan | Date Released : 05 Apr 2001 0 comments Print Close Question: I would like to know a basic protocol to follow five months after total knee replacement surgery. Along with that, what would be the difference between the upright versus recumbent cycle for a total knee replacement client? Answer: The knee is considered the most complicated joint in the body. There are several things to consider when trying to regain function in a replaced knee. The top two are the age and sex of the person. Older women with knee replacements tend to take longer to improve. Bone mass is another concern and develops slower in older people. Other concerns are with the joint capsule. If it is still swollen and painful, this may limit your exercise selection. There is a difference between the recumbent bike and the upright bike, but I am unsure what the mechanics of the false knee will be. There are a few things you'll need to keep in mind when training someone with a replaced knee. The first is range of motion. Determine whether there are any limitations in flexion or extension. To my knowledge, it is usually flexion that is limited. Most people have up to 120 degrees (0 degrees is when the leg is straight, 90 degrees is half bent), but some have more. Most rehab places start with leg extension and leg flexion and range of motion stationary bike work. Talk to your client's doctor and/or therapist directly for exact instruction before recommending anything. Next, how is the client's functional stability? Are they stable on their feet? Proprioception of the lower limbs can be affected by a knee replacement. The balance board (two feet by one foot) and stepping up and down on aerobic steps are good (line them up and have them walk through). You can elevate the steps as they progress. Moving sideways in both directions is also great for mobility and coordination. How are the contiguous joints doing (hip and ankle)? Are they functional? Usually, the joints above and below the replaced joint regress. In this case, hip and back extension, abdominal flexion and ankle extension (plantar flexion) exercises must also be included in the program. Introduce the leg press after the client can get up and down out of a chair without too much lateral compensation (leaning to the side). Be careful not to go too deep (knee flexion) or too heavy. Increasing the work load by reps and sets is the safest route. In my view, it is better to go slower than faster when dealing with someone with a replaced joint. Most people are somewhat uncertain of their new knee and deal with a lack of trust issue, both for themselves and you. The stationary bike is a great tool for quad development and general fitness and poses little threat to the new joint-bone union and the person. It may not be exciting, but it is effective. If you pepper your routine with five minutes of bike work between exercises, it may help to alleviate boredom. References: Calliet, R. Knee Pain and Disability 2nd Edition Davis Publishing. Philadelphia. Back to top About the author: Steve Rhyan Steve is a member of: National Strength and Conditioning Association American College of Sports Medicine American Society of Exercise Physiologists. <br><br> Steve has been an athlete, coach, teacher and trainer for over 20 years. Steve received his Undergraduate degree in Physical Education/ Biology and Graduate degree in Physiology of Exercise from San Diego State University, San Diego, CA. He has taught from middle school to college and coached high school, college and professional athletes. <br><br> As an athlete, Steve was a professional moto-cross racer for 10 years. He was California State Champion several times, ranked in the top 10 Nationally and in the top 20 Internationally. Steve has also participated in the Decathlon, numerous Triathlons, several Fitness Challenges and won the Police Heptathlon in San Diego, CA. To better understand "Body-Power," Steve studied Kajukenbo(Hawiian Karate) for several years and received a Black Belt. He is pursuing an education in Kodokan Judo to further understand anaerobic conditioning and the application of strength, power and agility. As a coach he specializes in Moto-Cross Racing, Track & Field, Mountain Bike Racing and Surfing. <br><br> Steve is presently a part time lecturer in Exercise Science at Santa Ana College for the Police and Fire Services and is Director of Strength and Conditioning at Specialized Personal Training(SPT) in Mission Viejo, California. At SPT, he specializes in Sports Medicine and Fitness Training for all ages, but especially people over 40 years of age. One of Steve's clients won the female division of the Navy Seal Fitness Challenge, she is 50 years old! Steve has several articles on training for a Fitness Challenge published in the Journal of Strength and Conditioning. When he is not writing, studying, teaching or training you can find him, with his family, on the beach surfing. Aloha. <br><br> "I learn by going where I have to go." 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