Stories of Recovery

Pre Operation
● Prior to surgery- most treatment is around Education as Education is key.
Motion is lotion. Every time you move, the joint will lubricate itself.
● Heavy emphasis on the importance of exercise, in building muscles strength to stabilise the knee joint itself and other physiology benefits of releasing various chemicals in help body to help reduce pain
● Ran through expectations in the hospital to calm her down, create peace of mind, take the stress away.
● Educated patient on the different types of gait that she might be using, set expectation that she will be mobilising on the day of the surgery. What to expect from the physios point of view over at the hospital.
● ERAS protocol - what she should be doing diet, exercise, setting up home. The importance of having pain under control + getting out of bed and moving ASAP in the hospital (assuming medically safe)
● 5 Exercise personalised to go home with- keep it simple, targeting quad x2, hamstring, glute and calf strength

Post Operation
● Management after surgery - caught up at 2wk, 6wk and 8wk mark.
● Unlike conventional methods, I like to take a different approach that less is more.
● So rather than a thick handout with 10 exercises or getting her to sit on a chair for hours a day with the peddle trying to force the knee bend.

● First focus on reducing pain and swelling, once those 2 things are managed, everything else will come.
● In order to reduce pain and swelling, started with inner range exercises, bed based, with gentle range of motion. Pedals to begin with, and once the wound had healed, walking around and marching in the pool.
● Pool is good as it allows normal gait / walking patterns, and bending of the knee without weight going through legs
● Once pain and swelling hard reduced, which in this case, happened very quickly I was able to focus on building the strength up and range of motion.
● For building range of motion I used the guidelines set from the peak protocol, designed by Prof Bennell from University of Melbourne.
● Started off with 3 simple exercises starting off with one targeting the range of motion, which was sitting on the edge of the pool doing gentle kicks. Another exercise for quad and hamstring respectively
● And she then progressed on we then focused on introducing calf strength and glute strength. I never gave her more than 5 exercises at a time as that would be too much.
● Similar to pre op management education is very important so I set the expectations pretty early on in terms of what to expect in recovery and her benchmarks.
● Often patients think that they will be back walking with no problems, or have a full knee range of motion within 8 weeks post surgery which unfortunately is not the case.
● So I ran her through what we call the normative Values based of evidence of what people should be achieving at different time frames. And ran her through what we call the over activities cycle.
○ Which is making sure she doesn’t go into this harmful cycle where she does a lot of activity and exercises one day and it becomes extremely painful the next day and does nothing for 2 days and once feeling better feels the need to catch up and then is doing extra and then the cycle continues.
● Rather than giving her too many exercises, I kept it pretty simple and she was able to recover very well.
● By the 8-12 weeks post operative mark her range of motion was great, her gait patterns were very good, she had strong weight bearing as well and it was a case of progressing the exercises each time I saw her.
● She is now doing very well and back to doing all the activities she wants to and there is no longer nothing limiting her.
● So the take home message, especially from the postoperative side of things is to go by the saying, ‘ Less is more’, listen to the body, focus on pain and swelling first, after that range of motion will come. Don’t try and force that range of motion when the knee is still quite angry and painful as that justphysiologically won’t be beneficial at the same time, also just gives us physios a bad rep with the patient as well as surgeons.
● In terms of weight bearing exercises, I did progress her as I saw fit. Its very important to progress from bed exercises into more functional exercises but this wasn’t really introduced until about 4 weeks. Depending on how your patient is doing you can gauge that yourself