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Hi Leslie,Well what you will actually find once you have your knee replacements is that they will be putting you on a bike within days of the replacement surgeries.I have seen and worked with tons of joint replacement patients and the very first thing is actually putting you on the bike to passively range the knee and see where you are at. Basically it allows you to very carefully activate the muscles of the thigh to work you(over time) into a usable range of motion. So my first recommendations are going to be the standing bike and the elliptical and then followed by the recumbent(seated bike). The seated bike requires a little 'flexibility' per se to use, its slightly more uncomfortable for some people.So with the bikes they will require a different "type" of cardio compared to running and compared to non impact elliptical. Bikes use the quadriceps muscles in such a way that it requires and trains a level of muscular endurance as the primary movers. Whereas with running and elliptical, its the BACK of the thigh doing the moving and the quad muscles(front thigh) actually almost act to stabilize the knee during the weight transfer.So following your surgery, you will be taught by your therapists to fire your quads again, they will be forcing your knee not only into a bending range of motion but ALSO and very importantly into whats called a terminal extension(aka lockout). So to me its important to almost, pre-train that motion and muscular activation so that post surgery its already familiar and the muscles already are more ready to "help you" with the therapy.So I would recommend the standing bike as well as the elliptical both which are non impact, the latter being weight bearing exercise that closely simulates running(which I'm sure you are anxious to get back to) but are awesome ways to build your cardio back safely while being kind to your joints.Regards,Mike
That is great info, BUT I meant what can I do BEFORE surgery to get back some cardio and strengthen the muscles, ligaments and tendons around the knees, and without strain on L1-L2? I have chronic renal failure so now only weigh 145-150 pounds, which is my goal weight at 5'7". It is mostly flab. I want to spend a month "getting into shape" before the surgery for the best results. I have tried on my own but end up in bed because of the bad disk at the top of my fusion, L2-S1. My orthopedic surgeon recommends pre-op: leg press, thigh abduction, thigh adduction, leg extension to 45 degrees of knee flexion and calf curls. In this age of super specialization the orthopod is only concerned with the knees and not the back. I need a different orthopedic surgeon for the back!
To sum it up, I am mainly interested in what to do cardio-wise pre-op. I am a retired doctor, a D.O., if you know what that is- a combination of M.D. and chiropractor, so be as technical as you want.
So I have some more considerations if you are up for it Leslie.Balance and stability, in ANY population is a "use it or lose it" type of skill. ALSO remember that muscle activation is often hindered and shut down in periods of injury where there is lots of swelling or pain limited factors. We know that a 10 horsepower body, when subjected to a 12 horsepower load, will eventually become a 12 horsepower body - the beauty of human performance. So with this, its pretty safe to say most people walk on flat surfaces, with supportive shoes, using 2 feet and generally live in a stable(as far as footing is concerned) world.For you because of your age and the fact you are having your TKRs its important to train balance NOW so that everything is easier as life continues for your and more importantly so that when you are post surgical, proprioceptive awareness is there and so that it is easier for you with your therapy once you start your functional transition(the best part :) ). I personally have such limited time to train my own self that I have resigned to doing all my daily tasks on single foot, showering with eyes closed single leg all the stuff that I would do in a clinic or a gym, just modded for the house. With this I would start working on balance, even the simple things like standing at the sink washing your hands on 1 foot, or doing dishes with 1 foot. Simple things where you stand with 2 feet, just lightly lift 1 off the ground.REMEMBER balance is also affected by your vision; we use visual cue as a way to stabilize ourselves, so anytime your eyes are closed, balance is tremendously affected until is trained and upregulated.What you will find is that your clinicians, once you get good at functional basics will be putting you into situations for you to train stability - soft foam pads to stand on, playing catch with 1 leg, using shoeless standing - eventually progressing you into a situation of being able to deal with many things instable. ***And if they don't...THEY SHOULD.*** Balance and stability training is a huge part for older populations and HUGE for anyone with an injury of any age. Making sure your body knows where it is in space and being able to react is imperative to relative performance.The other thing I would do, is figure out who your therapist is going to be and make sure you have a GOOD gut feeling about him/her. Ask the clinician questions about how they progress patients with TKRs and make sure you are confident -ALL THERAPISTS ARE NOT CREATED EQUAL. Also, I would get a list of the exercises they will be progressing you with once you are post surgical, you can get a head start on that coordination and conditioning.And for whatever it's worth to you Leslie, I worked with a 65 yr old avid runner who had a DOUBLE TKR and we actually had to slow him down during his rehab. He progressed so well because he wanted it so bad. Needless to say hes back to running and strong as an OX.