This is a continuation of a blog posted Nov. 19, 2014 called The Pleasures and Pains of Knee Replacement Surgery and Rehab.
What is Cartilage: How OA Happens?
Thus, activity and movement are essentially good – no, they are essential – for healthy cartilage.
It’s just a matter of time before it’s so worn out that the space between the two bones is thinner, and bones start rubbing on each other creating osteophytes, or what most of us know as ‘spurs’.
At some point, if you live long enough and prefer to have a quality of life beyond sitting in a chair, joint replacement, or arthroplasty, becomes an option.
Who Gets OA and Arthroplasty?
- In fact, it is estimated that over 300,000 kids have arthritis.
- Arthritis affects people of all races: “more than 36 million are Caucasians, more than 4.6 million are African-Americans and 2.9 million are Hispanic.”
- About 27 million of the 50 million with arthritis have OA.
- “People with arthritis account for 44 million outpatient visits and 992,100 hospitalizations.
- It is estimated 67 million Americans will have arthritis by 2030.
- According to a study in Canada, 10-15% of arthritis patients have OA due to prior injury which generally affects younger, more active people.
Quick Review of Physical Therapy Goals
It is the purpose of the rest of this essay to discuss, not the surgical procedures or post-surgical therapies for those getting joint replacements, but the kinds of exercises one can do for oneself in addition to the basic therapies. In other words, discuss the post-rehab exercises that will enhance both recovery from surgery as well as quality of life afterward.
First and foremost, in addition to the ever-present prevention of infection which could severely hamper recovery and even lead to catastrophic consequences such as revision (corrective surgery) or death, doctors and therapists strive to get range of motion (ROM) restored.
- First, the reduced ROM sufferers have developed as their disease progressed and movements were hampered.
- Second, after surgery, there is a tendency for muscles to contract to protect the joint as they don’t want to allow excessive movement at the joint.
- Finally, there is inflammation and the swelling around the joint causes tightness of the surrounding tissues, from the inner joint capsule to the skin, further hampering full motion.
- quadriceps (quads = front thigh muscles)
- hamstrings (hams = back thigh muscles)
- glutes = buttocks muscles
- gluteus medius
- glute med = the muscle on the side of the hip that pulls the thigh away from the other thigh sideways
These valiant efforts by the therapists come during the most fearful time for the patient, and when the patient is very likely to believe if not truly experience both pain and drug-related lethargy. But they are essential to rapid and full recovery.
- As for hips/glutes, unless there is concomitant hip OA, normal range is intact in those with knee OA; however, normal function is not, but this takes us into the strengthening realm, below.
- Early in therapy, though, glute exercises such as ‘tightening your butt’, ‘squeezing your cheeks together’ or ‘pushing your heel into the bed’ are encouraged.
You can see that these early, post-surgical exercises are ones that can be done in the hospital or residential bed and should be done frequently throughout the day to ensure rapid recovery even as it could be weeks or even months before full recovery is noted.
PT can go on as long as:
- Your insurance covers it
- You are willing and able to afford it on your own
- You are released due to successful restoration of basic function.