by Shari
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| X-Rays of Knee Replacements (from Wikimedia)
Nina asked me to add to Baxter’s previous post Arthritis of the Knee and Yoga about what the next step might be when your own self-care management techniques are not as effective and your quality of life is severely impacted. So I thought I would you give some background about the elective procedure total knee replacement and why you might elect to have it done. Professionally, I see a lot of total knee replacements in my work as a home health physical therapist, and I also have yoga students who come to my class either after the procedure or beforehand as they are preparing themselves for the surgery. |
Although many people will never need surgery for arthritis of the knee, if you have severe joint damage, extreme pain that isn’t helped by other treatments, or very limited motion as a result of the condition, knee replacement surgery may be necessary. So if the arthritis pain in your knee worsens, and the exercise that once helped you feel better has become unbearable, your doctor may recommend a total knee replacement (TKR). Surgery for osteoarthritis can provide several benefits, including :
- improved movement
- pain relief
- improved joint alignment
When you research the procedure, you will discover there are gender-specific knees, which are knee replacement models designed for women, and dozens of other options, too, including different materials, sizes and models from a variety of manufacturers. How do you choose? Generally, you don’t. Surgeons typically determine which implant they’ll use when they are in the operating room and actually looking at the structure and size of your bones.
Prior to surgery, however, you should have an informed conversation with the doctor about your options so you can ask good questions about why a particular model might be chosen, and determine if you’re comfortable with the doctor’s approach and experience or whether you’d like a second opinion.
When only a portion of your knee has severe arthritic wear and tear symptoms, as confirmed by diagnostic testing as well as subjective complaints, you may be recommended to undergo a “partial or unicompartmental knee replacement.” This may be recommended because it helps to straighten up the joint, which has changed its position as a result of osteoarthritis. Partial knee replacement can be more effective and durable if appropriate and are less invasive. Recovery time is less because there is less surgical trauma.When the entire knee joint is replaced that is called a total knee replacement, and the ends of the femur, top of the tibia and often the patella (knee cap) are fully replaced.
When you are ready to return to your yoga class, you should take time to talk with your teacher about your knee replacement. I will routinely ask these students a series of questions:
- How long ago was the surgery?
- Are you still in pain?
- Are you still in physical therapy?
- Do you have any hip or back pain (either before or after the knee replacement)?
- How much mobility do you currently have? Can you get up and down from the floor?
- Do you have arthritis in any other joints?
So be prepared to provide your teacher with this information. Knee range of motion will vary widely both in a recent post-operative knee as well as a knee replacement that is over one year old. A lot depends on how much motion you lost prior to the surgery and how hard you worked postoperatively. The answer to the question “Can you get up and down from the floor?” is important because it tells the teacher a lot about a student’s flexibility and strength. Knee flexion will vary considerably, but I have never seen a knee replacement with 155 degrees flexion nor have I ever seen someone able to do a deep squat. Whether this just happens to be my student demographic or not, I don’t know.
When resuming yoga practice, alignment is a big deal with knee replacements because post operatively you want to avoid torque forces through the joint because that affects cement in the joint. “Closed chain activities,” where your weight is shifted with your foot remaining on the floor,” where your foot is lifted off of the floor with subsequent weight bearing will affect the joint differently. For standing poses, I teach students with recent knee replacements to pick their feet up and then replace and position as opposed to pivoting to change directions. Down the road, you can introduce pivoting if it doesn’t cause pain or discomfort. Liberal usage of props; walls, chairs, blocks will assist the student in not over-doing too quickly.
Strengthening all of the muscles that cross the knee joint as well as secondary stabilizers is also important. This means front, back and side leg muscles. Attention to hip alignment and strength also translates to protection of the knee replacement. Kneeling is problematic but not necessarily injurious to the new knee. Finally, pay attention to the feet—where is the weight on the foot? A lot of individuals who suffer from arthritic hips and knees have feet that need some tender loving attention. Baxter in his prior posts talked about feet (see Your Feet on My Mind), and I agree that where the body meets the ground and how we stack up from there is crucial in protecting our joints for longevity, especially when we become bionic.
I would like to add that lot depends on your pre-surgical state of health. If you have been active up till the day of the surgery then your recovery time will take about three months till you feel like you have integrated the new knee into your body. This is a rough estimate, but it seems about right for a traditional total knee replacement. Minimally invasive and partial knee replacements have less trauma, so healing and function comes more quickly. For those individuals who have lost a lot of mobility and have developed severe range of motion loss and significant loss of muscle strength, the recovery time will be more arduous because of all the structural as well as cardiac changes.
Finally I want to emphasize this: talk to your surgeon before and after surgery to know what your particular limitations and precautions may be, and remember to share them with your yoga teacher. Remember this is an invasive surgical procedure and everyone heals in a different manner. Be kind to yourself and remember that with a lot of hard work you will regain function and improve the quality of your life. This the reason why you decided to undergo this surgical option in the first place.
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Some people think that yoga is alternate of knee replacement surgery but I don't agree. It is just waste of time.
private knee surgery kent
Since I became aware of my condition of severe osteoarthritis in both knees and knew that I would be facing knee replacement surgery, my yoga practice has become even more important than previously in my self-care program. Although certainly no cure for arthritis, yoga has enabled me to strengthen all my muscle groups, greatly increase my flexibility and above all, my physical self-confidence as I face this inevitable surgery. I expect that yoga practice, although temporarily (?) altered by the expected restrictions post-op, will also be a key factor in my rehabilitation.
Without yoga I am convinced that I would not have been able to enjoy even my present level of mobility. I am 65 years old and began yoga practice just 3 years ago.
It takes a lot of hard word and time to strenghten you muscles. Last year i wasnt able to walk properly cus of the pain in my knees. I quit cycling, strenght excersises and the pain got a lot worste. Good muscles are so important for support and can give a bit of pain relieve. Its hard to find a proper way to train tho,since most exersises for the knee are simply to painfull and most of the time undoable.. So i start from building with cycling. 10mins a day then 15 mins, 20 now i can cycle 1,5h a day without pain (i cycle to work.. but winter can be challenging cus i hate the cold and it gives me more pain! GRR) This took me a couple of months but it was great to feel an improvement. And i lost a bit of weight too with it. I was to heavy which is also very bad for your joints so that kept me motivated. Besides that i do leg excersises and yoga which helps me alot. Not only with my knee but with my whole body. Cus of the pain in my knees i was tenced. breathed incorrectly, my shoulders and neck where always stuck. With yoga i got a lot of my souplesse back and it is a great way to strengten the musles in your leg and other parts. It keeps you aware of your whole body and i need that. Every time they say Relax you shoulder im aware that i tence up, so im happy to get reminded :) . But like i say it takes alot of time and dedication. I do yoga almost 1,5 h every day (started with 20mins).and i also have to cycle 1,5h a day to keep my muscles strong. I know that when i quit the pain returns. Its not that im painfree atm, but it became bearable. I can't jump/run/jog/ and in the eveing the pain gets much worste so im very limited, but i try to make the best of it. I know a replacement would take care of the pain, but im afraid to lose my own joints and that is a personal choise… But still i disagree if you say yoga is useless. Im not spiritual so i try to do the power yoga variant since hatha and some other variants are to slow and to spiritual for my taste. But its great for body control, balance and strengthening. It only takes a lot of time and patience and i can understand that that can be hard. Combination of cycling, yoga and weightloss is worth to try. Even tho you descide to do a surgery its always better to do it on a prober weight and with muscle strenght which wil improve the recovery. My last years had a lot of ups and downs. Months of training and sometimes weeks of sitting in a corner in tears with my bag of chips and a chocolate bar cursing at the pain.. But now my motivation got the upperhand and im glad with it. I got my bad days, but who hasnt. Yoga helps me alot since there are a lot of ways to train. Core, legs, whole body, abbs. When i have a lot of pain in my knees i try to do more lying exersises for my abs for example or more for my shoulders. Sitting on 4 can be hard tho. But with my kneeprotectors it is doable… sometimes. But most of the time i try to pick a creative alternative :) So i think yoga is worth to try!
I'm extremely limber and after my knee replacement I was back in full rotation within a couple weeks I mean I could completely move my knee in every position that I could prior the problem is I've had it lock up 5 times in the last year-and-a-half it's only been 3 years since I had it replaced and i guess I'm not supposed to sick cross legs or do any kind of yoga poses and it's driving me nuts I can't not sit like that that's me it's part of me it's I don't know what to do
Debbie, regarding your knee replacement locking up 5 times in the last 18 months-if that was my knee, I'd make sure to check in with my orthopedic surgeon to make sure my new knee device was OK before doing anything else. And as for what poses are safe or not safe, I'd also check with my ortho doctor about the range of motion that is safe for me to do, as well as my Physical therapist, if I have one, to get even more clear information on what is safe to explore. You can then take that information and work with a Yoga Therapist to see what sitting poses and other poses might work for you down the road. Baxter
There are so many poses that I cannot do anymore since having my total knee replacement because many of the poses I loved to do previously entail being on your hands and knees, like the Cobra and Cat-Cow. My doctor has advised me that I shouldn't kneel. So now I need to find a revised Yoga program that can be done without kneeling so my implant will have a "longer shelf life" and not wear out so soon.
Any suggestions?
I have had a tkr in March this year (5 months ago). I still have pain and swelling in the repaired knee, mainly on the outer side and behind the knee. Is there any yoga exercise recommended to stabalize the knee and make it healthy.
Try Choga (chair yoga) or just create your own home program without kneeling poses. A yoga instructor should be able to help you.
I had a partial knee replacement 9/11. I've started adding standing poses. My down dog is really just a wide forward bend at this point but is helping with the back of the knee.
I was taught to do explore knee posture by stacking folded blankets and placing my weight on my shins with my knee(s) hanging over the front edge of the blankets. It takes a bit of getting used to but works! I especially love the 6 movements of the spine (includes cat/cow) first thing in the morning and now I can do them once again. Hope this helps. C :)
Thank you so much Christine!
TKR four weeks ago. In addition to the physical therapy exercises, I added some 'chair yoga' moves plus stretching for my hamstrings and back. I checked all this with my doc/physical therapist before doing it. A significant 'exercise' is something of an upside-down deep knee bend. On my back, I lift my leg and support my thigh with my hands while allowing my lower leg to flex as much as it will using the weight of the leg. It is important not to try to force this move, but instead, simply let the weight of the lower leg flex the knee as much as the surgical trauma and pain allow. Adding this low-impact stretch has yielded some good results. When I went in for my three-week follow-up, my surgeon was surprised at how quickly I had regained flexibility, and he cancelled further physical therapy (supposed to last another two weeks) and told me to keep doing what I've been doing. As with anything, sticking to it and regularly exercising is important. I am approaching 120 degrees of flex, and am careful not to push it, but gaining a degree every other day at this point. If I manage a deep knee bend, I'll let you know.
Hi your sharing is very helpful. I am on day 7 after my tkr. Obviously swollen still and in pain. Did you or anyone reading find the CPM Machine helpful?
Can you describe your exercise in more detail. I'm not sure what you mean by "lower leg" and "support my thigh". do you raise your thigh off the floor? thanks for the clarification.
My partial knee replacement was April 2007.. I started back to Yoga this past summer-one day a week, but I found child pose with the knees wide uncomfortable, but I did do it for a few weeks this fall. I now have some pain in my knee and I'm hoping that I haven's loosed the cement in the joint. Any help would be appreciated.
To sandy K: I had both knees done this year, eight weeks apart. I found the CPM machine to most helpful!. I was put on it immediately following surgery and was sent home with it for 2 weeks. In addition to using it as advised by my therapist, I used it any time I was in pain. I recovered very quickly and have good flexion. I am 67 years old. I tried all the other avenues of treatment before having the TKR. I'm so glad that I found an excellent surgeon and facility in my hometown. I'm still working on my yoga. Kneeling is uncomfortable, and I can't sit in lotus, but I just do what I can and expect that over time I will continue to improve and gain even more flexibility. Losing some of these things is a small trade off for what I gained. My legs had bowed from the arthritis and they are now straight!
I had a TKR in December 2012. Recovery was complicated because I'm one of the very rare individuals allergic to titanium. My surgeon wouldn't deal with me because I wasn't one of his successes but another, wonderful orthopedic surgeon in Seattle was determined to find the reason for my pain, swelling and "hot" knee. Finally after sending 6 vials of my blood to one of the few places in the world that does the testing, the allergy was confirmed. The good news is that with anti-inflammatories twice a day my body appears to be adjusting to the titanium and I am enjoying yoga as I once did. I need a thick pad under my yoga mat though. My child's pose has my butt in the air because my knee doesn't bend enough to sit on my heels and there are a couple poses that need to be modified (I can't stand on one foot and lift my other foot high enough to hold behind me in my hand) but I'm 90% successful with the poses and love it. I'm so glad I didn't have to give it up. If I can do it, I'm sure you can too! Best of luck. BTW the hardest part of my recovery was depression. I think yoga helped with that too.
Mukilteo WA
had a TKR 8/2014 and after 6 weeks of land and aquatics PT I am at a 120 degree flex. had to revised most of the yoga positions I was used to doing, the child pose is still not possible.
anyone getting a TKR request aquatics as part of your PT, a big help. in 4 weeks I was able to do 40 slow and low squats, where in the land exercises 3 and I was pushing it with my back and other knee feeling discomfort. I will continue aquatics long after my PT is over. doing some simple yoga stretching positions in the pool. I am a born again swimmer at the age of 65.
Keep up the hard work. I had TKR 6 months ago, July 2014. After 6 months of continuous and different types of exercise, my yoga is coming along quite nicely. I can bend the new knee enough to get my foot just above the knee of my other leg in tree pose. I can get on all 4's for cat/cow (it feels very weird but the Doctor says it will not injure the knee, It is starting to feel a bit less weird). I can put my weight on the new knee as I lift the other leg and alternate arm for a good balancing pose. I find that doing the pigeon is comfortable. Childs pose leaves my butt in the air but I notice it is getting lower and lower. I haven't taken pain meds or anti-inflammatory drugs in a few months…although I leaned heavily on the Vicodin for the 8 weeks of therapy. I had asked for a PT who knew I went into this in shape and knew what I was capable of, she pushed me…I liked it. I ice often, probably should ice more often; it's tough in the winter! I can walk as fast as I did before surgery, I can do a three mile walk with ease. Going down steps is my last hurdle, I do it like it doesn't hurt…but it does, so I go slowly. Overall, my experience has been wonderful, the hard work pays off nicely.
This last comment was helpful to me! 3 months after TKR, just returned to yoga & feel surgery knee hurts again, was worried I'd overdone although tried to be careful..
Thanks, really appreciated your story, having TKP in May and wondering about returning to yoga.
I had both knees total replacement fur ti osteoarthritis . Surgery was 2yrs. A go I've been thru therapy twice I have kyloid scar tissue,my knees are still swollen,,have never gone down. My range of motion sucks. I can get up and down off the floor, but have difficulties getting in and out of the car. I walk fine, but I was wondering if yoga would be beneficial to me. I need something that will strengthen my knees as well as my body and mental health. Im 53 Yes. Old and I'm wanting to persue yoga.if possible. What do you think?
Yes, I think yoga would be very beneficial for you! Just be sure to find a teacher who has experience working with people with your condition (ask the teacher before taking the class) and make sure that every teacher of every class you take knows about your condition.
In addition to strengthening quadricep and leg muscles, regardless of if a person with arthritic knees has a knee replacement or not, it is also imperative to focus on the core muscles, pelvis, psoas and other muscles in the torso area that are fundamental to leg strength and stabilization. I have been told to have a knee replacement (due to pain) for the last 15 years (I'm at 60), as my knees are basically bone on bone and I'm missing ACL in right knee. But through hard work, pilates, PT and yoga – with also an emphasis on the core muscles, I get along well and have tabled getting a knee replacement for now. Three years ago my right knee was nearly always swollen and could only bend 105' and now it can bend 132' and only swollen after significant exertion. Physical therapists and Orthopedic surgeons should emphasize not only strengthening the quads and leg muscles but the entire core, pelvic area, psoas and gluteal muscles. I do not downhill ski anymore or run (I used to be marathon runner) but I can do many other things to that I enjoy – thanks to a Physical therapists / Pilates instructor who got me to work on more than just leg muscles. Thanks for this forum.
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Do they make an appratis that I can wear that will support the knee while doing yoga on it?
Can you tell me if you have had a knee replacement or have knee pain but have not had it replaced? Baxter