The physiotherapist had an integral part in the process that lead to my knee replacement and in the recovery process. So I feel it is important to detail his part in the whole scenario that was my knee replacement.
Before the operation:
In July 2007, mild pain and soreness began to occur often on the inside of my right knee. An x-ray found that the deterioration found years earlier had increased particularly on the inside front section of my knee near my knee cap. My GP advised me to go to my physiotherapist to get exercises to strengthen the knee. The physiotherapist gave me a series of exercises to strengthen the muscles on the inside of the knee to protect the damaged part of my knee. These exercises were to be done on both knees. I did these exercises usually on the bed each evening. At first, I found them difficult mainly because I lacked the strength in the muscles I was aiming to improve. I soon found them easy and comfortable to do taking less than 15 minutes to complete the routine.
The problem with my knee became serious in September 2012. I developed significant swelling of the knee and upper calf. There was often an ache around the knee and down the leg. The swelling would reduce after significant rest but would flare again after sustained exercise with an accompanying ache around the knee and calf. A new x-ray was ordered. It showed very significant deterioration to the knee that indicated I should see a specialist about a knee replacement and return to my physiotherapist for exercises to strengthen my knee still further.
The physiotherapist gave me a series of exercises to strengthen the knee muscles further and advised that I should ride a bike 20 to 30 minutes a day on an easy course as this would increase the strength of the muscles around my knees rapidly, causing little or no further damage to my knee. I saw him again a week later. He noticed quite a significant improvement in my muscle strength around my knee in just that week.
The hospital, which I went to, has prepared a booklet on the whole process surrounding the operation including a list of the exercises to do while in hospital. It included diagrams and a detailed explanation of how to do each exercise.
The operation entailed cutting an incision, pushing back the muscles, cutting the bones above and below the knee, inserting and gluing the artificial knee to the bones, returning the muscles to their rightful place and stitching up the wound. It was a major operation.
The most important reasons given to me for the exercises was to prevent a blood clot from forming. To me, that was a motivation to get going on the exercises/physiotherapy ASAP.
Other reasons for the exercises were to:
• Control the swelling;
• Fully straighten the knee;
• Bend the knee to at least 90degrees before you went home;
• Gain greater control of the muscles around the knee;
• Teach you
o How to get in and out of bed and a chair;
o How to use a walking aid and crutches;
o How to walk up and down stairs.
As well, the physiotherapist would organised any equipment you might need at home e. g. special chair, toilet seat, crutches and so on. He/she also talked about the exercise program at home.
I returned to my personal Physiotherapist after returning home. Here I want to discuss the post-hospital work he did with me.
The exercises I used in hospital were replaced by a new set by the physiotherapist. These were to
• Increase flexibility;
• Correct my walking action;
• Increase my knee bend up to 130 degrees, if possible;
• Straighten out my knee;
• Soften the skin around the scar and my calf by massaging in cream to aid this;
• Help reduce the swelling; and
• Improve my balance.
The exercises changed as my recovery continued. Each consultation started with the physiotherapist watching me walk up and down an aisle to check on improvement. He emphasised the “heel and toe” action that was necessary.
The exercises he gave me were to be done daily. I did them in short bursts which meant I never gave myself a chance to get bored or to overdo it and cause pain to my knee.
At six weeks, he advised me to start riding a stationary bike. I was to ride it in two ways, first with knee bent and secondly sitting high enough to stretch my leg out fully. I aimed at 300 revolutions of the pedals each time with a minimum workload. In the weeks that followed this was a daily chore.
At eight weeks, he encouraged me to begin using the road bike. I found I needed to sit high on the bike to prevent any pain in the knee. I kept to a thirty minute limit on the road bike travelling on mostly flat courses.
As I began to walk further and further at a time I noticed my knee cap began to click often. So the physiotherapist began manipulating the area around the kneecap to loosen up the muscles around the kneecap.
In the period directly after the operation, I visited the physiotherapist weekly for the first couple of months. Then the visits became fortnightly and now, at 6 months we are back to a monthly visit for the last two visits. My physiotherapy is now at an end although my exercise regime will continue.
The physiotherapy I had before and after the operation made a significant contribution to the ease and speed of my recovery.