TKR: Knee Pain Recovery

Painful knees are a very common occurrence among the elderly and fear about knee pain recovery makes it even worse. So was the case with Mr Narayanaswamy. He continued to live with painful knees which eventually hampered his everyday activity. There was chronic knee pain and despite medication his walking and general movement continued to decline. He consoled himself that the reduced activity and stamina were owing to his increasing age.
After a period of about two years, by when he was bed-ridden and almost totally inactive – he underwent total knee replacement as advised by his doctor.
After an initial rehab of knee replacement, an average person usually reports significant improvement in walking and other movements. Unfortunately Mr Narayanaswamy was not showing any signs of recovery. Instead he consistently suffered from fever and weight loss. Eventually a TB infection was diagnosed that had affected the TKR implant too. So a revision surgery had to be performed on him shortly, thereafter.

Tips for an Injury-free Run

For runners taking on a run for the first time, the key is to have a solid training base and a detailed plan that allows for a gradual increase in SPEED as well as DISTANCE. Here are Five tips for an injury-free run:

5 Tips to Prepare for an Injury-free Run

  1. Strength train two or 3 times a week, functionally. Running is great. Nevertheless, it can create muscle imbalances or increase ones that you already have. Your core, calves, quads, hams, hip muscles and arms need to work equally well for efficient running. When you strengthen all the links in the chain and maintain good flexibility from top to bottom, you will run stronger and stay injury-free.
  2. Wear the right kind of shoe for your running. See that they are not worn out and make sure that you replace them after every 500 miles of running. Have one pair of shoes for longer runs and another pair of shoes for shorter runs and fast speed workouts. IF possible, get a gait analysis
  3. Have proper warm ups and cool downs. Pre- and post-run stretching is very important in preventing injury. Dynamic stretches before a run and static stretches after a run work best.
  4. Keep yourself well hydrated in order to prevent depletion of electrolytes, and eventually muscle cramps.
  5. Correct your running biomechanics and run at the right skill level. Your trainer or physical therapist will best be able to help you with that. The basic aim is to avoid over striding and allow your feet to act as shock absorbers while running.

After these quick tips, let us look at the five most common mistakes new marathon runners can avoid and ensure a smooth injury free running stint.

A. Too Much. Too Soon. Too Fast

The most common issue that we see is the Terrible Too’s. You suddenly get up and start to train without a plan and end up doing “Too much. Too soon, Too fast”
And that is the most common cause of Injury!
Chalk out a plan of training! Even better, if you do it along with a trained expert. The training plan should strike a balance between speed and strength. It would help you build up stamina, strength and endurance gradually, without causing any injury.

B. Prevention is better than Cure

Always remember to warm up, before you start running. Many injuries can be avoided by:
warming up  and stretching regularly
Spending 10 minutes to warm up before each run will definitely cost you much lesser time than if you injure yourself and wait back to recover.
However if you do injure, it’s best to see a physiotherapy expert immediately to chalk out a quick recovery plan.

C. Mix Things Up

It is very easy to get into a habit of running the same route, at the same pace during your training. That begins to limit your muscles and their strength.
“Mix things up!”
Challenge your body with harder runs on certain days and recover at a slower pace another day. This will work-out many more muscles in a much more variety and keep them prepared against injuries.

D. Keep Moving

Any good training plan needs no more than four days of running or walking every week. That’s not too much to do!
It is important that you don’t overdo it! And equally important, that you keep doing it sincerely! You can make the switch from run & Walk to only run if you
find it too easy. The day you feel, you’re not ready, continue to do walking! But ensure that you ‘Keep Moving’.

E. Look after your Body

While you train for your run, your body and muscles undergo a lot of wear and tear. Listen to your body! If you are tired, it’s a sign that the body needs rest! Overtraining immediately shows in form of decreased performance and injuries!
Look after your body. Swimming, Sauna or steam room can really help relax and stretch on a bit.

With these 5 things you can easily train for your run without worrying to injure yourself. Enjoy every step that you take to prepare yourself. Remember – “It only makes you stronger and better than what you were before!”


Plantar Fasciitis: Heel Pain


Plantar Fasciitis may be the reason for your foot problems. If you are experiencing heel pain which is usually most severe when taking the first few steps of the day or after long hours of standing, then chances are that it is Plantar Fasciitis. Physiotherapy is an excellent way to cure this condition and reduce the heel pain.
Plantar Fasciitis is mainly caused due to the inflammation of the plantar fascia, a dense fibrous connective tissue connecting the heel to the toes.
Plantar fasciitis is the most common cause of heel pain presenting in the outpatient setting1. The exact incidence and prevalence of plantar fasciitis by age are unknown, but estimates do show that approximately one million patient visits per year are due to plantar fasciitis

Did you know that Runners are more likely to have Plantar Fasciitis?

You’ve probably heard about the connection between running and Plantar Fasciitis. Well, here’s why! The impact your feet absorb when you run can be as much as four times your bodyweight!

Studies indicate that Plantar Fasciitis accounts for about 10% of runner-related injuries and 11% to 15% of all foot symptoms requiring professional medical care2.

Can Plantar fasciitis go away on its own?

Usually Plantar Fasciitis gets resolved on its own in around 6-8 months, in 80% of cases with simple stretching / exercises but if the pain is persistent and not reducing even a bit, then you need to consult a doctor for treating the same with medical management.3

What are some of the Plantar Fasciitis remedies at home?

Plantar Fasciitis can be managed at home with simple methods as mentioned below:

  • Rest
  • Apply ice
  • Wear supportive shoes
  • Replace old athletic shoes
  • Stretch
  • Massage
  • Lose weight

But if above methods do not work, please consult a doctor or a physiotherapist for the same.

What is the best treatment for Plantar Fasciitis?

Medical management of Plantar Fasciitis usually includes a variety of measures. It is best managed non-invasively by physiotherapy in 90% of the cases. However, surgical intervention may also be considered, generally as the last option.

Your treatment options include the following:

  • NSAIDs (ebuprofen)
  • Physiotherapy management
    1. Ultrasound (reduces inflamation)
    2. TENS (reduces pain)
    3. Stretching (sole of foot, calf, Achilles tendon, plantar fascia)
    4. Contrast bath (reduces inflammation and relaxes sole of foot)
    5. Strengthening of foot muscles (to avoid re-occurrence)
  • Corticosteroid injection
  • Surgical intervention

How does Physiotherapy help treat Plantar Fasciitis?

Physiotherapy in the acute/early phase of Plantar Fasciitis focuses on pain relief methods along with the various passive and active stretching techniques to relieve the stress posed on the fascia along with reduction in the inflammation present.
plantar fasciitis treatment

Can Plantar fasciitis go away on its own?

  1. Therapeutic ultrasound is used over the posterior surface of the heel to reduce the pain as well as the inflammation.
  2. Contrast bath, i.e. keeping the foot dipped in hot water for 10 minutes followed by cold water immediately forms a very important part of the home program which helps in reduction of pain.
  3. Other methods like using taping may be used for correcting the alignment of the bones of the foot which would be contributing to the pain and inflammation because of increased load on the fascia.
  4. Along with this, stretching of the plantar fascia, calf muscles and tendon Achilles (fibrous band connecting the calf muscles to the heel bone) is taught to the patient and performed by the patient.
  5. As a part of chronic management of this condition, other therapeutic techniques like deep friction massage and inotophoresis could also be used, along with the basic stretching and pain reliving techniques.

Curing plantar fasciitis also involves few lifestyle modifications that not only help cure but also prevent the re-occurrence of this condition.

  • Basic changes like using a firm and comfortable footwear and avoiding wearing heels for women are very essential.
  • Footwear modifications like inserting an insole or using cushioned heel insets helps provide support as well as makes the surface more stable and comfortable.
  • Long hours of standing must be avoided and frequent short breaks must be taken to relieve the foot of the constant pressure.
  • Reduction in body weight in case of over-weight and obese individuals also helps decrease the load on the foot/heel.

Plantar Fasciitis Heel Pain

Is walking good for Plantar Fasciitis?

Heel pain is a common foot condition. One may experience intense pain while you place weight on your heel. The pain usually builds up gradually and gets worse over time. Walking usually improves the pain, but it often gets bad again after walking or standing for a long time.

Is standing ok for Plantar Fasciitis?

Standing for long periods of time can put you on the fast-track to developing Plantar Fasciitis.

Sometimes all it takes is standing still to develop heel pain. While standing in one place causes strain to be placed on a few muscles over a long period of time, rather than spread over numerous muscle, standing in place is much more conducive to the development of plantar fasciitis.

What are the causes of Plantar Fasciitis?

  • Increased load on the fascia is the major cause of developing pain and inflammation, leading to stiffness.
  • You are at a greater risk of developing plantar fasciitis if you are overweight or obese.
  • Sudden weight gain may also lead to development of plantar fasciitis.
  • Pregnant women often experience bouts of plantar fasciitis, especially during late pregnancy. 
  • If you are a long distance runner or athlete, or have an active job that involves being on the foot often may also pose increased risk of developing this condition.
  • Having foot problems like very high arches, flat feet and tight Achilles tendons also contribute to the factors causing pain and stiffness. =

What are the symptoms of Plantar Fasciitis?

Heel pain is the primary symptom of plantar fasciitis. People often report their pain and stiffness are most intense during their first steps after getting out of bed or after prolonged periods of sitting; which may be exacerbated with following:

  • prolonged standing
  • stair climbing
  • toe raises


Plantar Fasciitis is a condition where there is inflammation of the fibrous connective tissue present in the soul of our foot. The fascia extends through the longitudinal arch of the foot and connects the heel to the front of the foot. This is an important static structure supporting the foot, taking up all the strain posed on the foot and hence helps us walk. As the load increases the fascia elongates to act as a shock absorber and support our body. Inflammation may start setting in due to the repetitive micro trauma to the tissue and the stresses placed on it, this leads to:

  • Heel pain,
  • Decreased mobility and
  • Stiffness

Benefits of Physiotherapy in heel pain

Physiotherapy helps in dealing with the symptoms of plantar fasciitis like reducing pain, stiffness and inflammation. It helps make life more comfortable, less dependent and also prevents the consequences if treatment is taken well in time.


Disc Prolapse [PIVD]

Slip disc is such a commonly heard term among the back pain sufferers. Already about 70% of Indian Population is reported to have suffered from back pain atleast once during their lifetime. Slip disc or disc protrusion or PIVD makes the largest chunk among the possible cause for this LBP.
As we age the discs that are present in our vertebral column, become less flexible and begin to harden, making them more prone to tears. A herniated disc can be caused by a single excessive strain or injury. However, as degeneration of the discs progresses with age, some people may suffer herniated discs from more minor exertions or twists.

Slip Disc

First line of treatment, if you have recently had a slip disc

Low back pain relief position

Immediately after having an episode of PIVD, care should be taken to:

  • Stop the offending /painful movements and activities
  • Lying on your back with feet on a chair & knees at 90 degree angle can sometime be quite comfortable for the back.
  • Apply a cold pack atleast 4-5 times a day for 10 minutes at time
  • See a health care provider (Physiotherapist/orthopedic) to assess the causes and undertand your pain clinically

What are the treatment options for Prolapsed disc?

Treatment of a PIVD depends on the level of severity and discomfort you are facing and how far the disc has slipped out of its place. Usually the line of treatment includes:

  1. Local pain relief: Muscle relaxants or analgesics or non-steroidal anti inflammatory drugs under the ortho’s prescription can be useful.
  2. Physiotherapy – Once the initial inflammation has settled, an appropriate physiotherapy program can relieve the pain. A Physiotherapist will also prescribe an exercise program that strengthens the core and other involved structures.
  3. Surgery – Severe nerve entrapments may require minor surgeries like microdiscectomy.

Tips to manage Prolapsed disc at home

Inspite of the line of treatment you choose for slipped disc, you still need to consider the following tips to manage PIVD better:

  • Sit for only short period of time

    – Your back wants movement and sitting in a chair for an extended period of time puts your back into a loaded flexed position, which your spine will not like. Try to change positions every 30-40 minutes by standing up, going for a little walk, or grabbing a glass of water. While you are sitting for short periods, you want to make sure you sit with good posture and proper lumbar (lower back) support.

  • Apply heat to the affected area

    By using heat you are helping to decrease muscle spasm and improve blood flow through the body. Try using a hot water bottle for 10 minutes or as often as required. Just be sure to place something between your skin and the heat pack to prevent any skin burns.

In case there is swelling or localized warmth, use ice pack for 10 minutes. Read more about using heat and ice .

RICE protocol for Ankle Sprain

  • Find a comfortable sleeping position

    It is important to sleep with proper support so if you like to sleep on your side, place a pillow between your legs to take off any extra pressure through your hips and lower back. If you prefer sleeping on your back, place a pillow or rolled up towel underneath your knees so they are propped up allowing your lumbar spine to relax in a neutral position. These small modifications can help ease any pressure on your spine

  • Healthy exercise lifestyle

     Most importantly, continue your exercise program as a part of maintenance and do regular follow ups with your physiotherapist.

How does Physiotherapy help in treating Prolapsed disc?

Physiotherapy provides a successful treatment for spinal disc prolapse rehabilitation. Typically the treatment includes back pain relief and protection, exercise program for lower abdomen and core stability, restoration of function and preventing a recurrence.

ReLiva Physiotherapy provides Disc prolapse rehabilitation for managing such symptoms at its clinics in Mumbai, Pune, Bangalore, Chennai and Hyderabad. The treatment phases are described hereunder:

A. Back Pain Relief & Protection:

Our physiotherapists will use an array of treatment tools to reduce your back pain and inflammation. These include: ice, electrotherapy, and unloading taping techniques. Apart from these certain techniques or exercises that unload the inflamed structures are also utilized to provide pain relief and reduce inflammation.

B. Prolapsed Disc Exercises:

Slip Disc pain cycle

  • As your pain and inflammation settles, our physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
  • Our physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilize your spine.
  • Our physiotherapist may recommend a stretching program to address your tight or shortened muscles.

C. Restoring Full Function:

Depending on your chosen work, sport or activities of daily living, our physiotherapist will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some it is simply to walk around the block. Others may wish to run a marathon.

Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.

D. Preventing a Recurrence:

Back pain does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week.

What is Prolapsed disc or PIVD?

To understand Prolapsed Intervertebral Disc (PIVD), also known as herniated disc or disc protrusion or disc prolapsed; it is important to understand the central structure of our disc.

A prolapsed /herniated disc means displacement of the content of the disc beyond its boundaries into the intervertebral space. Your disc is made up of 2 layers- thick outer layer called Annulus Fibrosus and the soft gel-like center called Nucleus Pulposus.

You can relate this stricture to a cream biscuit. The biscuits as the tough outer layer annulus and the cream as the central gel like structure nucleus.

These discs act as cushions or shock absorbers between the vertebras.

Intervertebral Discstages of disc herniation

PIVD is actually an age related problem. But trauma, strains, torsion or heavy lifting can cause disc prolapse/herniatons. It can occur in any disc of the spine but lumbar (lower back) and cervical (neck) disc prolapses are common forms.

What are the causes of Disc Prolapse?

Pain caused due to disc prolapse/ herniation may seem to occur suddenly but it is usually a result of a gradual process accumulating due to many of the following causes:

  • Ageing
  • Being overweight (creating more pressure on the spinal column)
  • Smoking (which can contribute to the degeneration of discs)
  • Incorrect lifting of heavy weights.
  • Repetitive strenuous activity.

Less common causes would be traumatic injuries like a fall or an accident that puts pressure on the disc and causes its displacement.

What are the signs and symptoms of prolapsed disc?

Slip Disc symptoms

The most common symptom of a herniated disc are:

  • Pain &/or numbness
  • Pain that extends to the arms from your neck OR pain that extends to the legs from the lower back (sciatica pain)
  • Pain worsening at night while asleep or with certain activities that defines the pressure on your discs
  • Pain worsening on standing/sitting
  • Pain on walking specific distances
  • Muscle weakness in higher degree of disc involvement
  • Tingling, aching or burning sensation in the affected area

The type of pain or symptoms may vary from person to person depending on the severity of disc involvement.

If problems with bowel or bladder function are experienced this may be a sign of cauda equine syndrome – a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.

How much time does it take to recover from prolapsed disc?

Your discs do not have a blood supply (blood is what brings the healing to any damaged structure). This means that your disc doesn’t have any repairing powers of its own and if injured, your spinal disc cannot repair itself.

After a disc injury, your disc would undergo the following 3 stages:

  • Significant dysfunction due to pain
  • Long phase of instability which makes you more prone to back pain episodes
  • Body tries to re-stabilise the segment and you may have lesser episodes of pain.

Either ways, a physiotherapist at ReLiva will plan your treatment based on your assessment and your recovery stage. The time frame of recovery varies based on the severity of structural involvement. But in general your recovery stages would be as follows :

1. Acute inflammatory stage

– in this stage, your pain has just started but is very severe in nature and constantly present. No movement or position helps you relieve the symptom.

2. Acute stage without inflammation

– here the symptoms are intermittent in nature and usually related to offending activities or movements.

For eg: if you cannot stand longer that 15 min/sit longer than 30 min/walk for more than a mile. Attempting these activities beyond your mechanical limits will aggravate your pain symptoms.

3. Subacute stage

– usually at this stage, certain movement & postures still provoke the pain.

4. Chronic stage

– when this stage is reached, emphasis is placed on returning the highest level of activity that require you to perform repeated movement or we can say repeated loading. For eg: lifting something or playing a sport etc.

What are the complications of a Prolapsed disc?

An untreated slipped disc can manifest in various ways:

  • An untreated, severe slipped disc can lead to permanent nerve damage.
  • In very rare cases, a slipped disc can cut off nerve impulses to the end of the spinal column called as cauda equina in your lower back and legs. If this occurs, you may lose bowel or bladder control.
  • Another long-term complication is known as saddle anesthesia. In this case, the slipped disc compresses nerves and causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum.

While the symptoms of a slipped disc may improve, they also can worsen. If you cannot perform the activities you once could, it’s time to see your doctor.


Running Injury: Treatment and Self Care

An understanding of Running Injury treatment becomes very important if you pursue running for fitness or as a competitive sport. Running is a great form of exercise, recreation, and sport for adults as well as children. Naturally, it has gained popularity and has become one of the most preferred fitness activities among urban Indian population.
If you are running then it is important for you to recognize early warning signs of an injury, know to prevent it and also learn to differentiate a serious injury from a minor one. Sports physiotherapists from ReLiva Physiotherapy cover in this article, what care should be taken to treat the running injuries to ensure complete and earliest possible recovery.
What to do if you are injured while running?

In case you did injure yourself while running, follow these steps:

  • If you are injured, you try to fix it as soon as you can. Follow the RICE protocol in order to do so. Ice the affected area for 15-20 minutes several times per day.
  • Elevate injured part while icing
  • Rest, at least initially
  • Analyze training / running program for possible causes. Question yourself for the following:

o What did I do differently in training?

o Did I just had a big jump in speed of running?

o Was there a significant increase in pace?

o Are my shoes worn out? Or is there a change in shoe model?

o Was there a change from all treadmill or soft surface to road running?

  • Cross-train on non-impact cardio – Follow similar timing that you were earlier doing for running/walking. You could use an elliptical or take up swimming or cycling.
  • Determine a plan to return to full program, return to running very slowly. It is best to consult a physiotherapist to plan your gradual return into the running routine.
  • Consult a physiotherapist and/or orthopedic if the pain persists.

How do you treat a running injury?

If you have had a running injury, it should be treated as per the following plan of care:

  1. Week 1:

Week 1 should always be the period of most care resting and understanding what caused the injury in the first place.

  1. Week2:

After doing all of these for a week, if your pain subsides, do the following:

  • Reduce your training distance or time by half. (refer above for specifics on re-training)
  • Avoid running on successive days as long as you can run pain free.
  • Stretch and wear supportive shoes.
  • Ice the injured area for 15 to 20 minutes, two to three times per day, or just right after running if you feel any pain after a run.
  1. If none of these works, you will have to meet with a doctor or a physiotherapist for the same.

What is the best treatment for a running injury?

  1. Prevention is better than cure. However, despite the best of your effort, you did manage to get injured, it is most crucial to follow rest and Ice immediately after injury.
  2. Then the next most important step is to gradually retrain the injured part to ease back into running while maintaining the strength and ability of other body muscles while the injury recovers.
  3. Physiotherapy is a combination of rehabilitative activities and exercises designed to reduce pain and recover from injury. This makes it the best treatment for recovering from a running injury.
  4.  Even if your doctor has given you the green light to continue running, but you’ve had other injuries before or keep getting the same injury, then too you should consider making an appointment with a physiotherapist. Even a few sessions might help you. Physiotherapists can show you some exercises that will strengthen weak parts.


How does Physiotherapy help in treatment of running injuries?

Since many runners suffer from running injuries, taking measures to limit the associated risks is an important element of a runner’s routine for pain free activity. Your physiotherapist is an excellent source of guidance and information on avoiding running injuries and enhancing your performance on the road and tracks.

When you visit the physiotherapist, he/she will first try to determine what caused the injury in the first place including the following:

  • Your running biomechanics
  • Your footwear
  • Your training load
  • Your joint range, muscle length and overall flexibility
  • Your muscle strength and muscle control

Once your physio has identified the factors that have led to your running injury, he/she will look to work with you to get you back into running as soon as possible. A physiotherapist who specializes in running injuries is the best person to advise you.

Should I run through pain?

You might be able to push through the pain, but it might get worse and possibly keep you out for a longer period of time.

If you continue to run while injured, you might be causing injuries elsewhere. You might even be altering your gait subtly and who knows if that will cause another injury later.

Think hard – What is more important? What is the bigger goal? Stop running at the onset of injury so you don’t have to take a much longer period off.

Will running with Plantar Fasciitis make it worse?

If you are a long distance runner or athlete, you may be at an increased risk of developing pain in the heel due to plantar fasciitis. It is very important to catch and treat plantar fasciitis quickly.

Fortunately, if you take care of it, you can usually treat it and be back running with 3-7 days. Within two weeks, you should be back to your normal training.

Physiotherapy helps in dealing with the symptoms of plantar fasciitis like pain, stiffness and inflammation.


Knee Replacement Surgery: Care & Exercise

You are about to have Knee Replacement Surgery (TKR). A lot of the long-term results of knee replacements depend on how much work you put into it following your knee surgery.
After a knee replacement surgery, chances are very high that you’ll feel far less pain and can move around much better than before. Physiotherapy after knee surgery is an important part of that recovery. Patients who prepare for surgery and actively take part in their care can recover in less time and with less knee pain. Knee Rehab exercises will help you walk, climb stairs, and return to other normal activities more quickly.
This knee pain treatment guide has general information along with tips for things to do before and after knee replacement to help you make it a success.
You may get different instructions from your surgeon, doctor or physiotherapist. Always follow the directions of your care team. This guide is meant to be used under the direction of your physiotherapist.
Caution: If you have too much knee pain to exercise, or if any of the exercises cause more pain or knee swelling, stop. Tell your physiotherapist or doctor. If your whole leg becomes swollen or hot, tell your doctor right away!

Why do I need to exercise before Knee Replacement Surgery?

If you exercise before knee surgery you can have a faster and easier recovery. Exercise helps to:

  1. Maintain the range of movement of your knee
  2. Make your muscles strong
  3. Control your pain
  4. Build your knowledge of how to exercise after surgery
  5. Improve your sleep

Do activities that put less stress on your knee. It is best to do specific knee movements; your physiotherapist will help you do specific knee strengthening exercises after thorough assessment of your knee joint and associated pain.

  • Try cycling on a stationary bike (upright or seated) for 5-10 minutes,
  • Walking in water (water level should be atleast thigh deep).
  • Always warm up before exercising.
  • Your physiotherapist may tell you to apply moist heat to the front and back of your knee for 5-10 minutes OR Have a warm shower / bath.

When should I see a physiotherapist for TKR recovery?

Well, in order to maximize your functional mobility and recovery after total knee replacement, you may want to consider physiotherapy throughout the process.

Phase 1 – Preparing for Knee Replacement Surgery

I can begin to assist you as soon as you decide to have knee replacement surgery – take pre-surgery knee strengthening exercises at a clinic near you.

Phase 2 – Inpatient Physiotherapy after knee replacement surgery

Rehabilitation begins as soon as possible after your operation. If you return to the ward in the afternoon, you will be assessed by a physiotherapist to see if you are able to stand and take a few steps with your new knee with their help. (Did You Know,in which case will continue to help you with In-patient physiotherapy in the hospital.)

Phase 3 – Physiotherapy at home for Knee Rehab

Your knee may still be painful, once you have left hospital. Well, in order to maximize your functional mobility after total knee replacement, you should consider physiotherapy at home. ReLiva home physiotherapist will initially teach you exercises to:

  • Reduce swelling
  • Control your pain
  • Recover your knee movement

How long do I need to do physiotherapy after a knee replacement?

TKR recovery

A follow-up physiotherapy outpatient appointment will ideally be arranged within a week after you leave hospital. Physiotherapy at this stage is aimed to help you develop your strength, knee movement and walking ability.
It usually takes 6-8 weeks after surgery for one to resume normal unassisted activity. The recovery may vary from person to person. You may still need to continue to do your knee exercises for longer time based on your goals. Ask your physiotherapist about returning to active or sporting hobbies. Gardening, swimming (once stitches/clips removed and wound is dry), cycling, golf and walking are highly recommended.

Is physiotherapy necessary after total knee replacement surgery?

Exercise after surgery will help you recover and regain the movement and strength of your knee. Exercise also helps to:

  • Reduce swelling
  • Prevent blood clots (Thrombosis)
  • Control your pain
  • Prevent constipation
  • Improve your sleep

Your physiotherapist, who is an expert in muscle and movement, will initially assess your knee recovery and teach you the appropriate knee exercises.

What should I do to make the most of Knee surgery?

Physiotherapist who regularly work with orthopaedic surgeons to aid recovery of patients after knee surgery suggest these Dos and Don’ts to make the most of your Knee replacement surgery.

Do’s after Knee Replacement Surgery

  • Take your recovery and rehab seriously. Exercise regularly as per the programme charted by your physiotherapist.
  • Continue with your knee replacement rehab programme for at least 3 weeks after surgery, probably 3 months of physiotherapy guided knee exercises to get the best result from your knee replacement.
  • Follow-up regularly with your surgeon, to monitor internal recovery.
  • Walker or crutches should be used until discontinued by Doctor or Physiotherapist.
  • Change knee position at least once an hour, while awake, to avoid stiffness.
  • Home exercises should be performed 3 times every day, unless advised differently by your Physiotherapist.
  • Walking, Swimming or walking inside swimming pool (where water level is at least till your thigh) is a very good strengthening exercise that prevents jerks and unnecessary strain on the knee.
  • Stay positive and committed. Don’t give up, and do what you can to keep a good attitude.

Don’ts after Knee Replacement Surgery

For 6-8 weeks after knee surgery, avoid:

  • Any pivoting (twisting) on your knee
  • Avoid kneeling down & squatting
  • Avoid high impact activities that cause jerk and stress on the knee joint, example running, jogging, rock climbing etc.
  • Avoid unnecessary stress on your knee by lifting very heavy objects. This can cause damage to your new knee.
  • Avoid using Indian traditional toilet, instead use a Western Commode (WC) or toilet chair.

Is walking good after knee replacement?

Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance after you leave hospital. It is important that pain does not restrict your walking or exercises. If you are in pain, tell your doctor. They can check your pain relief and see whether you need different or stronger painkillers.
Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.
You may also consider walking inside a pool once the stitches/clips are removed and knee-wound is dry and healed. Water absorbs any sort of jerk, making it safe for your knees. Ensure the water is thigh deep in the pool.

How often should you exercise after knee replacement surgery?

For the first three weeks you should do your exercises at least three times throughout the day. You do not have to do them all at the same time. After three weeks you can do all the exercises for the suggested number of repetitions or holding time, at least three days a week.
This will help to maintain and improve the movement and strength you have gained.

What are the best exercises after knee replacement?

A. Exercises in bed, after Knee surgery

Immediately after surgery, you can continue to do the following in bed:

  1. Deep Breathing and Coughing Exercises
    Until you are up and moving well, take at least 10 deep breaths, followed by a cough, every hour that you are awake.
    TKR pump your ankles
  2. Pump Your Ankles
    When lying down, move feet up and down and in circles. Repeat 10 -15 times every hour you are awake.
  3. Buttock Contractions
    Tighten your buttock muscle and hold for a count of 5 seconds. Repeat five to ten times, three to four times each day
  4. Moving your new knee
    It is important to move your knee soon after the operation unless your surgeon or physiotherapist tells you not to. This will minimize stiffness, pain and swelling, and reduce the formation of scar tissue. Check with your physiotherapist for guidance about the best way to warm up your new joint.

B. Knee Exercises, once you are home after knee surgery

To Keep Pain and Swelling under control, once you are home here is what you should do:

  1. Rest Your Joint after knee surgery
    • Rest your jointChange positions often (every 20 minutes) when you are awake. Try sitting, standing, and walking.
    • Pace yourself. Take things easy and slow.
    • Lie down 3 times a day for 30 minutes on your bed.
    • Put your leg up and support it with a rolled towel or with pillows (as shown).
  2. Use Ice after knee replacement surgery
    Ice your knee when it is hot and red, painful and after exercises. (If your knee is very stiff and painful, check with your physiotherapist before icing. Follow these steps:
    • If your scar is not healed, cover it with a clean bandage and clean plastic wrap
    • Put a damp hand towel over your knee
    • Put a flexible gel pack, or plastic bag with crushed ice on your knee
    • Leave the ice ON for 10 minutes. Take it OFF for 10 minutes. Put it back ON for 10 minutes. Repeat 4-6 times a day.
    • DO NOT use ice if your doctor has told you that the circulation to your legs is poor and that you should avoid using ice or heat
  3. Use Pain Medicine
    Use your pain medicines as prescribed by your doctor. Tell your doctor if the pain is too much or not improving.
  4. Use Walking Aids
    Use the walking aid that your physiotherapist has measured and recommended. Do not change or stop using the walking aid until your physiotherapist or surgeon tells you to. Walkers, crutches and canes help to:
    • If your scar is not healed, cover it with a clean bandage and clean plastic wrap
    • Reduce the stress on your knee Reduce pain Improve your balance and reduce falls
    • Remember it is better to have a good walking pattern using two crutches than to limp and risk losing balance.
  5. Sleep
    It helps with rest and recovery. It is normal to have some sleepless nights up to 12 weeks after your knee surgery.