Home Exercise and Rehab

Gina John is a Pilates Practitioner and Registered Osteopath who has spent many years offering help and advice, especially to the over 50 age group.

She is founder of The Osprey Clinic in the St. Johns Wood area of London and now specialises in Home Exercise and Rehabilitation Programmes. For further advice on exercising safely, and a selection of exercise films for general fitness and medical conditions, visit the website: www.home-exercise-rehab.com

This month: Exercises whilst waiting for knee replacent surgery.

Q: I am currently awaiting knee replacement surgery and have been advised by my consultant to perform daily exercises in preparation for the operation. Please would you advise me on which exercises would be beneficial?

A: Knee replacement surgery is required when the cartilage which lines the knee joint suffers degenerative change and no longer provides adequate shock absorbency during weight-bearing activities.

The surrounding ligaments initially become quite lax due to a narrowing of the joint space between the articulating long bones – the femur (thigh bone) and the tibia (shin bone). At this stage, the joint may become excessively mobile and overstrain the surrounding soft tissues. This involves the ligaments and muscles surrounding the joint, which may become swollen or sore after walking or standing for longer periods.

As the degenerative process continues, more severe joint pain and excessive swelling may ensue, making day-to-day activities difficult. The joint becomes progressively stiff and sore while the bony margins of the joint may thicken and the normal joint alignment or congruence is adversely affected. The limited range of movement of the joint and increasing intensity of symptoms may present an increasing challenge. Ultimately, these accumulating factors result in a patient’s referral by the GP for a consultation for knee replacement surgery.

Recovery from surgery depends on the good health of the muscles and tendons surrounding the joint, as well as the body’s postural muscles. It is therefore, important to exercise the pelvic floor, buttock, abdominal and back muscles as well as lower limb muscles. Performing a daily exercise routine will promote blood flow and provide essential nutritional elements to the soft tissues which surround the knee joint, as well as improve the strengthen and condition of the supporting musculature.

Each person’s ability to perform exercise will vary depending on the severity of the symptoms and congruence of the joint. Pain is the body’s natural warning mechanism, so always stop exercising if you start to feel pain. You may feel able to continue exercising after symptoms have subsided.
If you continue to experience increasing pain or swelling during or after exercise, consult your GP or consultant.

The following exercises will help to strengthen and condition the lower limb and postural muscles and may also help to relieve some of the symptoms, while awaiting surgery.

Parallel Leg Press Place a folded towel or small pillow under your knees. Pull up your toes towards your chin while you press both knees gently down to the pillow. Hold for 10seconds and repeat upto 20 times.
Leg lifts Lying with the right leg extended in line with the body and the left leg bent. Squeeze the right buttock so that your knee is angled to the side, in a rotated position. Repeatedly, lift and lower the outstretched leg, up to 20 times, keeping the foot flexed. Keep pulling in your abdominal muscles for support and avoid arching your back. Bend back the right leg and repeat the exercise on the left leg.
Spine Curls Lie face up on the floor or a firm bed with your knees bent, and with a pillow pressed between them. Pull in your abdominal muscles with maximum effort, while you exhale to lift the pelvis and spine as far as the shoulder blades, to form a bridge position. Inhale as you hold the position and exhale as you lower your body again, while scooping in the abdominal muscles firmly. Try to wheel the spine, vertebra by vertebra, back to the start position. Repeat 10-15 times.
Conditioning Exercise 1 - back of the leg and knee Lie on your back with your knees bent and place the right foot in a scarf or Theraband. Stretch the right leg up to the ceiling to feel the stretch at the back of the thigh and knee. Hold the position while pointing and flexing the foot, 20 times. Repeat the stretch for the left leg. Conditioning Exercise 2 - side of the leg and knee Lie on your back with your knees bent and place the right foot in a scarf or Theraband. Stretch the right leg up to the ceiling to feel the stretch at the back of the thigh and knee. Exhale as you move the leg across the body to feel as stretch to the side of the leg and knee. Inhale as you hold the stretch and exhale as you return the leg to the vertical position, with the foot facing the ceiling. Try to keep your elbows bent, pulling them down towards the floor, while moving the leg across the body and back again. Keep the abdominal muscles scooped in to support your back throughout the exercise. Repeat upto 10-15 times on each leg.
Buttock Stretch Pull up the right leg towards your chest, keeping the right knee angled to the side, so you feel a stretch through the right buttock and hip area. Hold the stretch for 20 seconds, and repeat the stretch to the left buttock and hip.
Hip and Front of Thigh Stretch Kneel down on the floor or at the side of your bed for extra support. Place your right knee on a pillow and the left foot flat on the floor in front. Keep your body upright, and take your weight forwards towards the left knee to feel the stretch at the front of the right hip. Hold the position for 20 seconds, using the side of the bed for support if necessary. Repeat the stretch for the left hip.

See all Gina's Home Exercise and Rehab features

Please send your questions for Gina John to answer in next month’s column to:
info@home-exercise-rehab.com

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