Life After Hip & Knee Replacement - Exercise · PDF fileLife After Hip & Knee Replacement Laura Abbott, MS, ... •40% of total procedures performed on Baby ... •Many exercises for

Webinars on Demand, 2017

(c) 2014, 2016 by Exercise ETC Inc. All

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Life After Hip & Knee Replacement

Laura Abbott, MS, LMT • Master’s Degree, Sports Medicine

• Licensed Massage Therapist

• Undergraduate degree in Exercise Science

• Instructor of Kinesiology, Georgia State University

• ACE Certified Personal Trainer

• Guest speaker at Atlanta area massage schools and at the Georgia State University Physical Therapy department.

• Owner of Premier Performance, Atlanta, GA

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

http://www.exerciseetc.com/



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Learning Objectives (5)

• After viewing this webinar you will be able to: – Identify precautions to take after a joint

replacement

– Explain the success rate after a hip replacement

– List the mobility joints as opposed to those joints that are for stability

– Explain the predictors for successful knee replacement

– Explain the role of proper nutrition in joint replacement recovery

REMINDER:

Obtain medical clearance and physician’s release

prior to beginning

an exercise program

for clients with medical or

orthopedic concerns.

Is There Life After Joint

Replacement?

• Yes, many senior

patients do return to

full activity and

recreational activities

such as tennis and

golf

• Continued vigilance

and specific

preventive training is

essential to protect

the replacement

joint



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Precautions To Take

• Talk With PT & Physician about progress and limitations

• Manage Asymmetries

• Always reevaluate

• Understand Proper Progression/Regression

• Identify Risk Factors

Negative Correlation To Functional Outcomes

1. Living alone

2. Increased BMI

3. Preop Condition

4. Females

5. Older ages

6. How long they wait before surgery

7. Lack of prehabilitation before the surgery

Hip Replacement



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Numbers To Know

• 85% of patients diagnosed with osteoarthritis

• Hip Replacements performed is expected to grow 174% in the next 20 years.

• 40% of total procedures performed on Baby Boomers

• Success rate is ~95% at 15 years

What Causes Need for THR?

• Osteoarthritis

• Rheumatoid arthritis

• Trauma/Falls

• Avascular Necrosis

• Tumors

• BMI

Restrictions & Contraindications

• Movement restrictions will vary.

• Physicians will set limitations and ROM restrictions based on procedure:

– Posterior Approach

– Anterior Approach



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Exercise Programming For THR

• Goals: 1. Assessments

2. Improve ROM

3. Improve Hip Stability & Strength

4. Manage Contralateral Imbalances

5. Integrated Strengthen Exercises

6. Low Impact Cardio Respiratory Training

Assessments For Hip Replacement

• Flexibility/Mobility: – Ankles

– Hips

– Thoracic Spine

• Strengthen: – All ROM of Hip Muscles

– Knee Extensors/Flexors

– Plantar Flexors/Dorsi Flexors

– Compare with non surgical limb

Improving Strength

• Improving strength improves ROM.

• Progress from isolated movements to integrated.

• Open chain exercise may be beneficial at first.

• Progress with hips unloaded (prone/supine) to loaded (kneeling/standing)



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Getting To The Floor

Supine Hip Dissociation

Supine Triple Flexion Ball Roll



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Standing Band Triple Flexion

Clam Shell With Core Activation

Closed Clam Shell



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Active Straight Leg Raise

Side Lying Active Straight Leg Raise

Quadruped Rocking



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Standing Hip Dissociation

Closed Chained Assisted Dorsiflexion

Hip Hikers



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Seated External Rotation

Monster Walks

Seated Sliding Abduction



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Integrated Training

Low Impact Cardio Strategies

Knee Replacement



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Things To Know

• By 2030 there is projected to be more than 3.5 million knee replacements completed.

• 91-96% success rate at 15 years

• Predictor of physical performance post surgery is quad strength pre surgery.

The Fitness Professionals Role Is Critical

• A 2009 study found that: – 60 days after knee replacement, extensor strength

was only equal to pre-surgical levels (which were deficient compared to the uninvolved knee.)

– Strength gains beyond the pre-surgical level occur after 60 days of training, but most PT stops at 60 days.

– Fitness training is vital to increase strength & function of the involved knee after 60 days.

Proper Nutrition

• The Journal of Clinical Investigation found benefits of EAA supplementation on TKR.

• Those taking placebo saw quad atrophy of 18%.

• Those taking EAA only lost 6%.

• Those on supplement also increased the recovery time post surgery due to less loss of muscle mass.

• Control group took 32% more time to perform functional mobility tests.



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Surgery And Recovery

• Unilateral Total Knee Replacement

• Bilateral Total Knee Replacement

– Simultaneous

– Stage

• Unicondylar Knee Replacement

– Common For osteoarthristis

Goals For Knee Replacement Program

• Assess Strength & Flexibility

• Improve Range Of Motion

• Improve Knee Stability

• Increase Isolated Strength

• Integrated Strength Training

• Low Impact Cardio

Improving Stability

• The main function of the knee is to provide stability.

• Many exercises for the hip replacement are appropriate for the knee replacement.

• Improve stability on both legs.



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Weight Shifting Exercises

Standing Hip Flexion With Core Activation

Assisted Toe Touching



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Band Resisted Scissor Stand

Isolated Strengthening Exercises

• If there is no strength in isolation, there is no strength in integration.

• Build strength and teach activation of weaker muscles.

Leg Slides



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Seated Leg Slides

Towel Presses

Band/Ball Resisted Bridges



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Seated Ab/Adduction

Marching & Butt Kicks

Integrated Exercises



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Band Reaches

Overhead Reaches

Assisted Squatting Patterns

Monster Band

Assistance



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Other Strengthen Strategies

• Aquatic Exercise

• Neuromuscular electrical stimulation

• Whole Body Vibration Training

• Recumbent Eccentric Stepper

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

Post-course Learning Assessment This assessment must be completed if you are certified by BOC, CSCS or NSCA

Question 1

All of the following are appropriate precautions to take prior to working with a client who has had a

joint replacement EXCEPT:

A. Avoid working with asymmetries

B. Always re-evaluate

C. Identify risk factors

D. Talk with the physical therapist who worked with the client

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Question 2

The success rate for those receiving a hip replacement is ____% after 15 years.

Question 3

Which of the following joints is not considered to be a mobility joint?

A. Ankles

B. Knee

C. Hips

D. Thoracic spine

Question 4

The best predictor of physical performance post knee replacement is:

A. Consistency in rehabilitation

B. Age at the time of knee replacement

C. Quad strength pre-surgery

D. Extent of damage to the knee pre- surgery



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Question 5

What supplement as been shown to assist in the reduction of quad atrophy after a knee

replacement?

Correct Your Work: Answer Key

1. A

2. 95

3. B

4. C

5. Essential Amino Acids

Make sure to keep this assessment with your other

recertification documents for 4 years. Questions about

any answer? Email us at: [email protected]

PLEASE NOTE:

• Remember to complete this webinar and print the certificate

by December 31 of this year.

• Certificates with next year’s date may not be accepted by your

credentialing organization.

mailto:[email protected]



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Life After Hip & Knee Replacement - Exercise · PDF fileLife After Hip & Knee Replacement Laura Abbott, MS, ... •40% of total procedures performed on Baby ... •Many exercises for