Monday, April 14, 2014

" Stiff Knee" After Knee Replacement Surgery

I enjoy getting emails from my readers and those of you who pull up some of my articles that have been written over the years. One of the most frequent questions I get when it come to post surgical knee replacement problems is , " My knee is stiff, what should I do"

This is a frequent problem and something we all will experience after knee replacement surgery. Now it is of course very common and the norm for your knee to be stiff for the first six to eight weeks out from surgery. This is due to mainly the swelling and the fact the surgery is still new and the tissues are in the initial healing phases.

The problem is however if your knee one year after surgery is " still stiff", that can be from several problems that may have started after surgery.

I find the biggest problem with most of those patients has been the difficulty in handling the initial physical rehabilitation. As most find out, 95% of the exercises in physical therapy after a knee replacement are not bad at all, in fact your strength with todays surgery comes back rather quickly, its the bending and straightening of their knee that will either make you or break you.

If you have not spent the time in those first six weeks after knee surgery paying the price and being mentally tough when it comes to mobilizing your knee then, you will face the consequences later.

One of the ideal ways to get your knee moving again providing you do not have mechanical issues with the knee or massive amounts of scar tissue, is to get yourself on a stationary bike and work at it every day. 15-20 minutes of gentle biking to start. It also will have great cardiovascular affects as well.

I had my knee replacement surgery in 1999 and still to this day I stationary bike five days a week. My knee has all the flexibility I will ever need and is pain free. Of course I am beyond the gentle biking part and use it more for cardiovascular condition and weight maintenance.

I began stationary biking two weeks after surgery though and carefully at that. Try biking, if that does not loosen your knee up then it will not loosen up.

As I have mentioned in previous posts, you rehabilitation will never end after joint replacement surgery or lets say it shouldn't! If you expect a knee, hip or shoulder to feel like your own then find both strengthening and stretching exercises you enjoy and do them.

So in the case of the "stiff knee" providing you are not still suffering from unusual swelling or pain in which case you should have seen your orthopedic surgeon by now, if its been three to five months, then try repetitive biking, that still in my estimation is the best total knee replacement exercise there is for both strength and mobility.

Richard Haynes PTA
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Sunday, April 6, 2014

Hamstring Strength and Flexibility

Just because you have had  knee replacement surgery does not mean you have to stop strength training when it comes to your legs. In my previous post I discussed the fact that you can still continue to exercise your legs in fact, its encouraged after knee surgery.

By continuing to exercise your legs as soon as you get medical approval, you will help in restoring the natural function and feel of those muscle groups that are surrounding you new knee prosthesis.

I have listed below just two exercises that I personally do to keep my hamstrings strong and  pliable.

Weak hamstrings encourage faulty gait patterns, low back pain and the ability to transfer from a chair as we age for instance.

My favorite hamstring exercises our:

                                                             Romanian Deadlift
The Romanian Deadlift is a great exercise to add  more muscle and develop your gluteal area as well. A word of caution however, if you have a bad back or haven't done this exercises before, you might want to inquire with a fitness professional on what the correct form looks and feels like. Just start with the bar itself before adding any weight.
  1. Romanian Deadlift
  2. Prone Hamstring Curls               Prone Hamstring Curls

The prone hamstring curl is popular and almost every gym in America should be equipped with this type of machine. I personally do three sets of 12-15 repetitions with this exercise to keep my hamstrings strong. Strong hamstrings allow for more consistent  pelvic control and, also play a big part in low back strength and decreasing the chances of low back pain.

Strong hamstring's also help in supporting and strengthening your knees and helps in keeping the muscles surrounding your knee strong so that the muscles are doing the supportive work and not the joint itself.  For those of you that have had a knee replacement, keeping the surrounding muscles including the  hamstring's strong and pliable are vital in getting the most out of your prosthesis and a knee that functions like your original.

Working out in the gym like I do, I notice not only the hamstring group seems to be a  neglected body part but, the legs in general are not worked as often. The reason, because many people especially those of us who live in the north may not see our legs for 3-5 months when outdoors during the winter and second, lets admit it, working your legs is hard work, plain and simple.

Keeping your hamstrings strong and flexible through stretching are necessary if you want to keep your knees and low back strong and pain free along with developing a great looking pair of wheels.

Strong legs equal a strong foundation and your hamstring's are just one part of the lower body that needs your attention when working legs.

Richard Haynes PTA, CPT
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Saturday, March 1, 2014

Leg Presses and Squats After a Knee Replacement

When reviewing my email first thing in the morning one of the most frequent questions I get from current bodybuilders or weight training enthusiasts like myself is questions regarding using the leg press and /or squatting after knee replacement surgery.

Of course in the body of the email is the infamous, " my surgeon said to either swim or get into a pool to exercise my legs" well if you were like me that didn't go over too well. I was not about to give up my entire leg exercise routine and pretend I was 75 years old now.

But, I also was well aware now that some changes and modifications were in order when it came to weight training and my legs. I was never one in the first place who loaded up 500-600 pounds and did deep squats so, powerlifting was not something I excelled at or would have missed.

I did work on both the leg press and squats with moderate weights however and of course that's relative in a sense. After my surgery though, I didn't completely give up on either exercise.

Today nearly 15 years after knee replacement surgery, I still use both though I favor the leg press as I find the leg press is excellent in balancing the weight and taking the strain off other parts of my body.

As you age and wear and tear sets in, its a smart move. For you younger lifters that feel the leg press is for sissys, you will also in time  make the adjustments I assure you.

You just need to understand after knee surgery that the days of loading up on heavy iron will have to stop but, you still can get in effective workouts without damaging your prosthesis.

I am  a big believer in pre-fatiguing the quadriceps group before I get on the leg press for instance.
I may knock out two or three sets of leg extensions for 15-20 repetitions and then immediately go to either the leg press or the smith machine to knock out leg presses or squats.

The weight I tend to use is between 200 and 250 pounds and you can do that for high reps.

If you are looking to go heavy like you did before or cannot face the fact you have to use lighter weight, then I recommend you do not have the knee replacement surgery done in the first place.

Knock out a set of 20 repetitions with 225 pounds on the leg press then immediately follow that up with 20 bodyweight squats going as deep as your new knee will allow and tell me if your legs are not on fire after that.

You can use your imagination when it comes to working legs after knee surgery, just use some common sense.

And I realize that there are medical personnel right now that would think this may be a bit extreme, just work within and understand what your boundaries are first.

I have been doing this now close to 15 years without incident. By the way, I continue to work my calves and hamstrings no different then I  did before surgery with the same amount of weight etc...

Its the forces you put through the prosthesis with the heavy pressing movements that can damage and pre maturely wear it out.

But for heavens sake do not quit working your legs altogether or think you are doomed to a skinny pair of legs.

Where there is a will there is a way.

If I can be of more help in regards to this subject matter feel free to either email me at or leave a comment below.

Richard Haynes PTA,CPT
Total Joint Fitness LLC

"Where Fitness and Rehabilitation Never Ends"

Tuesday, February 25, 2014

Practice What You Preach In Medicine

There are two things I never understood while working  in the field of medicine now for over 18 years.
Seeing Respiratory Therapists that smoke and,  Physical Therapists that look like they have never exercised a day in their life. In other words, they talk a good game but they do not walk it.

Now I understand that there are excellent therapists in both fields that do exactly what I mentioned above and, are excellent in what they do. I however believe that someone that " walks the walk and talks the talk" is perceived by the general public as a little more credible at times.

We all know that first impressions are lasting when it comes to social mingling and when it comes to either casual introductions or, interviewing for a job. That's just the way it is.

How many doctors or nurses for instance have you seen that do not as you would say look like the picture of health? Far too many as far as I am concerned or, is it just me?

It is not about questioning someones competence here but,  questioning their desire to be a model or, someone that others can follow and see the results first hand what a human body can look like and perform like when its taken care of with quality exercise, sleep and nutrition.

We all have our own schedules and reasons why something like starting a dedicated exercise program or eating better is " too hard to maintain" but generally that all they are, excuses!

As  health care processionals, we should be setting the example for our patients and be a resource to each one of them when it comes to helping them improve their quality of life if they so choose.

Not everyone I meet for instance is the least bit interested it appears, in improving much of anything.

Obesity among health care workers like society in general, has never been at the all time highs it is today. With workplace wellness programs and gyms in almost every town in America, the healthcare worker should be leading the charge in improving the health of their patients.

Remember, its not so much what you say that's important as it is not what you are saying and that impression you are giving your patients and clients. Body language is a powerful thing.

Carry yourself with dignity, look like you have high self esteem because your outward appearance will always reflect what is going on in the inside of your mind.

Richard Haynes PTA,CPT
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Thursday, February 20, 2014

Physical Therapy Ends, Your Rehab Has Just Begun

After seeing a patient for maybe three to five weeks in home health there comes a time we have to part ways due to insurance company or Medicare guidelines. Some diagnosis  will go longer than others but, generally our time in your home will be restricted to approximately  four to six weeks.

My typical joint replacement home health visits last about four weeks these days making three visits a week.

What I tell you as the patient is that just because we are discharging you does not mean we  feel that you have reached your maximal potential. If you have a had a knee, hip , or shoulder replacement, you by no means are even close to your maximal level.

Before you let your physical therapist leave your home for the last visit, be sure to inquire about  ideas to keep your rehabilitation and fitness going. Some of my patients I find were active to begin with and, will consider going back to their local gym or wellness center to continue their physical rehabilitation for instance. Very smart move!

A few will not. These are the patients that could have some form of difficulty with their joint replacements down the road for the mere fact they did  not continue with the exercise program they were assigned or, did not get themselves involved in an exercise program to further strengthen themselves.

Many do not feel that they have enlisted themselves into a new way of life after total joint surgery. Whether you know know it or not you have secretly enlisted yourself into the fitness brigade when you have had joint replacement surgery. Your surgeon may not tell you this but, most physical therapists will.

In fact, many go back to their old ways of poor food consumption and, lack of physical exercise. Your new joint replacement will require in my estimation continual attention to prosper for years to come.

No, you do not have to eat and sleep it 24/7 but, being conscious of your body weight after the surgery and getting physically stronger will only benefit you new joint the long-run, so why not?

After four weeks of home health and maybe four more weeks of out-patient physical therapy you will possibly feel that you have made it to the promise land in fact, you may even feel that you are the exception,  "I don't need to continue that exercise stuff".

I personally work out five times a week taking the weekend off. I do not say this to toot my own horn but, to demonstrate the importance of keeping your body-weight in check and, keeping your new joint mobile and the surrounding muscles strong.

With the continual rising costs of healthcare and getting a big chunk of your budget eaten up by medical costs, isn't it smart money to stay in good physical condition?

If you have a question or comment about exercise programs after surgery, please leave a comment in the box below to share with the rest of us that have gone through total joint replacement surgery.

Richard Haynes PTA, CPT
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Saturday, February 15, 2014

Aging Its Not Just Sitting Back And Accepting Your Fate!

I am on the road most of the day and I go in and out of a lot of seniors homes providing physical therapy. Like anyone else, seniors still have their basic personalities they had when they were younger unless their cognition has begun to slip a little.

And like most of us that have lived part the half century mark, we just about seen it all. For instance in patient care,I have seen some that will take the bulls by the horns so to speak and find a way to get through their rehabilitation and make the time we spend a success and some, not so much.

They are the go-getters. they expect success and generally get it. But for 85 % or more I come across on my caseload the patient/client that is already defeated once I get to the home. Grant you chronic disease and or pain will beat anyone down to ground level if they allow it but, to be true survivor we all must find a way to conquer those feelings of inadequacy and defeat.

We must pick ourselves up and understand that there are forces and unforeseen events that will try its best to test our mental resolve, courage, and the willingness to live.

Though there are some things in life we may not have control over like the weather, taxes, or at times our spouses, we do have the ability control our fate and our future events as we age right now through proper exercise and eating.

How do we do this? Its not as hard as it may sound. But I can tell you it takes daily not weekly or monthly mental and physical  renewal. This is done by making sure we take it upon ourselves first to get involved and strictly follow a cardio and strengthening exercise program.

Second, always remember, your food choices as you age become more important than ever, what you consume comes through by reflecting your overall health and appearance.

Another important aspect though in changing your course and taking control of your own fate is to be sure along with that exercise I program I mentioned a few minutes ago, to start a disciplined reading program for one hour a day.

And by a reading program I believe myself personally that reading non-fiction books that are educational and allow you to think and learn something of value is what will help you control your own fate later in life.  In fact  a good motivational book can actually get you to change your life around this very moment if read and acted upon. It will take daily practice though.

In other words to avoid sitting back as you age in just allow your teeth to get kicked in by life in general and, add getting older on top of everything, get pro-active and hit the gym, or fitness center. Your body will always follow your mind.

If your mind and thinking are right and, determined that you are not going to roll over and die without leaving this world without a fight then, get moving both physically and mentally.

We all know we will not leave this world alive but, no matter whether you are going through physical rehabilitation for an injury, elective surgery, or training for an upcoming event, give it all you got and be determined that you and you alone will write the each chapter in your life.

I want to see a  patient who is on fire to get better to improve their physical qualities. Don't waste your time, the therapists time, and insurance companies money with half-hearted efforts.

You control your fate, don't blame the President or the government in general like most do here lately. You can control your fate if you just step back for a moment and decide to do so!

Richard Haynes PTA
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Monday, February 10, 2014

Diet And Poor Physical And Mental Performance

As we can figure out by now, the subject of diet and exercise has been consuming the news and magazine world heavily this past decade. After all, society is getting older and healthcare costs are not only gobbling up our personal bank accounts but, adding a tremendous burden on society as well.

It is said not only in the gym where I work out at but by any one that is involved in weight training or bodybuilding, that your diet is 80% of your success. That number might be higher or lower depending on who you talk with but, we all can agree that the food we put into our bodies will determine how successful we are physically and mentally.

Your food consumption and preparation like your vacations should be thought out and planned. By not planning properly and making grocery lists that stress the importance of low fat , high protein foods and more fibers, and less white breads, you are setting yourself up for failure at the dinner table.

To expect to perform at your best day in and day out whether you are still working 9-5 or, retired and playing 18 holes at the golf course, what you consume the day before and that morning before you leave will directly affect how you perform.

Our society here in America likes everything right now and for many that includes what we eat. Instead of preparing high nutritious meals, we settle for something instant or a fast food window down the street.

If you concentrate on eating foods high in protein and low in fat like turkey breast, skinless chicken breast, tuna and other assorted types of fish, along with eating foods with plenty of fiber like lentils and beans, oatmeal for your  carbohydrate sources, you would have much more energy, perform better either at the office or on the course and, feel better!

There are of course a large assortment of foods that fit into this category that are not listed but, I think you get the idea.

To expect your body and your mind to be as sharp and effective as possible, whether you are training for an event or, going through physical rehabilitation, you must take a good hard look at what foods you are consuming.

Its been asked by others if you would put bad fuel into your car and of course everyone says no, then why do we put it into our bodies and expect it to function any better? Your body is a machine as well, treat it as such.

By cleaning up your diets with low fat foods and, staying away from salt, sugar, and  white breads for instance, will help you tremendously in getting better performance out of your body physically and mentally.

I personally rather eat at home where  I can control what  I am eating rather than eating out constantly and not knowing what is in the ingredients.

And by all means, stay away from fad diet plans and anything that promises quick fixes, there is no such thing. Take the time to take either a Saturday or Sunday and prepare your food for the week.

A cleaner diet and food intake means better performance and a leaner body.

Richard Haynes PTA,CPT
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"

Wednesday, February 5, 2014

Aging and The Importance Of Fitness

I don't think anyone has to preach to us in todays world how important  it is to stay healthy with proper exercises and, nutritional habits as we age. Exercise for instance, though we  all have heard about its benefits etc... ,how many actually follow the lead and information  they are given?

Not too many right? I just closed a case today where my patient will need more rehabilitation and explained to the family the importance of getting her involved in a exercise program to continue helping her get stronger and hopefully become more independent with her daily activities.

Having spent the time I had with her working on land based exercises, I feel it is beneficial for my client to now think strongly about looking at pool therapy to help with the strengthening process and, also to change up the exercise routine.

After all, doing the same exercises and movements after awhile your body will adapt and the routine will get stale both physically and mentally. This leads to non-compliance. There are numerous ways to change the program up however, unless you are with someone who can instruct you on changing intensity , exercises and repetition schemes most people  will not do it on their own.

It seems as we age, we become more concerned about our pocket books then we do about our health, not totally understanding that are finances as we age will be directly affected by our health. My patient was jumping up and down how she could not afford to go out to a fitness center and join. In her case one of her daughters will be able to foot the tab, as she feels it will be a good investment for the entire family and of course mom.

I stress to many of my clients the importance of changing their dietary habits as they age and incorporating the exercise component in as well. Our bodies do not use food resources like it did when we were younger and, loosing muscle mass equals a weaker body prone to falls.

Exercises for instance can be anything you enjoy doing from swimming to biking to running to one of my favorites lifting some iron. I always recommend to my clients and former patients that whatever exercise's they end up doing, to make sure they have added a resistance training program in it somewhere.

Keeping as much muscle tissue as you age keeps you stronger, allows you to maintain an efficient  metabolism which is vital in weight control  and, gives you much better insulin control.

Who in the world wants to battle type 2 diabetes for instance if it can be preventable right?

Stronger muscles in the core and lower extremities also help in reducing the chance for falls that seem to take its toll on the elderly causing disability that can be long-lasting and potentially changing your life due to lack of confidence in walking etc,... for fear of falling again.

Working in the field of physical therapy and fitness now over 18 years, I have seen what age can do both to our bodies and minds if they are not kept active in both physical labor like a structure fitness program and, being willing to learn new information and getting acclimated to the 21st century.

Take the time to ponder what your future could possibly turn out to look and feel like. You can design the future and the life you want if you plan ahead and, work towards accomplishing it. We cant stop every little thing that comes our way and, we wont live forever but, we sure can make the life we have as we age more productive and enjoyable by investing some time and a few dollars into our health and fitness starting right now!

Richard Haynes PTA,CPT
Total Joint Fitness LLC

" Where Fitness and Rehabilitation Never Ends"