Many individuals who undergo Total Knee Replacements (TKR’s) struggle to gain maximum flexion of 130-135 degrees. Many just are unable to go through the window of pain that is in front of them when they undergo Physical Therapy (PT). I talked to many people who are unable to ride a bicycle at all after 6 months post-op.
The video above is of me at Method Strength & Fitness, Seminole, FL, working on the Octane r6000 Recumbent Elliptical at 10 weeks post-op after my TKA on the right knee. This is my primary technique to improve and increase the bend angle.
I have been steadily increasing the maximum flexion at the top of the pedal stroke over the month. There is no doubt that one must endure a level of pain to keep increasing the flexion angle without revision surgery which only increases the rehab time. Riding a bicycle comfortably and safely requires a minimum of 120-125 degrees of knee flexion.
It is also important to have a well-designed stretching program that is performed a minimum of two times per day once the edema (swelling) has receded to a level that allows for both SMR (Self Myofascial Release) and proper stretching of the muscle groups of the leg.
In this video, I have achieved a flexion angle of 130. One must dance with lady pain utilizing your will and determination. If you really want it. The only way is “Through”.
You can call, text, or email me anytime. I will get back to you.
As the Romans used to say, “Carpe Diem!” Each day is the best gift.
As older adults, we have experienced the ups and downs that life brings. With that experience, we have acquired “attachments” to certain ideas. These become reinforcing beliefs as we stay in our “comfort zone.” For instance, many of us have tried all sorts of ways to manage our body weight, and all through these different “diet plans, we may have lost the desired weight only to put it back on again, and in many cases, even more than we lost! The story or beliefs we now have, based on these failed experiences, is that we can’t lose weight.
So, how do we overcome these mental attachments?
Here is my story.
About eight years ago, my daughter, her husband, and my spouse and I went out to get a bite to eat. It was Christmas time here in Florida, and my weight issue was simple. While I was standing, my daughter took a side shot picture of me. My belly was hanging over my belt line. Everyone had a good laugh when I gave a shout out to my new “beer belly” which really wasn’t that new. The very next day that picture shot through me to my core. For quite a while, I held a story; my story, that the extra 30 lb I had gained over a period of 10 years couldn’t helped. I didn’t have the time to work it off. As a full-time caregiver to my spouse, it was just the way it was and is. As a matter of fact, I had all sorts of attachments to being a full-time caregiver. ” Ican’tt do what I want when I want. I couldn’t do this, and I couldn’t do that.” On top of that, I also held a story about myself that I was always in trouble. Particularly in making ends meet. and this was what was really bothering me.
We all have these thoughts and beliefs about ourselves. And you know what? They may be our reality, but they are not reality. They are the product of my “False and Failed intentions.”
Intention- “Intentions are mental states in which the agent (me) commits myself to a course of action.” Now, this goes on all the time in my head, and when I don’t follow through, it is absolutely a “false intention.” In other words, I lied to myself, which also means that I was not “impeccable with my word” to myself.
“Breaking the lying to myself habit.”
How did I break this vicious cycle of lying to myself about my weight? I called a close friend and shared with him the fact that I was decieving myself about having this “Intention of losing the weight.”I wasn’t taking the actions I visualized. By sharing this and being vulnerable about my weakness, I could now be accountable to him. I committed to him that I would start by taking two steps toward my goal of losing 25 pounds. I am going to ride my bike three times per week for a minimum of 45 minutes and cut down on the bread intake. And we agreed that I would speak with him next week to confirm that I had taken the action of my intent.
Within two weeks, I had dropped 1.5 pounds. Sure, it was only 1.5 pounds, but after a month, it was three! I now had momentum and a new healthy habit. Getting on the bike was now actually joyful! I admit cutting way down on the bread wasn’t actually delightful, but I still had my peanut butter on toast, but one slice was enough. It became a real treat! So did eating more vegetables. I improved my diet, and also Deb’s (my spouse) because I do all the cooking as a full-time caregiver.
As I gained more confidence and momentum over the next 14 months, I went from 200 pounds to 175! The major factor in my success was threefold.
1.) I reached out and shared my problem authentically and vulnerably with someone I could trust to be straight with me.
2.) I visualized myself as a fit personal trainer. (This was a longer-term goal)
3.) My commitments ( the actions of my intention) were accountable to another human being.
The major takeaway to this post is that I could not lose the weight all by myself. I needed encouragement from a trusted friend and/or professional coach who understood.
Today, I am full of gratitude for so many things.. particularly for my friends, my coaches, and family. And I try everyday to hold this intention… “To be grateful “
Post-op 8 weeks after my TKA (Total Knee Arthroscopy), and I am on the Spin Bike at Method Strength and Fitness, Seminole, FL. The swelling and pain are down, and I can work on increasing my knee flexion to a max of 130 °. At least that is the goal. Currently worked it to 122° Important in this rehab is the following:
1.) Positive Thoughts and Emotions Generate Positive Outcomes ( The most important!)
From day 1, even though the pain was + 8, thinking and visualizing myself back on the bike was and is crucial in maintaining my drive to move the joint when doing so was a big “Ouch.” One has to keep his or her “Eye on the Prize.”
2.) Elevating the Joint and Keeping it in a 0° to no more than 10 ° position for the 1st four weeks while at rest in thesupine (on your back) position. This is the only way to reduce the edema (swelling in the leg); it is challenging to work the new joint with the increased soft tissue water pressure in and around the knee. It is of utmost importance to be mobile each day to prevent collagen formation (scar tissue). Physical therapy can prevent help this and keep one on track with the proper exercises.
3.) Performing lengthening exercises for the Quadriceps, Adductors, Hamstrings, and Calf Muscle Complexes. At week 4, I started performing SMR (Self Myofascial Release) and warm water Massage Therapy 2-3 times per day in conjunction with lengthening exercises (stretching the muscle complexes.) The optimal length-tension relationships of the muscles need to be readjusted to their newly established ratios from the surgery. It takes time and patience. It is a challenge, and (.1) above is the number 1 factor in achieving success. (As it is in life)
SMR (Self Myofascial Release) of the Quads
4.)Increasing Knee Flexion
Goniometer
xR6000 Octane Recumbent Elliptical
At week 6, I started on the Octane xR6000 Recumbent Elliptical at Method Strength & Fitness. It enables me to measure the knee flexion at the top of the pedal stroke using a goniometer. I am increasing this by 2-3 degrees per week. I have also moved to the Stationary Spin Bike, now working on my stamina, keeping the pedal force tension very low. Easy does it for now. The Spin Bike’s maximum knee flexion is 120° which is the same as my road bike. I use it as a conditioning exercise machine. Next week, I will incorporate more strength exercises and continue to increase flexion using the Recumbent Elliptical machine.
As a fitness and life coach, my first approach to addressing body-weight issues is to discuss your thoughts and emotions on the subject. Do you view yourself as overweight? When you look in a mirror, what are your thoughts about your body? Are they negative? How often do you think about it during your day? Do you compare your body to others and then wish you looked more like them? Can you visualize how you want to look physically?
How you think and what you feel are of the highest importance. This means taking an honest and authentic (real) look at your “State of Being.” Are you being “Impeccable with your word?”
That is to say, for example, are you using the following type of language in your self-talk?
“ I know I should be more disciplined in terms of what I eat.” I know I should be more active.” These are authentic thoughts, and they have integrity because you are being honest with yourself. You are being “impeccable with your word.” When you think these thoughts, however, how do you feel? Do they make you feel good?
Here is another fundamental axiom about you and everyone else on the planet. “You Don’t know what you don’t know.” Let me state that again. “You don’t know what you don’t know.”
Here is what I do know. “Positive thoughts and emotions, on the whole, generate positive actions and outcomes. This is a universal law. Another is that you can become more aware of your thoughts and change them. This is where the “Rubber meets the Road.” This is the time to take action. What we are talking about is your inner self. It’s your will.
It is taking that small step to change the direction of your thoughts.
When a negative thought or emotion arises about your weight issue, do you just let it go to only have that negative feeling come back later? At that moment, what if you changed your inner dialogue to the positive? For example, “I’m calling Gina (a friend I just created, and I know you have someone like her) right now and ask her if she would like to join me in my journey to a healthier weight. If she doesn’t answer, commit to calling her again and making contact. That is a positive thought coupled with a positive action that can lead to a positive result. Just that tiny step…. Be Bold.it is inside you…
Health and fitness-related research has consistently sought to connect, or identify, benefits of exercise in older adults. According to the American College of Sports Medicine physical aptitude is related to health through 5 basic components: body composition, aerobic fitness, strength, local muscular endurance, and flexibility. Among these, strength and flexibility are important variables of physical aptitude. Adequate levels are necessary for the promotion and maintenance of health and functional autonomy and safe and effective sports participation.
Some studies have been performed to investigate the influence that aerobic, strength, and flexibility training have in improving or increasing flexibility (increased range of motion) without pain on both Sedentary Men and Women.The studies strongly (statistically) indicate that a combined strength and flexibility protocol is best for improving total ROM (Range of Motion) in all arthro-kinetic complexes (joints).
The bottom line for those 50 and over is that an effective training program begins with an endurance training regimen that includes circuit strength- training, balance, and flexibility.
The rewards of such a program are very simple to understand. Greater range of motion, less pain, and with a diet plan; weightloss. You will just feel better physically and emotionally.
Our metabolisms have slowed, we’re eating things we know we want to cut back on; but yet we choose not to….why? Because our brains are protecting us from the pain of commitment. The excuses it delivers. ( No time, I don’t look that bad, I’ll just cut back on my eating, I can’t afford it, etc.)
It’s your metabolism. It has slowed with age.
Motivation….Where do you Get it? Another human being could be a big help. The” Buddy System” increases your chances of losing weight combined with a Wholistic Fitness & Coaching Approach.
The “Buddy System” holds you accountable to another person. It’s key. And it’s Behavioral Science…mostly.
Diet
Instead of “ I have to cut way down on pasta & bread.” It’s more like, “I choose to eat more veggies I like and try new things (foods) in place of old things. I like it. It’s working for me.” “I also just cut down on my portions. “ It’s just changing things a little at a time in the beginning and working from there.
Physical Training (Exercise)
You don’t have to belong to a gym as part of your physical training program. You only need a few pieces of equipment that take little space at home. But most importantly you will be accountable and choose to train (exercise) earnestly and with purpose. Ie. Weight Reduction
“I used to play football, soccer & baseball back in the day. I’ll never look like that again”
(That’s true, all too true. It’s your metabolism.)
“I should get my butt to the gym.”
(Find another (buddy) to train with and hire an “Over Fifty “Strength & Conditioning Coach like me.)
Balance training has been demonstrated to be effective in improving balance and decreasing falls in cognitively intact older adults. It has been confirmed in many clinical studies over the last decade that Balance Training (BT) is a very effective means to improve both functional and sport performance-related balance tasks over a relatively short period of time.
The Berg Balance Scale is a test used to measure and calculate a score based on a series of tasks that are measured both quantitatively and quantitatively. It is used to access balance & mobility in physical therapy.
Proprioception is basically one’s ability to know about the movement of his or her own body part without having to look at it. … You can sharpen your proprioceptive (balance, agility) skills by practicing exercises that can help in preventing injuries to the body by making it adaptable to the changing environment.
Supervised balance training shows immediate benefit for older adults at fall risk. The long-term effects of such training can be enhanced by implementing a safe and simple home exercise program (HEP). It is important to consult a Specialist in Senior Fitness to ensure the safety and effectiveness of your fitness program. It is an integral part of every training program that I create for my clients.
The Single Leg Balance Test
Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O,Granacher U. Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial. Gerontology. 2016;62(3):275-88. doi:10.1159/000442087. Epub 2015 Dec 9. PMID: 26645282.
Tisher K, Mann K, VanDyke S, Johansson C, Vallabhajosula S. Functional measures show improvements after a home exercise program following balance training in older adults with elevated fall risk. Physiother TheoryPract. 2019 Apr;35(4):305-317. doi: 10.1080/09593985.2018.1444116. Epub 2018 Mar5. PMID: 29505321.
MartÃnez-Amat A, Hita-Contreras F, Lomas-Vega R, Caballero MartÃnez I,Alvarez PJ, MartÃnez-López E. Effects of 12-week proprioception training programon postural stability, gait, and balance in older adults: a controlled clinical trial. J Strength Cond Res. 2013 Aug;27(8):2180-8. doi:10.1519/JSC.0b013e31827da35f. PMID: 23207891.
14: Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA. Power training improves balance in healthy older adults. J Gerontol A Biol Sci Med Sci. 2006 Jan;61(1):78-85. doi: 10.1093/gerona/61.1.78. PMID: 16456197.
Older people who have never taken part in sustained exercise programs have the same ability to build muscle mass as highly trained master athletes of a similar age, according to new research at the University of Birmingham.
Published in Frontiers in Physiology, researchers in the University of Birmingham’s School of Sport and Exercise Science compared muscle-building ability in two groups of older men. The first group was classed as ‘master athletes’ — people in their 70s and 80s who are lifelong exercisers and still competing at top levels in their sport. In the second were healthy individuals of a similar age, who had never participated in structured exercise programs.
The researchers had expected that the master athletes would have an increased ability to build muscle due to their superior levels of fitness over a prolonged period of time. In fact, the results showed that both groups had an equal capacity to build muscle in response to exercise.
The study clearly showed that it doesn’t matter if you haven’t been a regular exerciser throughout your life, you can still derive benefit from exercise whenever you start.
More specific guidance on how individuals can improve their muscle strength can be provided by professionals who specialize in strength and conditioning programs for older adults. Also, I always teach my clients activities that they can perform at home to improve their strength endurance, balance, and core as an adjunct to their written training and fitness program which is designed to help them achieve the goals we set together.
The loss of lean muscle mass occurring with
advancing age is termed sarcopenia. This condition
often leads to a concomitant loss of strength, increased frailty and risk of
falls and an overall loss of functional independence in older adults..
Muscle protein balance is a dynamic process and is the difference between the body’s ability to make muscle protein versus the rate at which muscle protein breaks down.
It has been observed through clinical studies that older adults are more resistant to the production of muscle mass or what is referred to as resistance to the anabolic response. (the replacement of muscle). The loss of this equilibrium leads to the loss of muscle mass, and this is a major factor in the development of sarcopenia.
This is part of the aging process. The good news is that recent studies have investigated interventions to overcome this anabolic resistance. In particular,
Combining a resistance Training program with
increased Quality Protein intake restored
the anabolic (muscle-building response) in older men. Recent studies have confirmed the same in older
women.
.The present evidence strongly suggests that the loss of lean tissue in the elderly is exacerbated by low dietary protein intake.
As such, protein supplementation may prove to be an effective approach to delay the loss of muscle mass with age and has led to calls for the recommended daily intake of protein to be increased for the older population.
The Conclusion
The present study indicates that a protein intake of 0.75g/ lb of body weight per day has the most beneficial effects in regard to preventing sarcopenia and weakness in conjunction with a total body resistance training program
So, if you weigh 150lb, you should be ingesting 110- 125g of quality protein a day. 100lbs; 70-80g per day.
I always recommend to my older clients that they supplement their diet in the mornings with a ready to drink (RTD) protein such as Boost® or Ensure® that supplies quality Protein and adequate micronutrients as an effective anti-aging supplement. There are also vegetarian alternatives in this category.
If you sit at a desk for hours at a time at your workplace you’re definitely going to feel the tightness and pain over time. This is where “CAR” stretches are highly effective at improving flexibility in the two joints. CAR stands for “Controlled Articular Rotation” They are incorporated into a training program to combat the effects of lifestyles where hours are spent in a seated position. Hip flexion range of motion (ROM) will be severely restricted and Hip CARs can aid in improving ROM in the joint.
These stretches are more dynamic than the usual “static” stretches used to lengthen muscle tissues like a “supine bridge plank”. Cars add mobility (movement ) to the stretch.
These stretches are also employed after a client has been released to exercise after undergoing a hip replacement and subsequent physical therapy.
As a cyclist and an individual who also does a lot of writing (which means I am sitting for a couple of hours at a stretch) I perform these dynamic stretches at home 3 times per week. Also in training programs, I incorporate these with specific resistance (weight) exercises to strengthen the corresponding weak muscle sets to bring the joint into a more balanced tension relationship.
