February 26, 2025 • 18 mins
In Episode 153 of the Golf Fitness Bomb Squad, Chris dives deep into the world of joint pain, focusing on knee replacements and their impact on golfers. He shares insights from a client’s journey through multiple operations and tackles the common fear of losing distance post-surgery—spoiler: it’s not normal! Chris walks us through the critical decision-making process behind opting for a knee replacement, emphasizing that it’s not a quick fix unless the pain’s been relentless for years. He highlights how delaying surgery often leads to bad habits and compensation patterns that can sabotage your game. Plus, a reality check: going it alone rarely works if you don’t know how to progress properly. The secret weapon? Prehab. Chris explains why getting stronger before surgery can turbocharge recovery and keep you swinging strong. Whether you’re battling joint pain or just curious, this episode is packed with practical wisdom for every golfer.
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Episode Transcript
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Speaker 1 (00:09):
On to the golf in his Bomb Squad. I'm your host,
Chris bin In. Today we're going to dive into a
topic for those of you who've had giant replacements. We
had a guy come in today, actually drove like six
hours to come down to work with us for the day.
Two total new replacements, two shoulder replacements. I jokingly called
him the Biotic Man, but he had a lot of
(00:30):
really great questions. And so this obviously relates to a
lot of you listening who've had joint replacements. Maybe you
have joint pain and that's you know, joint replacement has
been something that's been talked about with your doc. Maybe
you're wondering if it's for you and what does that
mean in terms of your golf swings. What we're gonna do.
We have obviously tons of experience being a physical therapist
myself as well as having our physical therapy practice here
(00:52):
at p for US Golf, you know, working with guys
and girls who've had joint replacements, both in person here
in Raleigh, North Carolina, and also thousands of you that
we've worked with around the world and navigating that, you know,
just from whether it's brand new, you're prepping for it,
you've had it for years, you've just had it, whatever. Maybe,
So what I want to start with is we'll just
(01:14):
start with this chronologically. So we'll start with kind of
considerations if you're thinking about having one, and then we'll
talk about what does that kind of post surgical recovery
look like. And then we'll talk about those of you
who've had you know, had him for a long time,
and you know what's normal what's not normal. I think
there's a lot of bad information out there, and so
kind of the goal would be to make sure you
guys have good information. So I'm gonna we're gonna focus
(01:37):
definitely on the on the knees today. This was a
big topic of question that this gentleman his name is
actually Christ that he had too but he basically came
in and having had both knees replaced, he's I think
you said he's lost. Our call was like thirty yards
in the last five plus years. We'll send it like
you used to hit it like two eighty. He's sixty
(01:59):
mid sixty. I used to hit it to eighty. You know,
it's at about two fifty something. Massive change obviously, And
so for those of you who are thinking about knee replacements.
Distance loss after knee replacements, if done correctly, is not normal.
I'm gonna say that again, and I'm gonna say it slowly.
Distance loss after knee replacements is not normal. I want
(02:23):
you to let that sink in. For those of you
who've had knee replacements and you've lost distance, that means
your rehab was bad or something else is going on now. Naturally,
do we see a decreasing ground forces immediately post operatively,
like when you start going back to swing, Yeah, heck yeah,
because as you have a new joint, you got to
(02:43):
learn to use it again. But for those of you
who let's you know, starting in you know, before surgery,
and I'm gonna I'll dive into that like why that's
not normal as we go through this episode here. But
for those of you who are thinking about the knee
replacements and if if you guys are you know, have
other joint replacements you want me to dive into, you know,
believe comments, you know, reach out you know obviously and
let me know and I'll record you know, some more
(03:04):
episodes on those other topics. But you know, joints, whether elbows, shoulders, hips, ankles,
whatever it may be. I've worked with all of them.
So yeah, the the thing is beforehand, and this gets
lost I think after the near replacement, is that you
don't get a joint replacement unless it's been really bugging
you for a really long time, meaning it hurts when
(03:25):
you walk, it hurts when you play it like and
so naturally what's going to happen is you're going to
use it less. You're gonna avoid it, You're gonna use
your other leg, You're gonna walk differently. Right, So there's
you know a lot of people who get knee replacements
or other joint replacements, like particularly lower extremity, you have
back issues because you try to get through it right.
You try to go as long as humanly possible until
you have to have that giant replaced. And when that happens,
(03:48):
what happens to the joint that ends the leg on
the side that the joint is replaced is you atrophy,
which means you lose muscle. But you also when you swing,
if it hurts, you're gonna change how you swing. You're
not going to push through the ground, you're not going
to clear you're not going to produce the correct sequences
of forces. From a performance standpoint, you're going to correct
the sequence of forces and the amount of weight shift,
(04:08):
and you know the you know the obviously like the
amount left and right, but also you know the degree
to what you push into the ground. All those sorts
of things are going to be based around what feels
the best so you can get through the eighteen holes.
So what a lot of people don't realize is as
you're waiting to get that jar replacement, you're developing bad habits.
And that's you know, that's fine as long as you
(04:29):
know that you're doing it right. And it's obviously the
cost benefit analysis. If you make you know your living
playing the game of golf, maybe you get that jarant
replacement quicker. If it's just something you love doing right
creationally and you want to put off having that knee
replacement as long as possible, then by all means you
do that. But I think I want to make sure
that people understand that the longer you wait, your knee
generally hurts more, so you generally have to compensate more,
(04:52):
and so you're going to have things that aren't great
in your swing, you know, leading up to the surgery
and that's not uncommon for people to see their handicapp
rising and you know, club at speed, go down, accuracy,
all that sort of stuff kind of goes the wrong direction.
Usually speaking, some cases it doesn't, but in a lot
of cases it does. And you know, I think the
things that you can do to be successful pre replacement
(05:14):
are what's called prehabilitation. So I'm going you know, we
have a lot of people who come see us, you know,
before their surgery, to get ready to get strong. Depending
on your insurance, sometimes you'll get your insurance they can
they'll pay for you to go to a couple of
pet sessions beforehand. In my opinion, if you're going to
and this is based off of you know, having done
this for over a decade, a couple sessions isn't enough
(05:37):
unless you I'm just gonna say it's generally not enough.
There's very few people. There's a lot of people who
think they can do stuff by themselves. They get a
couple exercises, they're like, I'm good, I'm gonna go do it.
What people miss is like you don't know how to
progress from that, Like, yeah, that's the right stuff for
you today. But if you're doing the right stuff. Well,
in two weeks, you're going to need new stuff. You're
gonna progress. And that's I think the gap that I
(05:58):
see in a lot of people who work with a
coach or go to a couple sessions and they're like, Okay,
I got it, I'm gonna move on. Well, well you don't.
You have You've got it for that moment for the
next couple of weeks, but you don't have it for
when like you've mastered that and you need to continually
overload that tissue. Like the way the strength training works
is you have to create a constant stressor in that
tissue environment for there to be adaptation. And if you
(06:21):
do the same exercise for the eight weeks leading up
to the surgery, you didn't create any adaptation, like after
probably week two, maybe sooner, depending on what you're doing.
So I think going to somebody you know, at least
on a weekly basis who can progress you. Make sure
you're going into that surgery and as as good of
shape as possible. It's going to be massively beneficial to
you on your recovery and how quickly you get back
(06:42):
to playing golf. I can tell you from experience people
who do that genuine, genuinely are back playing golf like
in half the time if on average, now there's going
to be outliars left, right, right. But generally, speaking from
my experience, to people who come in and do the
work all the way leading up to the day before
surgery will will perform way better on the reab side
(07:06):
of things. They get their knee extension back quicker, they
get their knee bend back quicker, their quads are turned
on way quicker, they're walking without a device way quicker,
their pain levels are way less. It's just it's amazing
how different it is. So if your pre surgery, go
see someone on a weekly basis, get ready for that surgery.
Make sure you're in as good shape as humanly possible.
(07:28):
So literally when you wake up like good preab is
like you're not only are you getting you as strong
and as mobile as possible at the knee, but you're
also how's your hip mobility? Look, how's your shoulder mobility?
Because you get that knee replaced, we want to make
sure you have as minimal stress on that knee as
humanly possible. You just paid five figures plus for it, Like,
let's protect it, let's make sure it's optimized and just
like you would do for a normal joint. You know,
(07:49):
the better your rotary joints are moving the joints around it,
the hips, the shoulders, the spine, and the neck, the
less stress you're gonna have on it, and the more
optimal performance golf wise you're gonna have too. So a
lot of guys who and girls who do their rehab
the prehab first and then do the rehab correctly, actually
are not just rehabbing their knee, They're actually using the
time to optimize their body for their golf swing. And
that's why I made the statement in the beginning, because
(08:10):
every single person that I have ever our our team
has ever rehabbed from a knee replacement, who's done all
the work, shown up beforehand, showing up afterwards and done
it consistently plays better golf after the knee replacement. Like
like bar none that those people who do half the
work and you know, maybe are kind of average, right,
but the people who do the work bar not are
(08:31):
great after the after theknee replacement. So yeah, I think
that's that's for beforehand, you obvious you're gonna have the surgery,
you're gonna wake up. You know, the in the impatient
therapy is gonna come in. Get you up, try to
get your walk in, get just you know, get you
to the side of the bed, you stand, and they'll
take the pain meds for the first couple of days.
Allows you to get moved and get through that initial pain.
Don't try to be you know, Sylvester Stallone or the
(08:54):
Terminator and try to get through it without the pain meds.
Like you're sure, you're you're listening, You're yes, you're tough guy,
But it's actually smarter to take the pain meds in
the first couple of days. It helps you get through.
It allows you to do more, which helps get the
blood flowing, helps the the a demon all the swelling
actually move out of the need the more that you're moving,
which actually helps your pain later on. So they've actually
(09:15):
they've done studies on this stuff. So definitely, you know
you gis the value of the prehab is like even
before the therapist gets you out of bed the first time,
like I literally I drill like the fear of God
into every single person that comes in, Like the second
you wake up, start trying to new quad sets and
any one who's had a knee replacement, probably like maybe
(09:35):
just had a versive reaction to that word, where you know,
the first thing you gotta is you got to get
your quad working. So you're trying to contract your quad
while you're just sitting in bed. Get it firing. So
pull the knee cap up, which is helps the post
to function. Unfortunately, a lot of people, they've been in
pain for so long, they co contract the quad, which
is the muscle on the front of your thigh above
your knee, and the hamstring, which are the muscles on
(09:56):
the back and quad obviously is four muscles. There's a
try your night triceps, that's your arms, your hamstrings on
the back, there's two of those, and you've got to
you know, a lot of people will co contract both
the hamstring and the quad in order to create a
false sense, like not a false sense. It's it's creating
stability around the knee. But they're doing it inefficiently and incorrectly.
(10:18):
That's going to make your git funky. It's gonna, you know,
affect it negatively the ability you know, to move the knee,
those sorts of things. So immediately post up. You want
to get a clean quad contraction. So that we can
dissociate or separate, just like we talk about in golf,
disassociating your lower body and your upper body, where your
lower body fires first, your upper body comes second. You
want to do the same thing just after an ear placement.
You want to get your quad firing without your hamstring
(10:39):
having to go, and vice versa. Make your walking better,
You stabilize better, your pain's better. You're able to get
the swelling out better because you're contracting. You know, people
a lot of people don't realize like using Like when
you have a lot of swelling, the way that your
body drains that is through the limp system, which is
a passive system, meaning it doesn't actively contract like your
blood vessels, like your ories contract and push blood your
(11:03):
your limp. Your limp system is a passive system, so
that actually is going. You need the contraction of the muscles.
The more you contract and move, the more it helps.
To kind of think of it as like the garbage system.
The garbage disposal of your body gets all that waste
and all that the swelling out of there. You know,
the swelling is going and your body's attempt to heal
the knee. That's good initially, but then we want to
(11:24):
help to make sure eth get stuck there. So that's
where kind of moving it and doing the muscle contraction
all that sort of stuff, it really helps to get
the limp system kind of clean and move into you know,
blockages where stuff gets stuck. And the more you have
swelling generally, the more uncomfortable it's going to be. But
you can't avoid the swelling that's going to be there.
It's a massive surgery. They literally cut your bones off
and then put in you know, drill and hammer and
(11:45):
glue in. It's not a gentle surgery, but you're obviously sleeping,
but that's why it's sore, and so that's not a
surprise when it's uncomfortable afterwards. But definitely taking those pain
MEAs initially help you to get through, you know, be
more active and kind of get to that better you know,
on the on the better side, you know that first
week out where you're you're walking in your golf. Now
let's fast forward. You've had the surgery. Now you're going
(12:07):
to your therapy, you know, getting your knee bending, you're
doing all the scar tissue massage. You should be doing scars.
They should be putting their hands on you and massaging
your scar tissue. You know, you're trying to get that
knee bending. You know, at least a hundred twenty degrees.
You're definitely the first thing in the first two weeks.
You've got to get your knee straight. If you don't
get that knee straight's gonna be hard to walk guys.
So that's the number one priority that you have. The
(12:28):
bending can come later, but those are generally you know,
at least on hundred twenty degrees is functional for golf
officecy you're going to get down and read a putt.
You need more than that, so but one twenties is fine.
Then after that, I think this is where like a
lot of people then start to fall off the wagon
because insurance stops paying once you're walking community distances, once
your pain's under control, and honestly, once you've used up
(12:48):
all your visits and there don't give a lion rat's
tail about your golf game trying to keep this clean,
So they're not going to pay for you to rehab
to golf. They're not. So that's where there's this like
Abyss in our healthcare system, where he probably you got
the knee replacement because you wanted to be able to
enjoy the game of golf. You get the near replacement,
(13:10):
then they're like screw you, Like, we're not going to
help you get back to play golf. You got to
pay out of pocket. And that's where places like what
we do come in, where we are not constrained by
the insurance side of things, because they won't let us
work on your hips if we're supposed to be treating
your knee, even though that's probably one of the most
important things we can do to protect the knee. They're
not going to teach you how to weight shift again, right,
They're not going to teach you how to produce tow
(13:32):
heel forces and horizontal forces and vertical forces and do
it in the right sequence, because you basically have to
now start to work out of all the bad habits
that you had developed just because you had pain. And
that's not your fault. You had pain. You're doing what
the best you could to get through it. So I think,
as you're thinking and just just hit me. As you know,
Chris was here talking about the double knee replacements and
(13:52):
he was excited to get on the force plates and
we're going to look at what compensation does he still have?
How can we help him overcome those things? Yeah, the
same principles apply. We always talk about the performance epaiment.
Do you have your got to get the mobility right right,
So for your knee specifically, you got to get it
to fully straight and get it at minimum one hundred
and twenty degreas of ben that's what we're looking for.
You can get more great then you got to then
(14:13):
now you're talking about your actual golf specific mobility or
your rotary centers, your hips, your shoulders, your spine, your neck.
Right now you've checked all of those boxes. Now it's
strength both isolated where you had the kne replaced? Right,
how can you do? Can you squat up and down?
Can you get up and down out of a chair?
Can you balance on one leg? How strong is your
(14:33):
operated leg compared to your non operative leg? They should
be equal like but that that's not normal to have
them different in the initial parts. Yes, they it will
be weaker, but you're talking, you know, eight twelve months out. No,
they should be starting to get pretty close to each other.
If you've been doing the work, big asterisk right, and
doing the work doesn't mean showing up to therapy once
(14:55):
a week and then working out on your own doing theoughbands.
You got to be lifting. You got to be lifting
weight gobblet squads like kettlebell work where deadlifts at the
very least. Like I think that's a big misnomer in
the in my field of physical therapy is we give
people a bunch of bands and think we're doing them
some favor like it's a crock honestly, and a lot
of the puppy milk pete places. We don't get you
(15:17):
guys strong enough. As a profession, we don't do a
good job, you know, not across the board. There's some
therapist out there who are great, but I've seen so
many terrible rehab outcomes because the therapy sucked. Therapists may
get maud of that. But you know, and I understand
those constraints if you're a therapists and you're listening, but
do better or leave, go find a different place to work.
And you know that's what that's what we've done here.
(15:39):
You you know, so as a consumer, for those of
you who are not therapists, demand more. It's okay to say, hey,
I think I need to be lifting you know, heavier
loads I need. Doing step ups on a six inch
little step up is not strength training when it's just
your body weight. When you're trying to put two three
x times that vertical four into your lead leg through impact,
(16:02):
that's not helping your golf game. Just stepping up with
one foot on a six inch six inch step So
I could go for hours here, but just to recap
pre so I think of the three phases of the
knee replacement. You need to prehab. You need to do something.
You go see somebody at least once a week. You
got to you gotta be working out three four times
a week on your own or at least in total. Maybe
(16:25):
you go see that person. That's the one time you
do it. You know, get as strong as you can.
Get insight in terms of how to do quad sets,
how to get your kne a straight as possible, how
to do the everything you possibly can. The rehab after
an initial knee replacement could be done by a monkey.
It's not that hard from a physical therapy standpoint. Get
your quad firing, get your knee bending, get your knees straight.
Most poorly, get the knee straight in the quad firing right.
(16:46):
So knee straight number one quad firing. And you know,
then obviously we can work on bend as we as
you go. Now, then you go to your rehab you
should be generally most places are going to have you
come two times a week for six weeks. They're going
to try to That's how they get their appointments up.
That's the game they have to play in order to
stay in business. It's not their fault, it's the insurance
system that we live in. But make sure you're doing
(17:08):
stuff outside of that and get be You know, you
can work on that leg a couple hours a day,
like you can do two a days, go see your therapist,
and then you do stuff on your own too, and
the more you do that, the quicker you will get better.
And then obviously then you're going to transition into that
gray area where like you're walking your functional in your
day to day life, but you're then the insurances like
(17:28):
kind of kicks you out. And a lot of golfers
that we have know that they're like they just you
just know inherently like I'm not ready, like there's still
more to be done. And then that's where you you know,
we work with lots of people that way, but it's
okay to say that you're not wrong. I'm giving you
permission to say that the medical systems left you shorty,
(17:49):
they left the pot short they never gave you a chance.
But there are options out there, and hopefully you know
this podcast, we have lots of other resources on our
YouTube page and those sorts of things. There's lots of
other people out there that that you can get information
on how to get yourself back to playing the game
of golf and how to do it the right way.
So hopefully that helped a little bit of a soapbox. Apologies,
(18:09):
I have no idea on this podcast is gone, but
I could talk for days on this stuff, just because
I'm so passionate about so many people that I've seen
get screwed just with bad information. And you know, hopefully
this pod and everything that we do is a platform
where we can at least one of you listening get
something out of this that makes me so happy and
so grateful. So thanks so much for hanging out in
here on the golf and this pop Squad. Look forward
(18:31):
to catching in the next episode.
On to the golf in his Bomb Squad. I'm your host,
Chris bin In. Today we're going to dive into a
topic for those of you who've had giant replacements. We
had a guy come in today, actually drove like six
hours to come down to work with us for the day.
Two total new replacements, two shoulder replacements. I jokingly called
him the Biotic Man, but he had a lot of
(00:30):
really great questions. And so this obviously relates to a
lot of you listening who've had joint replacements. Maybe you
have joint pain and that's you know, joint replacement has
been something that's been talked about with your doc. Maybe
you're wondering if it's for you and what does that
mean in terms of your golf swings. What we're gonna do.
We have obviously tons of experience being a physical therapist
myself as well as having our physical therapy practice here
(00:52):
at p for US Golf, you know, working with guys
and girls who've had joint replacements, both in person here
in Raleigh, North Carolina, and also thousands of you that
we've worked with around the world and navigating that, you know,
just from whether it's brand new, you're prepping for it,
you've had it for years, you've just had it, whatever. Maybe,
So what I want to start with is we'll just
(01:14):
start with this chronologically. So we'll start with kind of
considerations if you're thinking about having one, and then we'll
talk about what does that kind of post surgical recovery
look like. And then we'll talk about those of you
who've had you know, had him for a long time,
and you know what's normal what's not normal. I think
there's a lot of bad information out there, and so
kind of the goal would be to make sure you
guys have good information. So I'm gonna we're gonna focus
(01:37):
definitely on the on the knees today. This was a
big topic of question that this gentleman his name is
actually Christ that he had too but he basically came
in and having had both knees replaced, he's I think
you said he's lost. Our call was like thirty yards
in the last five plus years. We'll send it like
you used to hit it like two eighty. He's sixty
(01:59):
mid sixty. I used to hit it to eighty. You know,
it's at about two fifty something. Massive change obviously, And
so for those of you who are thinking about knee replacements.
Distance loss after knee replacements, if done correctly, is not normal.
I'm gonna say that again, and I'm gonna say it slowly.
Distance loss after knee replacements is not normal. I want
(02:23):
you to let that sink in. For those of you
who've had knee replacements and you've lost distance, that means
your rehab was bad or something else is going on now. Naturally,
do we see a decreasing ground forces immediately post operatively,
like when you start going back to swing, Yeah, heck yeah,
because as you have a new joint, you got to
(02:43):
learn to use it again. But for those of you
who let's you know, starting in you know, before surgery,
and I'm gonna I'll dive into that like why that's
not normal as we go through this episode here. But
for those of you who are thinking about the knee
replacements and if if you guys are you know, have
other joint replacements you want me to dive into, you know,
believe comments, you know, reach out you know obviously and
let me know and I'll record you know, some more
(03:04):
episodes on those other topics. But you know, joints, whether elbows, shoulders, hips, ankles,
whatever it may be. I've worked with all of them.
So yeah, the the thing is beforehand, and this gets
lost I think after the near replacement, is that you
don't get a joint replacement unless it's been really bugging
you for a really long time, meaning it hurts when
(03:25):
you walk, it hurts when you play it like and
so naturally what's going to happen is you're going to
use it less. You're gonna avoid it, You're gonna use
your other leg, You're gonna walk differently. Right, So there's
you know a lot of people who get knee replacements
or other joint replacements, like particularly lower extremity, you have
back issues because you try to get through it right.
You try to go as long as humanly possible until
you have to have that giant replaced. And when that happens,
(03:48):
what happens to the joint that ends the leg on
the side that the joint is replaced is you atrophy,
which means you lose muscle. But you also when you swing,
if it hurts, you're gonna change how you swing. You're
not going to push through the ground, you're not going
to clear you're not going to produce the correct sequences
of forces. From a performance standpoint, you're going to correct
the sequence of forces and the amount of weight shift,
(04:08):
and you know the you know the obviously like the
amount left and right, but also you know the degree
to what you push into the ground. All those sorts
of things are going to be based around what feels
the best so you can get through the eighteen holes.
So what a lot of people don't realize is as
you're waiting to get that jar replacement, you're developing bad habits.
And that's you know, that's fine as long as you
(04:29):
know that you're doing it right. And it's obviously the
cost benefit analysis. If you make you know your living
playing the game of golf, maybe you get that jarant
replacement quicker. If it's just something you love doing right
creationally and you want to put off having that knee
replacement as long as possible, then by all means you
do that. But I think I want to make sure
that people understand that the longer you wait, your knee
generally hurts more, so you generally have to compensate more,
(04:52):
and so you're going to have things that aren't great
in your swing, you know, leading up to the surgery
and that's not uncommon for people to see their handicapp
rising and you know, club at speed, go down, accuracy,
all that sort of stuff kind of goes the wrong direction.
Usually speaking, some cases it doesn't, but in a lot
of cases it does. And you know, I think the
things that you can do to be successful pre replacement
(05:14):
are what's called prehabilitation. So I'm going you know, we
have a lot of people who come see us, you know,
before their surgery, to get ready to get strong. Depending
on your insurance, sometimes you'll get your insurance they can
they'll pay for you to go to a couple of
pet sessions beforehand. In my opinion, if you're going to
and this is based off of you know, having done
this for over a decade, a couple sessions isn't enough
(05:37):
unless you I'm just gonna say it's generally not enough.
There's very few people. There's a lot of people who
think they can do stuff by themselves. They get a
couple exercises, they're like, I'm good, I'm gonna go do it.
What people miss is like you don't know how to
progress from that, Like, yeah, that's the right stuff for
you today. But if you're doing the right stuff. Well,
in two weeks, you're going to need new stuff. You're
gonna progress. And that's I think the gap that I
(05:58):
see in a lot of people who work with a
coach or go to a couple sessions and they're like, Okay,
I got it, I'm gonna move on. Well, well you don't.
You have You've got it for that moment for the
next couple of weeks, but you don't have it for
when like you've mastered that and you need to continually
overload that tissue. Like the way the strength training works
is you have to create a constant stressor in that
tissue environment for there to be adaptation. And if you
(06:21):
do the same exercise for the eight weeks leading up
to the surgery, you didn't create any adaptation, like after
probably week two, maybe sooner, depending on what you're doing.
So I think going to somebody you know, at least
on a weekly basis who can progress you. Make sure
you're going into that surgery and as as good of
shape as possible. It's going to be massively beneficial to
you on your recovery and how quickly you get back
(06:42):
to playing golf. I can tell you from experience people
who do that genuine, genuinely are back playing golf like
in half the time if on average, now there's going
to be outliars left, right, right. But generally, speaking from
my experience, to people who come in and do the
work all the way leading up to the day before
surgery will will perform way better on the reab side
(07:06):
of things. They get their knee extension back quicker, they
get their knee bend back quicker, their quads are turned
on way quicker, they're walking without a device way quicker,
their pain levels are way less. It's just it's amazing
how different it is. So if your pre surgery, go
see someone on a weekly basis, get ready for that surgery.
Make sure you're in as good shape as humanly possible.
(07:28):
So literally when you wake up like good preab is
like you're not only are you getting you as strong
and as mobile as possible at the knee, but you're
also how's your hip mobility? Look, how's your shoulder mobility?
Because you get that knee replaced, we want to make
sure you have as minimal stress on that knee as
humanly possible. You just paid five figures plus for it, Like,
let's protect it, let's make sure it's optimized and just
like you would do for a normal joint. You know,
(07:49):
the better your rotary joints are moving the joints around it,
the hips, the shoulders, the spine, and the neck, the
less stress you're gonna have on it, and the more
optimal performance golf wise you're gonna have too. So a
lot of guys who and girls who do their rehab
the prehab first and then do the rehab correctly, actually
are not just rehabbing their knee, They're actually using the
time to optimize their body for their golf swing. And
that's why I made the statement in the beginning, because
(08:10):
every single person that I have ever our our team
has ever rehabbed from a knee replacement, who's done all
the work, shown up beforehand, showing up afterwards and done
it consistently plays better golf after the knee replacement. Like
like bar none that those people who do half the
work and you know, maybe are kind of average, right,
but the people who do the work bar not are
(08:31):
great after the after theknee replacement. So yeah, I think
that's that's for beforehand, you obvious you're gonna have the surgery,
you're gonna wake up. You know, the in the impatient
therapy is gonna come in. Get you up, try to
get your walk in, get just you know, get you
to the side of the bed, you stand, and they'll
take the pain meds for the first couple of days.
Allows you to get moved and get through that initial pain.
Don't try to be you know, Sylvester Stallone or the
(08:54):
Terminator and try to get through it without the pain meds.
Like you're sure, you're you're listening, You're yes, you're tough guy,
But it's actually smarter to take the pain meds in
the first couple of days. It helps you get through.
It allows you to do more, which helps get the
blood flowing, helps the the a demon all the swelling
actually move out of the need the more that you're moving,
which actually helps your pain later on. So they've actually
(09:15):
they've done studies on this stuff. So definitely, you know
you gis the value of the prehab is like even
before the therapist gets you out of bed the first time,
like I literally I drill like the fear of God
into every single person that comes in, Like the second
you wake up, start trying to new quad sets and
any one who's had a knee replacement, probably like maybe
(09:35):
just had a versive reaction to that word, where you know,
the first thing you gotta is you got to get
your quad working. So you're trying to contract your quad
while you're just sitting in bed. Get it firing. So
pull the knee cap up, which is helps the post
to function. Unfortunately, a lot of people, they've been in
pain for so long, they co contract the quad, which
is the muscle on the front of your thigh above
your knee, and the hamstring, which are the muscles on
(09:56):
the back and quad obviously is four muscles. There's a
try your night triceps, that's your arms, your hamstrings on
the back, there's two of those, and you've got to
you know, a lot of people will co contract both
the hamstring and the quad in order to create a
false sense, like not a false sense. It's it's creating
stability around the knee. But they're doing it inefficiently and incorrectly.
(10:18):
That's going to make your git funky. It's gonna, you know,
affect it negatively the ability you know, to move the knee,
those sorts of things. So immediately post up. You want
to get a clean quad contraction. So that we can
dissociate or separate, just like we talk about in golf,
disassociating your lower body and your upper body, where your
lower body fires first, your upper body comes second. You
want to do the same thing just after an ear placement.
You want to get your quad firing without your hamstring
(10:39):
having to go, and vice versa. Make your walking better,
You stabilize better, your pain's better. You're able to get
the swelling out better because you're contracting. You know, people
a lot of people don't realize like using Like when
you have a lot of swelling, the way that your
body drains that is through the limp system, which is
a passive system, meaning it doesn't actively contract like your
blood vessels, like your ories contract and push blood your
(11:03):
your limp. Your limp system is a passive system, so
that actually is going. You need the contraction of the muscles.
The more you contract and move, the more it helps.
To kind of think of it as like the garbage system.
The garbage disposal of your body gets all that waste
and all that the swelling out of there. You know,
the swelling is going and your body's attempt to heal
the knee. That's good initially, but then we want to
(11:24):
help to make sure eth get stuck there. So that's
where kind of moving it and doing the muscle contraction
all that sort of stuff, it really helps to get
the limp system kind of clean and move into you know,
blockages where stuff gets stuck. And the more you have
swelling generally, the more uncomfortable it's going to be. But
you can't avoid the swelling that's going to be there.
It's a massive surgery. They literally cut your bones off
and then put in you know, drill and hammer and
(11:45):
glue in. It's not a gentle surgery, but you're obviously sleeping,
but that's why it's sore, and so that's not a
surprise when it's uncomfortable afterwards. But definitely taking those pain
MEAs initially help you to get through, you know, be
more active and kind of get to that better you know,
on the on the better side, you know that first
week out where you're you're walking in your golf. Now
let's fast forward. You've had the surgery. Now you're going
(12:07):
to your therapy, you know, getting your knee bending, you're
doing all the scar tissue massage. You should be doing scars.
They should be putting their hands on you and massaging
your scar tissue. You know, you're trying to get that
knee bending. You know, at least a hundred twenty degrees.
You're definitely the first thing in the first two weeks.
You've got to get your knee straight. If you don't
get that knee straight's gonna be hard to walk guys.
So that's the number one priority that you have. The
(12:28):
bending can come later, but those are generally you know,
at least on hundred twenty degrees is functional for golf
officecy you're going to get down and read a putt.
You need more than that, so but one twenties is fine.
Then after that, I think this is where like a
lot of people then start to fall off the wagon
because insurance stops paying once you're walking community distances, once
your pain's under control, and honestly, once you've used up
(12:48):
all your visits and there don't give a lion rat's
tail about your golf game trying to keep this clean,
So they're not going to pay for you to rehab
to golf. They're not. So that's where there's this like
Abyss in our healthcare system, where he probably you got
the knee replacement because you wanted to be able to
enjoy the game of golf. You get the near replacement,
(13:10):
then they're like screw you, Like, we're not going to
help you get back to play golf. You got to
pay out of pocket. And that's where places like what
we do come in, where we are not constrained by
the insurance side of things, because they won't let us
work on your hips if we're supposed to be treating
your knee, even though that's probably one of the most
important things we can do to protect the knee. They're
not going to teach you how to weight shift again, right,
They're not going to teach you how to produce tow
(13:32):
heel forces and horizontal forces and vertical forces and do
it in the right sequence, because you basically have to
now start to work out of all the bad habits
that you had developed just because you had pain. And
that's not your fault. You had pain. You're doing what
the best you could to get through it. So I think,
as you're thinking and just just hit me. As you know,
Chris was here talking about the double knee replacements and
(13:52):
he was excited to get on the force plates and
we're going to look at what compensation does he still have?
How can we help him overcome those things? Yeah, the
same principles apply. We always talk about the performance epaiment.
Do you have your got to get the mobility right right,
So for your knee specifically, you got to get it
to fully straight and get it at minimum one hundred
and twenty degreas of ben that's what we're looking for.
You can get more great then you got to then
(14:13):
now you're talking about your actual golf specific mobility or
your rotary centers, your hips, your shoulders, your spine, your neck.
Right now you've checked all of those boxes. Now it's
strength both isolated where you had the kne replaced? Right,
how can you do? Can you squat up and down?
Can you get up and down out of a chair?
Can you balance on one leg? How strong is your
(14:33):
operated leg compared to your non operative leg? They should
be equal like but that that's not normal to have
them different in the initial parts. Yes, they it will
be weaker, but you're talking, you know, eight twelve months out. No,
they should be starting to get pretty close to each other.
If you've been doing the work, big asterisk right, and
doing the work doesn't mean showing up to therapy once
(14:55):
a week and then working out on your own doing theoughbands.
You got to be lifting. You got to be lifting
weight gobblet squads like kettlebell work where deadlifts at the
very least. Like I think that's a big misnomer in
the in my field of physical therapy is we give
people a bunch of bands and think we're doing them
some favor like it's a crock honestly, and a lot
of the puppy milk pete places. We don't get you
(15:17):
guys strong enough. As a profession, we don't do a
good job, you know, not across the board. There's some
therapist out there who are great, but I've seen so
many terrible rehab outcomes because the therapy sucked. Therapists may
get maud of that. But you know, and I understand
those constraints if you're a therapists and you're listening, but
do better or leave, go find a different place to work.
And you know that's what that's what we've done here.
(15:39):
You you know, so as a consumer, for those of
you who are not therapists, demand more. It's okay to say, hey,
I think I need to be lifting you know, heavier
loads I need. Doing step ups on a six inch
little step up is not strength training when it's just
your body weight. When you're trying to put two three
x times that vertical four into your lead leg through impact,
(16:02):
that's not helping your golf game. Just stepping up with
one foot on a six inch six inch step So
I could go for hours here, but just to recap
pre so I think of the three phases of the
knee replacement. You need to prehab. You need to do something.
You go see somebody at least once a week. You
got to you gotta be working out three four times
a week on your own or at least in total. Maybe
(16:25):
you go see that person. That's the one time you
do it. You know, get as strong as you can.
Get insight in terms of how to do quad sets,
how to get your kne a straight as possible, how
to do the everything you possibly can. The rehab after
an initial knee replacement could be done by a monkey.
It's not that hard from a physical therapy standpoint. Get
your quad firing, get your knee bending, get your knees straight.
Most poorly, get the knee straight in the quad firing right.
(16:46):
So knee straight number one quad firing. And you know,
then obviously we can work on bend as we as
you go. Now, then you go to your rehab you
should be generally most places are going to have you
come two times a week for six weeks. They're going
to try to That's how they get their appointments up.
That's the game they have to play in order to
stay in business. It's not their fault, it's the insurance
system that we live in. But make sure you're doing
(17:08):
stuff outside of that and get be You know, you
can work on that leg a couple hours a day,
like you can do two a days, go see your therapist,
and then you do stuff on your own too, and
the more you do that, the quicker you will get better.
And then obviously then you're going to transition into that
gray area where like you're walking your functional in your
day to day life, but you're then the insurances like
(17:28):
kind of kicks you out. And a lot of golfers
that we have know that they're like they just you
just know inherently like I'm not ready, like there's still
more to be done. And then that's where you you know,
we work with lots of people that way, but it's
okay to say that you're not wrong. I'm giving you
permission to say that the medical systems left you shorty,
(17:49):
they left the pot short they never gave you a chance.
But there are options out there, and hopefully you know
this podcast, we have lots of other resources on our
YouTube page and those sorts of things. There's lots of
other people out there that that you can get information
on how to get yourself back to playing the game
of golf and how to do it the right way.
So hopefully that helped a little bit of a soapbox. Apologies,
(18:09):
I have no idea on this podcast is gone, but
I could talk for days on this stuff, just because
I'm so passionate about so many people that I've seen
get screwed just with bad information. And you know, hopefully
this pod and everything that we do is a platform
where we can at least one of you listening get
something out of this that makes me so happy and
so grateful. So thanks so much for hanging out in
here on the golf and this pop Squad. Look forward
(18:31):
to catching in the next episode.
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