November 25, 2024 • 34 mins
Understand the intricacies of managing knee pain with insights from expert physical therapist Shehla Rooney. Shehla unpacks the complexities of knee osteoarthritis, revealing its symptoms, risk factors, and the demographics most affected, emphasizing that while we can't halt time, proactive steps can significantly enhance knee health.
Shehla shares details about conservative treatments while also clarifying the role of surgery and the crucial importance of physical therapy in knee replacement surgical success.
Our discussion about the post-surgery phase emphasizes the significance of tracking range of motion to ensure a smooth recovery. Learn why objective measurements are crucial, how they guide professionals, and what benchmarks indicate progress. We wrap up with practical advice on maintaining knee function through consistent exercise and engaging activities. Plus, stay tuned as we hint at a revolutionary device, the Go Knee, that promises to reshape recovery strategies. Don't miss this episode packed with expert tips and valuable advice for anyone navigating the challenges of knee pain or surgery preparation and recovery.
To connect with Shehla Rooney, PT, visit: thegoknee.com
To connect with Dr. Timothy Kavanaugh, orthopedic surgeon and knee specialist, visit: azortho.com
Together, we'll build Healthy Cells, and a Healthy You!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Janet Walker (00:02):
Knee pain, whether it's from an injury, wear and
tear, a chronic health conditionor a cause unknown.
You just want your knees towork again without pain.
Sometimes, prevention andconservative treatments make all
the difference.
Other times, surgicalintervention is the only
solution is the only solution.
(00:27):
In either case, physicaltherapy for the knees is a way
to ease your muscle and jointpain, strengthen the muscles
around your joint, increase yourflexibility and get the best
knees that your body can giveyou.
Welcome to Healthy Cells,healthy you.
I'm your host, janet Walker.
I've been working in thehealthcare community for over 30
years and for 20 of those yearsI've also worked as a writer
(00:47):
and producer for the WindsorBroadcasting award-winning
national PBS, health informationTV shows, american health
journal and innovations inmedicine.
We've interviewed thousands ofdoctors, scientists and
researchers on every topicrelated to health, medicine and
medical technology.
You can watch current episodesof Innovations in Medicine on
(01:07):
your local PBS channel or youcan stream our programs on the
American Health Journal channel,the Better Health channel and
TV Healthy Kids.
I'm also a new host forWindsor's award-winning podcast
entitled Better Wellness.
Today we're talking to she,sheila Rooney, physical
therapist and creator of a homephysical therapy knee program
(01:30):
that can help you in your questfor healthier knees.
Welcome to the program Sheila.
Shehla Rooney, PT (01:37):
It's so nice to be here, Janet.
I'm excited.
Janet Walker (01:39):
Let's first start talking about how you came to
specialize in knee damage andrecovery, because your practice
is pretty much limited to that.
Is that correct?
Shehla Rooney, PT (01:49):
It is correct and it was not intentional.
I'm what's called GCS certified.
I have a certification ingeriatric physical therapy and
I've been treating the olderadult for like 26 years.
So that's like heart conditions, lung conditions, you know,
cancers, heart failures,diabetes, the whole thing,
amputations.
But about six years ago had apatient that was struggling
(02:12):
after knee replacement surgery.
He shouldn't have been meaning,he was healthy and motivated,
he was doing everything right,but he just wasn't progressing
and was told he needed anotherknee procedure and he just
begged for a solution to avoidthat second surgery.
And as they say, you know,necessity is the mother of
invention.
We created something for him.
It worked.
(02:32):
We tried it on another patientand it worked.
And I just realized, you know,that we had created something
bigger and could have a biggerimpact on a much larger scale.
And knowing that you know thatthere's a possibility of helping
millions of people all over theworld, that we had to explore
it.
And so that's how I became theknee replacement guru, Not
(02:54):
intentional, just by chance.
Janet Walker (02:56):
Wonderful.
Well, we're going to talk alittle bit more about what you
created later, but first let'stalk about osteoarthritis of the
knees.
What is it, who gets it, andwhat symptoms do patients
experience?
Shehla Rooney, PT (03:10):
I feel like everybody kind of knows that
osteoarthritis is the wear andtear arthritis.
It's the shock absorbers in theknee wear down.
Bones are not supposed to toucheach other and so if your
cartilage and your soft tissuewear down, well then instead of
your bones moving smoothly andeasily, with those absorbers in
between, they start getting morerugged and rough, and what that
(03:32):
does is it causes the bones torub together, which causes pain,
stiffness, you know, locking ofyour joints.
So I would say the hallmarksign of knee osteoarthritis is
pain.
The pain is persistent.
It develops gradually over time, like months and years.
So if your pain just started,like two days ago in your knee,
(03:54):
it's not likely osteoarthritisand most people describe it as
like a dull ache.
It gets worse if you'restanding for a long time,
walking for a long time, goingup and down stairs, and then
again people would say, inaddition to pain, they have
stiffness.
Some swelling Patients willtell me you know, my knee
buckles every now and then or itlocks up when I'm walking.
(04:16):
So all those symptoms combinedreally do affect the ability to
move and do everyday tasks.
Now, as for who gets kneeosteoarthritis, there's a lot of
research all over the place.
I mean I call it an older adultissue, like mostly people over
the age of 50, but it can occurin patients that are younger.
It can happen in people whohave, like, excess body weight
so if you're overweight it doesplace extra stress on your
(04:38):
joints but also those who havedone like repetitive aggravating
activities during theirlifetime.
You know, maybe they wererunners, maybe there were
factory workers that werestanding on concrete, you know,
for eight hours a day, you know40 hours a week.
Maybe it was people who didconstruction or climbed ladders
over and over again.
So any job that placed a lot ofstress or activity that placed
(04:58):
a lot of stress on their kneesmakes you a higher risk to kind
of develop osteoarthritis.
But honestly, since I've beendoing all this knee stuff, the
people that tend to need kneereplacement surgery or have like
severe osteoarthritis are thosethat had an injury in the past.
So they'll tell me, like when Iwas 18, I played soccer and I
had a knee injury, or I playedcollege football and I blew my
(05:19):
ACL out and you know they had tohave a repair.
Maybe a meniscus repair ACL,repair ACL out, and you know
they had to have a repair.
Maybe a meniscus repair, an ACLrepair, so that surgery 30, 40,
50 years ago kind of startedthat trajectory of arthritis
developing in that joint andkind of just worsens over time.
So it's a wear and tear of yourknee.
Janet Walker (05:38):
I recently spoke to orthopedic surgeon Timothy
Cavanaugh, who does total kneereplacements.
Orthopedic surgeon TimothyKavanaugh, who does total knee
replacements.
But certainly there are somepreventative measures or
treatments that patients can tryfirst before they make that
surgical leap.
So what are some of theconservative treatments for pain
related to osteoarthritis?
Shehla Rooney, PT (06:00):
As for preventative, I don't know that
we can prevent osteoarthritisbecause I can't prevent myself
from aging, I can't preventmyself from having the injury
that I had when I was, you know,20 years old.
But, you know, maintaining ahealthy weight can help you
maybe prevent it from worsening.
You know, there's like anadditional 10 pounds of weight
on our bodies puts an additional40 pounds of stress on our
knees.
You know, also, activitymodification If you love running
(06:25):
, then maybe you need to lookinto your proper footwear, maybe
get an assessment of how you're, how you're running.
Maybe that needs to be modifiedor maybe running is not an
option for you at this pointbecause it does cause that high
impact activity over and overagain.
And also, I think that thebiggest thing that we don't do
enough is like looking at ourposture, you know, looking at
our footwear.
You know, are we flexible, arewe strong, where we need to be?
(06:49):
I think those basic thingsthey're not like sexy and
glamorous.
You know, just like a warmup,warmup before activity.
You know, I play pickleball andI find I'm the only one on the
court and I'm one of the youngerones that is doing an elaborate
warmup.
They just kind of get on thecourt and start warming up with
their paddles and their balls.
But you know, I'm so aware,being a PT for 26 years you know
injury prevention, warming upmy joints, preparing them for
activity, you know that canreally, in essence again, not
(07:12):
prevent arthritis but maybe slowdown the occurrence of it or
the rapid progression of it.
As for other conservativemeasures knee braces, you know,
or knee supports and I mean yes,they have been proven to help
but nobody wears them, nobodylikes them.
You know they're bulky, theyslide down, women don't like to
wear them under their clothes.
So I you know there's acompliance issue with knee
(07:34):
braces.
So, even though they've beenproven to help reduce that pain
associated with kneeosteoarthritis, I just find if
you don't wear them then itdoesn't help.
Orthotics, like again if youhave, depending where your pain
is or where your arthritis is inyour knee sometimes it's on the
inside of your knees, maybeyou're a little bow-legged
there's certain orthotics andinserts that can kind of help
(07:54):
with that lower body alignmentand help manage your pain a
little longer.
I like some soft wraps, likepeople kind of pull on those
compression sleeves over theirknees when they're doing
activities that are aggravating,and then other conservative
things.
You know there's research outthere that says some supplements
like glucosamine and chondritinand again there's probably
people listening that are like Idon't know, the research is
(08:17):
conflicting.
But you know, depending on thequality of the supplement,
depending on how long you'vetaken the supplement, there are
research that says it hasbenefits to helping manage knee
pain related to osteoarthritis.
And then, as a PT, I stronglyadvocate like topical treatments
(08:37):
, like there's things likeBioFreeze or ointments that have
capsaicin, cbd creams, voltaren, like there are topical agents
that I'll just rub on my kneewhen I need to and it can help
control the pain and allow me todo activities like going to the
gym or walking to maintain ahealthy weight, and these are
ointments and creams that peoplecan try.
Janet Walker (08:54):
if they help them, great.
If they don't help them,there's no adverse effect.
Shehla Rooney, PT (08:56):
Correct, that's exactly right.
Low risk but high value.
And to me you start with thingslike a soft knee sleeve.
You start with things like anointment that you can rub on,
and then you know, if thosedon't work, then you go to
something more like over thecounter, maybe a medication like
a Tylenol or an ibuprofen.
But I find sometimes people goto that first and I don't want
to put something in my body.
(09:17):
That's systemic and you know,again, the older adult might
have stomach issues or ulcerissues and there's certain
medications they can't take.
So let's start with things thatare a little more conservative,
but yeah, ultimately you know,the most beneficial conservative
treatment out there for themanagement of knee OA is
exercise, and everybody hateshearing me say that because it
(09:39):
requires effort.
It's not a pill, it's not, youknow, but ultimately the
research out there, you know, iscompelling on the benefits of
exercise, and what physicaltherapy can do is we can teach
you what exercises you need todo.
That will help you veryspecifically.
Now my pet peeve is, you know,you go to a physical therapist
and they tell you to do allthese like exercises that cause
(10:00):
pain.
But to me remember, as you saidat the beginning, I'm known in
my hometown as the knee lady andI have realized in my earlier
career like I would tell peopleto do activities that literally
increase their pain, which thenreduce their compliance, and
then they just didn't come backand see me and I thought they
were healed but really they justkept living with their pain.
So I think a very intentionalexercise program that's specific
(10:21):
to the knee, stretch the thingsthat get tight around the knee,
strengthen the muscles that getweak around the knee, I think
those are really advantageous.
And if you are going to go tothe PT for conservative, there's
tons of things nowadays that wedo like dry needling and
cupping and taping and scrapingand massage techniques, and then
(10:43):
we have all these modalitieslike electrical stimulation and
shockwave and shortwave,diathermy and ultrasound.
All of these things are kind oflike the ointment, you know,
kind of like the knee sleeve.
They're not taking a pill,they're not having surgery, but
they can just maybe help reduceyour pain so that maybe you can
go to water aerobics, so you canhelp, you know, do the motions
(11:04):
and maybe help doingcardiovascular exercise.
But I do think conservativetreatments tend to for some
reason not be done as early onin the arthritic journey as they
should.
Janet Walker (11:15):
Some of those treatments sound really
interesting.
I'm going to have to have youback for another interview to
talk about those things.
You know, the cupping and thedry needling.
These are all things that arepopping up on our newsfeeds and
our social media and I'd love tohave our listeners learn more
about them.
So I'm going to tap you for anepisode about those things.
(11:39):
But let's talk a little bitabout physical therapies, since
that's what you specialize inand we've been talking about it
a little bit.
When should a patient seek helpfrom a physical therapist, and
can they go on their own, or dothey need to get a doctor to
refer them to a physicaltherapist?
Shehla Rooney, PT (11:57):
There's something called direct access
in physical therapy and most ofthe states in the United States
allow direct access, meaning ifyou think you need physical
therapy you can walk into thetherapy office, you know, make
an appointment and go see them.
The whole point isreimbursement right If you want
insurance to pay for it.
A lot of insurance requires youto go to the doctor first, get
the order and then go tophysical therapy, and a lot of
(12:18):
therapists prefer that as well,just to always have a doctor
involved.
But it's easy to accessphysical therapy is my point
either through direct access orthrough your primary care doctor
.
But as to when to go, what Ifind is people come to see
therapists when their arthritisis severe like or moderate to
severe, not when it's mild.
(12:39):
I think there's a misnomer thatas we age, pain is normal and
that's a myth, like to me.
There's something called normalaging and pathological aging,
and pathological aging is that?
Oh, because I'm this age, Ishould have aches and pains,
like we've all read thosearticles of the centurions that
are like 105, and they don'thave knee pain and they're
walking up and downstairs andliving in Asia or whatever.
(13:01):
So to me it's not true.
So I sometimes think they don'tcome see me soon enough.
But if I was talking to theaudience about when should you
go see a PT?
When you have knee pain, youknow when it starts impacting
your everyday routine, when youstart realizing that you're
sitting down to put your shoeson or you're changing how you
put your socks on, you know,maybe you're not playing
pickleball as much.
(13:21):
Maybe you're like, ah, maybe Iwon't golf 18.
I'll golf nine.
You know.
So when you're I call it yourlife getting smaller, when you
start making your life smallerbecause of your knee pain, go
seek out assistance.
And that's when I'd be likecome see me.
Because what if it's a matterof simply changing an insert in
your shoe?
You know that's not thatevasive, right?
(13:43):
Um, what if it's a posturalthing?
What if there's lots oftherapists that specialize in
golfing?
Like, what if they can changethe mechanic so you're not
hurting that knee?
So I think sometimes they don'tcome see us soon enough.
Janet Walker (13:56):
And is there ever a time when you've worked with a
patient and then you've saidyou know what?
I think it's time for you tohave a surgical consult?
Shehla Rooney, PT (14:05):
100%.
I mean, as we talked about allthose conservative measures, I'm
not going to do that for twoyears, three years, like the
goal is the ones that you talkedabout having me come back, like
the scraping, the taping, thedry needling, those are all
modalities to help reduce painso that we can get you to do
something longer term.
So you know, I'm not going todo that for months and months.
I'm going to do it to controlyour pain, so I can then put you
(14:26):
on the best exercise program tomanage your knee pain and then
that will control it until itdoesn't.
You know, again, it's a wearand tear.
We're standing on our legs,we're bipedal, so we stand up.
So once the conservativemeasures are no longer working,
then I'm going to absolutelyinstruct the patient or tell
them when they're dischargedfrom therapy, like, do these
(14:47):
techniques?
But once your pain starts toget really bad and it's
affecting your daily routine,it's time to go get an
orthopedic consult.
Janet Walker (14:54):
So I don't know if you listened to my recent
episode with Dr Kavanaugh?
I did.
My recent episode with DrKavanaugh I did.
He's a big proponent ofphysical therapy.
In fact, he said that physicaltherapy is probably 40% of the
success of a knee replacementsurgery.
You've worked with a lot ofknee replacement patients.
(15:14):
Have you also found thatsuccessful patients are those
who are really dedicated totheir physical therapy?
Shehla Rooney, PT (15:21):
Yes, I feel like patients compare knee
replacements to hip replacements.
Hip replacements you don't haveto do as much physical therapy
to get the results you want, butwith the knee joint it's very
specific.
Your knee needs to bend andstraighten repeatedly every day,
multiple times a day, in orderto get this recovery.
And I think without guided andagain, I'm not saying it has to
(15:44):
be a physical therapist, butthere has to be somebody that
establishes a very diligentexercise program in order to
have the success.
I did listen to Dr Kavanaugh'sand I fully agree.
Like you could have the bestsurgeon with the best implant,
but if that patient goes homeand just expects to rest for
four to six weeks and assumethat after that time that knee
is going to work great becauseit's brand new, that's not how
(16:05):
this works.
Knee replacement recoveryrequires intentional, active
involvement from the patient.
Janet Walker (16:12):
Yes, Should patients begin physical therapy
before knee replacement surgeryor is it strictly something that
they want to do following kneereplacement surgery?
Shehla Rooney, PT (16:22):
You know again, I've been doing this for
26 years there used to be acommon thread that everybody
went to a joint camp or a prehabprogram before surgery.
And you know, I think the shiftwas that, you know, all of a
sudden reimbursement wasn'tpaying for the prehab programs
or the joint camps, and you know, everything, unfortunately, is
a business, and so it kind ofwent away to the wayside that
(16:44):
you'd scheduled a surgery.
You were given a huge bookletthat kind of had all the
information in it and noteverybody reads it, not
everybody knows what to do withit, and so I feel like it became
a passive process.
But the answer to the questionis should people do prehab or
some kind of therapy before thesurgery?
To me, 100% yes.
The research is clear that themore motion you have in your
(17:08):
knee before surgery, the betterthe outcome.
The stronger your quadricepmuscle is before surgery, the
better the recovery and theoutcome.
So to me those are two thingsthat I am experts in.
Like physical therapists knowhow to increase knee motion and
we know how to strengthenmuscles around the knee joint,
and to me that soft tissue prepwork really helps.
When someone like Dr Kavanaughgoes in and replaces that joint
(17:31):
he's doing a lot of bony changes.
The surgical process involves alot of bone replacing different
things and implant replacingthe bone so that soft tissue
component is integral.
So if you can do things beforethe surgery to prepare, not to
mention the brain, you know Ifeel like people forget that
with knee arthritis your brain'snumber one job is to protect
(17:53):
your knee.
So it almost in essence, like Isaid, when the person starts
sitting down to put their sockson or they start avoiding stairs
, maybe they stop walking asmuch.
You know that's the brain kindof telling them that that's
going to hurt, so let's avoidthat activity.
So part of doing prehab isreawakening the brain and
connecting it to this arthriticknee and saying it's okay to do
(18:15):
some activity with this knee.
So that way when the surgeryhappens and there's a brand
spanking new knee in there, it'snot a shock to your brain Like
whoa, we haven't done anythingwith this knee for months, maybe
years, you know, you think it'sjust going to let you do things
that inflict pain on yourself.
It doesn't work that way.
So yes, prehab, somethingbefore surgery, is crucial.
Janet Walker (18:37):
You know, it's interesting because in preparing
for this series on total kneereplacement, I've talked to a
lot of knee replacement patientsand the majority of them have
said that their second knee waseasier, they recovered faster,
and I wonder if that's becausethey've been doing the rehab on
(18:59):
their first surgical knee, whichyou know in turn gives them
some exercise and prehab on thesecond.
Shehla Rooney, PT (19:06):
I think there's absolute truth in that.
I think, in addition to them,like maybe walking more, because
it takes two legs to walk, ittakes two legs to stand up, it
takes two legs, so all of asudden they're doing more
activity number one, but I thinkit's also expectations.
I think it's like they realizedhow much work it took to get
(19:26):
that knee moving, and so I thinkthat the expectation is
different for the second one,and when the expectation is
different, you're going to havea different result.
Janet Walker (19:31):
Let's talk about that a little bit.
What are some commonmisconceptions that patients
have with total knee replacement?
Shehla Rooney, PT (19:37):
Well, we just I think the one we just talked
about, where you know, doingphysical therapy or exercise
before surgery won't make a hugedifference, you know.
So they avoid activities, youknow, which in essence results
in them becoming weaker andtighter and more deconditioned
leading up to the surgery.
So I've heard many people say,yeah, I'm not going to go to
therapy.
The surgery has been scheduled,the surgeon's going to fix my
(19:58):
knee, so I'm just going to waitit out.
So that's one misconception iskind of sit tight and rest until
the surgery because you mightcause damage to that knee before
.
That's not true.
I think another misconceptionis people get their hip done and
then they think their knee,although listening to Facebook
support groups I'm realizingpeople now realize there's a big
difference between hips andknees.
So definitely hips are not thesame as knees.
(20:20):
So that's a misconception.
And I think anothermisconception is they think
their knee is going to feelnormal after the surgery.
But you know, in essence youhave put a brand new, you know,
metal, plastic implant into yourbody.
It can never feel the same asthe one that God gave you at the
beginning.
And so I think people are likeI thought it was going to feel
normal, or I can kind of feelthat in my knee, or my knee
(20:42):
looks a little bigger than theother knee.
When's it going to feel normal?
I think that that's amisconception.
I think they don't understandthe pain will go away or reduce
and they'll be able to do thingsthey didn't do before that pain
was inhibiting them from.
But I don't know that it everfully feels normal per se.
And then I think also themisconception that I hear all
(21:03):
the time is underestimating howlong the recovery actually takes
.
I think people are like youknow, four to six weeks, and I
should feel normal.
Four to six weeks, why is myknee still hurting and stiff?
Or even eight weeks.
So I think there's amisconception that you know the
recovery should be faster thanit is, and so that causes a
whole slew of.
You know, if your expectationsare in six weeks, I should feel
(21:25):
so much better.
Or maybe they're going back towork in six weeks and they
realize they're not ready right.
So there's a misconception.
I don't think people plan longenough for how long the recovery
takes.
Janet Walker (21:36):
What is the typical recovery time, like
what's normal, for saying, okay,I'm this many months past
surgery but you averages, butI've had all spectrums, but you
(22:01):
know it depends on what theirtherapy looked like.
Shehla Rooney, PT (22:04):
It depends what their pre-surgical status
looked like.
It looked, it depends on theircomorbidities, it depends on
their motivation level, itdepends on their financial
situation.
You know, even where they arein the United States can make a
difference in terms of whatinsurance covers or doesn't
cover.
So, you know, I will give youthe generic response that I
think all surgeons would agreewith me is you know, give it a
(22:24):
full year before you make adecision on whether you regret
having the surgery.
Now, I don't like that.
So that's my, that's my generalresponse that I should give.
But if you're asking mespecific, which I shoot it
straight, I'm going to say youknow, most people regret having
that surgery the first seven to10 days, you know for sure.
You know, because it's a verypainful recovery.
(22:46):
But by two weeks and threeweeks, I mean, you know this
surgery, you're walkingindependently the day of yes,
you're using a walker, butyou're walking independently.
You know, within a week you'regetting yourself dressed and
taking yourself to the bathroomand you're, you know, walking
around in your house.
Again, it doesn't feel great,but you're doing all those
things, um, you know.
(23:08):
So I would say, by four weeksyour knee is moving better, so
you're able to get up and downbetter and again get in and out
of a car.
You might be able to resumedriving at that point.
Um, but yeah, I would say eightweeks is when you're like yep, I
can dress myself, yep, I candrive, yes, I can walk and move
around.
Uh, maybe stairs are still alittle tweaky and you feel like
I don't like how my knee feelswhen I go upstairs or walk long
distances.
But really for three monthsyou're, it takes like three
(23:31):
months for your bone to evengrow into that implant.
So to expect in less than threemonths you're not going to have
pain or swelling or discomfort,I think is unreasonable.
But I think you'll be veryfunctional well before the three
month mark, meaning veryindependent, like if somebody
watched you, it looks likeyou're resuming normal life, but
you personally are like I stillfeel my knee.
It reminds me if I do toolittle or too much.
(23:53):
You know you can't forget itfor those first three months.
Janet Walker (23:57):
Are there any common mistakes that patients
make that can inhibit theirrecovery?
So many, so many so many.
Shehla Rooney, PT (24:05):
So one that a patient just told me a couple
of days ago was he took it as abadge of honor that he was off
all the pain medications thatthe doctor had prescribed and he
was only like six days aftersurgery.
So I think that's a mistakepatients make, is they think
it's a badge of honor to weanoff the heavy pain meds because
of the fear of addiction andnarcotics and all that stuff.
So unless there is a history ofaddiction in your life or
(24:28):
you're having a major sideeffect to the heavy pain meds, I
suggest you really do takethose, especially for the first
two weeks, because if it allowsyou to work your knee harder,
then you're going to reap thebenefits of gaining that knee
motion faster, trying to getthat quadricep muscle to
activate sooner.
So common mistake is weaningoff the pain meds too soon.
I think another one is doingtoo much of the wrong stuff.
(24:51):
Again, I had a patient thispast week who was telling me
that he was adding like I don'tknow something like 500 to a
thousand steps every hour.
That he was awake and he'sright, and he still hadn't met
his range of motion goals.
So you know.
And then he was saying that hisleg would swell up at the end
of the day.
So part of me was like you'redoing too much of the wrong
stuff.
After knee replacement surgerywe already know you can walk.
(25:11):
You can walk the day of surgery.
I think the thing you can't dois bend and straighten your knee
easily.
So, to me, doing too muchwalking or doing too much riding
a bike even I like riding abike.
It loosens the knee up andhelps reduce stiffness.
But the bike should be in not30 minutes of riding a bike, it
should be five minutes so thatyou can then do some active
exercise to increase yourbending and your straightening.
(25:34):
So doing too much of the wrongstuff I think is a mistake
people make.
They think because I'm walking,I'm exercising, but not all
exercises are created equalafter knee replacement.
I think also a mistake patientsmake is they defer to the
physical therapist too muchabout their recovery, meaning
what I do two or three times aweek when I go see Shella trumps
(25:54):
anything that I do at home.
And that is not true.
I think that what you do athome every day is going to trump
whatever I do in the clinic.
So what we do seven days a weekis going to make a bigger
difference than what you do athome every day is going to trump
whatever I do in the clinic.
So you know what we do sevendays a week is going to make a
bigger difference than what youdo two or three times a week.
So a lot of patients are kindof like they pass the buck to
the physical therapist, to kindof be reliant on gaining the
knee motion or getting the legstraight.
(26:15):
I think that's a big mistakePTs make.
And then another one is thatbecause of the pain after the
surgery they don't pushthemselves.
I think a huge mistake.
Patients don't realize and thisis specific only to knee
replacements.
I'm not saying this toeverything.
So if your listeners are likewhoa, I had pain and I tore
something, no, no, no For kneereplacement recovery, a lot of
(26:36):
patients will say it's hurtingso bad so I'm going to stop the
activity.
But I think that there's aneurological component they're
not aware of that your brainsays it hurts so you should stop
doing it.
But in actuality there's notissue damage occurring and so
there's a disclaimer, meaningpain with tissue damage means
don't do something, but painwith no tissue damage means just
(26:59):
proceed with caution, and so acommon mistake I see is my knee
hurt too bad.
I couldn't do the exercises,and that is not negotiable in
knee replacement recovery.
Pain is just a reminder thatyour brain doesn't like what
you're doing with kneereplacement, but it doesn't mean
to stop doing what you're doing.
So again, people will walkbecause it feels better than
(27:19):
bending the knee.
But bending the knee is the keyto the recovery, more than
walking is.
Janet Walker (27:26):
What is normal range of motion?
I assume that's the bending andstraightening you're talking
about.
Shehla Rooney, PT (27:31):
Yes.
Janet Walker (27:32):
What is normal for a knee replacement patient and
when do they want to questionthe fact that they're not where
they should be and take the nextstep?
Shehla Rooney, PT (27:42):
Okay, so normal range of motion.
You'll hear a therapist saylike zero to 135 or zero to 140.
Zero means your knee is fullystraight.
So zero is a straight knee.
140, 145 is like my heel to mybottom, like it's all the way
back.
Think of like a, you know ahamstring curl thing.
Your, your, your heel istouching your bottom.
(28:03):
So that's normal range ofmotion.
Some people have 150, 155.
It depends on your soft tissuerestriction.
But you know, as far as yourknee can bend After surgery,
obviously the biggest thing thathappens is you wake from
surgery after anesthesia andyour leg just balloons up, it
swells up, it stiffens up andyou know, motion is very
restricted.
So what normally happens ispeople lose that knee
(28:25):
straightening ability.
So instead of that number beingzero, sometimes therapists will
say minus 15.
That means you're lacking 15degrees from straight.
Okay, um, and then they'll say90 degrees.
Well, 90 degrees is you know mesitting in my desk chair right
now with my you know hipparallel to the floor and my
ankle directly underneath myknee.
(28:46):
So those are kind of norms,like 90 is, you know, just
sitting regularly in a chair.
But as for norms after kneereplacement surgery, again it's
going to depend on how hard didyou work?
What was your pre-surgicalrange of motion?
How hard did you push yourself?
What are your goals?
You know, if you only had ahundred degrees before, you know
(29:06):
, research says that you'regoing to be lucky to get to
maybe 105, 110, you know, maybemore.
That's why it's so important todo that prehab.
But for me, and what I do everyday, my I'm going to throw out
numbers that some people aregoing to be like whoa, but to me
I want my patients at one weekto be at, like, you know, zero,
meaning they can get to fullystraight to about 110 degrees.
(29:26):
You know, by two weeks I wantthem to get as close to zero to
120 degrees.
You know, by three weeks I wantthem to be at 120 plus and
everything after that is icingon the cake.
But again, that's my goals forthem.
I think it's reasonable andobtainable.
I think that that's not alwaysthe norm because patients, you
know the pain makes them inhibit.
(29:47):
They don't want to do as much.
Maybe they have weaned theirpain medicines.
But the range of motion numbers,I like objective numbers.
Some patients hate it, but mything is you have to know the
numbers because the number tellsme something.
If they say I'm off the walkerin the cane, I'm like what's
your straightening number?
And they're like minus eight.
I'm like, oh so you're walkingwith a limp.
(30:10):
And they're like, oh so youknow, it tells me you shouldn't
be off the walker in the cane,like put that cane back in,
because we don't want to walkwith a limp and reinforce a
habit that will be hard to break.
So the range of motion numbersare important because they tell
health professionals you knowwhat is normal, what is not
normal.
And when you asked about whenshould you worry, if you go back
to your follow-up appointmentwith your surgeon at the 30-day
mark and they look at your rangeof motion and it's between like
(30:32):
85 and even 95 degrees ofmotion, they're going to start
to get concerned because it'sbeen four weeks.
They're probably going to havea conversation with you that hey
, if you don't get that kneebending more, we're going to
have to discuss on your nextvisit, maybe at the two month
mark, that you need amanipulation under anesthesia
because your knee is not movingas well as they think it should.
So that's kind of a stapleacross the board that if you're
(30:55):
still kind of stuck at 90degrees at four weeks in.
You're kind of behind the eightball.
Janet Walker (31:03):
So we've talked about how important physical
therapy following surgery athome is.
How long should patients dophysical therapy or exercises
for their surgical knee for, youknow, a few weeks after the
release from physical therapy, afew months, a few years or
forever?
Shehla Rooney, PT (31:19):
Great question.
So it kind of depends on theindividual's goals and how fast
they recover.
So you know you could havepatient A who gets their range
of motion to like zero to 130 inthe first month.
But if you let up too soon, Imentioned that it takes three
months for that bone and thatimplant to kind of grow together
.
So I find people who gainmotion really quickly kind of
(31:41):
back off because their knee isdoing so well and then they'll
lose some.
So you'll lose like 10 degreesof range of motion in those
first three months if you let up.
So the answer to your questionis for those first four to six
weeks you were doing exerciseslike three to five times a day
every day.
After the first four to sixweeks, if you're meeting your
range of motion goals, you couldprobably ease up on that to
(32:01):
maybe three times a day everyday.
You know, for the next fewweeks, till you're yeah, till
you're like at the eight weekmark, nine week mark.
But you know to me even thatlast you know the second month
to the third month, you shouldbe doing something still every
day that bends and straightensthat knee because you can lose
it.
So I've seen people at threeand four months that had done
really well beginning.
(32:22):
You know they're like why am Iwalking with a limp?
And they're they lost a littlebit of their knee straightening?
Or they're like my.
You know, my knee used to beeasy to bend and now it's like I
feel like I've lost about 15degrees.
Or the PT measured it from lastweek to this week and I've lost
seven degrees.
Why would that be?
And it's because they eased upon the exercises.
So my answer to people is howoften should you do it?
It depends.
(32:43):
I mean, ease back off on yourexercises and then if you feel
the tightness starting to comeback, then you have to increase
that back up.
But it's a fluctuating gamethat if you do too little you
lose it, if you do too much youcan cause some increased
discomfort.
So it's a balancing act.
But it is very individualbecause some people they get
that motion back and then theyresume activities they like,
(33:04):
which also puts their kneethrough a full motion and that's
great.
I would rather you be outsidedoing something to bend your
knee than sitting in a chairdoing a standard exercise.
Overall, you should still bedoing some sort of knee exercise
program within the first threemonths, and from three to six
months you should be doingsomething, albeit at a maybe
reduced frequency.
Maybe it's three times a week,but I will also say that even at
(33:27):
a year mark you got to be doingsomething that keeps that knee
active.
But I hope it's, like you know,a fun activity that you enjoy
doing, instead of these seatedexercises or bed exercises that
you've been doing the firstthree months.
Janet Walker (33:41):
Now, I know you created a device and protocol
that's proving to be a greathelp to knee patients, but I was
hoping that I can talk to youabout that a little bit when you
come back, because we're out oftime right now.
So would you come back to talkto us about the Go Knee?
Shehla Rooney, PT (33:55):
Oh, it would be, my pleasure.
Janet Walker (33:58):
Well, shella, thank you so much for being with
us today and educating usListeners.
You can connect with Shella atthegonicom that's wwwthegonicom.
And thank you so much, everyonefor listening to the Healthy
(34:19):
Cells Healthy you podcast withme, your host, janet Walker.
You can find us on ApplePodcasts, google Podcasts,
iheartradio, spotify or whereveryou get your podcasts.
Subscribe and tell your friends.
We'll help you find solutionsand together we'll build healthy
cells and a healthy you.
Knee pain, whether it's from an injury, wear and
tear, a chronic health conditionor a cause unknown.
You just want your knees towork again without pain.
Sometimes, prevention andconservative treatments make all
the difference.
Other times, surgicalintervention is the only
solution is the only solution.
(00:27):
In either case, physicaltherapy for the knees is a way
to ease your muscle and jointpain, strengthen the muscles
around your joint, increase yourflexibility and get the best
knees that your body can giveyou.
Welcome to Healthy Cells,healthy you.
I'm your host, janet Walker.
I've been working in thehealthcare community for over 30
years and for 20 of those yearsI've also worked as a writer
(00:47):
and producer for the WindsorBroadcasting award-winning
national PBS, health informationTV shows, american health
journal and innovations inmedicine.
We've interviewed thousands ofdoctors, scientists and
researchers on every topicrelated to health, medicine and
medical technology.
You can watch current episodesof Innovations in Medicine on
(01:07):
your local PBS channel or youcan stream our programs on the
American Health Journal channel,the Better Health channel and
TV Healthy Kids.
I'm also a new host forWindsor's award-winning podcast
entitled Better Wellness.
Today we're talking to she,sheila Rooney, physical
therapist and creator of a homephysical therapy knee program
(01:30):
that can help you in your questfor healthier knees.
Welcome to the program Sheila.
Shehla Rooney, PT (01:37):
It's so nice to be here, Janet.
I'm excited.
Janet Walker (01:39):
Let's first start talking about how you came to
specialize in knee damage andrecovery, because your practice
is pretty much limited to that.
Is that correct?
Shehla Rooney, PT (01:49):
It is correct and it was not intentional.
I'm what's called GCS certified.
I have a certification ingeriatric physical therapy and
I've been treating the olderadult for like 26 years.
So that's like heart conditions, lung conditions, you know,
cancers, heart failures,diabetes, the whole thing,
amputations.
But about six years ago had apatient that was struggling
(02:12):
after knee replacement surgery.
He shouldn't have been meaning,he was healthy and motivated,
he was doing everything right,but he just wasn't progressing
and was told he needed anotherknee procedure and he just
begged for a solution to avoidthat second surgery.
And as they say, you know,necessity is the mother of
invention.
We created something for him.
It worked.
(02:32):
We tried it on another patientand it worked.
And I just realized, you know,that we had created something
bigger and could have a biggerimpact on a much larger scale.
And knowing that you know thatthere's a possibility of helping
millions of people all over theworld, that we had to explore
it.
And so that's how I became theknee replacement guru, Not
(02:54):
intentional, just by chance.
Janet Walker (02:56):
Wonderful.
Well, we're going to talk alittle bit more about what you
created later, but first let'stalk about osteoarthritis of the
knees.
What is it, who gets it, andwhat symptoms do patients
experience?
Shehla Rooney, PT (03:10):
I feel like everybody kind of knows that
osteoarthritis is the wear andtear arthritis.
It's the shock absorbers in theknee wear down.
Bones are not supposed to toucheach other and so if your
cartilage and your soft tissuewear down, well then instead of
your bones moving smoothly andeasily, with those absorbers in
between, they start getting morerugged and rough, and what that
(03:32):
does is it causes the bones torub together, which causes pain,
stiffness, you know, locking ofyour joints.
So I would say the hallmarksign of knee osteoarthritis is
pain.
The pain is persistent.
It develops gradually over time, like months and years.
So if your pain just started,like two days ago in your knee,
(03:54):
it's not likely osteoarthritisand most people describe it as
like a dull ache.
It gets worse if you'restanding for a long time,
walking for a long time, goingup and down stairs, and then
again people would say, inaddition to pain, they have
stiffness.
Some swelling Patients willtell me you know, my knee
buckles every now and then or itlocks up when I'm walking.
(04:16):
So all those symptoms combinedreally do affect the ability to
move and do everyday tasks.
Now, as for who gets kneeosteoarthritis, there's a lot of
research all over the place.
I mean I call it an older adultissue, like mostly people over
the age of 50, but it can occurin patients that are younger.
It can happen in people whohave, like, excess body weight
so if you're overweight it doesplace extra stress on your
(04:38):
joints but also those who havedone like repetitive aggravating
activities during theirlifetime.
You know, maybe they wererunners, maybe there were
factory workers that werestanding on concrete, you know,
for eight hours a day, you know40 hours a week.
Maybe it was people who didconstruction or climbed ladders
over and over again.
So any job that placed a lot ofstress or activity that placed
(04:58):
a lot of stress on their kneesmakes you a higher risk to kind
of develop osteoarthritis.
But honestly, since I've beendoing all this knee stuff, the
people that tend to need kneereplacement surgery or have like
severe osteoarthritis are thosethat had an injury in the past.
So they'll tell me, like when Iwas 18, I played soccer and I
had a knee injury, or I playedcollege football and I blew my
(05:19):
ACL out and you know they had tohave a repair.
Maybe a meniscus repair ACL,repair ACL out, and you know
they had to have a repair.
Maybe a meniscus repair, an ACLrepair, so that surgery 30, 40,
50 years ago kind of startedthat trajectory of arthritis
developing in that joint andkind of just worsens over time.
So it's a wear and tear of yourknee.
Janet Walker (05:38):
I recently spoke to orthopedic surgeon Timothy
Cavanaugh, who does total kneereplacements.
Orthopedic surgeon TimothyKavanaugh, who does total knee
replacements.
But certainly there are somepreventative measures or
treatments that patients can tryfirst before they make that
surgical leap.
So what are some of theconservative treatments for pain
related to osteoarthritis?
Shehla Rooney, PT (06:00):
As for preventative, I don't know that
we can prevent osteoarthritisbecause I can't prevent myself
from aging, I can't preventmyself from having the injury
that I had when I was, you know,20 years old.
But, you know, maintaining ahealthy weight can help you
maybe prevent it from worsening.
You know, there's like anadditional 10 pounds of weight
on our bodies puts an additional40 pounds of stress on our
knees.
You know, also, activitymodification If you love running
(06:25):
, then maybe you need to lookinto your proper footwear, maybe
get an assessment of how you're, how you're running.
Maybe that needs to be modifiedor maybe running is not an
option for you at this pointbecause it does cause that high
impact activity over and overagain.
And also, I think that thebiggest thing that we don't do
enough is like looking at ourposture, you know, looking at
our footwear.
You know, are we flexible, arewe strong, where we need to be?
(06:49):
I think those basic thingsthey're not like sexy and
glamorous.
You know, just like a warmup,warmup before activity.
You know, I play pickleball andI find I'm the only one on the
court and I'm one of the youngerones that is doing an elaborate
warmup.
They just kind of get on thecourt and start warming up with
their paddles and their balls.
But you know, I'm so aware,being a PT for 26 years you know
injury prevention, warming upmy joints, preparing them for
activity, you know that canreally, in essence again, not
(07:12):
prevent arthritis but maybe slowdown the occurrence of it or
the rapid progression of it.
As for other conservativemeasures knee braces, you know,
or knee supports and I mean yes,they have been proven to help
but nobody wears them, nobodylikes them.
You know they're bulky, theyslide down, women don't like to
wear them under their clothes.
So I you know there's acompliance issue with knee
(07:34):
braces.
So, even though they've beenproven to help reduce that pain
associated with kneeosteoarthritis, I just find if
you don't wear them then itdoesn't help.
Orthotics, like again if youhave, depending where your pain
is or where your arthritis is inyour knee sometimes it's on the
inside of your knees, maybeyou're a little bow-legged
there's certain orthotics andinserts that can kind of help
(07:54):
with that lower body alignmentand help manage your pain a
little longer.
I like some soft wraps, likepeople kind of pull on those
compression sleeves over theirknees when they're doing
activities that are aggravating,and then other conservative
things.
You know there's research outthere that says some supplements
like glucosamine and chondritinand again there's probably
people listening that are like Idon't know, the research is
(08:17):
conflicting.
But you know, depending on thequality of the supplement,
depending on how long you'vetaken the supplement, there are
research that says it hasbenefits to helping manage knee
pain related to osteoarthritis.
And then, as a PT, I stronglyadvocate like topical treatments
(08:37):
, like there's things likeBioFreeze or ointments that have
capsaicin, cbd creams, voltaren, like there are topical agents
that I'll just rub on my kneewhen I need to and it can help
control the pain and allow me todo activities like going to the
gym or walking to maintain ahealthy weight, and these are
ointments and creams that peoplecan try.
Janet Walker (08:54):
if they help them, great.
If they don't help them,there's no adverse effect.
Shehla Rooney, PT (08:56):
Correct, that's exactly right.
Low risk but high value.
And to me you start with thingslike a soft knee sleeve.
You start with things like anointment that you can rub on,
and then you know, if thosedon't work, then you go to
something more like over thecounter, maybe a medication like
a Tylenol or an ibuprofen.
But I find sometimes people goto that first and I don't want
to put something in my body.
(09:17):
That's systemic and you know,again, the older adult might
have stomach issues or ulcerissues and there's certain
medications they can't take.
So let's start with things thatare a little more conservative,
but yeah, ultimately you know,the most beneficial conservative
treatment out there for themanagement of knee OA is
exercise, and everybody hateshearing me say that because it
(09:39):
requires effort.
It's not a pill, it's not, youknow, but ultimately the
research out there, you know, iscompelling on the benefits of
exercise, and what physicaltherapy can do is we can teach
you what exercises you need todo.
That will help you veryspecifically.
Now my pet peeve is, you know,you go to a physical therapist
and they tell you to do allthese like exercises that cause
(10:00):
pain.
But to me remember, as you saidat the beginning, I'm known in
my hometown as the knee lady andI have realized in my earlier
career like I would tell peopleto do activities that literally
increase their pain, which thenreduce their compliance, and
then they just didn't come backand see me and I thought they
were healed but really they justkept living with their pain.
So I think a very intentionalexercise program that's specific
(10:21):
to the knee, stretch the thingsthat get tight around the knee,
strengthen the muscles that getweak around the knee, I think
those are really advantageous.
And if you are going to go tothe PT for conservative, there's
tons of things nowadays that wedo like dry needling and
cupping and taping and scrapingand massage techniques, and then
(10:43):
we have all these modalitieslike electrical stimulation and
shockwave and shortwave,diathermy and ultrasound.
All of these things are kind oflike the ointment, you know,
kind of like the knee sleeve.
They're not taking a pill,they're not having surgery, but
they can just maybe help reduceyour pain so that maybe you can
go to water aerobics, so you canhelp, you know, do the motions
(11:04):
and maybe help doingcardiovascular exercise.
But I do think conservativetreatments tend to for some
reason not be done as early onin the arthritic journey as they
should.
Janet Walker (11:15):
Some of those treatments sound really
interesting.
I'm going to have to have youback for another interview to
talk about those things.
You know, the cupping and thedry needling.
These are all things that arepopping up on our newsfeeds and
our social media and I'd love tohave our listeners learn more
about them.
So I'm going to tap you for anepisode about those things.
(11:39):
But let's talk a little bitabout physical therapies, since
that's what you specialize inand we've been talking about it
a little bit.
When should a patient seek helpfrom a physical therapist, and
can they go on their own, or dothey need to get a doctor to
refer them to a physicaltherapist?
Shehla Rooney, PT (11:57):
There's something called direct access
in physical therapy and most ofthe states in the United States
allow direct access, meaning ifyou think you need physical
therapy you can walk into thetherapy office, you know, make
an appointment and go see them.
The whole point isreimbursement right If you want
insurance to pay for it.
A lot of insurance requires youto go to the doctor first, get
the order and then go tophysical therapy, and a lot of
(12:18):
therapists prefer that as well,just to always have a doctor
involved.
But it's easy to accessphysical therapy is my point
either through direct access orthrough your primary care doctor
.
But as to when to go, what Ifind is people come to see
therapists when their arthritisis severe like or moderate to
severe, not when it's mild.
(12:39):
I think there's a misnomer thatas we age, pain is normal and
that's a myth, like to me.
There's something called normalaging and pathological aging,
and pathological aging is that?
Oh, because I'm this age, Ishould have aches and pains,
like we've all read thosearticles of the centurions that
are like 105, and they don'thave knee pain and they're
walking up and downstairs andliving in Asia or whatever.
(13:01):
So to me it's not true.
So I sometimes think they don'tcome see me soon enough.
But if I was talking to theaudience about when should you
go see a PT?
When you have knee pain, youknow when it starts impacting
your everyday routine, when youstart realizing that you're
sitting down to put your shoeson or you're changing how you
put your socks on, you know,maybe you're not playing
pickleball as much.
(13:21):
Maybe you're like, ah, maybe Iwon't golf 18.
I'll golf nine.
You know.
So when you're I call it yourlife getting smaller, when you
start making your life smallerbecause of your knee pain, go
seek out assistance.
And that's when I'd be likecome see me.
Because what if it's a matterof simply changing an insert in
your shoe?
You know that's not thatevasive, right?
(13:43):
Um, what if it's a posturalthing?
What if there's lots oftherapists that specialize in
golfing?
Like, what if they can changethe mechanic so you're not
hurting that knee?
So I think sometimes they don'tcome see us soon enough.
Janet Walker (13:56):
And is there ever a time when you've worked with a
patient and then you've saidyou know what?
I think it's time for you tohave a surgical consult?
Shehla Rooney, PT (14:05):
100%.
I mean, as we talked about allthose conservative measures, I'm
not going to do that for twoyears, three years, like the
goal is the ones that you talkedabout having me come back, like
the scraping, the taping, thedry needling, those are all
modalities to help reduce painso that we can get you to do
something longer term.
So you know, I'm not going todo that for months and months.
I'm going to do it to controlyour pain, so I can then put you
(14:26):
on the best exercise program tomanage your knee pain and then
that will control it until itdoesn't.
You know, again, it's a wearand tear.
We're standing on our legs,we're bipedal, so we stand up.
So once the conservativemeasures are no longer working,
then I'm going to absolutelyinstruct the patient or tell
them when they're dischargedfrom therapy, like, do these
(14:47):
techniques?
But once your pain starts toget really bad and it's
affecting your daily routine,it's time to go get an
orthopedic consult.
Janet Walker (14:54):
So I don't know if you listened to my recent
episode with Dr Kavanaugh?
I did.
My recent episode with DrKavanaugh I did.
He's a big proponent ofphysical therapy.
In fact, he said that physicaltherapy is probably 40% of the
success of a knee replacementsurgery.
You've worked with a lot ofknee replacement patients.
(15:14):
Have you also found thatsuccessful patients are those
who are really dedicated totheir physical therapy?
Shehla Rooney, PT (15:21):
Yes, I feel like patients compare knee
replacements to hip replacements.
Hip replacements you don't haveto do as much physical therapy
to get the results you want, butwith the knee joint it's very
specific.
Your knee needs to bend andstraighten repeatedly every day,
multiple times a day, in orderto get this recovery.
And I think without guided andagain, I'm not saying it has to
(15:44):
be a physical therapist, butthere has to be somebody that
establishes a very diligentexercise program in order to
have the success.
I did listen to Dr Kavanaugh'sand I fully agree.
Like you could have the bestsurgeon with the best implant,
but if that patient goes homeand just expects to rest for
four to six weeks and assumethat after that time that knee
is going to work great becauseit's brand new, that's not how
(16:05):
this works.
Knee replacement recoveryrequires intentional, active
involvement from the patient.
Janet Walker (16:12):
Yes, Should patients begin physical therapy
before knee replacement surgeryor is it strictly something that
they want to do following kneereplacement surgery?
Shehla Rooney, PT (16:22):
You know again, I've been doing this for
26 years there used to be acommon thread that everybody
went to a joint camp or a prehabprogram before surgery.
And you know, I think the shiftwas that, you know, all of a
sudden reimbursement wasn'tpaying for the prehab programs
or the joint camps, and you know, everything, unfortunately, is
a business, and so it kind ofwent away to the wayside that
(16:44):
you'd scheduled a surgery.
You were given a huge bookletthat kind of had all the
information in it and noteverybody reads it, not
everybody knows what to do withit, and so I feel like it became
a passive process.
But the answer to the questionis should people do prehab or
some kind of therapy before thesurgery?
To me, 100% yes.
The research is clear that themore motion you have in your
(17:08):
knee before surgery, the betterthe outcome.
The stronger your quadricepmuscle is before surgery, the
better the recovery and theoutcome.
So to me those are two thingsthat I am experts in.
Like physical therapists knowhow to increase knee motion and
we know how to strengthenmuscles around the knee joint,
and to me that soft tissue prepwork really helps.
When someone like Dr Kavanaughgoes in and replaces that joint
(17:31):
he's doing a lot of bony changes.
The surgical process involves alot of bone replacing different
things and implant replacingthe bone so that soft tissue
component is integral.
So if you can do things beforethe surgery to prepare, not to
mention the brain, you know Ifeel like people forget that
with knee arthritis your brain'snumber one job is to protect
(17:53):
your knee.
So it almost in essence, like Isaid, when the person starts
sitting down to put their sockson or they start avoiding stairs
, maybe they stop walking asmuch.
You know that's the brain kindof telling them that that's
going to hurt, so let's avoidthat activity.
So part of doing prehab isreawakening the brain and
connecting it to this arthriticknee and saying it's okay to do
(18:15):
some activity with this knee.
So that way when the surgeryhappens and there's a brand
spanking new knee in there, it'snot a shock to your brain Like
whoa, we haven't done anythingwith this knee for months, maybe
years, you know, you think it'sjust going to let you do things
that inflict pain on yourself.
It doesn't work that way.
So yes, prehab, somethingbefore surgery, is crucial.
Janet Walker (18:37):
You know, it's interesting because in preparing
for this series on total kneereplacement, I've talked to a
lot of knee replacement patientsand the majority of them have
said that their second knee waseasier, they recovered faster,
and I wonder if that's becausethey've been doing the rehab on
(18:59):
their first surgical knee, whichyou know in turn gives them
some exercise and prehab on thesecond.
Shehla Rooney, PT (19:06):
I think there's absolute truth in that.
I think, in addition to them,like maybe walking more, because
it takes two legs to walk, ittakes two legs to stand up, it
takes two legs, so all of asudden they're doing more
activity number one, but I thinkit's also expectations.
I think it's like they realizedhow much work it took to get
(19:26):
that knee moving, and so I thinkthat the expectation is
different for the second one,and when the expectation is
different, you're going to havea different result.
Janet Walker (19:31):
Let's talk about that a little bit.
What are some commonmisconceptions that patients
have with total knee replacement?
Shehla Rooney, PT (19:37):
Well, we just I think the one we just talked
about, where you know, doingphysical therapy or exercise
before surgery won't make a hugedifference, you know.
So they avoid activities, youknow, which in essence results
in them becoming weaker andtighter and more deconditioned
leading up to the surgery.
So I've heard many people say,yeah, I'm not going to go to
therapy.
The surgery has been scheduled,the surgeon's going to fix my
(19:58):
knee, so I'm just going to waitit out.
So that's one misconception iskind of sit tight and rest until
the surgery because you mightcause damage to that knee before
.
That's not true.
I think another misconceptionis people get their hip done and
then they think their knee,although listening to Facebook
support groups I'm realizingpeople now realize there's a big
difference between hips andknees.
So definitely hips are not thesame as knees.
(20:20):
So that's a misconception.
And I think anothermisconception is they think
their knee is going to feelnormal after the surgery.
But you know, in essence youhave put a brand new, you know,
metal, plastic implant into yourbody.
It can never feel the same asthe one that God gave you at the
beginning.
And so I think people are likeI thought it was going to feel
normal, or I can kind of feelthat in my knee, or my knee
(20:42):
looks a little bigger than theother knee.
When's it going to feel normal?
I think that that's amisconception.
I think they don't understandthe pain will go away or reduce
and they'll be able to do thingsthey didn't do before that pain
was inhibiting them from.
But I don't know that it everfully feels normal per se.
And then I think also themisconception that I hear all
(21:03):
the time is underestimating howlong the recovery actually takes
.
I think people are like youknow, four to six weeks, and I
should feel normal.
Four to six weeks, why is myknee still hurting and stiff?
Or even eight weeks.
So I think there's amisconception that you know the
recovery should be faster thanit is, and so that causes a
whole slew of.
You know, if your expectationsare in six weeks, I should feel
(21:25):
so much better.
Or maybe they're going back towork in six weeks and they
realize they're not ready right.
So there's a misconception.
I don't think people plan longenough for how long the recovery
takes.
Janet Walker (21:36):
What is the typical recovery time, like
what's normal, for saying, okay,I'm this many months past
surgery but you averages, butI've had all spectrums, but you
(22:01):
know it depends on what theirtherapy looked like.
Shehla Rooney, PT (22:04):
It depends what their pre-surgical status
looked like.
It looked, it depends on theircomorbidities, it depends on
their motivation level, itdepends on their financial
situation.
You know, even where they arein the United States can make a
difference in terms of whatinsurance covers or doesn't
cover.
So, you know, I will give youthe generic response that I
think all surgeons would agreewith me is you know, give it a
(22:24):
full year before you make adecision on whether you regret
having the surgery.
Now, I don't like that.
So that's my, that's my generalresponse that I should give.
But if you're asking mespecific, which I shoot it
straight, I'm going to say youknow, most people regret having
that surgery the first seven to10 days, you know for sure.
You know, because it's a verypainful recovery.
(22:46):
But by two weeks and threeweeks, I mean, you know this
surgery, you're walkingindependently the day of yes,
you're using a walker, butyou're walking independently.
You know, within a week you'regetting yourself dressed and
taking yourself to the bathroomand you're, you know, walking
around in your house.
Again, it doesn't feel great,but you're doing all those
things, um, you know.
(23:08):
So I would say, by four weeksyour knee is moving better, so
you're able to get up and downbetter and again get in and out
of a car.
You might be able to resumedriving at that point.
Um, but yeah, I would say eightweeks is when you're like yep, I
can dress myself, yep, I candrive, yes, I can walk and move
around.
Uh, maybe stairs are still alittle tweaky and you feel like
I don't like how my knee feelswhen I go upstairs or walk long
distances.
But really for three monthsyou're, it takes like three
(23:31):
months for your bone to evengrow into that implant.
So to expect in less than threemonths you're not going to have
pain or swelling or discomfort,I think is unreasonable.
But I think you'll be veryfunctional well before the three
month mark, meaning veryindependent, like if somebody
watched you, it looks likeyou're resuming normal life, but
you personally are like I stillfeel my knee.
It reminds me if I do toolittle or too much.
(23:53):
You know you can't forget itfor those first three months.
Janet Walker (23:57):
Are there any common mistakes that patients
make that can inhibit theirrecovery?
So many, so many so many.
Shehla Rooney, PT (24:05):
So one that a patient just told me a couple
of days ago was he took it as abadge of honor that he was off
all the pain medications thatthe doctor had prescribed and he
was only like six days aftersurgery.
So I think that's a mistakepatients make, is they think
it's a badge of honor to weanoff the heavy pain meds because
of the fear of addiction andnarcotics and all that stuff.
So unless there is a history ofaddiction in your life or
(24:28):
you're having a major sideeffect to the heavy pain meds, I
suggest you really do takethose, especially for the first
two weeks, because if it allowsyou to work your knee harder,
then you're going to reap thebenefits of gaining that knee
motion faster, trying to getthat quadricep muscle to
activate sooner.
So common mistake is weaningoff the pain meds too soon.
I think another one is doingtoo much of the wrong stuff.
(24:51):
Again, I had a patient thispast week who was telling me
that he was adding like I don'tknow something like 500 to a
thousand steps every hour.
That he was awake and he'sright, and he still hadn't met
his range of motion goals.
So you know.
And then he was saying that hisleg would swell up at the end
of the day.
So part of me was like you'redoing too much of the wrong
stuff.
After knee replacement surgerywe already know you can walk.
(25:11):
You can walk the day of surgery.
I think the thing you can't dois bend and straighten your knee
easily.
So, to me, doing too muchwalking or doing too much riding
a bike even I like riding abike.
It loosens the knee up andhelps reduce stiffness.
But the bike should be in not30 minutes of riding a bike, it
should be five minutes so thatyou can then do some active
exercise to increase yourbending and your straightening.
(25:34):
So doing too much of the wrongstuff I think is a mistake
people make.
They think because I'm walking,I'm exercising, but not all
exercises are created equalafter knee replacement.
I think also a mistake patientsmake is they defer to the
physical therapist too muchabout their recovery, meaning
what I do two or three times aweek when I go see Shella trumps
(25:54):
anything that I do at home.
And that is not true.
I think that what you do athome every day is going to trump
whatever I do in the clinic.
So what we do seven days a weekis going to make a bigger
difference than what you do athome every day is going to trump
whatever I do in the clinic.
So you know what we do sevendays a week is going to make a
bigger difference than what youdo two or three times a week.
So a lot of patients are kindof like they pass the buck to
the physical therapist, to kindof be reliant on gaining the
knee motion or getting the legstraight.
(26:15):
I think that's a big mistakePTs make.
And then another one is thatbecause of the pain after the
surgery they don't pushthemselves.
I think a huge mistake.
Patients don't realize and thisis specific only to knee
replacements.
I'm not saying this toeverything.
So if your listeners are likewhoa, I had pain and I tore
something, no, no, no For kneereplacement recovery, a lot of
(26:36):
patients will say it's hurtingso bad so I'm going to stop the
activity.
But I think that there's aneurological component they're
not aware of that your brainsays it hurts so you should stop
doing it.
But in actuality there's notissue damage occurring and so
there's a disclaimer, meaningpain with tissue damage means
don't do something, but painwith no tissue damage means just
(26:59):
proceed with caution, and so acommon mistake I see is my knee
hurt too bad.
I couldn't do the exercises,and that is not negotiable in
knee replacement recovery.
Pain is just a reminder thatyour brain doesn't like what
you're doing with kneereplacement, but it doesn't mean
to stop doing what you're doing.
So again, people will walkbecause it feels better than
(27:19):
bending the knee.
But bending the knee is the keyto the recovery, more than
walking is.
Janet Walker (27:26):
What is normal range of motion?
I assume that's the bending andstraightening you're talking
about.
Shehla Rooney, PT (27:31):
Yes.
Janet Walker (27:32):
What is normal for a knee replacement patient and
when do they want to questionthe fact that they're not where
they should be and take the nextstep?
Shehla Rooney, PT (27:42):
Okay, so normal range of motion.
You'll hear a therapist saylike zero to 135 or zero to 140.
Zero means your knee is fullystraight.
So zero is a straight knee.
140, 145 is like my heel to mybottom, like it's all the way
back.
Think of like a, you know ahamstring curl thing.
Your, your, your heel istouching your bottom.
(28:03):
So that's normal range ofmotion.
Some people have 150, 155.
It depends on your soft tissuerestriction.
But you know, as far as yourknee can bend After surgery,
obviously the biggest thing thathappens is you wake from
surgery after anesthesia andyour leg just balloons up, it
swells up, it stiffens up andyou know, motion is very
restricted.
So what normally happens ispeople lose that knee
(28:25):
straightening ability.
So instead of that number beingzero, sometimes therapists will
say minus 15.
That means you're lacking 15degrees from straight.
Okay, um, and then they'll say90 degrees.
Well, 90 degrees is you know mesitting in my desk chair right
now with my you know hipparallel to the floor and my
ankle directly underneath myknee.
(28:46):
So those are kind of norms,like 90 is, you know, just
sitting regularly in a chair.
But as for norms after kneereplacement surgery, again it's
going to depend on how hard didyou work?
What was your pre-surgicalrange of motion?
How hard did you push yourself?
What are your goals?
You know, if you only had ahundred degrees before, you know
(29:06):
, research says that you'regoing to be lucky to get to
maybe 105, 110, you know, maybemore.
That's why it's so important todo that prehab.
But for me, and what I do everyday, my I'm going to throw out
numbers that some people aregoing to be like whoa, but to me
I want my patients at one weekto be at, like, you know, zero,
meaning they can get to fullystraight to about 110 degrees.
(29:26):
You know, by two weeks I wantthem to get as close to zero to
120 degrees.
You know, by three weeks I wantthem to be at 120 plus and
everything after that is icingon the cake.
But again, that's my goals forthem.
I think it's reasonable andobtainable.
I think that that's not alwaysthe norm because patients, you
know the pain makes them inhibit.
(29:47):
They don't want to do as much.
Maybe they have weaned theirpain medicines.
But the range of motion numbers,I like objective numbers.
Some patients hate it, but mything is you have to know the
numbers because the number tellsme something.
If they say I'm off the walkerin the cane, I'm like what's
your straightening number?
And they're like minus eight.
I'm like, oh so you're walkingwith a limp.
(30:10):
And they're like, oh so youknow, it tells me you shouldn't
be off the walker in the cane,like put that cane back in,
because we don't want to walkwith a limp and reinforce a
habit that will be hard to break.
So the range of motion numbersare important because they tell
health professionals you knowwhat is normal, what is not
normal.
And when you asked about whenshould you worry, if you go back
to your follow-up appointmentwith your surgeon at the 30-day
mark and they look at your rangeof motion and it's between like
(30:32):
85 and even 95 degrees ofmotion, they're going to start
to get concerned because it'sbeen four weeks.
They're probably going to havea conversation with you that hey
, if you don't get that kneebending more, we're going to
have to discuss on your nextvisit, maybe at the two month
mark, that you need amanipulation under anesthesia
because your knee is not movingas well as they think it should.
So that's kind of a stapleacross the board that if you're
(30:55):
still kind of stuck at 90degrees at four weeks in.
You're kind of behind the eightball.
Janet Walker (31:03):
So we've talked about how important physical
therapy following surgery athome is.
How long should patients dophysical therapy or exercises
for their surgical knee for, youknow, a few weeks after the
release from physical therapy, afew months, a few years or
forever?
Shehla Rooney, PT (31:19):
Great question.
So it kind of depends on theindividual's goals and how fast
they recover.
So you know you could havepatient A who gets their range
of motion to like zero to 130 inthe first month.
But if you let up too soon, Imentioned that it takes three
months for that bone and thatimplant to kind of grow together
.
So I find people who gainmotion really quickly kind of
(31:41):
back off because their knee isdoing so well and then they'll
lose some.
So you'll lose like 10 degreesof range of motion in those
first three months if you let up.
So the answer to your questionis for those first four to six
weeks you were doing exerciseslike three to five times a day
every day.
After the first four to sixweeks, if you're meeting your
range of motion goals, you couldprobably ease up on that to
(32:01):
maybe three times a day everyday.
You know, for the next fewweeks, till you're yeah, till
you're like at the eight weekmark, nine week mark.
But you know to me even thatlast you know the second month
to the third month, you shouldbe doing something still every
day that bends and straightensthat knee because you can lose
it.
So I've seen people at threeand four months that had done
really well beginning.
(32:22):
You know they're like why am Iwalking with a limp?
And they're they lost a littlebit of their knee straightening?
Or they're like my.
You know, my knee used to beeasy to bend and now it's like I
feel like I've lost about 15degrees.
Or the PT measured it from lastweek to this week and I've lost
seven degrees.
Why would that be?
And it's because they eased upon the exercises.
So my answer to people is howoften should you do it?
It depends.
(32:43):
I mean, ease back off on yourexercises and then if you feel
the tightness starting to comeback, then you have to increase
that back up.
But it's a fluctuating gamethat if you do too little you
lose it, if you do too much youcan cause some increased
discomfort.
So it's a balancing act.
But it is very individualbecause some people they get
that motion back and then theyresume activities they like,
(33:04):
which also puts their kneethrough a full motion and that's
great.
I would rather you be outsidedoing something to bend your
knee than sitting in a chairdoing a standard exercise.
Overall, you should still bedoing some sort of knee exercise
program within the first threemonths, and from three to six
months you should be doingsomething, albeit at a maybe
reduced frequency.
Maybe it's three times a week,but I will also say that even at
(33:27):
a year mark you got to be doingsomething that keeps that knee
active.
But I hope it's, like you know,a fun activity that you enjoy
doing, instead of these seatedexercises or bed exercises that
you've been doing the firstthree months.
Janet Walker (33:41):
Now, I know you created a device and protocol
that's proving to be a greathelp to knee patients, but I was
hoping that I can talk to youabout that a little bit when you
come back, because we're out oftime right now.
So would you come back to talkto us about the Go Knee?
Shehla Rooney, PT (33:55):
Oh, it would be, my pleasure.
Janet Walker (33:58):
Well, shella, thank you so much for being with
us today and educating usListeners.
You can connect with Shella atthegonicom that's wwwthegonicom.
And thank you so much, everyonefor listening to the Healthy
(34:19):
Cells Healthy you podcast withme, your host, janet Walker.
You can find us on ApplePodcasts, google Podcasts,
iheartradio, spotify or whereveryou get your podcasts.
Subscribe and tell your friends.
We'll help you find solutionsand together we'll build healthy
cells and a healthy you.
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