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As a physical therapist, having progressed hundreds of total knee replacement patients through the first 3 weeks after surgery, walking endurance is one primary focus of the patient’s rehabilitation program. Out of all the exercises a human being can do, walking is the best overall exercise that will return the best benefits for the time and effort invested. That includes everyone of all ages, including total knee replacement patients. Research shows that total knee replacement patients have a significant increase in tolerance of the number of times they are willing to get up and walk short distances. Research shows that total knee replacement patients have a significant increase in tolerance of the number of times they are willing to get up and walk short
distances. All of my patients are using either Ice Packs or Cold Therapy Machines
(Amazon affiliate links) multiple times daily to help control pain levels. How soon after Total Knee Replacement will I be able to walk?A new total knee replacement recipient will be walking with a physical therapist in the hospital the day after the surgery. Most hospital records I read, before seeing the Total Knee Replacement patient in their home to initiate home health physical therapy, reports the patient has usually ambulated with a physical therapist about 150 feet using a front wheeled walker. Additionally, if the total knee recipient has stairs at home to negotiate, the therapist will train the patient on stair climbing and the patient will be required to demonstrate going up and down stairs safely. How far should I walk immediately after Total Knee Replacement?A total knee replacement patient should be walking about 150 feet with a walker the day after the surgery. Most surgeons have a post-surgery binder of specific instructions that are issued to the total knee replacement recipient upon their discharge from the hospital. In this binder of instructions is usually a section that discusses how much the surgeon wants the patient to walk during the two to four weeks of home therapy before the patient initiates outpatient physical therapy. In those instructions, they almost always say “Walk 10 to 15 munites a day”. First,
the surgeon is telling the patient to “walk 10 to 15 minutes a day” as part of a home exercise rehabilitation program. Secondly, the recommended 10 to 15 minutes of walking is all at one time. It is not broken into smaller segments of time that are then added together to achieve 10 to 15 minutes of walking. Thirdly, the surgeon is not taking into consideration the patient’s speed or stride length when recommending walking 10 to 15 minutes daily. On rare occasions, at my first home health physical therapy visit, usually day 1 or 2 after surgery, the patient’s ability to walk is severely limited (less than 100 feet). This limitation is almost always apprehension about falling, but occasionally the limitation in walking is some other orthopedic or medical problem. There is a balance test I perform at the initial evaluation that gives me some information about the patient’s risk of falling, but also gives me some indication of the patient’s ambulation endurance tolerance. TUG Test:TUG test (Timed Up and Go). The test instructs the patient to rise from a seated position, walk 10 feet away from a chair in which they were seated, and then return to that same chair and sit down. If it takes the patient more than 14 seconds, the test scores rate the patient as High Fall Risk. In the many years I have been performing this test with my home health physical therapy knee replacement patients, I would say less than 5% complete the TUG test in 14 seconds or less (and almost 100% of these patients are younger than 65 years of age). Almost all my patients
initially test at 30 to 90 seconds to complete this 20 foot round trip test. That being said, if my most speedy patient walks 10 minutes they would have walked 400 feet. The point being that recording the amount of time a patient can ambulate continuously tells me very little about the patient’s functional ability but the distance a patient can ambulate tells me a lot about that patient’s functional ability. How I Progress My Patients With WalkingI always request my patient to not take pain medications at least two hours before my arrival, otherwise, the pain medications mask the pain. I need unmasked pain responses from my patient during treatment to be sure the treatment is within the patient’s pain tolerance limits. At the initial evaluation, I walk my patient, usually with a front wheeled walker, to the distance that they begin to feel like that is as far as they should go. I request they walk until their body gives them the first sign that they should consider stopping. Since I am asking the patient to stop at the first signs of discomfort, I have to pick a walking route that will allow the patient to be seated as soon as any discomfort is felt. This means I can’t walk the patient in a straight line until discomfort (we would still have that same distance to return), so I pace out a 50-foot lap within the home that we walk until the patient needs to sit down. Usually, that first session, the tolerated distance is somewhere between 150 feet and 500 feet. For the patient’s home program, I request the patient to walk 50% the distance that the patient walked with me. I do not want them to walk as far as they walked with me, only ½ that distance, but to repeat that distance 2-3 times daily. At each physical
therapy session, with me present, I will push the patient for additional distance. Within 3-4 sessions I expect the patient to have reached at least the 1,000 feet mark (a ¼ mile is 1,320 feet). By then I expect to hear my patient say something like: At this point, I am going to start walking with my patient using no assistive device at all. Again we will establish a baseline of tolerance for walking without any assistive device and increase that distance at each of the next 3-4 visits with the expectation they will be able to walk about ¼ mile without any assistive device. I do not transition my patients from a walker to a cane. It has been my experience that transitioning to a cane causes patients to activate that old ambulation motor memory pattern of limping, canes just do that. On rare occasions, a patient may need additional support when transitioning from a walker to nothing, but it is never because of the need to reduce weight-bearing on the new total knee. Weight-bearing should not be painful even from the start. Almost always the
issue of transitioning from walker to nothing is a confidence or balance issue. Walkers and walking sticks allow the patient to walk without activating that old “limp” motor memory. A cane will activate that old motor memory limp. What Is Average Non-Surgical Walking Metrics For Adults Under 60?Walking has become the rage of the human population over the last few years. Many opinions have been expressed about how far the average human being should walk. The consensus seems to be about 10,000 steps a day, and 3,000 should be at a brisk pace. Studies show that the average man’s stride length is 2.5 feet per step while a woman’s stride length is 2.2 feet per step. 10,000 steps per day translate into: Men: Women: EVERYTHING CHANGES PAST THE AGE OF 60 YEARS OLD!!!!! Studies show the average number of steps a senior citizen should be achieving should be 5,500 steps but can go as low as 1,200 steps daily for patients with complications (such as a new total knee), however, the senior citizen should try to
increase those 5,500 steps to as close to 10,000 steps as they can tolerate. Not only does stride length start to decrease, but the walking speed also declines about a ¼ mile per hour every decade after 60 years of age. And after a Total Knee Replacement surgery, things come to a grinding halt for about 3 weeks!!!!! The walking progression I have described above is what I see in 95% of my total knee replacement patients. The exceptions are frequently patients that have other orthopedic or medical issues that prevent them from achieving the walking goals defined above. Of all the total knee replacement patients I see, I can classify them into three groups:
Those that I have to continually try to restrain their over-activity are the only patients that have problems meeting the goals (not only of walking but also range of motion and pain). At least 50% of these over-achiever type A personalities will set themselves back 7-10 days because of the surgical site’s bad reaction to being over-exerted. Stay in the lane and you too can walk out of this post-surgical debilitation in about 3 weeks. Happy Non-Limping Painless Walking.Other Articles That May Be Of Interest To You: Perhaps you are approaching or already retire and wondering how you could earn extra money in retirement. See My Related Total Knee Articles For Additional Information: Best Exercises To PREPARE For Total Knee
Surgery Paying It ForwardAge In Place School is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. We also participate in other affiliate programs which compensate us for referring traffic. How much walking should you do after a total knee replacement?Your orthopaedic surgeon and physical therapist may recommend that you exercise for 20 to 30 minutes daily, or even 2 to 3 times daily; and walk for 30 minutes, 2 to 3 times daily during your early recovery.
How long does it take to get back to normal after a total knee replacement?Barring any complications, most patients are able to return to most normal activities and walk without the need of assistive devices between three to six weeks after surgery. Overall, it usually takes two to three months to make a complete recovery from a minimally invasive knee replacement.
Is it painful to walk after knee replacement?Pain after knee replacement surgery is normal. Most of my patients have some level of pain and swelling for several weeks. At TRIA, we'll work with you to create a plan to help manage your pain.
How long does it take for a total knee replacement to stop hurting?Most people fully recover from knee replacement surgery in about six months. There may be a small amount of pain and soreness for the duration of the healing process, but this is normal. If you find yourself in severe pain after knee replacement surgery, call your doctor.
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