Knee Replacements - Pilates

Understanding knee replacements and working with them in a pilates and movement studio

Why are knee replacement exercises such an important topic? There were 50,000 knee replacement surgeries in Australia alone in the last year! The most common reason for knee replacements is osteoarthritis, a condition which affects one in nine Australians (AIHW 2018), as well as rheumatoid arthritis, which affects around 2% of Australians. These figures are quite consistent throughout the western world, so it is no surprise then if you will already have seen a client with a knee replacement or are likely to see one in the near future. My own mother has had two knee replacements and it was very interesting to see how the protocols for surgery and rehabilitation changed over the time between her surgeries. It was notable that there has been a big shift emphasising pre-surgery preparation for the knee replacement and then mobilisation of the knee joint as quickly as possible post surgery to improve range of motion of the knee.

In this article we will look at:

// Exercises and principles of movement to do after the surgery and various phases for those exercises:

// Phase 1 period – 2 weeks post surgery when there is a focus on achieving between 65 and 90 degrees of flexion in the knee;

// Phase 2 period – 3 to 6 weeks with a focus on achieving around 115 degree flexion in the knee;

// Phase 3 period – 7 weeks to 4 months, trying to increase flexion to 125 degrees or even 135 degrees in the knee;

// Phase 4 period – 5 months onwards, maintaining range but also addressing the broader gait patterns in the body.

Preparatory exercises prior to knee replacement surgery

Let’s remember that when a person is facing a knee replacement they are going to be in quite a lot of pain from the feeling of bone against bone wearing away. They will be limping and trying to avoid placing any pressure on the affected leg. As a result you will see compensations and problems in their hips, poor glute activation, probably a stuck sacroiliac joint (SIJ) and

then let’s throw in some ankle problems as well! It is going to be important to focus on strengthening the muscles of the lower leg whilst appreciating that there are going to be painful limitations affecting the joints which will make squats and lunges problematic. Wedging people so that they are standing on something like a Makarlu Lotus and supports with slings to reduce compression can be very useful.