Total Knee Replacement - 1 Simple Strategy to Improve Knee Extension at Home After Surgery

I wanted to address a couple questions that I've heard regarding improving your

knee extension after a knee replacement using braces and so you might call them a

DynaSplint dynamic bracing there's a lot of different terms for them but the

idea the the basic concept is my knee isn't going straight after a knee

replacement so what I need is long duration which I agree with low

intensity so kind of a gentle long slow stretch to try and stimulate that stretch

response to allow those those connective tissues the scar tissue the ligament the

tendon to lengthen we're not so much talking about muscular lengthening we're

talking about connective tissue in the form of joint capsule ligament tendon

scar tissue and so the problem I have with that is we understand from a

neurologic approach that when something presses against our body, our body's natural response is to press back. When a therapist, when a brace, when anything

presses down against the knee, the knee's response is to tighten and fight that

and press back. So what I find to be a little more effective is a form of

traction to gain extension. And one way you can do it is with these bands. Now

Now, there's different names for them. These are not TheraBands, they're not the flat band, they're not the tubing

Some people call these monster bands, pull-up bands. I post an affiliate link in the comments for the bands that I use So they about 15 to 20 bucks They very tense but they do have some stretch to them And the way I typically advise my patient to use it I not sure if I going to

lose the camera view, but I'll show you. So imagine this is my hallway. This is a closet door

What we would typically do is wrap it around the closet door. In this case, I'm going to double it

up just to make it a little bit shorter. You can keep yours full length to give

you a little more stretch. I'm gonna put my foot into the loop and so pretend

that there's a knee contracture, pretend that there's a knee contracture, I can't get it totally straight. All I do first is I just sit back and relax. From this

position I can do a little bit of a rocking motion. So my muscles, my nervous

system. Everything is working on getting the extension. If you notice the line of

pull, it's not pushing my knee down, it's pulling my foot forward. And that tends

to be a little less responsive to the nervous system. My body doesn't want to

protect as much. And then I'll slide the chair back, scoop my bottom back, and then

just kind of sit here. Now in this position, I could be watching TV depending

on where we are I could be reading a book checking my phone but I've got a

little bit of this kind of bouncing oscillation I've got traction pulling

through the knee I'm separating the joint surfaces just a little bit there

should not be anything that's going to increase my swelling this won't reduce

swelling but it shouldn increase the swelling and so the idea behind improving that knee extension is if you imagine this bottom bone and this top bone coming together to form the

knee joint, if somebody pushes down your body is going to react by contracting, by

tightening. If something hurts what happens? You get tense. If I poke you in

the stomach what do you do? Tighten up and then you giggle. Just kidding. But the

idea is that we want these bones to be pulled apart so that they will drop down

into extension and we can create some space so this is one of my favorite ways

if I've got a patient who's at home they're just struggling to get that last

little bit of you know ten five degrees of extension we get them set up here and

then like I said if that's too high and you can't get it doubled up you just put

it in like this you just have to be able to scoot back further this is a much more gentle way to do

it if i use a thicker band certainly same thing i get it in here i'm back i'm relaxed i can do a

little bounce a little oscillation i can work on a version of a heel slide this is just like a heel

slide but the idea is when I tighten the muscles in the back of the knee it will

reflexively relax the muscles on the front so let's think about this for a

second our bodies are designed to work in opposites when my brain tells this

muscle to tighten my brain reflexively tells this muscle to relax they both can be tight at the same time so when I sitting here and I tell my hamstring the muscles behind my leg to tighten to pull this back to me reflexively this muscle will turn off and then I come back in and

I can relax a little bit. And then I tighten it and I relax

This is a technique called contract relax. There's just so many different ways to do it

But the goal is we want to stay back so that there's that traction force pulling forward

on the knee. I would hang out here five minutes initially, seven minutes, ten minutes, probably up to

15 to 20 minutes if I could tolerate it in this position

If that was just too aggressive, no worries. Bring it here. I'll be off camera, but I would just back up so that there's still that traction force

but maybe my foot can remain supported right on the ground or close to it

So I hope that helps. Nothing fancy. I mean, the bottom line is if bracing worked, everybody in the world would have a brace

When it works for the right person at the right time, I'm super happy for you

but I see more people that get braces, that get frustrated, and end up spending way more money than they need to without the results they expect

So I want you to try a couple other solutions. This is one of my favorites that's worked really well over the years

If you have any questions, let me know. Otherwise, I'll keep posting videos as I see more questions coming in

Thanks, guys