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Hi guys and welcome to the Total Knee Replacement Support Group YouTube channel
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My name is Tony Maritato. I'm a physical therapist and today's talk is going to be really interesting
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I had the great fortune a couple weeks back now of talking to an individual who called to discuss
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the potential for jogging after a knee replacement. now full disclosure most of the clients most of the normal human beings i am fortunate enough to
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work to on a day work with on a daily basis are you know if they're running they're running two
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miles five miles i run two to five miles like that's about my limit i love it i enjoy running
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i enjoy nature and getting outside this particular individual was one of those people that's just
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in the upper echelon of performance. She was running, it was either 50 kilometer
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I think it was a 50 kilometer race through rugged terrain, not on the road. And she wanted to know
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if she had a knee replacement, could she return to running? And I was just blown away. I was floored
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Like somebody running two marathons at the same time back to back
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That's just crazy to me. But I am so happy there are people like her out there doing it at the age of, I think she
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was in her mid-50s, just because it is such a phenomenal feat to see a human being do
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something like that. So first, once I pulled myself back up off the floor after hearing this, I was thinking
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to myself, well, you know, what does running really mean to this individual, to you, to
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me, to anybody? I understand the mechanics. I understand, believe me, why the general consensus is no impact after the knee replacement
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We don't want failure of the prosthesis. We don't want to wear the joint out sooner than it otherwise would
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but like anything i always have to dig a little deeper as a physical therapist it's kind of my
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compulsion to go deeper ask deeper questions and i think about and i say well while yes
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one thousand percent there's risk of wearing out the prosthesis and doing these things
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there's also calculated risk to walking across the street right to driving my car to work every day
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And so I have to wonder for somebody who has achieved this kind of level in performance who able to go a 50k race on two feet
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this activity must be such a huge part of this individual's life to just give it up
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That's a hard pill to swallow. And so then I started looking at, okay, well, what are some options here
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What can we really do? How can we look at this in different ways
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and I wonder first well if we're looking at wearing out the prosthesis as a major risk factor
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what if there are ways to reduce the compressive forces to spread the load you know my background
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is kinesiology I love biomechanics and so when I think about force and ground reaction force and
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impact we certainly know that if she was running on pavement or a hard surface there's going to be
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higher forces than if she's running on more varied compliant surfaces like gravel and grass and sand
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and different things. I don't know where she's running. I'm just brainstorming at this point
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And so I'm thinking also if she's running on various elevations as she's running uphill
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for example, there's going to be less heel contact, less impact. The forces are going to
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spread over a longer period of time certainly her body like this is a major part of this her body
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has to be in such incredible physical shape cardiovascular shape health that how do you
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measure that how do you measure the difference between an individual who's dealing with
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cardiovascular disease and and diabetes and hypertension and so many of the chronic conditions
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that we see on a daily basis who maybe is not doing high-impact activity. So we're preserving
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the health of the prosthesis, but the health of the rest of the body needs a lot of work
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right? And everybody is working toward a better, healthier body. But how do we offset that with
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somebody who is in phenomenal cardiovascular shape so maybe we we have a higher risk to
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implant failure possible sooner revision but in exchange we're gaining incredible health in the
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rest of our body we're gaining personal life satisfaction and enjoyment you know i don't know
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I always I going to take a personal minute here and I going to go back to my mom Now my mom is deceased She passed away a couple years ago My mom was a type 2 diabetic and cardiovascular disease and multiple complexities comorbidities
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But my mom was one of those people, she would rather live a shorter life the way she wanted to live her own life
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than to live a couple extra years longer but not be able to do the things that she wanted to do
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That was a conscious decision that was within her rights as an adult, as a human being
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And so I have to respect her decision when it comes to something like that
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The same holds true for me with what my patients want. Now, I would never, as a therapist, I would never go against the recommendations of the surgeon
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But at the same time, I have to respect the request of the client, the patient, you, the individual
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and so if you want to do something that is so passionate and holds such an important part
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of your life of your being even though the risk is obviously higher because of the loading and
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the impact to the prosthesis but we can offset that risk with other benefits that come with that
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kind of activity I think these are challenging ethical questions that really take time and really
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have to be decided on a case-by-case basis. So to say across the board, no, nobody can ever do that
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I think that's irresponsible. I think that's a bad decision. I think for you, for your surgical team
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for your therapy team, to sit down and have a real conversation. Let's go to the other extreme
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Let's talk professional sports, right? Let's talk football. Is there really any doubt professional
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football players are at a higher risk for injury. Is there any doubt they're at a higher risk for
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trauma to the brain, concussions, and down the road problems and complications associated with that
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I don't think there is any doubt. But on the same token, I think that they're willing
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consciously willing, to make the decision to take on, assume that extra risk because that's what they
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do that's part of their career that's part of their passion that's the way they make their income
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so you know my goal in this video if you guys are still watching and i i thank you if you are and if
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you are please take a minute while you're listening give me a thumbs up like the video and subscribe
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to the channel if you haven but i i think these are the kinds of conversations that need to be had Hopefully you having them with your surgeon before you ever have a knee replacement or any other kind of
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surgery. If not, if the surgeon doesn't have the time, which I know they're busy, it's absolutely
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a conversation you need to have with a physical therapist, whether it be the therapist you're
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working with, whether you jump on a call with me. There is a link in the description if somebody
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wanted to reach out to me and do a telephone consultation, how you can do it. But the idea
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is that these are really, really complex decisions that need to be made and they're decisions that
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have long-term ramifications. I know several of you in the group, you're incredibly successful
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power lifters, you want to get back to heavy squats, the same thing holds true for you
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You know, how do you balance? How do you weigh the risk to benefit, the risk reward? Maybe you do a
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squat and in your non-surgical knee, you rupture an ACL, you have some sort of, you know
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catastrophic injury. It absolutely can happen. We need to weigh those risks and we also need to
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weigh the risk of how important is this to my life? How much of my identity is wrapped up in
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this particular activity? I think those are really, really interesting questions. So guys
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I hope that this at least gets your minds working. I know I didn't give you an answer
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but I don't think there is an answer. It has to be decided on a case-by-case basis
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But I do get a lot of questions. I do get a lot of questions about, can I return to Ron? Can I do
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crossfit? Can I squat? Can I lift? What can I do? We need to think about these and we need to be
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very specific about how we think about these, intentional about how we think about these
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questions. So let me know in the YouTube comments, what are some of the challenges that you've been
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facing? What is something you want to get back to doing that you used to do at a relatively high
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successful level that maybe you've been told you're not allowed to do, not able to do
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you just feel like you can't do it, I would love to hear from you
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So please let me know. I read every single comment, even if I don't reply to them as quickly as I would like to
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I absolutely read every single one of your comments. Guys, as always, I appreciate your time
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Subscribe to the channel, like the video, and I'll catch you on the next question