So you had you a total knee replacement and have been through post-operative rehabilitation in the hospital. You may have even had physical therapy at home. What's next? Well, in order to maximize your functional mobility after total knee replacement, you may want to consider outpatient physical therapy.
If you are able to leave your house after total knee replacement surgery, your doctor may refer you to outpatient physical therapy. This type of physical therapy occurs at an outpatient clinic. Many clinics are privately owned and operated by physical therapists, while other clinics are operated by larger hospital organizations. Ask your doctor to help you find the right physical therapist and outpatient clinic for you.
What to Expect from Outpatient Physical Therapy
When you first go to outpatient physical therapy for your total knee rehabilitation, you can expect to visit a clinic that looks like a gym or fitness center. Treadmills and bikes may be available, and various weight training machines may also be available.
Your first visit to outpatient physical therapy is an initial evaluation and assessment. During this appointment, your physical therapist will interview you to gain an understanding of your post-operative course of care since having your knee replaced. He or she will ask you about your pain level and about your prior level of functional mobility. A review of your past medical history should also be included in your initial evaluation.
After the interview, your physical therapist will take various tests and measures to determine your current status and to decide on the best treatment for you. Some impairments that your PT may measure include, but are not limited to:
- Range of motion (ROM)
- Gait and mobility, including assistive devices used for walking
- Scar tissue assessment
Your physical therapist may choose to use a specific outcomes measure to determine your current functional status and to help set reasonable rehabilitation goals during outpatient therapy. Common outcomes measures used after a total knee replacement include the 6 Minute Walk Test, the Timed Up and Go Test, or the Tinetti Balance Scale.
Physical Therapy Treatment after Total Knee Replacement
After your initial evaluation, your physical therapist can develop a treatment program for you. You will start working on the various problem areas that were found during the initial evaluation.
Range of Motion
One of the major obstacles to hurdle after total knee replacement surgery is to gain range of motion around your knee joint. Your physical therapist will likely prescribe exercises to help you improve the amount that your knee bends and straightens. You may be asked to ride a stationary bike to help improve the ROM of your knee. Don't be surprised if you cannot pedal the bike in full revolutions. You may have to slowly ease into pedaling the bike and work gradually on making full revolutions.
Decreased strength in the muscles around your knee is often a problem area after a total knee replacement. Strengthening exercises to help improve your quadriceps and hamstrings may be prescribed. The hip muscles are also very important knee stabilizers, so you may need to perform hip strengthening exercises as well.
You physical therapist may choose to utilize a therapeutic modality called neuromuscular electrical stimulation (NMES) to help improve the strength and forceful contraction of your quadriceps muscle. This treatment usually lasts for 10-20 minutes and involves using a machine with electrodes placed on you muscle to help it contract better.
You balance may be slightly impaired after your total knee replacement surgery. Exercises to improve your balance and proprioception may be performed while in the outpatient clinic. The use of a BAPS board and single leg standing exercises may be helpful for you to regain normal balance.
You likely will still be walking with a walker or cane when your begin outpatient physical therapy after your total knee replacement operation. Your physical therapist can work with you to help you restore your normal gait with no assistive device.
Scar Tissue Management
You will have a scar on the front part of your knee after your total knee replacement, and this scar tissue may feel tight and may limit your mobility. Your physical therapist may perform scar tissue massage and mobilization to keep the scar and skin around your scar moving normally. You can also learn how to perform scar tissue massage on your own to help speed the process along.
How Long Will I Be in Outpatient Physical Therapy?
Outpatient physical therapy after a total knee replacement typically lasts 4 to 8 weeks. Remember that everyone heals at different rates, and your recovery time may be shorter or longer. Be sure to work closely with your doctor and physical therapist to understand your specific rehabilitation process.
You may not feel like you are 100% when it comes time to stop attending outpatient physical therapy. Your physical therapist should ensure that you are performing an exercise program at home on a regular basis to help you make further gains in the months after discontinuing physical therapy.
Outpatient physical therapy can be a helpful and important component to your overall recovery after your total knee replacement surgery. By working hard in the physical therapy clinic, you can be sure you maximize your chances of quickly gaining normal functional mobility.