Rehabilitation after knee surgery

I am a a rehabilitation and conditioning specialist who lectures widely to other health professionals. In 2019, I presented a Masterclass for surgeons at Lord Cricket Ground. Over two days, 150 consultants discussed and practiced (on cadavers) the best ways to perform tibial  or femoral osteotomies.  My masterclass focused on the benefit of strength training to enhance patient outcomes.

 

Osteotomy surgery is advocated when the lower leg appears bowed (or the opposite), the person can’t walk properly and they are in significant pain. The surgery involves basically taking a wedge out of the bone (usually the tibia) to create a space, so when the bone heals, it corrects the deformity – i.e. straightens the leg.

This photo is of a patient I saw a while back, who I most definitely recommended go seek a surgical opinion for osteotomy. Can you see how her right leg isn’t straight like her left leg?

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Talking about rehabilitation and exercise to surgeons is a bit like a Marmite experience, some will really quite like it, ask questions and then speak to their physios the next day, the others probably don’t believe in the benefits of rehab and switch off. Fortunately there were plenty of the former in the audience.

Whilst strength training is imperative to enhance outcomes after surgery, it can really help with symptoms and function before surgery is advocated. We know this from knee OA studies, but it works with other populations.

I illustrated this (albeit with N=1) with a case study of mine. She couldn’t walk without pain, suffered sleep disturbance because of pain, her back hurt because she wasn’t walking properly and she had an active job, which wasn’t possible to perform. I recommended that she get a brace that partially corrects the deformity and (here comes the important bit) undertake a strength training programme – yes lifting really heavy weights.

In just 12-weeks by increasing her maximal leg strength her pain was halved, which meant she could do more (hence why the scores weren’t 0), her walking was better and faster and her back pain went completely – oh, and she could sleep again and didn’t need to rely on pain killers. Image shows the basics of the programme.

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As I said this is just a case study, but it illustrates the benefits of true muscle strength training. Incidentally, these findings are shown time and time again in the scientific literature.

Strength is king!

If you have any questions, just ask Dr Claire Minshull