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Hello Medical Exercise Specialist, this is the final in the “Bridging the Gap with Total Knee Replacement” series. In this segment we review a couple of specific techniques to recruit/activate the quadriceps and stretch the knee. REMEMBER….leave the acute management to the physicians and therapists. They will make your job easier if they have managed their responsibilites appropriately and refer a client ready for MET.

The swelling is the major limitation in the early stages. The swelling should be at a minimal level when MET begins. If the client is limited to less than 90 degrees of flexion and unable to achieve full extension, refer the client back to the therapist or contact the therapist o develop an appropriate training program. Terms you need to become familiar with are extensor lag and patella mobility. The extensor lag is a combo of quad weakness/lack of fiber recruitment, swelling and lack of flexibility and connective tissue pliablity. The therapist should address these during PT and turn the client over to you ready to continue with exercise. The patella must move with knee motion. The patella must have mobility to glide in the patella groove during flexion and extension.

I highly recommend every MedXPRO begin communicating with the surgeon performing the joint replacement physician and/or therapist of record. As you progress the client, your goals will shift toward functional abilities such as walking on unlevel surfaces, ADLs, and maybe some light sporting activities with physician/therapist approval.

Opportunities to manage total joints are tremendous and will grow more in the future. Most of these clients are covered by Medicare. At some point, the client reaches their limit with physical therapy and each one will need some level of MET. This could be one session in the client’s home to start their MET program or possibly continued sessions. In either situation, there is need to communicate with the physician and/or therapist. This opens avenues for more referrals and the establishment of medical relationships.

Please share your success stories working with total joint replacements. Email your stories to DrMike@postrehab.com.

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