PHYSIO FOCUS
RETURNING TO TRAINING POST OP Words: Britt Caling - APA Titled Sports Physio
Q. I WOULD LIKE TO START RUNNING TO GET BACK MY FITNESS AFTER A BILATERAL KNEE REPLACEMENT (DEC 2014) BUT HAVE BEEN TOLD THIS IS A “NO GO” IS THERE SOME WAY I CAN ACTIVELY DO THIS? THANKS, HELEN
To undergo a total joint replacement in any region of the body is very major surgery and both you and your treating post-operative Physio need to respect the extensive nature of the surgery. Some Surgeons have the philosophy that returning to jogging following joint replacement should not occur, however in reality it is possible, and does occur in some individuals. To do this a number of factors need to be taken into consideration, including: 1. Your pre-surgery activity levels, biomechanical issues and running technique 2. The Surgical technique used for your knee replacements 3. How your recovery progresses 4. Your lifestyle and current future lifestyle goals Your pre-surgery lifestyle and activity preference will have some impact on whether it is practical for you to return to running. For example, if you were not a runner before your knee pain developed, then it would not be advisable to suddenly decide to try and become a runner postoperatively, as running is actually an activity that requires a lot of skill and practice to
get it “right” so that your joint forces are minimised. Running does place more stress on lower limb joints and will wear your replacements faster than other lower impact sports, so you also need to decide if you are prepared to accept this risk for the future. The post-operative advice you are given by your surgeon is often dictated by his/ her philosophy on longer-term prognosis (ie some Orthopaedic Surgeons are more conservative than others and just don’t like the thought of increased wear on your prosthesis full-stop), their own experience with exercise, and the severity of your biomechanical issues, that may have contributed to needing the surgery in the first place. Sometimes in Total Knee Replacement surgery the Surgeon will change the alignment of your knee joint from what it previously was. If this is the case, your ability to return to impact weightbearing sports, without causing symptoms in other body regions, will be very limited. How you recover and regain your muscle strength and function is one of the most important factors in whether or not you may be able to return to jogging. Strength and strength-endurance in your quads, calves and hamstring muscles, and those around your hip joints, are particularly important to helping protect your knee joint prosthesis.
Regaining this muscle function can take much longer than you may expect, and is not guaranteed to return just because you exercise. Lastly, my philosophy as a Sports Physio (which may be criticised by some) would be to help you achieve your goal. If the goal for you is to be able to return to jogging, as it is an important part of your lifestyle, then I would discuss the surgical technique and any biomechanical concerns with your surgeon. Hopefully we could then put into place plan to guide you in what would be required to help you return to jogging. Some people do return to jogging following knee and hip replacements, but as you can see above, many factors influence whether this ultimately does occur or not. Good luck with your choices.
Britt Caling, An APA Titled Sports Physio at Gold Coast Physio & Sports Health and an adventure race athlete plus ultra-runner. Britt has been appointed as Australian Team Headquarters Physio for Rio Olympics and has a special interest in analysing sports technique, in particular running, triathlon, swimming, cycling and paddling. www.mygcphysio.com.au
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