Knee Replacement Surgery - How You Can Get Ready

Having a knee replaced is a significant procedure and requires frequent therapy and exercise sessions, after the operation, to regain both strength and mobility. There are some things the potential knee recipient can do before the operation to shorten the recovery time afterwards. One of the simplest is to exercise in advance of the surgery to build strength in the joint muscles.

Deteriorating knees move the patient into a destructive cycle that makes recovery more difficult. Increased pain leads to a reduction in activity. Reduced activity means a gradual weakening of the joints associated muscles. And weak muscles mean recovery afterward is prolonged and made more difficult.

Every individual is different in terms of the degree of discomfort or pain they are suffering as a result of their knee problems. Fortunately, doctors are more likely to recommend and schedule knee replacements earlier in the process now than they did years ago. Whereas previously they would only do the procedure for individuals suffering significant discomfort and reduced mobility, now they will schedule the replacement when it is obvious it will need to done soon, thereby saving much suffering.

The good news is that, with reduced levels of pain, higher levels of exercise are tolerated by the individual. They can embark on a muscle strengthening program before the surgery, ensuring they are in optimum condition for recovery afterwards.

Exercising for flexibility, while useful, is not as critical as exercising for strength. Simple exercises using your own body weight are sufficient to make a difference in post-surgery recovery. Two simple exercises that the individual can do at home are described here.

1. Leg Extensions - Sitting on a straight back chair, place one hand on your thigh muscle and simply extend your leg in front of you, pointing your foot back towards yourself as much as possible. You should feel your thigh muscle tighten up. Try and get your leg straight and level at full extension. Do ten repetitions, holding your leg extended for a count of 6 for each rep. If you can do this easily, try extending the length of time it takes you to lift your leg. That is, lift the leg very slowly, taking 5 seconds or so to get it fully extended. Then hold it for a count of 6. Then take a full 5 seconds to lower it to a relaxed position. If this is still easy, try putting on a heavy shoe or boot while you do the exercise, making the leg work harder. You can repeat this exercise twice a day in the months leading up to your operation.

2. Step Ups - Standing at the bottom of a set of stairs, or a step, place your foot up on the next higher step. Using your hands to balance yourself on a handrail or door frame, slowly step up by shifting your weight to the higher leg and extending it. The key here is to do this exercise slowly, until you have fully extended your leg. Then slowly bend at the knee and allow yourself to lower back down to your starting position. No additional weight is necessary for this exercise. If you find it easy to do, do it slower. If you find it hard to do, use the back of a chair or an extended cane to help boost yourself. Maintain an upright posture, avoid stooping or bending sideways and take it easy the first week or so you do this. Perform 10 repetitions twice a day.

The key with any exercise program is to start slow and build gradually. Do not fight through high levels of pain. Pain is a message. Find the best time of the day to do the exercises. For many people this will be morning. Consider placing a cool pack or bag of frozen peas or beans wrapped in a towel on your joint after exercise. Follow your doctors recommendations and best of luck.

Knee and Hip Replacements - Tips on Exercise Frequency and Duration After Surgery

During your rehabilitation process from either a hip or knee replacement, you will have been presented with a host of exercises to complete to assure your success. The exercises should be presented in an orderly fashion taking into consideration the date of surgery, your overall medical condition and age.

In the hospital immediately after surgery, most of the exercises you will have been given will be what is known as isometric in nature. The frequency and duration that you will be advised to complete these type of exercises will depend on either your surgeons protocol or, the acting physical therapist assigned to you.

After leaving the hospital, you will then be assigned to either a skilled nursing facility or out patient clinic or,receive home health to continue your physical rehabilitation. It is generally within one of these three settings that your exercise program will intensify and the ease in which exercise can be carried to far is at its most prevalent.

Exercise frequency and duration is a key component that needs to be discussed with each patient not only before but after surgery. There is so much information out today on how and when to exercise along with the amount that it leaves most people confused. Along with that most information is conflicting. There is also the old school thinking of " no pain no gain" which from my previous writings I have mentioned that it is not necessarily the case and progress can be made without excessive pain. In fact, it has been determined in most patients that by promoting excessive pain after surgery actually will slow down the healing process and also promotes noncompliance with the exercise protocol.

When recovering from your replacement surgery the ideal exercise frequency that I find with my patients is twice a day. Once in the morning another exercise session in the afternoon. The timing of these two sessions can be critical as well. Proper spacing of the sessions needs to be taken into account to avoid excessive fatigue and pain. Anything more then three exercise sessions a day is counter productive and will only break the body down physically.

Its is recommended that the exercise sessions be spaced approximately 4-6 hours apart. If the exercise session was intense enough this time frame will allow your body to recover and be refreshed for the next session.

By properly spacing out the exercise frequency along with the duration or time spent exercising you will have much better control over your levels of pain along with edema in the affected limb.

There are many components involved in having a successful hip or knee replacement. One of the major issues though you will want to understand will be your exercise frequency and duration. If you can master that and listen to what your body is telling you will have a successful outcome.

Remember no more then three sessions a day but preferably two. Total exercise time during your sessions should be no more then 20-30 minutes, with no more then 5-8 exercises total each session.

Finding Arthritis Pain Relief

Knowing what exactly arthritis is first...

In the search of expert's advice on arthritis pain relief, I was surprised to find out that there are more than a hundred forms of arthritis and rheumatic diseases. Now let's first take a look at what arthritis exactly is learn about the four most common types -- osteoarthritis, rheumatoid arthritis, gout, and fibromyalgia.

Arthritis, or "joint inflammation" is one of the most common ailments today that can cause excruciating pain in the body. It affects the muscles and specifically the place where two or more bones meet, ie the joint, such as the hip or knee. Arthritis signs and symptoms include joint pain, swelling, stiffness, weakness, deformities, inflammation, and limited movement of joints, which can interfere with the most basic daily tasks such as walking, climbing steps, opening bottles, or brushing your teeth.

Fibromyalgia, or "soft tissue rheumatism" refers to pain in the soft fibrous tissues in the body - muscles, ligaments, and tendons. (Ligaments and tendons connect muscles to bones.) People with fibromyalgia may have other symptoms, such as trouble sleeping, morning stiffness, and headaches, poor memory and concentration. Women are at least four times more likely than men to develop fibromyalgia. And fibromyalgia usually occurs in people over age 50.

Osteoarthritis, a degenerative joint disease, is the most common form of arthritis. It occurs when the cartilage wears away, causing the bones begin to rub against each other and making movements painful. Cartilage, a slippery and spongy substance, covers and cushions the bones such that it allows a smooth movement of the joints. Osteoarthritis often affects the hands and weight-bearing joints such as the knee, hip and facet joints (in the spine) and occurs as the cartilage degenerates with age. Hence, it is the most common form of arthritis pain amongst the aged.

Rheumatoid arthritis is a debilitating disease that affects commonly the hands, wrists, and knees. The immune system mistakenly attacks itself and causes the joint lining to swell. The inflammation then spreads to the surrounding tissues, and can eventually damage cartilage and bone. Rheumatoid arthritis does not just affect the joints. Tendons are like ropes which run inside lubricated tubes. The lubricating system is very similar to that in the joints themselves, so it is not surprising that tendons can also be affected by rheumatoid arthritis. In a few people, other parts of the body such as the lungs and the blood vessels may become inflamed Many people with rheumatoid arthritis have difficulty carrying out normal activities of daily living, such as standing, walking, dressing, washing, and using the toilet.

Gout is a painful condition that occurs when the body cannot eliminate a natural substance called uric acid. The excess uric acid forms needle-like crystals in the joints that cause swelling and severe pain. Gout most often affects the big toe, knee and wrist joints. To reduce the risk of urate crystallizing in the joints it is important to drink plenty of water - if possible as much as 3.5 litres a day. According to recent scientific evidence, drinking a glass of skimmed milk every day may be helpful in getting gout arthritis pain relief. But beer or other alcoholic drinks should be avoided as they could make gout worse.

Arthritis Treatment

Some of the factors that are linked to the development of arthritis pain are injury (e.g from sports) and complications from other conditions (such as diabetes), heredity and lack of physical activity. Many studies have also identified a link between obesity and arthritis. Excessive body weight puts an extra stress on the weight-bearing joints (back, hips, knees, ankles and feet). Because of the way joints work, the pressure in your knee joints is many times your body weight when you walk. Even a small weight loss can make a big difference to your joints. Too much body fat may also increase inflammation in the body, making your joints more painful. Joints also naturally degenerate overtime with age; hence arthritis is often associated with older people.

However, it is also known that children, though relatively rare, can also develop a condition called juvenile idiopathic arthritis. This involves an inflammatory disorder of the connective tissues, characterized by joint swelling and pain or tenderness. It can also affect organs as the skin, heart, lungs, liver, spleen, and eyes. Generally, arthritis pain relief can be found in a combination of medication, exercise, rest, weight-management, diet and nutrition. From blood tests and X-rays, you doctor would be able to diagnose which type of arthritis you have and recommend the most appropriate course of treatment. Manuka honey which has been known to have higher antibacterial activity than other types honey is also gaining popularity in treating arthritis pain due to its natural anti-inflammatory properties and healing power. It reduces joint inflammation and provides a natural form of pain relief. To prepare, mix 2 tablespoons Manuka Honey and 1 teaspoon of cinnamon powder into 1 cup of warm green tea, consume this honey cinnamon drink daily in the morning and evening.

The combination of honey and cider vinegar is also an extremely well known home remedy for arthritis. All over the world, people have so passionately testified about how this cleansing drink has helped them find relief in joint pains. Many nutritionists believe that in this cleansing drink you can find minerals such as potassium, phosphorus, calcium, magnesium, natural silicon, pectin, and tartaric acids that are effective in fighting body toxins, inhibiting bacteria and helping the body to maintain its vital acid-alkaline balance. To prepare this health tonic, mix two teaspoons of vinegar and two teaspoons of raw honey into a glass of warm water, and drink this three times a day. It may take several weeks to see the effects. Dr. D.C. Jarvis in his book

Arthritis and Folk Medicine (Galahad Books,1997) also offered the same folk medicine prescription for arthritis pain. He believes that treatment of arthritis, and many other health problems, must begin in the stomach. Jarvis found that when an apple cider vinegar cocktail is taken daily, calcium deposits are released back into solution in the bloodstream to be re-circulated to the bones, thus obtaining arthritis pain relief and preventing osteoporosis.

Alternatively, some people also recommend soaking arthritic joints in hot apple cider vinegar. To administer, use a quarter cup of vinegar mixed with one and a half cups of water. One can also soak a cloth in this mixture, put it on the affected area, and wrap a towel over the soaked cloth to keep in the heat. Keep the hot mixture on for only ten minutes at a time, and repeat it after the joint cools for another ten minutes.

Source: http://www.benefits-of-honey.com/arthritis-pain.html

Wound Care After Surgery - How to Heal Faster After Having Plastic Surgery

Wound care after surgery can take a toll on a person! To ensure the best results whether you are choosing plastic surgery to alter your looks, or having reconstruction done because of breast cancer, a good outcome comes from knowing how to take care of yourself before and after your procedure. The better you prepare - the better your outcome will be!

Keep in mind that about 1 in 100 wounds will become infected after surgery no matter what you or your doctor does. We will look at ways to make sure you are not that one.

Your wound care after surgery actually starts weeks ahead of time in getting your body ready.

To prepare your body for your surgery start a few weeks ahead of time in getting good nutrition, properly hydrated and plenty of rest and good exercise. Think of this as an athletic event you are getting ready for.

Being in good physical shape helps your body heal faster because good circulation is vital to getting blood, oxygen and nutrients to the surgical area.

Your skin is the largest organ of the body - and the thinnest. Only 1/10 of an inch separates you from all sorts of toxins. The skin is also highly permeable - what goes on your skin can get in your blood stream. You need to be good to your skin and prepare your skin for the upcoming incision or damage that is going to happen. When the skin gets what it needs; vitamins, minerals, proteins and nutrients, it can do what it does best - heal itself.

You need to make wise eating choices, and drink plenty of water. Your diet should include healthy proteins which are building blocks for cells, vitamin C and zinc which are known to promote wound healing. Lots of fresh green vegetables will also help speed up the recovery process. Eliminating processed sugars and carbonated beverages also helps the body mend quicker.

Being in good physical shape will help speed up your recovery as well. This does not necessarily mean go join a gym and go crazy - simply get your body moving. You will do yourself a favor to take a 30 to 40 minute walk each day just to get your blood moving.

Staying properly hydrated helps a body heal better as well. There is a simple way to know how much water is the right amount for you to be drinking daily. You need half your body weight in ounces. For example; if you weigh 150 pounds you should drink half that in ounces: 75 ounces of water daily. That will help flush toxins out of your system and help your skin heal where the incision is going to be.

Lack of sleep takes a toll on your immune system. Try to get a good 7 - 8 hours or more of sleep per night in the weeks leading up to your surgery. Naps are a good thing when needed as well.

Do I really need to say how harmful smoking is to your health and healing process? And please - no alcoholic beverages for a few weeks before at best, and at the least for one week prior to your surgery. Then be kind to your body and refrain for a few weeks after as well.

Afterwards, your healing is helped by continuing to drink plenty of water and getting your needed sleep. Get up and about as soon as possible - the body mends better when the blood is flowing and circulating. Talk with your doctor about what you physically can and cannot do.

If the skin around the wound becomes red, swollen and painful you may have an infection. Call your doctor.

In healthy patients following the wound care after surgery, most wounds heal within two weeks. If you have health problems such as diabetes or a weakened immune system, or are on certain drugs, such as steroids or chemotherapy drugs your healing will probably take longer.

Wounds on the face usually take one to two weeks to heal. Wounds on the arms, trunk and upper legs take about three weeks. Wounds on the lower legs, especially in people over forty, can take up to 3 months to heal.

Knee Ache When Sitting - You Don't Have to Stand For it Anymore - Special Report on Knee Supports

Can you relate to any of the following?

You don't enjoy going to the movies. You avoid long car rides. You dread sitting at your desk at work to finish an important assignment. Why? Is it that you're anti-social, or dislike travel, or hate your job? No! It's the knee ache when sitting. When you sit in one spot for too long, your knees start to ache and throb. The aches and pains can get worse the longer you sit until you can't stand it any longer. But the good news is, you don't have to stand for it anymore. The relief you've been looking for could be something as simple as a knee brace. Here's why...

A lot of people may think that knee pain occurs only with activity. However, knee aches and pains when sitting is a common problem. Knee aches when sitting is typically felt in the front of the knee, in the area of the kneecap (patella). Generally, this type of pain is caused by the compression of the knee cap (patella) and the cartilage underneath (meniscus) against the femoral groove (the indentation at the end of the femur-or thigh bone-where the knee cap sits). Normally, when the knee is bent, the pressure against the knee cap (caused by the pulling of the attached muscles and tendons), increases.

Over time, knee ache when sitting can be felt, especially if the knee cap is not sitting exactly as it should within the femoral groove. The ache may become worse the longer you sit. This type of pain (called patellofemoral pain syndrome), may occur in one knee or both. Still, while this condition is a common cause of knee pain problems while sitting, it may not be the exact cause of your particular pain, and it is always wise to have your condition evaluated by a qualified physician. In the meantime, while your symptoms might be partially relieved by taking a break from your sitting position, or by icing the knees while sitting, it would be preferable to prevent the knee ache while sitting from occurring altogether. A knee brace may help you do this.

A knee brace is designed to lend support to your knee joint. When used properly, a knee brace can help relieve the pressure on the knee cap as it is rests in the femoral groove while you are sitting. A knee brace may also help keep the knee cap properly aligned within the femoral groove, thus helping to relieve the ache caused by the compression when sitting.

What is Runner's Knee?

Runner's knee is a term used to describe a constellation of symptoms of knee pain that is frequently encountered in running athletes. Other terms that have been used to describe this condition are "anterior knee pain", "chondromalacia patella", or "patellofemoral pain syndrome (PFPS)". Runner's knee involves the kneecap, quadriceps tendon, patellar tendon, and the associated soft tissues that are critical to extension of the knee. Historically, "runner's knee" was attributed to irritation and softening of the cartilage lining on the undersurface of the kneecap ("chondromalacia"). More recently, however, it has been recognized that overloading of the underlying ("subchondral") bone can be a substantial source of pain, as it has a rich nerve supply. The soft tissues and fat pad in the front knee can be causes of pain as well.

Who gets Runner's Knee?

While classically associated with long-distance running, any activity that places significant stresses on the front of the knee joint ("patellofemoral") can result "runner's knee". This includes repetitive jumping sports like basketball or volleyball, as well as skiing, cycling, and soccer. The repetitive pressure and stress between the femur and patella in these sports can result in softening of the cartilage and abnormal loading of the underlying bone.

How does Runner's Knee present?

Runner's knee presents as activity-related pain in the front of the knee and around the kneecap. While the pain develops during athletic activity, it can often be most pronounced afterwards during a period of rest. Pain is also felt after sitting for a long period of time with the knees bent - the bent position actually increases the pressure between the kneecap and femur. For the same reason, marathon runners will often paradoxically complain of greater difficulty running downhill rather than uphill. Kneeling, squatting, or direct pressure on the front of the knees may be uncomfortable as well.

What things might predispose me to Runner's Knee?

The kneecap and its cartilage is subject to very high forces with daily activities, and any injury to the cartilage or factors which result in increased pressure between it and the thigh bone ("femur") can increase the risk of "Runner's Knee". These include:

o Malalignment of the kneecap and/or leg
o Subluxation or dislocation of the kneecap
o Direct trauma to the kneecap
o Overuse with running and jumping activities
o Wide hips and/or "knock knees" (valgus) resulting in maltracking of the kneecap
o A weak quadriceps/vastus medialis muscle
o Flat feet ("pronated" feet)
o Direct trauma to the kneecap
o Overuse with running and jumping activities
o Wide hips and/or "knock knees" (valgus) resulting in maltracking of the kneecap
o A weak quadriceps/vastus medialis muscle
o Flat feet ("pronated" feet)

In certain cases, runner's knee results from irritation or injury to the soft tissue around the kneecap. For this reason, inadequate muscle strength and/or stretching of the thigh and calf muscles can predispose to "Runner's Knee" as well.

What can I do to prevent Runner's Knee?

While certain predisposing factors such as kneecap and leg alignment are not in the control of an athlete, other preventative measures can be taken to minimize the risk of "runner's knee". These include:

o Quadriceps and vastus medialis strengthening - a strong quadriceps and, specifically, the vastus medialis muscle will improve the tracking of the kneecap and help to minimize contact pressures between the kneecap and thigh bone.
o Keep your weight down - the patellofemoral joint experiences forces that are 8 to 10 times our body weight, such that even small reductions in weight can significantly reduce the forces on the kneecap. Ten pounds of weight loss can be as much as 80 to 100 pounds less force of the kneecap when climbing or descending stairs.
o Stretch before running or jumping activities - Strains of the patellar tendon, quadriceps tendon, or other soft tissues that stabilize the patella can cause significant anterior knee pain. Warming up and stretching both before and after exercise can help to prevent strain injuries to these structures.
o Wear proper shoes and orthotics - Flat feet ("pronated" feet) can predispose to maltracking problems and knee pain. Orthotics to reconstitute the arch of the foot can help to alleviate these symptoms. High heels can also worsen anterior knee pain and should be avoided if you have "runner's knee" symptoms.
o Plan for a good running surface - Running on a flat surface without steep, downhill slopes can help to prevent significant stress on the knee cap. Even, padded surfaces and good running shoes can help as well.

How is Runner's Knee diagnosed in athletes?

Usually, the diagnosis of "runner's knee" can be made in athletes based on the history and physical examination of the knee by your sports medicine specialist. The exam will evaluate the stability of the kneecap as well as alignment of the leg. Signs of tenderness under the kneecap and/or instability will be assessed. Strength and tone of the quadriceps and hamstrings will also be determined. Flexibility of the feet and loss of the arch should also be noted as this will predispose to kneecap problems. X-rays, MRI, and CT scans can all be useful adjuncts depending on the examination findings and symptoms. Special views can show the position and alignment of the patella in its groove on the thigh bone ("trochlea"). Tilting of the patella that leads to abnormal contact pressures can be appreciated. If instability of the kneecap is suspected, CT scan can help to determine abnormalities in alignment and position. MRI is useful to evaluate for softening or injury to the cartilage on the kneecap and femur.

What is the treatment for Runner's Knee?

The first line of treatment for "runner's knee" is typically nonoperative. Recommendations include:

o Stop running, jumping, or any of the activities that cause pain in the knee. Even though it is difficult, the athlete must refrain from competition until he/she is pain-free. Fortunately, low-impact activities such as swimming or cycling can allow the athlete to maintain their aerobic fitness while protecting the patellofemoral joint.
o Avoid running down hills or down steep slopes or stairs that increase pressure on the kneecap.
o Ice and anti-inflammatory medications can certainly help to relieve the pain in the front of the knee.
o In certain cases, taping of the kneecap ("McConnell taping") or use of stabilizing braces for the kneecap can help. These are particularly useful in the setting of instability of the kneecap.
o If the athlete has flat feet ("pronation"), orthotic inserts to reconstitute the arch can be extremely useful to alleviate symptoms.
o When the knee is pain-free, a course of rehabilitation for range-of-motion of the knee and strengthening of the quadriceps and vastus medialis muscle may be useful.

However, exercises that are performed with the knee bent should be avoided, as the pressure beneath the kneecap is increased in this position. Instruction on preventative stretching exercises for the quadriceps, hamstring, and calf muscles is very important as well. In rare circumstances, the knee will continue to be painful and refractory to all of the nonoperative measures described above. When the pain of "Runner's Knee" prevents the athlete from returning to play, surgery may be considered.

The specific treatment will depend on the underlying cause for the pain. Arthroscopic ("minimally invasive" camera-based) surgery can be pursued to manage softening or damage of the articular cartilage of the kneecap and thigh bone. If there is accompanying instability of the knee cap, soft tissue reconstructive procedures or re-alignment of the leg ("osteotomy") may be performed to improve the tracking of the patella. These may also be performed to relieve abnormally high pressures between the kneecap and femur.

Causes of Knee Pain

Excessive use or abuse of the joint, incorrect positioning during movement, inadequate warm up or cool down activity prior to and after exercise, and insufficient stretching are some of the physical causes of knee pain. Knee pain resulting from these simple causes may resolve on its own through rest and careful self-nurturing. However, excess weight or obesity can increase the risk of developing painful disorders of the knee.

Some of the diseases that cause knee pain include:

• Arthritis - rheumatoid arthritis, osteoarthritis, gout, and other connective tissue disorders like lupus.


• Baker's cyst - when the posterior region of the knee is inundated with fluid, swelling and arthritic inflammation occurs. This engorged cyst can burst, causing pain to travel down the back of the calf.


• Bursitis - symptoms include inflammation from constant knee stress (e.g., prolonged kneeling, excessive joint use, or injury).


• Disorders of the hip - pain causing ailments which affect the knee. The Iliotibial Band Syndrome is one such example. This injury occurs in the thick band of tissue that extends from the hip to the knee exterior.


• Joint infection.


• Kneecap dislocation.


• Knee injuries - these injuries can result in internal knee bleeding, thereby aggravating the pain.


• Strains and sprains - these are minor ligament injuries that are caused by abrupt or irregular joint wrenching motions that may cause ligament trauma.


• Tendinitis (tendonitis) - characterized by anterior knee pain that is exacerbated by activities like going up or down stairs and other inclines. Athletes like runners, skiers and cyclists are more prone to this disease than most.


• Meniscus tears (cartilage tears) - these type of injuries result in pain in the interior or exterior knee joint.


• ACL tear (ligament tear) - the resulting pain and damage also causes the knee joint to become unstable.

Knee pain can also result from other less common illnesses which include:

• Bone tumours


• Osgood-Schlatter disease