Knee Surgery Recovery, Pre-hab, X10

An interview with physical therapist Kishore Jeevanandam

Editor's Note: The text below comes from our interview with physical therapist Kishore Jeevanandam. To listen to the full podcast interview click on the play button above.

My Background

Hi, I'm Kishore. I'm a physical therapist and I work for Advanced Home Care in Troy, Michigan. I've been working with Advanced for the last 10 years. I have worked on traditional physical therapy in a community based setting in the past. Regarding the X10, we partnered with the Halley Orthopedics/X10 Therapy in 2015.

Two Key Concepts: Muscle Inhibition and Recruitment

Muscle Inhibition

Inhibition is marked weakness of the quadriceps muscles, and that is typically observed following an injury, surgery or pathology effecting the knee joint. This is partly due to ongoing neural inhibition that prevents the central nervous system from fully activating the quadriceps muscle, a process known as arthrogenic muscle inhibition, or AMI. Essentially this is the inability of the nervous system to activate the muscles.

Muscle Recruitment

Motor unit recruitment refers to the activation of additional motor units to accomplish an increase in contractile strength in a muscle. Contractile meaning contraction, the ability for the muscle to contract. A single motor unit consists of one motor neuron and all the muscle fibers it stimulates, so we're really getting into the muscle to recruit one motor neuron to activate that portion of the muscle that that controls.

Expectations After Knee Surgery

The general expectations are that your knee is going to swell up. You will have tightness in your knee. Pain is going to be part of the surgery and recovery. Physical therapy and mobility are the key important things that you will want to address following any knee surgeries.

During the initial few days after knee surgery you are going to work more on range of motion, decreasing the amount of swelling in the knee, and keeping your legs iced and elevated. That decreases the amount of inflammation following the surgery and thereby, having very little chance for developing a scar tissue in your knee joint.

Generally after a knee surgery when your knee joint has swollen up, there is a lot of exudation and fluid build up. These fluids can ultimately result to a scar tissue formation wherein your range of motion can be restricted. Or, maybe, making it hard for you to regain your range of motion. Exercising and moving, mobilizing your joint, helps prevent and decrease the exudation, thereby helping you to prevent the development of scar tissue.

Recovery following a total knee replacement involves not only range of motion but also control. The quadriceps muscle group goes into a stage called muscle inhibition. And wherein these fibers do not act, and do not get recruited, they need facilitation (movement) just to let the body know, and especially the muscle know, that it is okay to move. It's needed, so this facilitation helps in breaking up this quadriceps inhibition and thereby, the control of the joint does return.

What happens with most patients is that when they don't have this control there is a good chance of them buckling and having a fall.