Pilates Post Knee Replacement

Transcription

1 Pilates Post Knee Replacement Nadine Taylor 1/17/18 Course year: Reading, MA/ Herndon, VA

2 ABSTRACT Osteoarthritis (OA) of the knees is a debilitating condition affecting everyday movements. Typical daily activities of the average person can become obstacles that otherwise would be unnoticeable with healthy knees. Walking can be painful, stairs may feel more like you are climbing a mountain, getting up out of a soft chair may seem impossible at times. Pain from OA may lead to a sedentary lifestyle, that can cause weight gain, loss of muscle mass and depression (website #1). Surgery is generally required for reconstruction of the knee. Postsurgery can in the beginning be just as challenging as the client will need to learn how to walk with new knees. Pilates post rehab can help continue the healing process, the workouts can help strengthen and lengthen the muscles in a safe manner. The BASI block system can help client s knees perform their function without unnecessary stress, while enabling the client to receive a total body workout in every session. This paper will provide a summary of the use of Pilates using the BASI block system prior to the clients knee replacement and post knee replacement routines.

3 TABLE OF CONTENTS 1. Abstract 2. Table of Contents 3. Anatomy 4. Information on Osteoarthritis 7. Case Study 8. Program using the BASI Block System 13. Conclusion 14. References

4 Figure 1: Anatomy of a healthy Knee (Website #2) Figure 2: Stages of Osteoarthritis (Website #3)

5 Figure 3: Healthy Knee vs OA knee with bone spurs (Website #4) Osteoarthritis (OA) may sometimes be called degenerative joint disease or degenerative arthritis. It is one of the most common chronic conditions of the joints currently affecting more the 30 Million Americans (website #1) OA can affect any joint. This paper will focus on how OA affects the knee joint. Figure 1 depicts a healthy knee having cartilage that covers and protects the bones from rubbing against each other. The cartilage acts as a cushion to help the knee move smoothly. Figure 2 depicts the stages of OA, the cartilage breaks down causing pain, swelling and affects the movement of the joint. OA overtime will cause the bones to break down and spurs to develop (Figure 3), bits of the bone and or cartilage may break off and float around the joint,

6 causing inflammation and damaging the cartilage even more. Once the OA is in its final stages there is no cartilage left to cushion the bones from each other and the femur, tibia and fibula will rub bone against bone. The rubbing action is painful for the client. The pain from OA can have negative effects on the mood, sleep and in general participating in any extracurricular activities that require more movement then just sitting in a chair. In social settings people may tend to be distracted because they need to make sure to be near an available chair because standing for too long can be quite unbearable. An active lifestyle can be difficult to maintain when experiencing pain. Pilates is low impact and can be custom designed for the client, which makes it a great exercise for someone with OA to keep active and keep their body moving prior to surgery and help make sure the client stays on the right track for a full recovery after surgery. According to Johns Hopkins Medicine Health Journal (website #5), the Procedure requires a stay in the hospital, and may vary depending on your condition and doctor s practices. It is most often performed while you are asleep under general anesthesia. Generally, knee replacement surgery follows the following process: You will be asked to remove clothing and will be given a gown to wear. An intravenous (IV) line may be started in your arm or hand. You will be positioned on the operating table. A urinary catheter may be inserted. If there is excessive hair at the surgical site, it may be clipped off.

7 The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. The skin over the surgical site will be cleansed with an antiseptic solution. The doctor will make an incision in the knee area. The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis. Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a knee. The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone). The incision will be closed with stitches or surgical staples. A drain may be placed in the incision site to remove fluid. A sterile bandage or dressing will be applied.

8 The Client Deb, 63-year-old, extremely busy entrepreneur. Deb has been taking Pilates for 4 years, for several years her knees had required replaced. However, Deb wanted to wait because she couldn t commit to the time off that was needed after this type of surgery. Debs job requires her to travel frequently and she wouldn t be able to fly for a couple months post-surgery. Together during our Pilates sessions we spent most of our time prior to her surgery focusing on keeping her moving. Pre-surgery workouts consisted of a warm up using a TheraBand to stretch out her hamstrings, hips, upper body and arms. She also has arthritis in her neck, in which she cannot raise her head for when working out, so all exercises (pre-and post-surgery) are done with her head down and use of a neck pillow. Majority of the workouts were spent on the reformer, foot work was done on light springs, she did a modified abdominal work (hundred, double leg stretch, single leg stretch) supine arms in straps and seated (on long box) arm work. She always felt better coming in to stretch and move her body. In November of 2016 she made the decision to get both knees replaced, they were replaced a month apart one in November and the other in December. She was very diligent on the pre- physical therapy exercises that were giving to her prior to and post-surgery. Deb was back to Pilates six weeks after her second surgery. When available she comes to see me three times a week, work still has her traveling a lot so that didn t always get to happen.

9 When Deb came back to Pilates she wanted to make sure she could get full range of motion back in her knees and her biggest goals were to be able to play with her grandchildren, walk through airports with ease and not feel limited by her knees. Below is the conditioning program using the BASI block system that was used for Deb as her Post surgery workouts: SESSIONS 1-10 BLOCK EQUIPMENT EXERCISES Warm up Mat and TheraBand TheraBand straight leg stretch TheraBand bend and straighten leg Pelvic curl Spine twist supine (feet on mat) Leg changes (feet didn t touch the floor) Leg lifts Footwork Reformer Parallel Heels Parallel toes V position toes Open V position heels Open V position toes Calf raises Prances AB Work Reformer Hundred Prep Hundred Hip Work Reformer Frog Circles Down Circles Up Openings Spinal Articulation Mat Pelvic Curl Stretches Reformer For the stretch I had her leave her feet in the straps and stretch her legs back towards the tower as she kept her tail bone down. This really helped with her tight hamstrings and she couldn t put her knees down on the mat at this time

10 FBI (F/I) N/A We didn t do any FBI at this time in her progression ARM Work Reformer Supine Series: Extension Adduction Circles up Circles down triceps FBI (A/M) N/A We didn t do FBI at this time in her progression Leg Work N/A We didn t do Leg work at this time in her progression Lateral Flexion/Rotation Mat Side lifts Back Extension Mat Back extension Sessions BLOCK EQUIPMENT EXERCISES Warm up Mat and TheraBand TheraBand straight leg stretch TheraBand bend and straighten leg Pelvic curl Spine twist supine (feet on mat) Leg changes (feet didn t touch the floor) Leg lifts Footwork Reformer Parallel Heels Parallel toes V position toes Open V position heels Open V position toes Calf raises Prances AB Work Reformer Hundred Prep Hundred Co-ordination

11 Hip Work Reformer Frog Circles Down Circles Up Openings Spinal Articulation Reformer Bottom lift **This was done with heavy springs to keep the reformer from moving too much and putting too much stress on the clients legs** Stretches Reformer For the stretch I had her leave her feet in the straps and stretch her legs back towards the tower as she kept her tail bone down. This really helped with her tight hamstrings and she couldn t put her knees down on the mat at this time FBI (F/I) Reformer Scooter **this was modified, her standing leg was a lot closer to the foot bar, as opposed to in line with the foot on the carriage** ARM Work Reformer Sitting Series (used the box) Chest expansion Biceps Rhomboids Hug-a-tree Salute FBI (A/M) N/A We didn t do FBI at this time in her progression Leg Work Cadillac Squats **Squats were mini squats working on pressing through the heels to engage the glutes more** Lateral Flexion/Rotation Mat Side lifts Back Extension Mat Back extension

12 Sessions BLOCK EQUIPMENT EXERCISES Warm up Mat Pelvic curl Spine twist supine Leg changes Leg lifts Leg circles Footwork Cadillac Parallel Heels Parallel toes V position toes Open V position heels Open V position toes Calf raises Prances AB Work Reformer Hands in straps: Hundred Double leg stretch Single leg stretch Co-ordination Hip Work Cadillac Frog Circles Down Circles Up Walking bicycle Spinal Articulation Reformer Bottom Lift Stretches Reformer Standing Lunge FBI (F/I) Reformer Scooter ARM Work Reformer Supine Series: Sitting Series: Extension Chest expansion Adduction Biceps Circles up Rhomboids Circles down Hug-a-tree Triceps Salute **switched up between sitting and supine** FBI (A/M) N/A

13 Leg Work Chair Leg press standing Lateral Flexion/Rotation Reformer Mermaid Back Extension Reformer Pulling Straps 1 Pulling Straps 2 Sessions 41+ BLOCK EQUIPMENT EXERCISES Warm up Mat Pelvic curl Spine twist supine Leg changes Leg lifts Leg circles Footwork Chair Parallel Heels Parallel toes V position toes Open V position heels Open V position toes Calf raises *done on Reformer* AB Work Reformer/Chair Hands in straps: Chair: Hundred Torso press sit Co-ordination Hip Work Cadillac/Reformer Cadillac: Reformer: Frog Frog Circles Down Circles down Circles Up Circles up Walking Openings Bicycle Spinal Articulation Cadillac **mixing it up** Tower Prep Stretches Reformer Kneeling Lunge ** working on having knees down and feeling he stretch, working on straightening out the leg just a little at first**

14 FBI (F/I) Reformer Kneeling lunge group: Round back Flat back ARM Work Cadillac Standing Series: Chest expansion Hug-a-tree Circles down Circles up Punching Biceps FBI (A/M) N/A Leg Work Chair/Reformer Chair: Reformer: Leg press standing Hamstring curl Lateral Flexion/Rotation Cadillac/Reformer Cadillac: Reformer: Side lift side over on box Back Extension Cadillac Prone 1 **Introducing a Prone 2 prep, not fulling going into is yet** To conclude this study, Deb is feeling great and is doing so much more then she even imagined she would be able to do. She is very pleased with the progression in her routine and enjoys working on the more challenging exercises that she never thought could be possible for her. We will continue to build on the repertoire and keep her body moving as it is meant to do. In my opinion Pilates is truly a lifestyle that can benefit almost everyone from the injured client all the way up to the athlete looking for the cross-training workout that will help them improve their performance in their sport.

15 References Books: Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, CA: Body and Arts Science International, Isacowitz, Rael. Mat Analysis Workbook. Costa Mesa, CA: Body Arts and Sciences International, Body Arts and Science International Isacowitz, Rael. Reformer Movement Analysis Workbook. Costa Mesa, CA: Body Arts and Sciences International, Isacowitz, Rael. Cadillac Movement Analysis Workbook. Costa Mesa, CA: Body Arts and Sciences International, Isacowitz, Rael. Wunda Chair Ladder Barrel Movement Analysis Workbook. Costa Mesa, CA: Body Arts and Sciences International, Websites: placement_surgery_92,p07673