CRAIG MCALLISTER, MD | ORTHOPEDIC SURGEON

    CRAIG MCALLISTER, MD | ORTHOPEDIC SURGEON

    SwiftPath Physical Therapy Protocol
    for the Knee

    The Preoperative PT Visit

    The preoperative PT visit is an opportunity for patients, family and physical therapists to become engaged in the SwiftPath approach to recovery after surgery.

    Be sure to take your Patient Guide to this visit. Your therapist will need it to complete the visit.

    4 goals of the Preoperative PT visit:

    1. Gain confidence in and demonstrate skills that enable discharge to home after surgery
    2. Provide instruction on basic exercises for patients for days and weeks after surgery
    3. Identify critical milestones that measure progress allowing patients to report after surgery
    4. Complete the Physical Therapy Evaluation section in the Patient Guide

    SwiftPath Post-op Protocol

    Dr. McAllister’s approach to rehabilitation includes opiate sparing pain management and patient engagement. This approach is proven to reduce pain, stiffness, and the need for prolonged, painful physical therapy. 1,2

    SwiftPath sets a new standard for communication between you and Dr. McAllister’s team. Engaged patients take control of their care, better understand their exercises, and advance to self-directed programs quickly. The result is a more pleasant and faster recovery. This timeline works for most patients. But if your experience is different, please share your goals with your physical therapist to make adjustments.

    1.McAllister, CM, et al. Rapid Rehabiliation after Joint Replacement. AAOS Annual Meeting, San Diego, March, 2016
    2. Austin MS, et al. Formal Physical Therapy After Joint Replacement is Not Required: A Randomized Controlled Trial. JBJS Am. 2017 Apr 19;99(8):648-655

    Postoperative Exercises and Milestones

    Do exercises for 5 minutes every hour for 8-10 hours per day until you get to PT.

    Days 2-7: Do your best to get up and walk or do your exercises

    Goals and Milestones: Icing/elevation, out of bed, chair rise, bathroom skills, stairs, household ambulation, community ambulation, in/out of a car.

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    Assisted leg raises
    When getting up from laying position, use your non-surgical foot or a leg-grabber to raise leg to lift it in and out of bed.

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    Gravity Stretch
    Sit on high stool or table so leg is hanging, and use gravity to work toward 90° of flexion.

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    Knee extension with support
    Place foot on another chair or coffee table height, and push knee to full extension and hold for 10 seconds.

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    Calf pumps
    (Foot flexed and pointed): Do these when awake and laying down.


    Weeks 1 - 2: Same exercises as above, and adding the ones below.

    Goals and Milestones:
    Independent walking, ascending/descending stairs (with walker, crutches, and stair rails for support, at least 90° of flexion, increase efforts at active range of motion, Continue with icing and (if appropriate) NSAIDs/acetaminophen before and after exercises.

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    Extension without support
    Sit in a stable chair, lift leg out straight. Hold for 10 seconds then relax. Repeat 10 times.

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    Heel slides and flexion
    Sit in a stable chair, slide heel back as far as it goes comfortably (i.e. 30-70°) If painful, slide forward in chair to slight pain tolerance. Hold for 10 seconds then straighten. Repeat 10 times.

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    Extension with gentle pressure
    Sit on a flat surface with a towel under ankle. Avoid touching the wound and push gently on leg to straighten.

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    Independent walking
    Walk without assistive devices. Use walker or rails for support on stairs.

    One of the main goals of physical therapy is to help regain your independence. The sooner that happens, the better patients do overall. This is a good time to consider fewer visits with a physical therapist with more emphasis on an independent, self-directed physical therapy program. Your therapist will help you develop a program that works best for you.

    Weeks 2-6:
    1. Walking with or without crutches.walker depending on doctor's orders
    2. Elliptical
    3. Treadmill
    4. Stairmaster
    5. Stationary bike
    6. Pool therapy (once physician has cleared wound healing)

    Continue with icing, NSAIDs before and after exercises. Avoid overexertion and limit duration of exercise based on pain and swelling and stiffness.

    Weeks 6 - 12:
    Transition to low-grade recreation (gentle hikes, golfing, extended walks, treadmill, elliptical, etc). Progress to more strenuous activities slowly and judiciously. If you struggle with pain, stiffness, range of motion or in any other way, return to the clinic and consider a PT consult.


    Post-op Knee Surgery DOs and DO NOTs

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    DO walk up steps with the non-operated leg first.

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    DO walk down steps with the operated leg first.

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    DO NOT bend deeply at the waist. To bend over, move the operated leg back or use a reacher.

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    DO NOT twist your body around with the operated leg fixed on the ground.