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Knee Replacement

 
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mvallada



Joined: 06 Nov 2012
Posts: 2

PostPosted: Fri Nov 09, 2012 10:55 am    Post subject: Knee Replacement Reply with quote

Hello Bernie,

Could you please advice me on what kind of exercises would be feasible to do for a new to yoga, overweight person. This person also has a three year old knee surgery.
Please advice,
Thank you,

P.S. I think I already asked this question before....
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Bernie



Joined: 23 Sep 2006
Posts: 995
Location: Vancouver

PostPosted: Fri Nov 09, 2012 1:11 pm    Post subject: Yin Yoga: student is overweight or had a knee replaced Reply with quote

Yes - you asked this question in the Hips thread and I responded there. Here was my response:

Two very different questions but we can easily see how someone who is overweight may require knee replacement surgery. In any case lets start with knee replacements.

As always, the surgeon is the one to ask about any physical activities post surgery. Every surgery is different and only the surgeon really knows what happened. How much of the ligaments was he able to save? How much range of motion is good or bad now? However there are some very general cautions that can be made. The knee is a condyloid joint, which means it moves in an elliptical fashion. That may be more information than is needed: basically think of it as a hinge joint but one that can also twist when the knee is flexed. Hinging is okay but due to the swelling post-op and the tightness of the remaining ligaments the range of motion that existed pre-op may be lost now, or may be greatly enhanced, due increased laxness in the ligaments. Twisting may not be so good now, again depending upon what is left in terms of supporting structures.

Sitting poses that internally rotate the hips (such as sitting on the heels) and those that externally rotate the hips (such as Butterfly or Shoelace, etc.) may start to put too much pressure on the knee, but on the other hand this may be just what the doctor ordered. The Yin Yoga for the Knees sequence may be great for the knees now, but it may also be a big "no-no". The student should print this out and take it to the surgeon and ask when and if this would be good to do.

Generally after replacement surgeries there is more range of motion due to laxness in the ligaments or missing ligaments so the intention now is not to increase mobility but rather increase stability. This means that the student, rather than doing lots of Yin Yoga may want to concentrate on Yang yoga that strengthens the musculature in the area. Now is the time to build stability not mobility.

Regarding weight issues: please read these earlier posts on the topic. I hope this helps.

Cheers
Bernie
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mvallada



Joined: 06 Nov 2012
Posts: 2

PostPosted: Sat Nov 10, 2012 12:20 am    Post subject: Knee Replacement Reply with quote

Bernie,
Thank you very much for your advice. So, postures such as crescent lunges would be beneficial for this individual?
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Bernie



Joined: 23 Sep 2006
Posts: 995
Location: Vancouver

PostPosted: Sat Nov 10, 2012 2:30 am    Post subject: strengthening the knees Reply with quote

Yes, there are many yang poses that can strengthen the knees: Crescent, high lunges, Warriors, Chair pose, and all the standing on one leg postures. Make sure your student doesn't go too deep and really engages the muscles. ("Hugging the muscles to the bone.")
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Renee



Joined: 08 Sep 2011
Posts: 47
Location: geldrop

PostPosted: Mon Oct 14, 2013 10:33 pm    Post subject: Full Knee replacement Reply with quote

Hello Bernie,

I have a question about after full knee-replacement surgery.
My mother had a full knee replacement and due to the pain she felt, she postponed the therapy which resulted in almost no flexion in her knee.
If this condition does not change the surgeon will narcotize her to flex the knee. I adviced her to avoid this action and to do yinyoga to her knee.
The therapist, she goes to now, manipulates her knee in a painful way. because he has only one hour to treat her.
What would you advice her to do Bernie. Aren't the actions/therapy she is having now kind of yinyoga in an agressive way.
I am just her daughter and a yoga teacher but I still believe that bending her knee in an agressive way can do more harm than good.
What will actually happen to the connective tissue when the knee is being bent in such an agressive way? Is not time the cure for her?
Thank you again.
Namaste,
Rene
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Bernie



Joined: 23 Sep 2006
Posts: 995
Location: Vancouver

PostPosted: Tue Oct 15, 2013 3:37 am    Post subject: Post knee surgery Reply with quote

Hi Rene

I can only offer speculations as to what is going on with your mother's knee: the surgeon is the best one to understand what was done, but it sounds like there may be some scar tissue impeding her range of motion (ROM). It is natural, after surgery, for there to be a lot of swelling. That swelling can limit range of motion, but only for a while. Hopefully, after a few months when the swelling stops, the ROM comes back, but if scar tissue built up in the meantime, that can permanently reduce ROM. There is no easy way to get rid of scar tissue except through physiotherapy. Because it is tissue, with nerves and blood vessels flowing through it, it will hurt to break that tissue apart. I am not surprised that the therapy your mother is undergoing hurts.

It is unfortunate that your mother was not able to mobilize the knee soon after the surgery: that would have been the best time to reduce or even prevent the scar tissue from forming. But that is in the past: the question is - what to do now? It sounds like your doctor is saying, "The scar tissue has to be broken down, and since it is so painful, we are going to freeze this area and really get in there and break it apart." It does sound aggressive, but I can see where she is coming from. I can also understand what the physio is suggesting and why. Your main question, however, is - can this be done via Yin Yoga instead?

Maybe! I certainly see no reason to not try it. The knee needs to be mobilized and the scar tissue present there is connective tissue. Yin Yoga stresses may do some good, but I would ask the physio or doctor if they think there is any chance that Yin Yoga stresses (long held, static stresses) could possibly make matters worse. I don't think so, but they know your mother and I don't. If you are given the "all clear" signal, then start to give your mother some flexion postures that she can hold for a minute or so at a time. Work up to longer holds, and then to deeper postures.

I have to assume that there is no way your mother can currently sit on her heels, but can she sit in a chair with her knee flexed at all? When you say that she has almost no flexion, how much can she bend her knee. Whatever that range of motion is, she would need to get to that limit and stay there for a while. Hopefully, with time, that ROM will increase little by little, and she will have to continue to play the edges: stay where it is challenging. She may find that spending as much time on the floor as possible will be very beneficial. Get off chairs, if she can, and sit on the floor, on a cushion. She can sit at a coffee table to read or eat. As she sits, she can be bending her knee as much as she can, then relax it for a few minutes, then bend it again.

I wish her good luck!
Bernie

ps - I would not categorize what the physiotherapist is doing as "aggressive Yin Yoga" because she is probably moving the knee, not just holding a static stress. But if holding the knee in one position for minutes at a time, and if by "aggressive" you mean holding it while pain is present, then - yes, that is a form of yin, alright.
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Renee



Joined: 08 Sep 2011
Posts: 47
Location: geldrop

PostPosted: Tue Oct 15, 2013 11:25 pm    Post subject: Reply with quote

Hi Bernie,

Thank you for this quick response. This wednesday my mother has an appointment with the surgeon.
I thought of the therapy being aggressive yinyoga because it is connective tissue that the physio has to manipulate and connective tissue best need yinyoga to be manipulated, my thoughts anyway.
What happens to connective tissue when it is to be 'broken down'. More scar tissue?
Thank you again.
Rene
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Bernie



Joined: 23 Sep 2006
Posts: 995
Location: Vancouver

PostPosted: Tue Oct 22, 2013 6:39 am    Post subject: Breaking down scar tissue Reply with quote

Hopefully the process of breaking down the scar tissue does not lead to new scar tissue: obviously that would be self-defeating. When the connective tissue is broken down, the body will try to re-absorb it.

Another possible option you could investigate is prolotherapy. In this treatment the doctor will simulate an injury in hopes of getting the body to react and fix up the area. The simulation is often through injection of something otherwise harmless, like sugar water. The body reacts as if it is damaged and tries to heal the area. This could include finishing the job of absorbing scar tissues. You may want to check out this page about prolotherapy and this site about torn meniscus and prolotherapy. I am not totally sure it would work for your mother, but it is an avenue worth exploring and talking to a prolotherapist about.

cheers
Bernie
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Renee



Joined: 08 Sep 2011
Posts: 47
Location: geldrop

PostPosted: Sun Oct 27, 2013 4:33 am    Post subject: Reply with quote

Thank you Bernie for your time and options on prolotherapy. I will check it out.
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