Nicole Liolios

Experienced Personal Trainer with a demonstrated history of working in the health wellness and fitness industry and a Kinesiology Student at the University of Toronto.

3 posts

Physical therapy advice after knee surgery to keep up with your exercises! – Part 3

Struggling with motivation to keep up with your exercises at home? Look no further!

Previously we discussed some of the reasons why people find it challenging to do their rehabilitation exercises. We looked at how fear and pain (Part 1) or a lack of time and equipment (Part 2) can affect a person’s willingness to do their exercises to recover after injury or surgery.

Staying motivated and enjoying your rehabilitation program is critical to recovery. I will discuss how these two factors effect a patient’s commitment toward their rehabilitation and include tips from our physical therapist to help you along the way.

Motivation

Motivation is having the desire to do something.1 We tend to do things because it is personally rewarding to us, or for an external reward like money or a trophy. In the case of exercising at home after injury or surgery, motivation is a huge factor that determines your success. Some people need an outside influence to maintain and/or increase their motivation, such as the presence of their physical therapist or other health care provider.2 For this reason, a lack of self-motivation is a barrier to completing exercises on their own.

Some people have higher levels of intrinsic motivation, which can be thought of as being “self-motivated,” and are more likely to complete their home exercises.3 The more motivation you have on your own, the more likely you will do your exercises at home without your physical therapist and increase your chances of a successful recovery.

Physical therapy advice - After reading the section above many of you might be thinking, "I am not one of those self-motivated people! What can I do?" Here are some tips I have learned from working with patients over the past 17 years and brilliant suggestions from my patients who have figured out the key to their own personal motivation:

  • Set an achievable goal! If you love soccer and you want to get back to playing let that be your long term goal after injury or surgery. In rare cases returning to sports is not recommended after injury or surgery but this can be discussed with your health care provider.
  • Find other people who have gone through the same thing and talk to them about their journey. This can be done face to face but more and more people are finding this community and support on-line. One of these examples is the ACL Recovery Club which is an on-line community for people after ACL injury or surgery. It helps to know others have gone through the same challenges and have had successful recoveries.
  • Give your self real or virtual rewards! Yes it sounds odd but even virtual rewards that are meaningful to you can make you more motivated. We have a simple system of stars and trophies within our ACL app that helps people stay motivated to do their daily exercises. Research has shown that even virtual rewards are effective to motivate people.
  • Track your progress! It is hard to be excited about knee movements or being able to lift your leg without pain but these will be some of your initial goals after surgery. Having a method to track your progress either on a piece of paper, a chart or an on-line or app tracker will keep you motivated. When you use our ACL app it tracks all of your progress daily for your exercises, knee movements, and achieved goals without ever having to write anything down. The easier it is to track your progress the more likely you will be to continue doing it!
Lack of enjoyment

When it comes to completing your rehabilitation exercises there may be times where you feel like you would rather be doing something else, especially if you are doing your exercises at home by yourself. After an ACL injury, most of the exercises given to patients by their physical therapist are low-intensity and may not be very exciting depending on the stage of recovery. Some people report that the exercises they do are “boring, mundane, and a waste of time,”2 and this discourages them from following their rehabilitation program. In order to commit to your rehabilitation program, it is important that you enjoy what you are doing, especially since recovery takes months and not days.

Physical therapy advice - This is a tough area to advise patients since I can't make anyone love their exercises. Here are some tips that can help:

  • Pair your exercises with an activity that you love. You can do your exercises while watching your favourite show, listening to some great music or a podcast or watching a sporting event on tv.
  • Make sure that you have a long term goal that will make the exercises that you are doing have some purpose and meaning. It is hard to enjoy leg raises but if you know that this will let you be more independent in walking and eventually jogging this might lead to you enjoying your exercises. In our ACL app jogging starts at 3 months!
  • Look into the future! It is important to remember why you are doing your exercises. Look at the later stages of your rehabilitation and this might get you excited about what you can do in a month or 3 months. Our ACL app provides you with weekly goals on the "Journey" page and this feature allows you to look at your goals currently but also throughout the entire rehabilitation process.
  • Do your exercises in a place that you love. Some people love the gym and some people love their living room. I encourage these people to workout in that space so that they feel better about what they are doing. Even if this means going to the gym to do knee bending exercises.

Remember this process is hard but the exercises have been designed to allow you to return to all of those activities that you love.

References

Physical therapy advice after knee surgery to keep up with your exercises! – Part 2

In my last post I discussed how fear and pain make it challenging to do your exercises after knee surgery (see Part 1 here). In this blog, we outline two more reasons why people struggle with their rehabilitation exercises after surgery. We also include physical therapy advice to help you overcome these barriers.

Perceived lack of time

Let’s face it; we live in a fast paced society with many personal and professional commitments. These commitments take a toll on the amount of available time for attending physical therapy appointments and doing daily exercises at home. When it comes to doing the things you need to do to recover, a busy daily routine and a perceived lack of time are significant barriers.1 When people were asked after surgery about why they find it difficult to complete their exercises at home, they mentioned work, holidays, family and social commitments all tend to take precedence over their exercises.1

Physical therapy advice - Recovery after ACL surgery is a huge time commitment for 8-12 months. After surgery is when all of the hard work starts. In the first month after surgery, rehabilitation can take 3-4 hours per day. In the later stages it can take at least 1 hour per day. Keeping an agenda (either on paper or electronic) is a great tool to keep track of all your responsibilities! Make your appointments or at-home exercise sessions a priority by scheduling a block of time during your day, as you would your other important life events! Here are some tips to help:

  • Do your exercises at the same time every day
  • If there is equipment you need have it in an easy to access place
  • Seeing your list of exercises either on a piece of paper or electronically is a very helpful reminder for you to do your exercises. If you haven't already, try our ACL app to help you do your daily exercises.
  • Ask friends and family to remind you to do your exercises or to check in on you every few days or weeks
  • If you know people who have gone though the same surgery ask their advice or exercise with them
  • Set reminders on your phone to do your daily exercises
  • Most importantly make time for these crucial exercises so that you can return back to your normal physical activity and daily activities.
Lack of availability of equipment

Doing your home exercises often requires some sort of equipment such as exercise bands, light dumbbells, or an exercise ball. When attending physical therapy appointments at a clinic all the necessary equipment is provided and completing the exercises is not an issue. However, when patients are given exercises that require the use of equipment at home, some patients report not having access to the appropriate equipment.1 As a result, instead of independently completing the exercises, patients opt to wait until they go to see their physical therapist. If you do not have access to the equipment necessary for the exercises given to you by your physical therapist, be sure to tell them so they are able to prescribe exercises that you can do at home.

Physical therapy advice - There is always an alternative that can be provided for most equipment that you do not have at home. You do not have to have access to a gym or any fancy equipment to recover fully after surgery. Ask your physical therapist how you can modify exercises that require equipment. Almost all of the exercises in our ACL app can be done with no special equipment. Here are some simple examples of things that can be substituted for equipment:

  • A folded pillow or couch cushion can be used as a balance disc or balance board for balance exercises
  • A water bottle filled with water or sand or rocks can be used as a weight
  • A few books can be used to replace a step for step up and down exercises
  • A water bottle can be used as a pylon for running drills, clock lunges and squat touch down exercises. All of these exercises are included in our app.
  • An office chair with wheels can be used as an exercise ball
  • Resistance bands (which can cost $5-15 per band) are a cheap alternative to using cable machines found in gyms and other forms of resistance equipment that you may not have

References

Physical therapy advice after knee surgery to keep up with your exercises! – Part 1

Fear, frustration, discomfort… These are a few things you may feel after a knee surgery.

If you have ever undergone an anterior cruciate ligament (ACL) surgery, you know the lengthy rehabilitation that is required for a successful recovery. For some people, a full recovery can take up to one year!1 Not only will this require a positive mindset to remain committed to recovery, but there are several other factors that influence your ability to complete all of the necessary rehabilitation. Full commitment to doing all of your exercises after surgery for 6-12 months can be challenging.

This challenge often leads to people not doing everything they need to do, which is called low rehabilitation compliance, some of which you may relate to. After each of the barriers I discuss below I have included "physical therapy advice" from our physical therapist Nirtal Shah who has helped patients overcome these barriers after ACL surgery for the past 17 years. Hopefully, the process of recognizing these barriers, realizing that you are not alone in your challenges and being provided with some helpful tips will allow you to successfully rehabilitate your knee!

Fear

The number one reason why people don’t return to their sport after ACL reconstruction is because of fear!2 Most people fear re-injury and because of this they are hesitant to return to their usual sport, physical activity, or exercise. In fact, only one third (about 33%) of people return to their previous levels of activity after ACL surgery.2 Some people delay their progress and limit their long term knee function by simply not doing any exercises due to this fear.3 The likelihood of actually sustaining another injury is very low when rehabilitation programs are effective and done consistently.4 Knowing this, you are limiting your progress by not attending your appointments or by avoiding your exercises, both of which are crucial for regaining functional strength in your knee!

Physical therapy advice - Recognize that fear is normal after surgery. Even if you have decided you will never return to a sport it is still important to do all of the rehabilitation that involves jogging, running, cutting, changing directions, etc at the appropriate stage. Meaning you would not do these things in the first month but when you are ready and your physical therapist determines your knee is ready for these activities. Once you have done these movements and also sport specific movements you can decide if you and your knee feel ready to return to sports. I never force my patients to return to sports but I do strongly encourage them to return to their prior level of physical activity and exercise. The health consequences of never returning to physical activity are far worse than re-injuring your ACL. My biggest concern for my patients who are fearful is that they do not regain the full function of their knee. This is a serious problem and leads to more knee joint issues in the future. I also do not deny that there is risk associated with sports. We have a blog on the risk of ACL injuries with various sports which can be found here. In the end it is a personal decision that the patient makes to return to sports. I try to help by providing information and an objective opinion on the health of their knee. In addition our ACL app can also help by overcome this fear by guiding you through your rehabilitation.

Pain

If you have ever gone through any type of surgical procedure, you have experienced the physical pain that comes with recovery. One of the reasons people don’t do the things they need to do to recover is because they are in pain. For most, being in pain is a negative experience and often leads to avoidance behaviours such as skipping appointments or not doing their exercises at home. In fact, patients report worsening pain during exercise as a barrier to rehabilitation compliance.5 They believe that exercises causing pain to their area of injury is harmful. As a result, patients will stop performing an exercise if they feel it is painful.5 However, exercise has actually been shown to reduce pain!6

Physical therapy advice - You will definitely have pain after surgery. In the early days after surgery it is very important that you take the pain medication prescribed to you in the correct doses. I have personally had a surgery and lived with the pain first hand and this guides how I help my patients with their pain. You can read about my pain experience and what to expect immediately after surgery here. Besides medication there are other things that help with pain such as ice, compression, elevation, (find a blog about how to do this here)and most importantly movement of the joint in the motions that you are allowed. This means you should move your knee as much as you can and have been instructed by your physical therapist and this will help with your pain. Even in the later stages of recovery often just sitting on a stationary bike (or lying on your back if you do not have access to a bike) and getting your knee to move without resistance (5 minutes of continuous movement) can help with knee pain. Movement is your friend, use it! Many of the exercises in the first month hurt. This is unfortunate but it has to be done. The pain is going to be temporary but the functional gains you make in your knee are going to be long term. There are many ways to help you manage your pain after ACL surgery which you can find in our ACL app.

References