Many Benefits To This Knee Exercise

Many Benefits To This Knee Exercise

 

Following an injury or surgery to your knee, regaining strength and mobility is a very important goal to establish.  In addition, your standing balance and hip stability may also be impaired during this time.  These goals are all very important if you have stairs at home, because you will need to safely navigate them so that you do not fall and become a "frequent flyer" at your local hospital. 

Most patients who have stairs in their home and are recovering from a knee or hip injury have been told "Up with the good, down with the bad."  This means that initially you must rely on the uninjured or "good" leg to control your body weight when ascending and descending stairs.  The "good" leg goes up first in order to lift your body to the next step.  On the way down, your "bad" leg goes to the lower step first as you must control the descent of your body using the stronger leg.  This is the safest way to navigate the stairs.  However, your ultimate goal is to regain symmetry in leg strength.  So a few weeks into recovery, as long as there are no weight bearing precautions on the injured leg, I will have my patient stand at the bottom of their staircase to practice placing the weaker leg on the first step.  Once they gain the appropriate range of motion in the hip or knee to allow placement of the foot on the step without compensation, I will progress them to lifting their body to the next step using the "weaker" leg.  Remaining at the lowest section of the staircase ensures client safety, as being at the bottom of the staircase, if the weaker leg does buckle, they will not fall down a flight of steps.  As confidence and strength improves, I will have my client perform multiple repetitions of this activity and eventually navigate the staircase alternating legs.

 

Now, going back to the "up with the good, down with the bad" technique.  Besides safety, there are many other benefits to using this technique.  In order to lift and place the "good" leg onto the first step, you must shift your weight onto the weaker leg.  This weight shift onto the weaker leg helps improve stance time on that leg during gait, which will minimize limping.  It also helps to improve the "weaker" side's hip, knee and ankle stability , as well as single leg balance, and client confidence level.  Many times, my clients will shift their weight onto the weaker leg and very quickly 'throw' the stronger leg up to the step, either because the injured leg is not strong enough to hold the body up, or their confidence in single leg stance on the weaker side is poor.  I provide verbal cues and sometimes manual cues to assist proper technique while letting them know that I will not allow them to fall.  They must perform this step-up slowly and with control.  The slower they lift the "good" leg to the next step, the longer they must stand on the weaker side, thereby improving hip strength, stability and single leg balance.  

As their confidence, balance and strength improve, I ask them to lift the "good" leg up two steps.  I do not require them to lift their body to the second step, but use this technique to challenge their stability and single leg balance on the weaker leg even more.  They must stand on the affected side for a longer time in order to place the "good" leg on the second step with control and coordination.  

If knee mobility is an issue, I will have them perform foot placement of the affected, weaker side on the first step with a progression to the second step, incorporating a lunge stretch in order to maximize knee flexion range of motion.  This technique will be easier  for them as they are standing on the stronger leg in order to place the weaker leg on the first or second step in order to perform the stretch.

 

So, you are not just performing stair training here.  You are also working on balance, stability, confidence, flexibility, and strength.  

 

Stair Training Tips:

1) Lifting the stronger leg first ensures safety and also forces you to balance on the weaker leg.  This improves standing tolerance on the affected side, single leg balance and hip/ankle/knee stability

2)Lifting the weaker leg first will help strengthen that leg as it must then lift your entire body to the next step.  Once the weaker leg is positioned on the next step, lunging into it will improve knee flexibility on that side. 



"The Good Go To Heaven, The Bad Go To Hell"

When working with a client status post hip, knee or ankle surgery, we must ensure that they will be safe when they are moving around in their home.  Many people have stairs that they will need to navigate to enter or exit their home or to move from one floor to the next.  Initially, they may have too much pain when fully weight-bearing on the surgical leg.  So we use the saying "The Good Go To Heaven, and The Bad Go To Hell" in order to explain that the "good" or stronger leg goes up first upon ascending the stairs, while the "Bad" or weaker leg goes down first, upon descending the stairs.  Basically, the stronger leg is in control of the body weight completely when ascending as well as descending the stairs.  It does the work of controlling the body safely up and down while the weaker, surgical leg goes along for the ride.  Many patients/clients receive home care treatments immediately following their surgery and may receive therapy for up to 2 months.  I have seen these patients many times towards the end of their 2 months, and when I ask them to show me how they climb stairs, they continue to perform the task with "The Good Go To Heaven, and The Bad Go To Hell" strategy.  I think many times, as therapists, we get so caught up in educating a patient to perform this task the safest way possible, that we never progress them to the next step.  As therapists, it should be our goal to get our patient/client as close to their prior activity level as safely possible.  There is nothing wrong with being safe, and advising our patients to perform stair-climbing this way.  However, when they no longer have us by their side, what happens if they accidentally forget and try to go up or down the stairs using the weaker leg to control their body weight?  They never practiced the technique this way while we were with them because we were so intent on doing it the "safest way."  We actually limited their functional improvment by 'protecting' them so much.  In general, the #1 most important thing is to be safe.  But we also want to challenge, progress and move forward.  If your patient/client independently climbs stairs using the "Good go, Bad go" rule, begin strengthening the surgical leg in the same manner so that they are symmetrical, safe and confident if they ever need to use it (Do this as long as their doctor allows full weight bearing on the surgical leg, of course).  Remember, if they didn't have to think about it before, you do not want them to have to think about it now.  Do not fall into the routine of doing the same treatment day in and day out.  Challenge your patient/client and take them to the next level.