Exercises with Thera-Band elastic bands have been shown effective at improving strength and function in knee osteoarthritis patients before total knee replacement (TKR) surgery. Dr. Robert Topp and his colleagues have published several research papers on their “prehabilitation” pre-operative exercise program using Thera-Band that benefits total knee replacement patients before and after surgery.
Knee osteoarthritis patients are expected to receive 3 million total knee replacements per year by 2020 in the United States. Unfortunately, over one third of total knee patients experience deficits in function one year after surgery (Franklin et al 2008). Few exercise intervention studies have evaluated the effectiveness of balance training in combination with traditional rehabilitation exercises after early post-operative rehabilitation. Most total knee replacement patients receive in-patient exercises and some outpatient rehabilitation for a few months after surgery. Previous research has suggested that total knee rehabilitation patients plateau at 3 months after surgery (Mizner et al. 2005).
Researchers at the University of Pittsburgh wanted to determine the feasibility of a balance exercise program in total knee replacement patients 2 to 6 months post-surgery. They randomly assigned 43 patients to either a ‘functional’ training group or a functional training group with additional balance exercises. Each group completed 6 weeks of supervised exercise over 12 sessions, followed by a 4-month home exercise program.
Both groups completed functional training including elastic band exercises to strengthen the hip and knee. The augmented group completing balance training used foam pads and balance boards as well. Download the functional and balance exercise program for total knee arthroscopy patients here.
Adherence was 100% in both 6-week supervised groups, and 67% and 64% in the 4 month home training for the functional training and functional plus balance training groups, respectively. Both groups had clinically important improvements in their function. While the balance-augmented group seemed to have more improvement, the differences were not statistically significant due to a small pilot sample size.
The authors noted that traditional clinical approaches to total knee replacement rehabilitation suggests a 3-month maximum after surgery to recover function; however, this study found improvements in patients 8 to 12 months after surgery. They noted this study “may serve as the first step to justify later implementation of exercise programs following TKA.” The researchers intend to determine the long-term effectiveness of the combined functional and balance training program with a larger sample size in the near future. Thera-Band elastic bands and stability training products can be used successfully in the rehabilitation of total knee arthroscopy patients up to 12 months post surgery.
REFERENCE: Piva SR, et al. A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial. Phys Ther. 2010 Jun;90(6):880-94. Epub 2010 Apr 8.