Before your knee replacement: what the weeks beforehand are worth

There is a stretch between being told you need a knee replacement and having one. For most people it is weeks or months, and for most people it is spent waiting. It is one of the few remaining variables you have any say over, and the way it is spent shows up on the other side.

You will be starting the recovery from wherever you are now

Surgery replaces a joint. It does not replace the muscle around it, and it does not restore range that was already gone. Whatever strength, control and mobility you have on the morning of the operation is the base the recovery starts from, minus what the surgery itself temporarily takes away.

It is also common for the months before surgery to be the least active of someone's life. The knee hurts, so movement drops, so the quadriceps and glutes weaken, so the knee is less supported. That is an entirely understandable spiral and it is the specific thing prehab interrupts.

The work is not dramatic. Quadriceps and glute strength within a tolerable range, keeping whatever knee extension and flexion you still have, upper body and core work so that crutches and a walker are not a shock, and general conditioning so that the whole event is less of a physiological hit. Where load has to stay light, blood flow restriction training is one of the tools Fortify uses for exactly this problem.

Range of motion is the number people wish they had understood earlier

After a knee replacement, a great deal of the early rehab is about range of motion, and it is time-sensitive in a way that strength is not. There is a window in which a stiff knee is much more workable than it will be later, and it does not stay open indefinitely.

This is the part where people are surprised by how much determined work is involved, and where having a therapist who keeps pushing matters. One of Fortify's reviewers, writing after a total knee replacement, put it plainly: getting into the desired range of motion for surgical success was amazing, and it also meant a lot of determined hard work.

Knowing that in advance changes the experience. The early sessions are not meant to be comfortable, and discomfort in that phase is not a sign that something has gone wrong.

Arrange the boring things while you can still walk around

• Sort the house. Loose rugs up, a clear path from bed to bathroom, the things you use daily moved to waist height rather than a low cupboard or a high shelf.
• Sort the sleeping arrangement. If your bedroom is upstairs, decide now whether you are going up and down or setting up downstairs for a while.
• Sort the lifts. You will not be driving for a period, and appointments are frequent early on. Get the schedule agreed with whoever is helping.
• Sort the therapy before the surgery. Post-surgical rehab is easier to arrange from a chair at home than from a hospital bed, and it means the first appointment is with someone who already knows you.
• Ask your surgeon what your specific protocol is, since weight bearing and range progressions vary, and bring it to your first therapy appointment.

Meeting the therapists first is worth more than it sounds

Fortify runs a Total Knee Workshop for people who have surgery ahead of them. Their own description of it covers what to expect on the day of surgery, how to start strengthening now, the stages and milestones of the recovery ahead, and the role physical therapy plays in getting you back on your feet. You also meet the licensed therapists who will be working with you, and leave with a personalised exercise plan built around what your knee needs rather than a generic handout.

The published session is a half hour, listed on the clinic's site as May 21st, 6:30 to 7:00 pm, with limited seats. Call the clinic for the next one rather than relying on a date printed on a webpage, including this one.

Afterwards, do not settle for good enough

The clinic's own line on post-surgical rehab is that you should not settle for good enough after surgery, and that is a more useful standard than it first appears. There is a point in a knee recovery where it stops hurting, you can manage the stairs, you can get round the shops, and everything is fine. It is very easy to stop there.

The difference between fine and actually restored is usually a few more weeks of unglamorous work at the end, on the last of the range and the last of the strength. That is the difference between a knee you manage around and a knee you stop thinking about.

Fortify Physical Therapy is at 792 S 3000 E, Unit 104 in St. George, open Monday to Thursday 8:00 AM to 6:00 PM and Friday 8:00 AM to 3:00 PM. If your surgery date is set, the useful call is the one you make now rather than the one you make afterwards.