08 Feb Case study Melinda – Running a Marathon After Knee Replacement

Situation:

Melinda (name changed) had a knee replacement after struggling with arthritis for the past 15 to 20 years in her right knee. She had been a runner for a couple of years prior to coming to me.

Changes to her running gait and an aggressive strengthening program reduced the pain and enable her to run 4 marathons, several half marathons, a Dopey Challenge, etc.

Even though, changes to her running gait enabled us to continue running 4 about 4 to 5 years before the surgery was inevitable.

Complete Knee Replacement Surgery August

Melinda chose a surgeon who used a minimally invasive procedure that would avoid cutting the muscle tissue.

Post-surgery progress: for the first 3 weeks after surgery Melinda had to focus on regaining range of motion and minimizing the swelling. Driving was not possible yet, and physical therapy was done in-home.

After 3 weeks she started to work with me three days a week again for 60 minutes, as well as with a physical therapist 2 days a week.

After having a conversation with the physical therapist, I decided that the training for her knee replacement recovery needed to focus on several important areas:

• An increase of range of motion of the knee in regards to flexion to 120-130 degrees as well extension to 0-1 degrees.
• Improving the proprioceptive reflexes in the surgical leg. Every surgery, and especially replacement surgeries, destroy proprioceptive receptors in the affected tissue. Regaining those abilities is crucial to avoid further injuries in other joints above and below or on the other leg
• Regaining the strength in the surgical leg as well as overcoming the mental hurdle of using that leg

Training

For the first 5 to 6 weeks off the training, we slowly increased the use of her leg primarily with bilateral exercises due to her inability to fully load the surgical leg.  As we progressed we increasingly focused on unilateral exercises closed kinetic chain exercises in order to minimize the deficit within the surgical leg.

Once a normal gait pattern was established again and the swelling caused by exercise was minimal, we started to reintroduce running patterns into the training.

These running patterns consisted of high knee running, high heels, side shuffle, heel to ball rolling patterns while walking, as well as focusing on Cross diagonal moving patterns with arms and legs.

Upon being able to execute these movements pain-free for a while we started to introduce run/walking back into the training program.

The duration of the run started between 20 and 30 seconds, while the walking interval was 60 seconds to 2 minutes. Even though her capability was higher than that, the goal was to be minimally fatigue only when running.

Throughout this phase, the strength training started to also slowly contain easy plyometric exercises.

Melinda completed her first half marathon after the surgery in the middle of November. She then proceeded to do the Dopey challenge in the beginning of January 2018. The Dopey challenge consists of a 5K, and 10K, 1/2 Marathon, as well as a Marathon on consecutive days.

Even though the healing process in the knee and the surrounding tissue had been going well, I opposed both race events.

The reason for my recommendation was that she had not built up the training mileage prior to the race and the likelihood of injury was too big. The concerned areas for injuries were not the actual knee replacement side, but the hip, the back, as well as the hip or the knee on the other leg.

Despite having worked hard to minimize the deficit on the right leg come on I did not feel confident in her ability to maintain an even running gait throughout the various races.

After the race series, she had only minimal swelling in the surgical leg which was to be expected and not all to worrying.  The problem was though, that she had a strong IT band issue on the left side as well as potential bursitis over the left trochanter major.

The recovery from those injuries took about 4 weeks and included absolutely no running, soft tissue manipulation by her and her massage therapist, and very careful leg training in order to minimize the impact on the site of injury.

We are now at week 5 after the race series and we will begin running again this week with a short distance of 1-2 miles at the most.

Outlook

To minimize further injuries the reintroduction into running will have to be slow. Both legs need to be equally strong and her running movement patterns need to be consistent even when fatigued.

Her strength training will continue to focus on movement education, proprioceptive training, light plyometrics, consistent strength training with a heavy focus on single leg training and hip stabilization.

Her run training will include running drills and a slow increase in her mileage. The goal will be to run a Half Marathon in May/June and a full Marathon end of October.

Conclusion

Running with a total knee replacement is perfectly possible if handled responsibly. Above you see the approach I have used. You cannot control the client and you can see that being too hasty to get back to race events led to consequences.

Having said that, her tenacity and willingness to work hard in physical therapy and personal training led to an incredibly fast recovery. It is amazing what you can accomplish with an exceptional work ethic.

Her physician had approved of her running marathons again.