Core Stability for Knee/Hip Arthritis and Joint Replacement
Core Stability for Knee/Hip Arthritis and Joint Replacement:
The natural inclination after TKR is to focus on the knee and the muscles that are immediately surrounding the knee. But what we are learning more and more is that it is important to go beyond that local area.
Research shows that core stability is essential in order to perform every day tasks such as getting up from a chair, negotiate stairs, and even getting in and out of a bed or car. And that patients who were only focused on strengthening their operated leg, in the long term were behind patients who had core stability training in addition to rehabilitating the knee or the hip: “a high intensity rehab consisting of higher treatment intensity, longer treatment duration, use of core stabilization, single leg balance exercises, and progressive body weight exercises led to superior strength and functional outcomescompare to lower intensity rehabilitation program.” (Bade MJ, Stevens-Lapsley JR. Physical Therapy. 2011)
Posture and Knee/hip forces:
“The knee and the hip may be a victim of core instability and poor posture.”(Tanaka et al 2008. Knee)
Rehabilitation of patient after knee or hip replacement should include these two aspects:
Pelvic obliquity or excessive sway back may be a predisposing factor for increase pressure on the knee and hip leading to progressed arthritis, pain and functional impairments.
Also, excessive trunk displacement side to side is known to be a predictor of knee and hip pathology and dysfunction after TKR. (Lewis CL, Sahrmann SA, Moran DW. Gait & Posture. 2010)
To understand the relationship between core stability and lower extremity function, it is important to have a clear definition of core stability and its function:
Panjabi 1985. Spinedefined core stability:
“The ability of the lumbopelvic-hip complex to prevent buckling of the vertebral column and return it to equilibrium following pertubation” (pertubation can be due to unstable leg/s or trunk)
The function of the core as a unit during every day activities such as walking, sit-to-stand, stairs is to resist any rotational forces from the activity and to keep the body moving in the most efficient way from point A to point B (saving the energy rising from rotation to sagittal plan movement only)
In the following videos my patients, who underwent either knee replacement or hip replacement, demonstrates core stability training that was given to them in addition to the leg rehabilitation regimen.