Do Knee Replacements Make You Fat?

Multiple studies are finding that people having knee replacements continue to gain weight after surgery.

(Oseoarthr. Cartil. 2010 Apr; 18(4):510-4; Orthopedics 2005 Feb; 28(2): 157-9; Scott Med J 2009 Feb; 54(1):26-8)

So why are they gaining weight?

Is it exercise or other lifestyle factors?

In a 2010 study published in Osteoarthritis and Cartilage, one hundred and six adults with unilateral, end-stage knee osteoarthritis (OA) and thirty-one persons without knee pain participated in the prospective longitudinal study. Subjects with OA underwent primary unilateral total knee replacement and received post-operative out-patient physical therapy. Height, weight, quadriceps strength and self-perceived functional ability were measured at baseline and at a 2-year follow-up.

Body Mass Index (BMI) showed a significant increase in the surgical group, but not in the control group.

67% of the surgical group gained an average of 14 lbs (despite decreased pain and improved function).

The weight gains after surgery cannot be attributed to age alone.  The high BMI of the surgical group should be treated as independent of their OA.

I often hear from patients that they have gained weight because their knee hurts and they can't exercise.  Studies such as the one above show they have reduced pain and increased function after surgery.  The patient-described barrier to weight loss is now gone.  There must be reasons other than a lack of activity for continued weight gain…and it’s not the total knee surgery!

Barriers to weight loss

Sedentary lifestyle.  Knee pain was just a good excuse…maybe they never did much physical activity anyway?

Other medical conditions- diabetes, hypothyroidism, and other disorders that effect metabolism often cause weight gain.

Medications- some prescription medications can directly or indirectly promote weight gain.

Sleep- inadequate sleep can cause release of stress hormones that can cause weight gain.

Diet- most important to weight management is your diet.  Too many calories get stored as fat.

The studies suggest that patients should not look at their painful knee as the cause of their weight gain.  Prospective surgical patients should pursue lifestyle modifications prior to surgery that will promote improved health, including weight loss.

Start lifestyle changes prior to surgery

·         Set weight loss goals.  Not just weight, but also take some body measurements such as your waist.  Men should try to have a waist measurement that is less than 40 inches.  This isn't your pant size, but actually tape measurement at the level of your belly-button.

·         Increase physical activity...make it a habit.  I realize that your knees may hurt with walking, so try to pursue lower impact activities such as pool based exercises and biking.  Perform resistance exercises for your upper body to build muscle.  You would also be surprised that performing resistance exercises for your legs may also help with your pain.

·         Sleep eight hours per night.  Sleep is very important for your body to recover and repair from the day's activities. 

·         Discuss medications with your physician.  Medications can directly and indirectly affect your weight.  If you are taking a number of medications, ask your physician how they may be affecting your weight.  If you are diabetic, your medications are sensitive to activity level and diet, so please consult with your physician when making lifestyle changes.

·         Diet.  I feel the most important lifestyle modification is diet.  Below are some recommendations I have found beneficial:

• Avoid processed foods and sugar. 

• Cut back on starchy carbohydrates (this included bread and pasta).  It is too easy to overindulge in starchy, processed carbs. 

• Your best carbohydrate sources are vegetables followed by fruit such as berries.  Veggies and fruits are good choices due to their high nutrient density and fiber content.

• Eat a hardy breakfast.  Eggs are good for you!

To answer the question, “Do total knee replacements make you fat?” the answer is, “NO.”  However, a total knee replacement alone will not help you lose weight. 

What has been your experience with weight loss or gain after a total knee replacement?

Benign Paroxysmal Positional Vertigo (BPPV)

Have you experienced episodes of dizziness or spinning with movement? You may be experiencing positional vertigo or Benign Paroxysmal Positional Vertigo (BPPV).  BPPV is a disorder of the vestibular system which is found in the inner ear.  Symptoms most commonly associated with BPPV include dizziness, spinning, nausea, unsteadiness or imbalance with walking.

BPPV occurs when the otoconia in our inner ear become “dislodged” and fall into semi-circular canals. Otoconia are calcium carbonate crystals or rocks.  Turns out we all have rocks in our head! When these rocks or debris are loose in the semi-circular canals they can cause nystagmus or jumping of the eyes. This can lead to the symptoms of spinning.  Usually these symptoms are short, lasting less than a minute. Typically these symptoms will occur with change of position with daily activities like looking up into the cupboard, bending forward to put on shoes or rolling over in bed.

These symptoms can be evaluated and treated by your physical therapist.  During a physical therapy evaluation your physical therapist will determine which of the three semi-circular canals is affected. Treatment is initiated after the examination, and depending upon the canal involved, their is immediate success the majority of the time. Specific instructions will be provided for self-management.  A follow-up visit or two is typically prescribed.  

Don't wait until your symptoms make you miserable or try to rely on prescription medications.  The described treatment is the safest and most cost-effective method of managing BPPV.

WHO'S YOUR PHYSICAL THERAPIST? IT'S YOUR CHOICE!

You have your primary care physician.  You have your dentist.  You even have your barber or hair stylist.  So who is your physical therapist?

Physical therapists are movement specialists.  Sitting, standing, walking, working, running, kicking, playing; these are the “ings” in life.  The physical therapists at New Life work 1 on 1 with patients to determine what is interfering with your movement, causing you pain, and how you can work together to return to the “ings” that matter most to you. 

It is your right to choose your provider of physical therapy services.  While a physician may suggest a location or therapist, ultimately the choice is yours.  In the state of Wisconsin, you can make an appointment with a physical therapist without a physician referral.  If your insurance company requires a referral, we will assist you in obtaining one. 

So you have aches and pains that interfere with your “ings” in life.  We ask, “who is YOUR physical therapist?”  Consider them as your first contact and step towards decreasing your pain and improving your function.  Don’t have a physical therapist?  Call us at 608.742.9356 to set up an initial evaluation with one of our New Life experts.  We can offer you an appointment time within 2 business days.  

© copyright 2011

New Life

New Life Provides Physical Therapy Treatment for a Variety of Conditions

Patients and clients come to New Life clinics with many different diagnoses, either requesting, or have a referral for physical therapy treatment.  A diagnosis is the art or act of identifying a disease from its signs and symptoms.  Usually, the diagnosis is an attempt to identify the suspected “pain-generator” that is causing limitations of the patient’s daily activities.

 Only one-third of physical therapy referrals have a specific pathology diagnosis or are anatomically specific (reference).  A diagnosis, in most cases, does not direct physical therapy treatment.  That may sound absurd, but think about it this way:   you have a diagnosis of a bulging disc confirmed by MRI.  However, there is poor correlation between MRI findings and cause of low back pain.  If physical therapists are relying on X-Rays or MRIs to direct treatment, the treatment will likely be ineffective.   

Physical therapists make a physical therapy diagnosis based on the suspected pathology in addition to physical limitations and impairments.  As experts in human motion, physical therapist should develop a reason why (hypothesis) you developed low back pain.  If that bulging disc is truly the pain-generator, then why did it happen?  An absence of ibuprofen or Tylenol in your diet is probably not the reason!    There is likely a combination of your posture, activities, or how you move, that caused the excessive strain on the disc.  

Below is an example list of diagnosis of patients we have helped at New Life.  There will be more to come in future blogs regarding the New Life approach to common medical diagnoses, including how we determine "Why" the body part is damaged or irritated and how you can manage it.

·         Low Back Region:

o   Lumbar Strain, and Low Back Pain (“lumbago”)

o   Lumbar Radiculopathy,  Radiculitis, or Sciatica

o   Lumbar Stenosis

o   Osteoarthritis

o   Degenerative Disc Disease

o   Sacroiliac Joint Dysfunction/Pain.

o   Herniated Disc

·         Hip Region:

o   Bursitis of the Hip

o   Hip Pain.

o   Hip Osteoarthritis (OA)

o   Hip Impingement

o   Tendonitis.

o   Snapping Hip

·         Knee:

o   Knee Pain.

o   Knee Osteoarthritis.

o   Condromalacia.

o   Patellofemoral Syndrome

o   IT-Band Syndrome

o   Ligament Strain/Tear.

o   Meniscus Tear.

·         Neck:

o   Neck pain.

o   Cervical Radiculopathy

o   Stenosis.

o   Thoracic outlet syndrome.

o   Arthritis.

o   Facet Arthropathy.

o   Herniated Disc

o   Cervicogenic Headaches.

o   “Trapeziuis” ‘Strain.

·         Shoulder:

o   Shoulder pain

o   Rotator Cuff Tendinitis/Shoulder Impingement

o   Rotator Cuff Strain/Tear

o   Biceps Tendonitis

o   Frozen Shoulder

o   Bursitis

·         Elbow:

o   Lateral Epicondylitis (“Tennis Elbow”).

o   Medial Epicondylitis (“Golpher’s Elbow”).

·         Wrist/Hand:

o   Carpal Tunnel Syndrome

o   Thumb arthritis

o   Complex Regional Pain Syndrome (CRPS or RSD)

o   DeQuervain’s Tendinitis

o   “Trigger Finger.”

© copyright 2011

New Life

New Life Physical Therapist Gains Advanced Training in Applied Functional Science

New Life PT and Sports Medicine staff physical therapist, Jamie Bockhop MPT, LAT has enrolled in Gray Institute's "Fellowship in Applied Functional Science" (FAFS) (http://www.grayinstitute.com/gift.aspx).  The AFS Fellowship is an intensive 42 week long continuing education program consisting of direct classroom and on-line learning.   


The Gray Institute has become an internationally recognized leader in Applied Functional Science (AFS).  The AFS fellowship encourages transformation through function.  Generally, patients and clients function on their feet during home and work activities.  In order to empower patients toward the most common goal of “normal function without pain”, a physical therapy program must address upright function.  Dysfunctional patterns in mobility, stability, integration, or chain-reaction biomechanics can be difficult to identify.  The fellowship has structured a systematic approach through the understanding of physical principles (i.e. gravity, ground-reaction forces, and momentum).  Understanding these truths of nature, and the reactions imposed upon the body during any functional process, allows the treating therapist to provide specialized treatment strategies and techniques. 

AFS Fellowship training will be a valuable addition to Jamie’s skill-set in identifying sources of increasing pain and declining function in his patients and clients.  Understanding true function permits an individualized treatment plan, which empowers both patient and therapist to reach optimal outcomes.

To schedule an examination with Jamie Bockhop, please contact New Life Physical Therapy and Sports Medicine at (608)356-2334.

© copyright 2011

New Life

Are You Working to Your Potential?

Is fatigue or discomfort at work preventing you from producing the quality and quantity of work you desire?  Is discomfort or fatigue from work keeping you from enjoying your family and recreational activities?  If so, New Life has a strategy to help you "Get Your ING on!"


Movement Prepairing:                  "Get Ready for Work."

Movement preparation will be performed prior to or at the beginning of your shift.  Movement preparation is designed to prepare specific body regions for the demands of the job activities.   Preparation is accomplished by performing movements that will promote blood-flow to working muscles, lubricate joints, and activate our nervous system.  This strategy will prepare your body to handle forces specific to your work.

Movement Unwinding:                    "Recover from Work."

Movement unwinding is recommended to perform throughout the day (ideally at mid-morning, mid-shift, mid-afternoon, and after work). Unwinding stretches should only take a matter of seconds to perform.   Movement unwinding will reduce load or strain on body regions that are frequently stressed during your job activities.

Example:  Lifting and forward bending places load on the hips and low back; frequent bending backwards, helps to off-load those areas.

Movement Training:                     "Work Better!"

Your job activities place demands on your body's ability to move through a range of motion (flexibility), balance, apply a force (strength), and to put it all together efficiently (motor-control).   If your movement is deficiency in any of these areas, compensation results.  Over time compensation can excessively strain body regions and produce discomfort, fatigue, and other symptoms.  Movement training will work on key movements performed during your job to ensure that you are moving optimally during the day, thus reducing discomfort during and after work.

© copyright 2011

New Life

How Does Your Walking Look?

Humans are the only mammals created to walk upright as their optimal mode of transportation.  We are able to walk upright due to our structural gifts such as arches in our feet and a curve in our low back.

Our sedentary lifestyle does not promote optimal walking.  A common dysfunctional walking pattern would include a forward head, rounded shoulders, a flat low back, short strides, and the toes pointed out (looks like an ape!).  Rarely do we walk like we are structurally designed to with long strides, rotation at our hips, arms swinging, and feet pointed forward.

A dysfunctional walking pattern can be both a symptom of and cause of a variety of aches and pains in addition to poor endurance.

If you or a family member has a dysfunctional walking pattern, call a New Life Physical Therapist to schedule a gait assessment and musculoskeletal examination.  They will determine causative factors and prescribe a corrective strategy.

© copyright 2011

New Life