Total knee replacement, if and when?

[hampsetwoden]

I am looking for comments on my decision to delay my total knee replacement until I am either suffering too much pain or my mobility becomes to restricted.

I am 71 and suffered from arthritis in both knees for over Forty years. The right one has been the worse, until 2020.

RECENT HISTORY

29 Jan 2021 NHS X-RAY shows OA on both knee caps. There was no discernable difference between the knees but the left one was the problem. Advised to use Escape Pain app with exercise program which helped a lot.

End of Dec 2022 I lots of pain in left knee and severe difficulty walking at the start of three weeks holiday in a warm climate. I restarted the Escape Pain exercises and took the max daily dose (2 per day) of prescribed NSAIDS. I experimented with different walking methods, walking short distances with regular stops and gradually improved.

Private MRI Scan on both knees at end of Jan. This showed GRADE IV OA on both knee caps and wear on both medial joints with the left one showing complete loss of articular cartilage in places. Private consultation tells me "ultimately for me to decide" when to have TKR.

As well as the exercises given in 2021 and also had Private physio. In June I saw a GP as improvement stopped and I was finding the NSAIDS were affecting my stomach. She said the waiting list was 12 months. Therefore I asked to go on the list and reduced the NSAIDS to 1 every other day. I expected more problems with the reduced dosage but if anything I could do even more. By chance I read a newspaper article on correct walking technique and further improved my own. The waiting time was much shorter. I soon had a letter giving me options of 5 different hospitals to choose from to see a consultant. The earliest date was only two weeks. I chose an appointment at a private hospital, on the NHS list, the end of July and increased my activities as I thought I needed to feel worse in order to get referred. Again that didn't happen and at the consultation I was mostly without pain and could walk for more than 5 miles without problems if no steep hills and pain was only intermittently bad on certain movements. The consultant advised me that 30% of patients in my state found that TKR made things no better or even worse. However I agreed to be referred as I had already decided to wait at least until December as I had trips planned. I was given a form to fill in which included a question asking me to list unavailable dates. I decided to put down that I was unavailable until Jan 2024.

A few days later the hospital called me saying that they were under contract to operated within 18 weeks of referral. Therefore they would take me off the list but I would keep my place. I was told to call in December to fix a date.

I then received a letter inviting me for preoperative tests on 1st September. I was surprised as my understanding was that these only lasted a maximum of 3 months. I called them and was told that it was now 6 months.

Meanwhile my mobility didn't worsen, I kept doing the exercises and made all my trips with my friend, who was still finding that I was walking too much for her! Although that was less than I was doing on my own, with 7 or 8 miles being ok.

The hospital physio contacted me regarding my post operative situation as I was living alone. As I didn't have a date I couldn't provide details of who would take me home. I asked about deciding on a date and she suggested that I could choose a date in February and postpone if I didn't feel ready and they could do another preop.

Come December I didn't know how to proceed. I arranged a GP telephone appointment to discuss. I briefly explained the situation and said that I was able to everything I wanted to do, which isn't exactly true. There are many things I can't do which I would like to do. Some for more than 30 years as I can't sit for more that about 30 minutes with my legs bent, no theatre, cinema, or spectator sport, travel limitations. I just don't do them or find work arounds.

Running is not possible at all now having gradually reduced, walking down steep hills and within the last year walking up steep hills as well.

The GP seemed to understand but said he didn't think I would be able to put the op off indefinitely. He also said that he didn't think that I would have been referred in my current state, but I was giving him the glass half full view.

6 Dec I decided to call the hospital to discuss the options. It didn't go to well. She questioned the Physio's advice and couldn't advise me on the options. She said she would have to take advice and get back to me, but it may take time as a lot of staff were sick. I said that I was away for two weeks up to Christmas and wouldn't be contactable. I didn't get a call back that week.

The very next day I was struggling to walk again, my plans for walking more whilst away were reduced to recovery again. I had a few days at home then two weeks away to review my situation. Initially I was very cautious and considered calling the hospital to arrange a date. I didn't and after a week I was able to walk quickly and pushed myself too far and went back again. I looked at my consultations in detail and eventually reached the conclusion that I would know when I needed the TKN and hopefully I would be able to get one within two months. My knee has been locking about once a day, and it takes a few minutes until I can free it to enable me to walk. I am also finding that I am getting severe pain on certain movements more often. I recorded all my walking over the two weeks and it was actually over 100 miles. Nearly all was on the flat mostly slow, but a fair bit of brisk walking. Also walking up and down stairs to my 3rd floor room four times a day.

Back home, I am feeling very well and walking two or three miles a day. Less problems which suggest that I was over doing it when away.

[piglette]

It is very much up to you as to how long you can put up with the pain. Exercise it seems can help for knees while not so much for hips. The consultant who advised you that 30% of patients in your state found that TKR made things no better or even worse, were they an orthopaedic consultant? All the people I know who have had TKR have had improvement, so one in three TKRs not working seems quite high to me.

I have been having Platelet-Rich Plasma (PRP) Therapy on one knee, which seems to work for me.

[hampsetwoden in reply to piglette]

Many thanks for your reply.

He is my surgeon, he told me that before referral. My reply was that I was planning to wait until next year by which time I expect to be worse. To be precise he said "I can do a perfect knee replacement but there is a 30% chance that it will be no better or even worse" That was reduced to 15% in his letter. He also said that the knee is a complicated joint and the replacement is a simple hinge joint. A hip replacement is the same joint as the original. It depends how bad the people you know were before their TKN. I am mostly pain free and quite mobile. When I joined this group the first post I read was someone who was still in pain five months after A TKN. One reply said 5 months wasn't long. I know quite a few people who have had the op who are all better afterwards but they were all worse than me before they had it.

[piglette in reply to hampsetwoden]

My company helped train surgeons on knee replacements. We had the training in Eastern Europe as post mortems were normally required there, so there were lots of bodies available! The knee is a lot more complicated than the hip as you say, but not as complicated as the shoulder, although the shoulder is not weight bearing.

[AudibleCurve]

Ultimately it is up to you and everyone’s experience will be different. I found recovery painful and longer than expected (3 months) - but you sound like someone who will definitely do the physio - I think lots don’t because it’s hard and painful. For me hydrotherapy was fantastic, albeit cut short due to lockdowns. I had my op 4 years ago and have no pain or locking and don’t need to cancel or postpone a walk so for me it was 100% worth the recovery time.

[Loobs39]

Do you need a full TKR? I heard an item recently (on the radio I think) stating that there are lots of TKR that could have been PKR (Partial Knee Replacement). I had a PKR and, although painful for a few weeks, I have never regretted it. However, my other knee needs doing now and I am waiting to find out how long the list is. Admittedly I am not looking forward to it but I love walking so will grit my teeth and get on with it.

[Finaus]

In not being able to bend your knees and sit for more than 30 minutes, is not your movement and quality of life, already severely restricted and compromised?

You also say your pain on certain movements is getting more severe.

Do you want to continue to manage the pain and loss of quality of life or have the operation and hope for a better future?

No one can give you any guarantee and the future is unknown for all if us, but many have gone before you who have had the operation and had a good outcome. Not perfect, but good.

It is a tough and frightening call and recovery may be equally tough, but there is the prospect of a positive outcome and improved quality of life.

The call has to be yours unless you decide to wait until pain or lack of mobility force the decision upon you, but might recovery then be harder and outcome less certain!

Sorry I can only speak from the experience of my hip operation, but a friend has had both knees replaced has not regretted the decision and another friend is currently recovering well after a single replacement.

Best wishes whatever you decide.

[Trill in reply to Finaus]

I reluctantly support your conclusion, being in a similar position as the original poster, Hampsedwoden, and am nearly 74 - all except I cannot walk hardly any distance. That has worened this year, but the general fatigue and the concentration of that on my legs might also be having hypothyroidism. I have very good ROM, but cannot walk downstairs without clinging to railings, cannot squat, cannot and must not kneel, but can't say I am in pain. There is no cartilege left - maybe 10% I was told, and also, what you may also have, osteophytes, which can complicate matters by chipping off or becoming entangled with suchlike as ligaments. I asked the clinic what would happen if I accepted the op because I was in severe pain (so hardly an advantage continuing to put it of, which is driven by a deep fear of the pain), and he replied, six to nine months. So, when I got to it being unbearable, I would be in for that wait in terrible pain. Another reason to get on with it. It's in both knees by the way. I see the clinic again in April, and I think I will have to go ahead, as I am living in dread. I think it's graspinfg the bull by the horns here and we just have to get through it. It affects people differently, and strenthened muscles will certainly help. I do physio too. It's getting me down so much dreading it that I know I can't carry on what's left of my life feeling so terrified, and so restricted.

[hampsetwoden in reply to Trill]

Many thanks for your reply.

I have just been out for a New Year's Day group walk. Only four miles, but no problem. Stairs no problem as I said originally. Driving is also not a problem. I feel that I will know when I am ready, that is when it gets me down too much. Ideally, it's for me to decide, the NHS may make that difficult, in which case I need to consider the private option. I am actually in this position because the NHS waiting time is far less than the 12 months my GP told me. It seems that a lot of people are in a far worse position than but having to wait.

[Trill in reply to hampsetwoden]

Two knees = £30.000.

[hampsetwoden in reply to Trill]

At least.

[Batty1]

If your able to get TKR get it done I don’t understand waiting until you can’t walk that just seems like a silly idea….My sister was up and walking after TKR in one week.

[papageno]

My reaction to your sharing your doubts with us (and thank you for this) and to some of the comments is that we do need much better research on the benefits and harms of orthopaedic surgery in general. Any surgery implying general anaesthetics does present risks and post-op recovery/monitoring follow up can be very difficult for people living on their own without social support. Has anyone heard of countries where older citizens do avoid surgery by using different types of alternative therapies, including physio, osteopathy, acupuncture, others..?

[hampsetwoden in reply to papageno]

Hi Papageno,

One country is the UK. However, that is mostly due to having an under funded National Health Service. Lack of resources firstly means that it takes time to see your GP. The you are advised to wait and see if things improve. Then you will be offered cortisone injections, then maybe an X-ray and or physio and general health advice, maybe drugs. Given that everyone knows waiting lists are long, they feel this is a process to keep them off the waiting list and therefore don't have much faith in these alternatives. It takes a long time to get referred to a specialist by which time most people are desperate for surgery. Given that it seems that a lot of knowledge has been gained and put into practice.

The other side of the coin is that people with the first signs of arthritis want to get on this list for an operation as soon as possible. That is me in a way, however I am not ready. Maybe in June, 12 months after starting the process, perhaps I will be, perhaps not, maybe next month. I know what I want, but will the NHS be able to manage my wishes?

[Trill in reply to hampsetwoden]

Why not proceed on the list and when you are called, decide then? I, too, am in the UK.

[hampsetwoden in reply to Trill]

Hi Trill, I am past that stage. There is a lot in my original post.

[Runrig01]

As someone who worked as an orthopaedic nurse, for over 30yrs, I get your hesitancy. It is a major operation, and is not without risks. The main benefit to having the surgery is to resolve pain thereby improving your mobility. You still seem to be fairly mobile, especially given the distances you can walk. If you do decide to proceed, then I would definitely works on the quad exercises prior to surgery, as that will make recovery easier. If you go for he route using a private hospital, funded by the nhs, then I would check what aftercare is provided. The patients in my area, didn’t get the same amount of physio afterwards, and only had one follow up with their consultant at 6 weeks.

Only you can decide when the time is right. You certainly seem to be well motivated, and I’m sure you’d commit to the tough post op exercise regime. Take care 🤗

[hampsetwoden in reply to Runrig01]

Hi Runrig, many thanks for your reply and your understanding of my position. My problem now is to make a suitable arrangement with the NHS/ private hospital. I don't think they have called me back since I last spoke to them but not sure as my phone has been out of action for a lot of the time for various reasons. I will wait until that problem is sorted before I call them. In August they took me off the list and said that I would keep my place and to call again in December to book a date for July. After that they called me for the pre-op, I will need another if I don't go for the op next month which is an unknown, but unlikely. Ideally I would like to have the op a month or two at the most, after I know the time is right.

[DistantMidget]

I am finally having my right TKR surgery on 5th February, all being well.

In short when I was 23 I was ‘immortal and bullet proof’ or so I thought.

After landing from a 6/8ft jump straight legged onto concrete, I very quickly learned in complete agony, that I was not.

Two lots of keyhole surgery and fast forward 29 years I now have great difficulty walking, I have a 15 degree deformity of my right leg where it appears to bend inward.

That is due to the bone on bone wear, I had been refused surgery twice before, even though the consultant told my both my knees now appear 20 years older, but with the right one severely damaged.

Cocodamol, Arcoxia etc never really helped. I look forward to being able to go for a walk, to the supermarket a mile away.

It’s not until you can’t even do that simple thing that you realise how much you miss it.

I know it’s harder to recover from than hip replacement, but I am not worried. It’s hurt for 20 years so what does 1 more year matter?

I guess the other one will need doing at some point, and as I’ve just turned 52 it isn’t ideal. What I wouldn’t give to tell my 23 year old self to bend your knees like you did every other jump!

The right time to replace your knees is when it’s having such a negative effect on your life that you need it to improve your quality of life.

I need to exercise, I’m too heavy.

I need to walk my daughter down the aisle in July.

I need to work and pay my way for another 20 years and therefore, for me at least, I need a new knee.

Kind regards

Steve

[Blackknight1989]

I posted this on a related thread, so I’ll summarize as I tend to be long-winded. I was diagnosed CKD stage 4 in 02/08/1996 and on 02/16/1996 had AKI, total organ failure and 6ish months in the ICU, 4 on a vent. I had just turned 29. I had my first orthopedic surgery in 02/98 and again in 03/98 just 2 scopes (both on the right knee) to clean out a stage 4 OA knee. In 2000 had an open high Tibial osteotomy (again right knee) with an external fixator that I used to turn 1/4 of a click a week for 16 weeks to lengthen the medial side of my tibia. X-Ray indicated the surgery was successful at about the 16 week mark so we removed the supportive fixator and the new bone growth had not “hardened” so it collapsed. Back to the surgery suite for a closed high Tibial osteotomy (the surgeon actually breaks the tibia again but instead of the fixator and natural bone growth, he inserts an actual “wedge” to expand the medial side of the tibia and swing the leg back to straight as opposed to bowed. This was more complicated in the late ‘90s before the AI assisted surgery currently available so once the initial procedure was complete, I was taken back to the surgery suite an additional 3 times to “revise” the first operation to create a “successful” outcome.

That’s TMI I’m sure BUT I say all that simply to say this, I was 31 in ‘98, had that knee replaced in ‘03 at age 36…all those “pre-TKA surgeries were done with “eyes wide open” as my surgeon was (and still is) my best friend from high school so a total collaborative effort and I probably spent as much total time in the hospital as I did when the ER doctor nearly killed me via malpractice in ‘96 AND the point (besides orthopods liking to “practice their craft” and operate) was to AVOID a TKA because I was so young.

However, after the TKA in 2003 (and after about the 7/8 weeks of soft tissue healing) I was almost able to walk, lift weights and run as I did when I was in the Army from ‘85-‘93. Further, I had a 5 year old and a newborn that I was able to keep up with for most of entire (pre-21 years old) childhood or close till about 2019. Unfortunately age and another TKR in ‘08, the left THR ‘09, ankle arthrodesis in ‘12, the left ankle in ‘13 and (finally) the remaining knee (TKA) in ‘14 all caught up to me and I am mostly wheelchair bound now. BUT my point is I kicked myself for waiting, as I was so much better off post TKA, slept a straight 8/9 hours post surgery (once the post op pain went away) and felt like a new man. So I completely understand the WHYS of waiting and the thought process around that decision but with the new procedures today even versus 2003 plus the freedom I know a successful TKA give to the patient post -op, I think waiting is a mistake BASED ON MY OWN EXPERIENCES, as I am certainly not trying to tell you what is right or wrong for you. Lastly, FOR ME (I’ve had over 20 orthopedic surgeries, 4 additional “major” surgeries as well as arthroscopic exploratory surgery of the Urinary Tract WITHOUT an incision) the TKAs were absolutely horrible to recover from, pain was off the charts for me for what I thought was a long time. PT was tough and if done correctly that is unavoidable if you want to ensure a successful outcome, as opposed to the THR which was an overnight in hospital and once BP stabilized I walked out, in fact after the second THR I left hospital and went to work…easy peasy. I promised “short” and failed to deliver so I apologize for that, I hope I helped in some way but more importantly whatever decision you make I wish you all my best in your journey with your OA/post-injury issues and decision on the TKA! Best!

[hampsetwoden in reply to Blackknight1989]

Thanks, Blackknight. It took me a long time to make my decision to delay the TKR. My quality of life is currently very good and I am really enjoying it. Therefore I don't feel the need to risk that. That's a short answer as I also can go on a lot, as in my original post.

[Jackie1947]

Basically it's up to you. My consultant said if I operated now you wouldn't thank me as it could leave me with more pain. Timing seems to be the key. Bone on bone now that's in a different league and I'd have it done in a shot. With a bit of weight loss and gel I have no pain now. Decisions! Good luck

[hampsetwoden in reply to Jackie1947]

Hi Jackie, thanks for your reply. It is well-known that how people manage with arthritis is not dependent on how much wear there is. Some people really struggle with slight wear and others, I guess that I'm one, manage with a lot of wear. At the end of the last millennium, an MRI scan showed my right patella to be stage 3, I guess it has been bone on bone for a few years. I seem to be managing it by accident and design. My place of work changed so I had to cycle instead of walk. I enjoyed cycling and did it for leisure as well. That built up my muscles. Then I started walking with a group, short flattish walks initially then longer and longer as my strength built. Walking poles to assist me up and down hills. I went back quite a lot, partly because of problems, but because I reduced my exercise. Resulting in serious difficulties a year ago. I worked hard on exercises and gradually building up my stamina, learning how to walk with less pressure on my knees, keeping healthy etc. The wear can't be any better and probably worse but I can do so much more than I could a year ago. Also, over the years I work out which activities give me problems do I avoid them. When I saw the consultant in July he said that 30% of people in my condition find that a TKR does give any improvement or makes it worse. Now I can do more than then snd have even less pain.Therefore I will go on until things change for the worst, which I expect they will.

[Trill in reply to hampsetwoden]

Very interesting. I have no pain but also no power in the knee so I now cannot exert enough pressure on the pedals to cycle. Can you please explain how to walk with less pressure on your knees, and which activities you have learned to avoid. Your sentence about TKR is astounding - what do you mean by 'in my condition'? Ta.

[hampsetwoden in reply to Trill]

In my condition..... mobile and with little pain.

The power is in your muscles not your knees. Building up your muscles is key. There are lots of exercises for that. Also exercises to increase your flexibility. These are among the things you need to do. Also keeping fit and healthy.

You can only find out yourself which things to avoid. For me, for many years, these include kneeling, walking down steephills, sitting with my legs bent. More recently, running, walking quickly for too long, sleeping in certain positions.

Regarding walking, I experimented with different things, then by chance I read something which helped. Land on your heels and keep them on the ground as long as possible, pushing with your back foot, not pulling with your front foot.

That's a brief summary. If you want any more information just ask.

[Trill]

That's very helpful. Some I'm already doing. Best is the walking advice - will try that. I have an arthritic toes so wear shows that I cannot spring off the front toes with anyway. Haven't run for many years!

[hampsetwoden in reply to Trill]

Hi Trill, just to warn you that what works for me may not work for you. We are unlikely to have the same wear and tear.

This youtube clip goes into a lot of detail with 10 tips. It makes me realise that there is a lot to learn still. I think it is best to consider each step individually, maybe choose which one you currently don't do. I will try that. Ideally I should get a professional to watch and train me.

Also walking should be natural, if you think about it you don't relax and enjoy the walk. I find walking with others and talking, I don't think too much about my technique and walk further without a problem.

Improving your walking and building up your muscles both take a long time. After 3 or 4 months I felt that I had reached the best I could get to so I went to GP and got referred as she said the wait would be about 12 months. As it happened to be only 2 or 3 months and I had trips booked for 6 months I decided to delay the op, In order to ensure that I stayed mobile and pain free I continued my exercises, walked more, started swimming again. At the end if six months I was actually better. Hence my decision to delay.

[Trill]

What youtubeclip, Hampset? Right now I need back tips too - couldn't stand upright yesterday and in awful lower back pain. My husband suggested it was the 1kg ankle weights for the leg-raising exercise, and I think he might be right. Don't worry - don't look for them. It's beter today than yesterday and it's a compensation to have to lie down listening to the radio.

[hampsetwoden in reply to Trill]

I thought I'd sent you it. Here it is again with the text of another link that I came across.They seem to agree

youtu.be/A1A9zwvvskw?featur...(Not working as expected?)

How to Walk Properly with Good Posture

Walking with the right technique and posture isn’t difficult. But it does involve being mindful of how you move. In this article, we’ll take a closer look at how to walk properly with good posture.

Tips for walking properly

Walking is an activity that involves your entire body. To fully understand how to walk correctly, it helps to focus on each part of the body, from head to toe.

Keep your head up

When you’re walking, focus on standing tall with your chin parallel to the ground and your ears aligned above your shoulders.

Imagine your head being pulled up gently by an invisible piece of string that’s attached to the ceiling. This may help prevent you from dropping your head into your chest while you walk.

Keep your eyes and gaze forward. Focus on an area about 10 to 20 feet ahead of you while you walk.

Lengthen your back

Focus on elongating your spine while you walk. Try to avoid slouching, hunching, or leaning forward, which can put stress on your back muscles.

Keep your shoulders down and back

Your shoulders also play a key role in your walking posture and technique. If your shoulders are tense or hunched forward, it can strain the muscles and joints in your shoulders, neck and upper back.

To ensure that your shoulders are correctly aligned while you’re walking, do the following:

• Bring your shoulders up high in a shrug-like motion, then let them fall and relax. Using shoulder shrugs helps relieve tightness or tension, and puts your shoulders in a natural position that allows you to move your arms easily.

• Try to keep your shoulders loose and relaxed, not tensed up toward your ears or slouched forward. You can do shoulder shrugs occasionally while you’re walking to ensure that you’re keeping your shoulders relaxed and in the right position.

Engage your core

Your core muscles also play an important role when you’re walking, and help you move more easily.

As you take each step, focus on tightening and engaging your core muscles by pulling your belly button in toward your spine. This can help you maintain balance and stability. It can also relieve stress and pressure on your back as you walk.

Swing your arms

As you walk, gently swing your arms back and forth at your sides. Make sure you swing your arms from your shoulders, not from your elbows.

• Don’t swing your arms across your body.

• Don’t swing your arms up too high. Keep them around your midsection, not around your chest.

Step from heel to toe

Maintain a steady heel-to-toe gait. This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe. Avoid flat-footed steps or striking the ground with your toes first.

What not to do while walking

To prevent injury or too much wear and tear on your muscles and joints, try to avoid the following habits.

• Don’t look down. Looking down at your feet or phone too frequently can put unnecessary strain on your neck.

• Don’t take very long strides. Your power comes from pushing off your rear leg. ResearchTrusted Source has shown that overstriding can put too much stress on your lower leg joints.

• Don’t roll your hips. Your hips should stay as level as possible while you walk.

• Don’t slouch. To avoid back and shoulder strain, keep your shoulders down and back when walking or standing, and focus on keeping your spine elongated.

• Don’t walk in the wrong shoes. If you’re going to be walking for more than a few minutes at a time, be sure to wear shoes that fit comfortably, have good arch and heel support, and are well cushioned to absorb the shock of your feet hitting the ground.

What are the benefits of walking correctly?

There are numerous physical and mental benefits of proper posture and good walking technique. These benefits include:

• Pain-free muscles and joints. Walking properly can help you avoid putting unnecessary stress and strain on the muscles, ligaments, and joints throughout your body.

• More energy. Walking with poor posture isn’t efficient. It can wear your muscles out faster, whereas walking with good form can conserve your energy.

• Better lung health. Walking tall with your shoulders back allows your lungs to expand fully, making breathing easier and more efficient.

• Improved circulation. When your body is properly aligned and moving correctly, it makes it easier for your blood to circulate to all parts of your body.

• Improved digestion. Your body is better able to digest your food when your internal organs aren’t compressed and there’s healthy blood flow to your digestive tract.

• Greater core strength. Your abdominal muscles benefit from walking tall and being properly engaged.

• Fewer tension headaches. If you walk with your head help up, not bending forward, it can help reduce neck strain, which may lead to fewer tension headaches.

• Better balance. When you walk properly with the correct posture, it may help improve your balance and make you less prone to falling.

The bottom line

Walking properly with the right technique and posture has many benefits. It can reduce unnecessary stress and strain on your muscles and joints, prevent back pain and muscle aches, reduce your risk of injuries, and much more.

Walking with the correct gait and posture isn’t hard to do, but it may take some practice. Some key tips involve walking tall, keeping your head up, your shoulders relaxed and back, and your core tightened.

If you have any issues with your walking gait, or are unsure of how to walk with the correct posture, be sure to talk to your doctor or physical therapist about ways to improve your walking technique.

[Trill in reply to hampsetwoden]

Really detailed reply and thank you. Will watch video next. My physio told me about posture and when I asked him he demonstrated what you describe: head up, ears above shoulders, shoulders aligned to hips, hips over feet. Basically a straight line. You're right to point out the very bad effects of looking down at screens - we're going to see a lot of people pay a heavy price for that. Unfortunately, these last few days I have not been able to walk at all, thanks to same physio who instructed me to wear ankle weights when I do the leg-strenthening exercises. I put my back out, havig a weakness of L5, and have been in a lot of pain. Hard to balance out what is good for one set of muscles but might impair another set. Old age!!

Another tip is to get a Mackenzie roll to keep back straight whilst sitting, especially at a computer; no awful slumping.

[Trill in reply to hampsetwoden]

Link just played extensive, unskippable ads. I see now it's something to do with functionality cookies so will allow those and try again.

[annpavitt250448]

That's very good advice, but found out way you have to look down or you are liable to call flat on your face due to the awful state of the paths. All broken up by card and vans parked on the pavements

[hampsetwoden in reply to annpavitt250448]

You can look down without bending your head, and you don't need to look down all the time and you can go somewhere where there is flat space. I walk a lot on country footpaths and can manage