TKR Muscle stimulation

Fender78

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Hello everyone. I am 5 days post op from having my LTKR. The past 2 days I have been struggling with pain, but what concerns me is I have no quad strength. I feel like my brain isn’t communicating with my quads. I’m on a cpm about 4-6 hours a day. I can reach 0 on extension and about 75 on flexion. My leg feels tight at all times. How long does it take to regain strength? This is really frustrating me.
 
@Fender78 Welcome to BoneSmart and the other side of surgery.

At only 5 days out of major surgery it is totally normal to have no quad strength. Everything in and around the joint as been totally traumatised. It will take awhile for the brain to reengage with the quad muscles.

All that work on the cpm is only adding to the problem. You are not in training - you are recovering from trauma. Rest that knee, ice and elevate for now. There will be plenty of time to work on ROM later when that knee is healed.

Here's some reading for you that might help clarify some of these issues:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this Activity progression for TKRs

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Hello @Fender78 - and :welome:

Please will you tell us the full date of your knee replacement, so we can make a signature for you? Thank you.:flwrysmile:

It's quite normal to lose quad strength at this early stage. It will come back.
Your leg has been through major surgery and it will take a while to recover.

Complete recovery from a TKR can take as long as a full year, although you will feel much better long before that.
By about 3 months, you should be able to return to almost all your normal activities.

This recovery is a long haul - it's a marathon, not a sprint, so you have to pace yourself.
 
Welcome @Fender78! Sounds like you are doing ok for this point in recovery. Pain management is a big hurdle during the first two weeks so hang in there. Your flexion sounds great at this point also. I hate to break the news but this is a very long recovery and you can expect the tightness for awhile - longer if you overdo the exercises. My experience was that the quad took a very long time to come back and get stronger. I couldn't even lift my leg for at least two weeks and I had been extremely active prior to surgery with pretty strong quads (cycling, hiking, etc). Slowly your strength will come back. My PT emphasizes glute strength over quad strength initially as it takes pressure off the new knee. Patience is one of the keys to recovery.
 
Surgery was done December 4th 2018
 
Thank you for your surgery date. I've put it in your signature.
 
5 days post op
Recovery isn't in days, it's in weeks and months. Don't worry.
no quad strength
No surprise, it's very common
This is really frustrating me.
Relaaaaaaaaax, it's early.

See the words given in posts above, don't rush, don't sweat recovery takes a long time and the body does it all by itself. Chill, watch TV, what's not to like? The arthritis is gone now, it all just gets better.
 
Recovery isn't in days, it's in weeks and months. Don't worry.
No surprise, it's very common
Relaaaaaaaaax, it's early.

See the words given in posts above, don't rush, don't sweat recovery takes a long time and the body does it all by itself. Chill, watch TV, what's not to like? The arthritis is gone now, it all just gets better.
Is this what your dr ordered? Mine told me to use cpm 8 hours a day, leg strengthening exercises and do some walking. In fact the hospital where I had it done had its own wing for TKR. They call it the joint ranch. My dr did not put me in that, he had me do one on one with PT. Patients in the joint ranch did 2 hrs of aggressive therapy a day.
 
Is this what your dr ordered?
Actually, yes, although he's known as an eccentric.

Knees are damaged in surgery, akin to pulling or straining a muscle. We know that training is no good for strained muscles - it makes them worse - and the BoneSmart view is that painful exercise for TKR people is akin to this, so counterproductive.

CPM shouldn't be painful.

I don't think it really matters one way or another if you use CPM; for people who don't have genuine problems like adhesions (almost all of us) ROM will return through just daily activity as the body heals.

Still, what matters is what works for YOU and only you can evaluate that. What we give is just advice from experience (as patients and, in some cases, practitioners).
 
My surgeon had me in the CPM for my first knee 18 months ago but he no longer uses it - it does provide passive stretching which sometimes felt good to me but he prefers that we get up and walk around and do our ADLs. I did fairly aggressive exercises also for my first knee (per my surgeon) which I think added unnecessary swelling and inflammation and made recovery more challenging. This time I am not being aggressive, primarily walking, doing my daily activities as I can and stretching on the stationary bike. It seems to be working well for me even if my surgeon would prefer I am more aggressive.
 
It sounds like you might not have been warned well enough. I was warned (by both Doctors and physical therapists) that the first six weeks would be miserable. Painful, with plenty of setbacks. That was how it turned out for me. I've been doing PT twice a week since surgery, but I only just started activating my quad significantly at the fifth or sixth week. I’ve lost almost two inches off of my thigh due to lack of use.

At 11 weeks, I’m finally making some ground towards starting to build my leg strength up. I’m hoping to have my previous strength back in 8 months or so. My plan is to continue strengthening well beyond that previous level (if I can) to make the knee last as long as possible.
 
Is this what your dr ordered? Mine told me to use cpm 8 hours a day, leg strengthening exercises and do some walking. In fact the hospital where I had it done had its own wing for TKR.
Different surgeons will order different things.
Many now consider the CPM machine unnecessary and old-fashioned.

My surgeon has a completely different approach from yours and he gets excellent results.
He doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM and mobility, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
 
@Fender78 it took almost 2 years for my brain and knee to communicate with harder things like skipping and running up the stairs. Less hard things came gradually, and I still get excited when I can do something new. I am currently working on a little jump in dance. It’s been 2.5 years since surgery. At first I wondered why I went through with it, but now am glad I did. People like Roy and Celle encouraged me and I’m so glad they did. They will be there to encourage you too. The quad strength WILL come back, but takes time!
 
Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!
 

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