Bilateral TKR CrossFit’s new knees

[Crossfit]

I had BTKR on 11/14 and mostly I’ve been recovering well. The first 7 days were rough, but it’s been getting better every day.

I had in-home PT a few times and began outpatient PT yesterday. I was really nervous, having read the horror stories on BS, but it wasn’t so bad.
I would say it was uncomfortable at times and mildly painful, but when I asked Larry (PT) to stop, he did.

Larry took some measurements, manually attempted to flex/bend my knees, watched me walk and discussed my history.

Next week, the real PT starts. He said it consists of using the bike, leg lifts on machine, stretching (manually attempting to increase flexion/extension) as deemed necessary.

From everything I’ve read on BS, I’m nervous about leg lifts. These aren’t good for new knees, correct? The minor stretching Larry did, I’m ok with, but I’m not putting up with anything that has me in tears or gripping the table! Hoping I can get some advice from all of the knowledgeable people on this site.

I’ve really enjoyed reading everyone’s stories so far, I’ve learned so much. This journey would have been terrifying if it weren’t for all of the wonderful folks and info on BS!

 

[Celle]

Next week, the real PT starts. He said it consists of using the bike, leg lifts on machine, stretching (manually attempting to increase flexion/extension) as deemed necessary.

Next week is far too soon for most of that. In the first month after surgery, your knee needs only a little, gentle exercise. That's the time for your knee to start healing. Stress it with too much exercise, too early, and you could slow down its recovery.

The bike could be OK, as long as you only rock the pedals back and forth. It's too early for any other machines - and don't allow Larry to stretch your leg manually, or to apply pressure.

In spite of what he's probably going to tell you, it's not exercising that gets you your ROM (Range of Motion) - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Right from the start, your knee has the potential to achieve good ROM, but it's prevented from doing so by pain and swelling. ROM will gradually increase as your knee heals and the internal and external swelling decrease.

There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

PTs like you to gain ROM early and fast - it looks good on their notes - but there's no need at all to rush.

By the way, it's your knees and you are in charge of their recovery. You don't have to please your PT - he has to please you. So, work with Larry, but make it clear that you won't allow anything you consider unwise.
Saying no to therapy - am I allowed to?
Your knees aren't lazy or unfit. They're wounded, and they need time and gentle treatment, so they can heal.

 

[Celle]

Now, having given you a lecture, I'll give you the BoneSmart recovery guidelines and some useful and informative articles:

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Pumpkin]

Here are a few things your PT can help you with.
A PT may be able to help you with finding ways to reduce pain with ice, elevation, and TENS, gait training, gentle exercises, and how to pace yourself so you do not cause additional irritation to your knee.

Here are two gentle activities that can help with your ROM.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

 

[pamsknees]

So glad you’re recovering well!

 

[Crossfit]

Thanks for the support and info @Celle and @pumpkin! I’ve read those articles over and over, I guess I just needed more reassurance that aggressive PT is bad. I’ll let you know how the next session goes.

 

[sistersinhim]

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 formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.

 

[Crossfit]

This morning I was experiencing what I would describe as nerve pain on the lateral side of my right knee when I was going down stairs. Stupidly, I pushed through it. A couple of hours later, my knee became very hot, swollen and tight, to the point that i couldn’t put ANY pressure on my right leg. My son practically had to carry me into the house. The pain has been intense. I took an oxy (even though I stopped painkillers two weeks ago) and am icing and elevating. Obviously, I overdid it somewhere, but should I be worried? It all came on so fast and intensely that I’m a bit freaked out. My recovery has been progressing nicely up to this point. To make matters worse, I’m getting on an airplane tomorrow evening for a 3 hour flight.

 

[sistersinhim]

Obviously, I overdid it somewhere, but should I be worried?

Oh my, you are now a member of that dreaded ODIC, (overdid it club). You implant is fine, but your soft tissues are very angry. You will need to rest and ice as much as you can to settle down your knees. Try to do as little as possible, just ice and elevate.

I'm sorry to hear you are going on that long flight. Arrange for a wheelchair for you. You will need it.

 

[Crossfit]

Thank you @sistersinhim. My plan is to ice and elevate for the rest of the day and hope tomorrow is better. Yes I’ve already arranged for a wheelchair!

 

[amymhere]

At least you got the wheelchair! Be careful you! No sense in overdoing it. Little steps forward. Not 1 step forward 3 steps backwards! You are doing great.