MUA A little worried

[Sisterpat]

Southlake, looks like you may be coming around to the BoneSmart way . You will not regret it! There are so many success stories here and you will be one of them. I get it about it not being considered “manly” to vent your feelings, but here on the forum it is safe to do so and we all understand what you are going through. You are not alone and please check in often and report your progress.

 

[Southlake]

Thank you all.

 

[sistersinhim]

Don't be afraid to push back and let your surgeon know you are working at your own pace.

And you are his boss and employer, not the other way around. The same thing with PT.

 

[Southlake]

I had my six week consultation with the surgeon two weeks ago. I was very low with my bend realistically still around 65/70. He suggested MUA and, desperate to see some kind of progress, I succumbed. I had the procedure on Monday, spent a night on a CPM machine set at 100, had PT Tuesday morning and came home. No doubt the bend is better - I am getting 90/95 when sitting and doing the ‘heel slide’ motion but I don’t quite have the confidence to fully bend when coming down stairs etc. It’s a mental block I’ll have to get over but I’ll get there. My main issue now is extension with my knee at maybe 20 and showing no signs of improvement. Working hard on ‘prone hangs’ using 2kg ankle weight and other exercises for it. My knee still really sticks out when I walk and it’s worrying. The positive element is that the severe knee and quad pains I had been expecting post MUA have not really materialised - some knee discomfort and an occasional quad twinge but that’s it. Still not sleeping well though, probably due to worry rather than anything physical. I’m now almost 8 weeks out from my original TKR op and in the grand scheme of things that’s not much I know. I believe (and really hope) my extension issues ease but I know it may take a while. I’m still icing and elevating constantly and careful not to do too much (I did some gardening yesterday and suffered a little today). Trying to stay positive for the long haul. Would be interested in anyone who has had similar extension issues though.

 

[Jaycey]

Unfortunately you reset your recovery time line when you had MUA. That knee will need to calm down a bit before you start to see progress. Ice and elevate as much as you can.

Working hard on ‘prone hangs’ using 2kg ankle weight and other exercises for it.

And this approach is not really helping.

It's your decision. But as we have seen here, an aggressive approach often hinders progress.

 

[Southlake]

I’m getting pulled everywhere by conflicting advice. In essence I really believe in the BoneSmart gentle recovery philosophy and can see it makes sense: working away at already damaged tissue can’t be a good thing. Yet I really want to see progress and the advice from surgeon and PT is exercise routines four times a day. Another conflict is ideas on night sleep. Some sources say elevate operated leg with pillows under calf and knee and others insist on a flat leg and no pillows. I chose the former and now wonder if this has been wrong. I honestly think the mental/emotional effects of surgery are as draining as the physical aspects.

 

[Ghostpipe]

You’re spot on with the mental/emotional effects. We all expect too much too soon.
With sleep, I didn’t start sleeping through regularly until 10 weeks. Sleep however you are most comfortable, I had both done at the same time and couldn’t pander to either of them, so had to ignore any advice and do my own thing with a couple of small cushions. You will feel much better with a decent night’s sleep, so will your knee.
Knee sticking out is mainly swelling, it will get better. Mine started to drain out overnight at around 10 weeks, especially if I’d not done too much during the day.
Stairs, I am at 16 weeks and going downstairs “properly” is still sore on the top of both knees, as is getting up from a chair. But it’s much better than it was at 8 weeks.
Your ROM will improve with decrease in swelling.
Hang on in there, everything gets better in time, but much slower then we all expect.

 

[Southlake]

Thank you. Greatly appreciated.

 

[Jockette]

but I don’t quite have the confidence to fully bend when coming down stairs etc. It’s a mental block I’ll have to get over but I’ll get there.

This may be a concern in your mind, but it’s not just that, your new knee is not healed enough yet to do stairs “normally.”

As far as conflicting advice, there are so many different opinions about how to do this recovery, and your opinion is what is most important. Do what you feel is best for you and try not to worry about what others say.

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

 

[Sisterpat]

I agree with Jockette about recovery being YOUR decision, however, I also agree with Jacey that using those weights on a recently replaced and manipulated knee is not going to do you any favors. Many, if not most doctors and therapists still subscribe to the outdated and often harmful theory of no pain, no gain.

 

[Jockette]

Yes, I forget to mention the weights. I’m going to quote one of our other staff members, as he worded this very well:

Ask what is the reasoning for painful exercises. Require a specific answer. They won't have one. BoneSmart has no issue, of course, with stretching or posture or indeed any exercise that does not cause pain.

To train, you make your muscles hurt as much as you can bear. But you are not training, you are recovering.

 

[eaglemom]

I have to ask about the ankle weights. Is that something PT has started with you? Something your doing on your own? Did the surgeon suggest using ankle weights? I'm just curious.

Your knee has had a major operation and now its had an MUA, thus the tissues are again very unhappy. You've mentioned about conflicting advice. This is something you have to sort through and follow through. Following the BoneSmart ways is how many of us have done our recovery. No matter what you do your knee has to recover and that takes time.

 

[Southlake]

It was my PT who suggested the ankle weights.

 

[GiantFinnegan]

@Southlake I think conflicting advice is the name of the game with this recovery. I've had a few different physical therapists and even at the same facility they gave me different advice (example: one was very pro-icing, the other just 2 days later told me I was icing too much). At my most recent post-op visit, the nurse checking me in said my ROM and activity level was good, then the physician's assistant came in 5 minutes later and told me I was way behind on ROM.

In a weird way, this conflicting advice relaxes me - which I know sounds weird! But I figure that if there are many people out there having TKRs and then all of them are getting different advice, and most of them end up recovering just fine (TKR has a good track record of patients being happy they had the surgery), then maybe it all really doesn't matter much what you end up doing, as long as it works for you (which is essentially what I think the Bonesmart way is). I listen to all of the advice, merge it all in my head, and do what feels right for my knee.

So, long story short, don't let all of the advice givers push you around. Do what you feel is working and don't be afraid to ignore the advice that doesn't work for you.

 

[Jockette]

@GiantFinnegan Excellent post!

 

[Jobiwan]

@Ghostpipe yes I feel the same way as far as feeling guilty that I should he doing more. It's really getting depressing just sitting elevating and icing!! I just want to walk on my own again...
It will make.2 weeks.post op for me in 2 days

 

[sistersinhim]

It was my PT who suggested the ankle weights.

I am sorry, but your PT is wrong. Weights shouldn't be used until around 4 months for most people. Only then are they healed enough to stress the healing soft tissues. Would you put weights on a broken leg before it's healed? Well, your knee has two broken bones that have to heal around and into an implant. That takes time.

 

[Jewlz1]

Hi Southlake-knee replacement is so much more than I ever expected. I had my left knee done in Dec 2019, and my right knee was just done this past June 9th.

PT is an important component in recovery. But it can be at your pace. There will be some discomfort when exercising, but it should never be painful. You know how much your body can take and if it gets in the pain zone, ask your PT to stop or let them know it hurts, and you need to stop. They won't know if you're in pain unless you tell them. Although a good PT should be watching for their patients reactions.

My first TKR and subsequent PT was not good at all. I suffered a quad strain due to an overzealous PT. It set me back quite a bit and then there was Covid and my outcome was not ideal. This time around is much better for me, thank goodness.

Keep your chin up, don't put time constraints on your recovery, sleep/rest when you can, and exercise at your pace.

Ice and elevate constantly. I will move my ice pack around to the area that seems the most bothersome, and hold the ice pack to that area with a cloth between my skin and the ice pack. I also massage my calf very gently, like you might with with a small dog. I hope that makes sense, it sounds kind of funny.

You've gotten lots of suggestions which I'm sure is way overwhelming. Just remember you know you and if you feel extreme pain during PT, stop whatever is causing the pain. Talk it over with your PT to reach a mutual agreement on what is best for you. The PT should still be able to incorporate stretching exercises that aren't killers. Strengthening (which uses weights) should come later.

And hardest of all for me was/is having patience. It's easier the second time around. But there are days when I'm past being patient! Hang in there!

 

[eaglemom]

I have to agree, your PT is wrong about ankle weights. (My surgeon has a strict rule to never do any ankle weights after a TKR. But that is his rule, and I happen to follow it as his patient.) I do understand how its confusing to hear so many different opinions / idea's. Even in a PT clinic different people will do things differently. As I stated, you have to decide if your going to follow your PT's advice or BoneSmart. The two don't work together - that's where you get conflicting advice. I do think you need to realize this was a major surgery and it takes time to heal. We are all inpatient and want to feel better, do more things, etc., but alas in due time you will.

I certainly don't mean to sound so blunt, I just want you to realize your trying to mingle two different healing methods together and your getting frustrated. Take a couple of days and do no PT - just ice elevate. Take a step back, so to speak and just chill as much as possible. You know your body and what will work for you - no one else does. Hang in there, it just takes time. (And I know your tired of hearing that.)

 

[Jewlz1]

I have to agree, your PT is wrong about ankle weights. (My surgeon has a strict rule to never do any ankle weights after a TKR. But that is his rule, and I happen to follow it as his patient.) I do understand how its confusing to hear so many different opinions / idea's. Even in a PT clinic different people will do things differently. As I stated, you have to decide if your going to follow your PT's advice or BoneSmart. The two don't work together - that's where you get conflicting advice. I do think you need to realize this was a major surgery and it takes time to heal. We are all inpatient and want to feel better, do more things, etc., but alas in due time you will.

I certainly don't mean to sound so blunt, I just want you to realize your trying to mingle two different healing methods together and your getting frustrated. Take a couple of days and do no PT - just ice elevate. Take a step back, so to speak and just chill as much as possible. You know your body and what will work for you - no one else does. Hang in there, it just takes time. (And I know your tired of hearing that.)

Hi Eaglemom-my PT is going so much better this second time around. It seems like the surgeon and PT are on the same page. Maybe the difference is that all of the providers involved in my care are within the same hospital system? The PT I'm rehabbing with is the same person who worked with me the day of my surgery. I think that has also made a difference for me. I don't think TKR rehabilitation is an either or between PT and Bonesmart. It's a ton of work and a commitment. If PT is working a person too hard, Bonesmart is here to support us and to offer alternatives and even help us with communicating with the PT. If PT is working-great! Finding a happy medium is key and can be challenging to find/reach.