TKR 5 weeks out TKR doctor wanting to do MUA

[Marynana07]

I have taken the advise of everyone on here and have given my knee a much needed rest. I feel you guys are right I have been working my knee way to much. I am not good with patience so this is not going to be easy. I normally work my knee twice a day trying to make it to the 120 degrees the doctor wants me to be at by 6 weeks. The swelling seems to be better.
I am just wondering what is the best work out for my knee on a daily basis?
I am trying to bend me knee instead of letting it stay straight when sitting down. I also am trying to rest more and keep it elevated when I sit down, along with ice 3 to four times a day. What more can I do to help my bend increase?
I have PT tomorrow and a doctors appointment on Tuesday I will post after those visits. prayers greatly appreciated

 

[Jockette]

I will be praying.

 

[kmak81230]

Hang in there! Most have found that just activities of daily living along with walking are the best exercise for your knee. Many doctors are happy with 90 degrees flexion at 6 weeks and most also do not push for an MUA once you have achieved 100 degrees. Try not to worry -- you are doing fine and you will have an even better chance of increasing your ROM now that you are resting your knee more.

 

[Marynana07]

So all weekend all I did was rest,ice and relax and when I went to therapy today I could only get to 95. I am so discouraged right now. I really believed that if i rested my leg and let the inflammation go down my ROM would get better but unfortunately I went backwards.
I know what everyone says about over working the knee and I really believe it; however I can not stop making progress. the swelling did go down considerably but the flexion was way off today. It is so hard not to cry when you do not see any progress.
can you please tell me what I can do on the off days that I am not at PT.

 

[KarriB]

You have a ROM of 104 at 7 weeks? That's great! I was released from PT with a ROM of 109 at 20 weeks post op and I continued to gain flexion months after. My leg was in an imbolizer with NO bending for 4 weeks due to a complication. My OS ordered non-aggressive PT which meant I did heel slides without any assistance or any tools to help, just me pushing my foot back/forth a few times a day. After a while I found riding a recumbent bike with 0 resistance for 5-10 minutes really helped.

You have LOTS of time to gain ROM, your knee just isn't ready yet because it's still healing. Also if you're doing aggressive therapy that's adding to internal swelling which isn't always visible. Give your knee the time it needs to heal, pushing it before it's ready won't help. Often when people have overdone things it takes longer than a few days to settle down a knee and those soft tissues.

 

[Jockette]

The fact that the swelling went down is progress.

All the rom numbers you've mentioned are so close they are almost the same. I bet if we saw a visual on a piece of paper we would be surprised at how little difference it is.

I'm sorry your surgeon is pressuring you so much. It doesn't seem fair. This recovery is difficult enough without them demanding time lines that other surgeons don't. I am constantly amazed at the differences of surgeon's opinions.

I think with the extra pain you have when you bend it's going to take more than a weekend of resting to make a difference.

Sending hugs!

 

[JJ65]

@Marynana07 It is great that the swelling went down !!! Do you do heel slides? Those would help you, I don't think they can hurt. Just do a few a few times a day, don't overdo. What do they have you do at PT? Do they measure you at the end of your PT session?

 

[Jockette]

And, I don't think that tool they use to measure rom is an exact science, even my husband said that as he's watched every time I was measured. I think it can vary slightly. It's not like measuring a flat piece of paper on a table with a ruler.

 

[kmak81230]

95 is really fine for where you are in recovery. In fact the difference between 95 and 104 on the goniometer is less than an inch so the difference could have easily been how the PT placed it on your leg. It takes time (maybe more than a weekend) for swelling to subside. While you may not see big gains on the goniometer you are healing every day. Don't be so hard on yourself, you will get there!

 

[JJ65]

I agree with kmak81230 the measurement could have been off and it is not much between 95 and 104. I think you are doing really well for only 5 weeks out.

 

[Celle]

I am just wondering what is the best work out for my knee on a daily basis?
I am trying to bend me knee instead of letting it stay straight when sitting down. I also am trying to rest more and keep it elevated when I sit down, along with ice 3 to four times a day. What more can I do to help my bend increase?

The best workout for your knee is no formal exercises at all - just a little walking around the house and garden. Spend the rest of your time resting, icing and elevating your knee.

So all weekend all I did was rest,ice and relax and when I went to therapy today I could only get to 95. I am so discouraged right now. I really believed that if i rested my leg and let the inflammation go down my ROM would get better but unfortunately I went backwards.

You didn't give it long enough. You need to rest, ice and elevate, and do very little else for at least 3-4 weeks before you will see progress.

No matter what your surgeon wants, you can't speed up this recovery. You have had a very major operation and complete recovery takes as long as a full year - although you will feel much better long before that.

This recovery is a marathon, not a sprint, so learn to pace yourself.
Your knee knows what it's doing and it's doing OK. You and your surgeon and PT are just expecting too much of it, too soon.
Where are you in recovery?? (TKR)

can you please tell me what I can do on the off days that I am not at PT.

Sit with your leg elevated and iced. Just take a short walk around the house about every hour.
Read, knit, watch TV, phone your friends, sleep.

Your job right now is to keep your knee happy and try to reduce its swelling, with lots of rest, ice and elevation.
Try not to think of resting as "lying around, doing nothing." Instead, think of it as working hard, to give your knee the best possible chance of healing well.
Life in the slow lane

 

[Marynana07]

I would like to thank everyone for their encouraging words and all the advice it is so nice to get on here and talk with people who really understand how I feel because each of you have walked down the same path I am walking on right now.
@KarriB you are right the therapy was very aggressive on Monday and this made the swelling even worse following my therapy it also made it extremely hard to ease the pain, my leg throbbed pretty much all night to the point of causing tears to run down my face. I do have a bike that I have been using and it seems to help.
@Jockette you are so right after I read your post about the measurement I checked the goniometer and the difference between 95 and 104 was barely an inch. I guess i just let the numbers intimidate me.Thank you for bringing that to my attention it was very helpful.
@JJ65 I have only been doing heel slides at therapy but I will add them to my therapy at home. as for therapy (I am not sure what all the exercises are called so I'll try to explain) first they start me off on a bike for 10 mins then I do calf stretches, then he pulls and massages my leg for a bit then he puts my foot on his arm and lifts my leg and tries to bend it after doing that for a bit he massages again then he has me do heel pulls a count of 10 holding for 10 secs, then I lay on my stomach and pull my leg toward my buttocks a count of 10 holding for 10 secs, then I stand and put my foot on a chair and I lunge forward bending my knee 3 sets of 10, then he has me do squats a count of 30 then he measures my leg again with me lying on my back pulling my heel to my buttocks.
@Celle I am 6 weeks out and you are correct when you say I am expecting to much. actually I do not know what to expect I just know I have never had anything keep me from being independent and this is very hard for me. Can you tell me when was your TKR and how are you doing today?

 

[Celle]

@Marynana07 - I have had three knee replacements.
The first one (right knee) was a partial (PKR), in 2000. That lasted for eleven years and I had it revised to a total (TKR) in 2011.
I had a TKR on my left knee in 2014.

I did very little formal PT for the first two knee replacements and none at all for the third one.
My surgeon 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, 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.

My surgeon doesn't focus on ROM numbers, because he says that function is more important. He looks at my knees and says "Show me what you can do."

Both my knees are great now. They are strong and reliable and I can do anything I want to with them. Apart from an occasional, very slight niggle, they give me no pain at all. I hardly think about them now and if I see an X-Ray I get a shock to see those large metal implants.
Both knees straighten completely and bend to over 125 degrees.

 

[Jockette]

My PT never made me do most of what yours has you do, oh my, I bet a person who has a healthy knee and no replacement would have trouble doing all that! It's way too much.

If you must go, please tell them you want to scale it back. If they refuse, don't go back, there is no reason to do all that. If you still want to go to a PT, search around for a better one.

I am still at a point where I am sorry I had this surgery. I hope I never have to have the other one done, and that I don't have to have my partial revised to a full (but it probably will) but if I have to do it again, I absolutely will not do PT again.

I wanted to stop going to PT by 5 weeks post op because what they had me doing at that point was hurting for days after, but my husband was afraid that if I defied the surgeon and had a problem later and needed him that the relationship would not be good. So I cancelled some appointments and kept some, but started saying no to things they wanted me to do and they didn't give me a hard time. At just before 8 weeks post op I got an honorable discharge, so all ended well.

But I know so much more now, thanks to Bonesmart, and that there is an alternative way to recover from this surgery, so I will recover very differently if there's a next time.

I am continually appalled at what surgeons and PT's expect from us in this recovery. I don't understand them at all.

Sending you more hugs!!!

 

[Jockette]

We are intimidated by the numbers because the professionals we trust make such a big deal about them.

Well I no longer trust those professionals like I used to. At this ponit if Bonesmart doesn't tell me to do it, I don't.

 

[Celle]

@Marynana07 - the exercises you describe are indeed far too much for your poor knee.
You must say NO to your therapist - pushing and pulling on your knee is bad for it. Tell him "Hands off my knee".
It's not necessary for him to ever touch your knee. You should also stop doing that exercise where you lie on your stomach and pull your leg backwards. Forcing your knee to bend is going to traumatize it and make its progress slower.

In fact, with a therapist like him, you'd be better off not going to PT at all. There are good OTs out there, but he is the wrong one for your knee.
Saying no to therapy - am I allowed to?

 

[Celle]

Marynana, I have copied the post below from mechellac's own recovery thread. I think you might benefit from reading it:

Five month kneeversary today and I will say that (knock on wood) this is the best I have felt. I finished a five day medrol pack yesterday for inflammation and it really helped. I measured at 120 degrees today with ease and it felt great! I have truly learned that for me "less is more". It's really difficult in the beginning to follow the Bone Smart mantras when you have surgeons and therapists still pushing intense physical therapy but if you happen to be reading this and you are new to this site - please please please listen to the Bone Smart mantras. It is the way to go. I honestly think that all my slow bending problems stemmed from overdoing, and working too hard at getting my range of motion. I just made myself swell and swell and the bending was impossible. Yes, I believe the MUA helped but what helped the most was backing off on so much exercise. I'm going to continue going to (gentle) PT once a week until they run out - which will be soon - and as I see it, anything on top of 120 will just be gravy.

Thank you my Bone Smart moderators and friends for more help than I could imagine with this crazy recovery. It is definitely an experience that you don't want to go through alone.

 

[sistersinhim]

riding rides, especially the roller coasters

first they start me off on a bike for 10 mins then I do calf stretches, then he pulls and massages my leg for a bit then he puts my foot on his arm and lifts my leg and tries to bend it after doing that for a bit he massages again then he has me do heel pulls a count of 10 holding for 10 secs, then I lay on my stomach and pull my leg toward my buttocks a count of 10 holding for 10 secs, then I stand and put my foot on a chair and I lunge forward bending my knee 3 sets of 10, then he has me do squats a count of 30

Oh my goodness. I can't believe you are doing all these at only 6 weeks. You are being set up for lots of pain, swelling and problems.

Many of us never took 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. This was enough therapy 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!

 

[KarriB]

For sure these exercises along with the PT pushing/pulling your leg are exacerbating the swelling in your knee. I hurt just reading about lunges and squats. There is no reason PT should hurt you. @SusieShoes managed to "handle" her PT very well and kept him/her from hurting her. She took charge of her recovery and didn't allow aggressive therapy because she knew it would backfire.

You probably need to take a vacation from PT for a week or more, then if or when you return set the rules. Truly, less is best in a TKR recovery.

 

[SusieShoes]

It's true, I did manage my PT therapist. Like many, I wanted to please my surgeon. He's top-notch and I figure if I'm paying good money for this man's expertise, I'll do things his way. I asked him if I could do no PT, but he really wanted me to give it a try, so I signed on.

If the exercise didn't hurt and I thought it was doing me good, I did it. If I knew it would hurt, or it actually did hurt, I didn't do it. If it wasn't on my surgeon's program of post-surgical exercises (video series), I refused to do it. My PT went along with my wishes. He didn't really have a choice. I was the one holding the checkbook. I could just go somewhere else, or simply stop going, if I was unhappy.

You are in total control of PT. Total. Control. You don't need to earn their approval, they need to earn yours. Mine did that by letting me set the pace. I would be on a PT table doing my "baby" bends and stretches while another patient on the next table, who had surgery the same week, was doing 5 lb. weights and sets of leg presses, which I'd refused. According to PT I was behind her in progress... but guess who was walking without a cane first? Guess who had better ROM because her knees were less swollen?
Build trust with your PT. If you can't do that, you need a different PT. But always trust yourself first.