TKR 5 Years Post Op

[Josephine]

Pheebs, I will answer your question this second time but please note that you are posting in dvannie's recovery thread and we don't care for people's recovery threads being derailed like this. So in future would you please post such questions in your own thread? Thank you.

The answer to your question can be found in here Bilateral TKR: having two knees done? Don't compare surgeries!!

 

[dvannie]

Well I did it, went back to work full time and yesterday was the first day. :cool:
Needless to say I was incredibly tired after supper and passed out on my recliner in the middle of the show we were watching. Thankfully my husband fell asleep first so I didn't feel too bad!

 

[Canada35]

Wow Diane! Good for you! Promise you will take it easy. We would like to revoke your membership in the ODIC!

 

[liam2015]

hope you got rested after your first day back at work. have another good one today and take it easy when you can, slowly you will build up your stamina.

 

[dvannie]

I felt amazingly good this morning and my knee felt a little less stiff! Today it's work again and then a break to do PT. I'm presently home elevating and icing and then back to work. Luckily I work fairly close to home so I can take a break in the middle of the day at home. I actually forgot about my knee when driving today, usually I'm flinching at each pothole and bump but today is a definite improvement!

 

[kmak81230]

Glad you work close enough to home to take that midday break - that was critical for me when I went back to work.

 

[sistersinhim]

I was so glad to read of your improvement! Your job being so close to home is a huge benefit!

 

[Josephine]

Today it's work again and then a break to do PT.

Honey, if you are back to work then you don't need to do PT as well! You have more than enough on your plate right now. Please don't do it. I already gave you this advise earlier.

Those physio sessions are not doing you any good. In fact, they are causing you pain and swelling which is blocking your ROM. You'd be much better off allowing things to settle and improve on their own.

If you continue, this is when you start getting tendinitis all over the place.

 

[Pheebs52]

Dvannie, it's really good to hear you are doing well enough to work, but please, don't join the ODIC, ok? You've been through enough!

Josephine, thanks for that link. My apologies for the posting faux-pas.

 

[dvannie]

@Pheebs52 Nope, not joining the ODIC, besides my work won't let me

 

[dvannie]

Found out something of interest from my PT that explained why they were pushing me so hard those first few weeks before they cleared up the adhesions. I guess the adhesions are not that common and when they do the MUA on those people having issues bending they find that as soon as they knock them out, the persons leg goes straight without any pushing. Once they see that, the person is categorized as having muscle guarding not adhesions. It's not something the patients are doing consciously, it's something that the muscles are doing to prevent the bend due to pain. At this point PTs choice of treatment is to push the leg until people cry and scream. They figure that this was the only way the person would get beyond the muscle guarding. How brutal! I don't agree, I think a much gentler approach possibly tricking the muscles to relax may be far less traumatic than what they are doing.

 

[liam2015]

that's really interesting @dvannie. is that what happened to you, that you had muscle guarding or did you have adhesions and how do they diagnose adhesions (sorry for the questions)? what would be the "gentler approach possibly tricking the muscles to relax......."? i think more research needs to be done in this field of recovery therapies. i'm glad you're improving. did you get the thunderstorms and heavy rain this evening like we did here? enjoy the long weekend ~ hopefully you have monday off work.

 

[Pheebs52]

Well that's a very interesting tidbit dvannie, especially since my PT has used that term with me. Good thing he's the gentle sort!

 

[dvannie]

@liam2015 I ended up being diagnosed with adhesions. The surgeon said that when they put me under my leg did not straighten past about 50 degrees, that he had to exert pressure to bend it and that he felt the adhesions let go. I'm not sure what the gentler approach would be other than possibly massaged etc. All I know is that I couldn't find one PT around here that advocated for anything other than the aggressive approach. I just think there has to be a better way.

 

[KarriB]

There is a better way. Lots of people don't do PT at all and have great ROM. I think it will take a while for the aggressive approach to be replaced, especially as it will mean less business for the PT. Mayo Clinic is no longer prescribing PT. Their in hospital therapist comes in to show a few stretches and heel slides, then the patient is sent home to do those. My mother's bff had TKR done at Mayo and did no therapy besides stretches and walking around the house. BoneSmart also had a member whose TKR was done at Mayo, she had no formal PT either.

I did have PT, but my OS prescribed non-aggressive therapy which was just heel slides, stretches and massage (not until 3 months post op). Then at month 4-5 I had strength exercises because my leg had become so weak from the inactivity the infection caused.

 

[kmak81230]

That's helpful @KarriB. I'm just at 3 mos and about to ramp up work on my extension (in a gentle way of course). My PT actually fussed at me a few weeks ago as I was sore and swollen from pushing too hard on my flexion. He reminded me that he had told me to hold my gentle stretches for longer periods of time but not to the point of pain - merely to fatigue the muscle so it would loosen up.
Take it easy @dvannie / glad they were able to break up the adhesions.

 

[Pheebs52]

Dvannie, I'm still in the gentle phase as KarriB and Kmak81230 just described. We also work on gait training and balance, but nothing in terms of strength training yet; just walking. I was given to understand that the hated heel slides and quad sets are performed as a means to let the brain tell the knee/leg, it's "ok," to bend. That's why I found your comment about "muscle-guarding," so interesting!

 

[KarriB]

In my opinion, biking is the best thing you can do for ROM and walking the best thing for strength. I wish I had done more walking early in my recovery. Since beginning a walking routine this year my knee feels so much stronger and I'm able to stand longer than ever. In church I'd get an antsy tired leg while standing through 3 songs, even at 2 years post op! But since I began walking, standing that long isn't an issue at all and I'm amazed everytime! Susie Shoes is definitely a testament to the importance of walking.

 

[Josephine]

s soon as they knock them out, the persons leg goes straight without any pushing. Once they see that, the person is categorized as having muscle guarding not adhesions. It's not something the patients are doing consciously, it's something that the muscles are doing to prevent the bend due to pain.

I would tend to agree with that.

The surgeon said that when they put me under my leg did not straighten past about 50 degrees, that he had to exert pressure to bend it and that he felt the adhesions let go.

I don't get that. Your leg did not straighten so he forced it to bend?

At this point PTs choice of treatment is to push the leg until people cry and scream.

Absolute tosh! There is never any excuse to do that. All it does is cause reactive swelling and pain which further inhibits ROM. This is such an obvious cause and effect and yet time and time again, these qualified therapists can't see the wood for the trees! It makes my blood boil!

 

[dvannie]

@Josephine Sorry, I put that wrong! I meant to say that my knee did not bend past the 50 so he forced it to bend further to 120 degrees.