TKR 6 weeks post op<

[Jockette]

I am doing my excercises at least 2 times a day. At this point walking gets painful fairly quickly. When I am quiet pain is a non issue. I am hoping the stiffness and pain will be gone sooner than later. Any thoughts? I think I am probably doing as good as I can but not sure. Thanks.

I’m going to tag @Josephine to advise you.

 

[Josephine]

I have been stingy with the pain meds so no withdrawal feelings if I do manage to skip a day.

It's a myth that you will get withdrawal symptoms after only a few days. You were/are doing yourself no favours by adopting this approach.

Not sure how the stiffness/tightness contributes.

Quite simply because stiffness and tightness are forms of pain!


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Roy Gardiner]

My hopes are that the stiffness will diminish and or go away.

Absolutely it will...

I am diligent with my excercises.

...whether you do exercises or not. Take care not to overdo exercising, your knee will tell you if you are.

I also need to get my glut stronger.

*after* everything has healed, please

Can you expand on that Roy? Thanks.

Er, what would you like to know?

I bought a recumbent excercise bike which has been great. I have a regular bile on rollers and fork mount but I going to wait on that and the treadmil. Right now the stationary recument for 10 minutes a day. I may increase that time, also no resistance

Using a bike:

• set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[JRS11]

I should have said I have been careful with my pain meds, I have not let myself be in pain but have tried to not over medicate. I have been taking the pain meds for 10 weeks now.

You can ask me any questions, no issues, I would appreciate input.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[JRS11]

1. Stiffness mostly 5, Above knee, 5 or so

2. Dilaudid, 2-4 mg. I usually take 2mg especially at this point. 4 makes me very tired, if pain climbs I will take 4mg.

3. Slight swelling

4. ROM greater than 120 last time it was measured. I do all of my physical therapy at home now, unsupervised. Extension was -2 last time measured. It was good from the start.

5. Not icing any longer, physical therapists felt it was no longer needed.

6. Not really elevating, mostly keeping it straight. I will elevate if it is hurting

7. I have been walking 15-20 minutes, I have been to the market a few times, I am ok for a short duration.. I will take my cane when I go out but have not used it in weeks. My knee is starting to feel stronger. I have not driven yet but feel once I am off the meds completely I feel confident my knee will be ok to drive (right knee).

I do a bit of cooking and keep the house neat. No heavy house work. I am not very active as I am not yet driving.

8. All exercises at home.
Walk 15-20 minutes once a day
Stretches and exercises

On my back
Leg slides to buttocks, 2-3 times a day, 3 sets of 10 hold 3 seconds
Leg lift with rolled up towel under knee, 3 sets of 10, hold 3 seconds 2-3 times a day
Half Straight Leg Raise about 6” 3 sets of 10, hold 3-5 seconds, 2 times a day.
Clamshell stretch, 3 sets of 10, hold 3 seconds, 2-3 times a day
Bridges, 3 sets of 10, 2 times a day this one is helpful for my back which I have had 2 surgeries

Self Mobilization Prone Knee Flexion Stretch using nylon strap, 5 held for 15 seconds. 2 times a day.
Sit in chair, bring right foot back to base of chair, scoot forward to edge of chair, hold 15 seconds, 5. 2 times a day
Gastroc Stretch, lean into wall, right foot back, stretch and hold 15 seconds, 5 times. 2-3 times a day
Knee extension, lift leg off floor by straightening knee. Hold 5 seconds, lower slowly. 4-5 sets of 5 reps
Standing lunge stretch (use stairs to balance), 5 times, hols 15 seconds, 2 times a day
Standing Hamstring Stretch, 5 times, 15 seconds 2 times a day
Recumbent stationary bike, no resistance, 10 minutes, 1 time a day
Strengthening given to me by physical therapists ( they gave ne all of these)
Wall slides, 3 sets of 10. 3x’s a week
Using a 6 inch block step, 3 point lateral step. 3 sets of 10. 3x’s a week
I also walk up and down the stairs in the house as directed to do at PT.

Physical therapy ended 4 weeks ago. They felt I was doing ok and to just do the above as written at home. I am consistent with doing all of the above.

I have a treadmill and think I would be ok using it slowly for 15 minutes. Any thoughts?

If any of this is not clear please let me know. Thank you

 

[Josephine]

1. Stiffness mostly 5, Above knee, 5 or so

Okay

2. Dilaudid, 2-4 mg. I usually take 2mg especially at this point. 4 makes me very tired, if pain climbs I will take 4mg.

I would suggest that you also take Tylenol 1,000mg 4 times a day 6hrly. A very underrated pain killer is Tylenol.

3. Slight swelling

Okay

4. ROM greater than 120/-2

Are you under the impression that ROM only stands for flexion? Because it doesn't - it's both flexion AND extension! But your ROM is pretty darned good for only 10 weeks out.

7. I have been walking 15-20 minutes, I have been to the market a few times, I am ok for a short duration.. I will take my cane when I go out but have not used it in weeks. My knee is starting to feel stronger. I have not driven yet but feel once I am off the meds completely I feel confident my knee will be ok to drive (right knee).I do a bit of cooking and keep the house neat. No heavy house work. I am not very active as I am not yet driving.

Good

All exercises at home.
Walk 15-20 minutes once a day
Stretches and exercises
On my back
Leg slides to buttocks, 2-3 times a day, 3 sets of 10 hold 3 seconds
Leg lift with rolled up towel under knee, 3 sets of 10, hold 3 seconds 2-3 times a day
Half Straight Leg Raise about 6” 3 sets of 10, hold 3-5 seconds, 2 times a day.
Clamshell stretch, 3 sets of 10, hold 3 seconds, 2-3 times a day
Bridges, 3 sets of 10, 2 times a day this one is helpful for my back which I have had 2 surgeries
Self Mobilization Prone Knee Flexion Stretch using nylon strap, 5 held for 15 seconds. 2 times a day.
Sit in chair, bring right foot back to base of chair, scoot forward to edge of chair, hold 15 seconds, 5. 2 times a day
Gastroc Stretch, lean into wall, right foot back, stretch and hold 15 seconds, 5 times. 2-3 times a day
Knee extension, lift leg off floor by straightening knee. Hold 5 seconds, lower slowly. 4-5 sets of 5 reps
Standing lunge stretch (use stairs to balance), 5 times, hols 15 seconds, 2 times a day
Standing Hamstring Stretch, 5 times, 15 seconds 2 times a day
Recumbent stationary bike, no resistance, 10 minutes, 1 time a day
Strengthening given to me by physical therapists ( they gave ne all of these)
Wall slides, 3 sets of 10. 3x’s a week
Using a 6 inch block step, 3 point lateral step. 3 sets of 10. 3x’s a week
I also walk up and down the stairs in the house as directed to do at PT.

I'd say that you don't need to do any of these any more because your ROM is excellent! And you are so active that that will more than compensate for the absence of any exercises. Mostly they are responsible for the pain you have right now.

 

[JRS11]

My extension was -2 last time it was checked the last day of PT. Sorry, the auto correct on my iPad must have messed that up.

Will try the Tylenol, never had much luck with it in the past but I have nothing to lose by trying it.
I have some tramadol at home, never thought it did that much except for neuropathy. Any thoughts on using it for this and trying to stay away from Dilaudid? I will only get 2 more small Rx's for the dilaudid. I have extra put aside as I have not been using the higher dose unless absolutely necessary.

If I understand you are saying that the stretching exercises can be put on hold or ended as they may be the cause of the pain/(not sure if you also meant stiffness?) I wonder what to do about the stiffness, this is what bothers me most. The pain I feel on the top of the knee is not severed enough to cause me concern right now.. Time should remedy it.

What about using the stationary recumbent?

Also, I tried the treadmill today at a low speed and found it to be very easy and it kept me focused. It is pretty cold outside and I prefer to stay warm as the cold seem to effect my knee since the surgery.

Also, what about strengthening exercises? Are there any I should be doing? I know I have to work on my glut, not sure what to do and when to do it.

Thank you for taking the time to help me.

 

[Roy Gardiner]

What Josephine said; you don't need any training until healing is complete - indeed it's counterproductive

 

[Roy Gardiner]

What about using the stationary recumbent?

• set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

Also, what about strengthening exercises?

See above about healing and training

 

[Roy Gardiner]

If I understand you are saying that the stretching exercises can be put on hold or ended as they may be the cause of the pain/(not sure if you also meant stiffness?)

Stretching is brilliant, if it's done pain-free (at the time and in the next 24 hours). It's the way to regain flexion lost over time pre-op

 

[hegel]

I've been doing very light bike peddling ( I'm approaching week 5 post surgery) but it turns out five-ten minutes is too much right now! How do I know? Pain that wasn't there before I began doing this. I'm sort of shocked really. I was an avid stationary bike person for months before my surgery. So now I'm backing off for a bit and then will start again, but gently and for just a few minutes to start. It seems ridiculous, but there you have it.

I didn't feel pain on the bike at the time. (well, I was wincing two days ago when I didn't warm up first, but it wasn't that bad.)

 

[kmak81230]

Yup @hegel - I was going to spin class 3 x week right up to surgery and after surgery I had to start at just a couple of minutes at a time on the bike with no resistance - maybe twice a day. Very humbling!

 

[JRS11]

What Josephine said; you don't need any training until healing is complete - indeed it's counterproductive

How will I know when healing is complete?

 

[Celle]

IT takes a full year for complete recovery of all your tissues after a knee replacement.
However, it is probably safe to start gentle strengthening exercises after 3-4 months, provided you experience no increase in pain or swelling, at the time, or in the 24 hours after doing them.

You simply can't rush this recovery, no matter how much you want to.

 

[Roy Gardiner]

Celle says it perfectly, listen to your body. It's a bit like if you pull or strain a muscle in training, you have to back off until it's healed or you'll make it worse.

My saying 'complete' was perhaps an overstatement; more accurately, you gauge training against how your knee reacts.

 

[JRS11]

Thanks again. I guess I just am confused as PT here said to do the excercises and have been doing and can tell my knee has gotten stronger. I also wonder about healing and how much to push it. I appreciate zhe time taken and advise given.

 

[NavyGunns]

@JRS11, there is nothing to be confused about. There is nothing wrong with doing the exercises and stretches your PT recommends. The point that Roy and Celle are making is don’t over do it. Just because your PT says “do 30 of these or do this for 40 mins” doesn’t mean you have to do it! It’s your knee, it’s your recovery! Do what you believe your knee is ready to tolerate. If it talks back, and you will know when that happens if you pay attention to your knee, then back off, way off if necessary.

When I was in PT, the first thing my pt asked every session was “how does the knee feel and how did it tolerate he last session”. If I complained of swelling, pain, or tightness, then we adjusted that session to focus on relief of those issues and backed off any strengthening type exercises. If your PT is any good, they treat you with respect and listen to you and won’t try to force you to do anything your knee won’t handle. You are in control. Make sure they know that.

 

[beachy]

When it finally sunk into my thick head that pt was hindering my recovery I quit. That was about 2 weeks post op.

But, I did want to do something other than walk. I took 2 weeks off to "interview" various pt facilities. At 4 weeks I found a new pt facility with a non aggressive philosophy and caring therapists.
It's exactly the way NavyGunns mentioned.

Hopefully, you can work it out with your therapist.
And yourself
Best wishes for your recovery!

 

[JRS11]

Thanks Navy. I don’t feel added pain after stretching, my big issue is the stiffness which I now know is another form of pain. This is worst after I move around a bit after getting out of bed in the morning.