MUA A little worried

[BBCG]

Yes, Southlake, it seems to me that in many PT centers, the PTs are given a template for “knees”, one for “hips”, etc. regardless of why the patient is present. Recovering from an injury is a different thing than recovering from the trauma of surgery like ours, but those differences, and the patient-specific differences seem to be dismissed and disregarded completely. So, if you are fortunate, you might find a realistic PT who has been down this road and knows how to help REAL people recover from this surgery. I’m fortunate, as I do have a local PT that I, and other kneezers have “trained” to be sympathetic to us! But, when we worked together 5 years ago, she still had a tendency to push more than ideal.

Most surgeons and PTs have never had this surgery! So, they operate from a position of training, not experience. Some of us, the feistier amongst us, end up training our PTs to be better therapists for all of us!

Visit some of those of us Kneezers’ stories here to find out how we overcame the PT disadvantage as it sometimes exists!

 

[Southlake]

Well it’s now four weeks since my LTKR and progress is slow. Since discovering BoneSmart I’ve tried hard not to worry about it but it still concerns me.

I still cannot get more than about 70 degree bend in my knee from sitting position. After that it’s pain. Extension feels a little better and my leg feels straighter when I lie down but when I try to walk the knee looks badly bent.

I am doing a fair bit of walking each day (one one crutch) which consists of 3 reps of about 200 meters (so around 600 in all) two or three times a day. Also doing the extension exercises with my wife holding down the knee for 20 reps of 30-second holds - and others too.
But it’s the lack of bend that worries me. Still have a lot of soreness around the knee, particularly the internal area .

The external area is still swollen, to the extent that it’s numb to touch, as if still under anesthetic. A couple of nights ago I was in a deeper sleep (the sleeping meds my GP have me have really helped) and when I woke I instinctively bent my leg to stretch, forgetting my situation. I absolutely screamed in agony and it only subsided as my wife straightened the leg.

When I thought about it the knee was probably near the 90 degree mark when I flexed - and it showed me how far away I am. I am also getting muscular pain at the front of the thigh which is causing some discomfort.

I know of course the BoneSmart way is healing first then exercise and I fully agree with and accept that. And I know four weeks is nothing. But maybe I’d like to see a chink of light.

 

[FourCats]

Are you doing heel slides? I found, even though they were painful, that they were the best exercise to improve the bend. Also, I’m a few weeks ahead of you and I still have that numb feeling which I asked my surgeon about. He explained that during the surgery, the nerves are “moved” as the work is done and they take the longest to return to normal. He also said there is a possibility that there may always be a bit of numbness.

 

[Bikeknit]

Just a note about the numb spot on your knee. We all have that as the surgeon has to cut and move nerves to get to your knee. Your feeling will come back over some time, at least partially, but at nearly a year on my left knee, I still have a numb area. It scared me so much when I discovered it that I called my surgeon's office in a panic. Why don't they tell us about that ahead of time? It isn't a big deal once you know what is happening.

Bending your knee to 90 before you were fully awake tells you that the bend is there, just the pain and swelling are keeping it from presenting itself. As they say here, ice and elevate. Your number 1 job right now is to heal and get the swelling down.

 

[Sisterpat]

It sounds like you are doing way too much in the way of exercises. 4 weeks is nothing in this 52 week recovery. You st need to be icing and elevating.

 

[Jockette]

I am doing a fair bit of walking each day (one one crutch) which consists of 3 reps of about 200 meters (so around 600 in all) two or three times a day. Also doing the extension exercises with my wife holding down the knee for 20 reps of 30
second holds - and others too.

I agree with SisterPat, you don’t need to do so much exercising. Too much for a particular knee can have the opposite effect and just maintain swelling, which prevents bend.

Especially, please stop letting your wife hold down your leg to encourage extension. This is not the way to do it. Extension often takes quite a while, and it will come along by itself as you heal, but here is a gentle way to help it if you really want to:

Extension: how to estimate it and ways to improve it

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[BBCG]

Hi Southlake, as others here suggested, when someone has a lot of swelling, which it sounds like you do (and I tend to swell easily too), any exercise can easily be too much! Even if it’s directed by PTs and we’re “supposed” to do it. I battled this issue last time, 5 years ago, but this time, I’m doing very few real exercises that push my knee in either direction, especially if weight bearing. One that does, only now at 5+ weeks feel good, is done at the kitchen counter/sink. I stand with my weight in my old new leg (left, in my case), and I gently bend both legs to carefully stretch the front on the knee. Now it feels really nice and stretchy. But, any force or pushing can have the effect of increasing swelling! So, with swelling goes one’s ability to bend!

Did you receive the moderators list of articles to read yet?

There are a few short articles that were really helpful to me, to get me redirected toward letting my knee heal first before pushing it or letting anyone else push it. I have not let anyone push me this time, even my old PT buddy who thinks she should still push me a little bit!

 

[Jockette]

Did you receive the moderators list of articles to read yet?

The recovery guidelines are on page one, post 4.

It might be a good idea to read through some of them again, as it’s a lot of information when we first get them.

 

[kneeper]

Others have more info on extension (I had no issues there), but regarding bend, I didn't get to 90 until 6 weeks. I really had to fous on getting the swelling down (ice, elevation) before I really began to make progress. Sometimes we hit a plateau of a week or two as well.

I never did 30 repetitions of anything at once. Perhaps 30 heel slides over the course of an entire day. That would be in addition to a little walking and getting simple meals etc.

 

[Southlake]

 

[Southlake]

Above is my operated left knee - four and a half weeks in. Still can’t get anywhere near 90 degree bend or full, flat extension. I’ve taken on board what I’ve been told on here and trying not to worry too much. Slightly concerned that my knee really juts out at an angle when I’m walking but that’s down to the swelling I guess. I’m icing and elevating constantly, exercising (I think) appropriately so I just have to wait for nature to take its course. The swelling actually looks worse on the photo than it seems when I look down. Back to see surgeon and PT in a week. Not looking forward to it.

 

[Newkneemelodee]

It looks very swollen. I think you just need to rest more, ice it, and let the swelling subside. If you keep doing so much the swelling will be made worse. Relax. My bend is taking longer than expected due to swelling. It moved six degrees in this last week because the swelling is finally subsiding. I am at week 13. Take care. Stay calm. Rest. Read the posts here. They are so helpful.

 

[Stuckinbed]

Stick with this program. I was told by PT I would never walk correctly if I didn't reach a certain ROM number by week 6. I was devastated because it was very close to 6 weeks. So I pushed my knee to where it did not want to go. I physically and emotionally broke down. The pain I gave myself was horrible. Swelling was ugly too. I'm a Bonesmart follower all the way now. Still suffering a little but feeling much less pain.. Ice...elevate...walk around the house will get me better.

 

[Bikeknit]

Some of us swell more than others. Some knees swell more than others (my first knee stayed swollen much longer than my second one.). I was lectured about not working hard enough when my first knee wasn't where they wanted it. The truth is I was working too hard.

My second and kinder physical therapist taught me a massage that seemed to help reduce swelling. Hang in there, a year from now you will look back and wonder what all the worry was about.

 

[Southlake]

I am certainly concerned that my constant icing and elevating isn’t having much effect. My knee hasn’t noticeably gone down more in the last two weeks.

 

[Celle]

I am doing a fair bit of walking each day (one one crutch) which consists of 3 reps of about 200 meters (so around 600 in all) two or three times a day. Also doing the extension exercises with my wife holding down the knee for 20 reps of 30-second holds - and others too.

But it’s the lack of bend that worries me. Still have a lot of soreness around the knee, particularly the internal area .
The external area is still swollen,

That's way too much walking for such a new knee. One walk, plus walking around your house, is plenty.

Please stop doing so much exercising and stop asking your wife to hold down your knee. With the best of intentions, it's doing more harm than good.

You're working much too hard at exercising and all it's doing is keeping your knee swollen and the swelling is physically preventing your knee from bending..

Your knee won't bend more until you get rid of a lot of that swelling. Your leg is still very swollen and all the exercising is keeping it irritated and inflamed.

Your knee isn't lazy or infit, needing lots of exercises - it's wounded, needing gentle treatment and time to calm down and heal.

I suggest you stop all the exercises, except for one gentle walk, plus moving around your house. Walking is exercise, too.

Spend a lot more time resting, icing and elevating your leg, to try and help your knee's swelling to go down. That won't happen overnight. With so much swelling, it could take a month or more.

to the extent that it’s numb to touch, as if still under anesthetic

That's normal.
This article explains:
Numb area after TKR: how long will it last?

I think I've given you this before, but it won't hurt to read it again:
Knee recovery - Lose the Work Ethic!!

 

[sistersinhim]

Still can’t get anywhere near 90 degree bend or full, flat extension.

With all that swelling no wonder you can't get a better ROM. Your #1 goal should be to get the swelling down. To be able to do that your knee needs to heal, not exercise. Doing things your knee isn't ready to do and having your wife hold it down is keeping it inflamed and swollen. It is not letting it heal. Think of a water hose full of water with the nozzle closed. Can you roll it up? Nope. Your knee is the same way. Get that fluid out and it will achieve a better ROM.

You can not speed up healing but you can certainly slow it down by doing too much, which is exactly what is happening to you right now. Take it easy and follow Bonesmart's guidelines and in a few weeks, you should see some improvement.

 

[Jockette]

Hang in there, a year from now you will look back and wonder what all the worry was about.

This is so true! All the worry and stress my medical team caused me was so wrong.

 

[Southlake]

Thanks all. I know I just want advice and reassurance. I’m feeling a bit low emotionally and that’s difficult for me to cope with. I was unfortunately brought up in a household where male vulnerability equates to weakness and problems are to be kept to yourself and never shared. I have broken that massively unhealthy chain not least by sharing on BoneSmart and I thank you all for that. This is such a supportive community. So, it’s rest, ice, medicate and elevate for the foreseeable future and when I see my surgeon next week I just need to be honest.

 

[Jaycey]

when I see my surgeon next week I just need to be honest

Your surgeon may quote "goals" that they hope you will reach. It's all rubbish. Each and every TKR recovery has its own individual milestones. There is no timeline. Don't be afraid to push back and let your surgeon know you are working at your own pace.