TKR Almost one year, still a bit sore

[Irelandliz]

Hi there
Well I did my first physio after a four week break and I'm so glad I waited because I was able to do the hour virtually with no pain just a little bit of discomfort.
However... Today I am a bit stiffer and I'm sore but only about a 4/10 which is not too bad.
I tried sitting in my car but I am just not ready - my right leg is too stiff and I'd be afraid of not being able to make an emergency stop if I had to.
I'm still walking with a dreadful limp when I don't use an aid - I thought it would come more naturally but I think my brain has totally forgotten how to walk properly!!!
My sister is flying in from South Africa on the 31st for two weeks so I definitely want to be driving by then as she is afraid to - they sit on the right side of the car and drive on the left side of the road!!
I'm going to go for a walk later with my husband and see if I can get this wooden knee loosened up a bit more!!!

 

[Irelandliz]

SusieShoes gave you really good advice about extension.
Walking is a great way to help it increase, especially if you lengthen your stride as you walk. That really helps to stretch those tissues at the back of your leg.

Don't forget that both flexion and extension can continue to improve for at least a year after a knee replacement. There's no need to rush.

Hi Celle
I'm frustrated because the physio I saw yesterday is telling me the same story about there being a 'window' before the scar tissue becomes solid that I need to get my flexion and extension right before that happens! I don't want to push until I'm sore but I'd be lying if what he said didn't make me worry a bit...

 

[Jockette]

Please don’t worry about that non existent window. Many many on here have proved otherwise.

I’ve been to South Africa, my daughter taught there for 3 years, and it was really weird being on the road! She did all the driving, but riding on the entrances and exits on and off the highway was so strange!

Enjoy your sister’s visit!

 

[Irelandliz]

Please don’t worry about that non existent window. Many many on here have proved otherwise.

I’ve been to South Africa, my daughter taught there for 3 years, and it was really weird being on the road! She did all the driving, but riding on the entrances and exits on and off the highway was so strange!

Enjoy your sister’s visit!

Thanks Jockette I appreciate your confirmation that the window is a myth.


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[Celle]

She told you that because that's what she's been taught.
It's wrong, though. Your ROM will continue to increase - at its own rate, not on some artificial schedule. We even have someone on BoneSmart who discovered that her ROM had increased 3 years after surgery.

There is some pressure on PTs to show fast improvement, because it's something tangible they can show to the insurance companies - "Look how valuable our treatment is. Look how fast we've improved ROM." And so, the insurance companies keep on paying the PT facilities!

There is no window of opportunity
Myth busting: the "window of opportunity" in TKR
and what your PT calls scar tissue is correctly called adhesions. In spite of what you've been told, they are very rare. They're not just sitting there, waiting to pounce if you don't exercise enough, or get good ROM fast enough.
Scar tissue and adhesions - what's the difference?
MUA (Manipulation under Anaesthetic) and Adhesions

One of our members posted this, to show her slow and steady improvement in flexion:
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months"

I didn't do any PT at all after my last TKR, and I did very little after the previous one. Both my knees are strong and reliable. They straighten fully and bend to over 125 degrees. I did this with the full approval of my surgeon.

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. It means that nobody developed adhesions and they all achieved good ROM.

 

[Irelandliz]

Thank you @Celle - I am going to give this to my husband to read too, and I am going to cancel the 3 times a week schedule that the pt thought I needed. On top of everything else each time I go it costs me a copay of $60 [emoji33] I will just work on the exercises by myself and follow the guidelines here on Bonesmart. No more listening to eager PT's lol


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[sistersinhim]

@Irelandiz, you have made the right decision about PT. Why pay out the money when you can do it yourself at home? 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! ADL,(activities of daily living), will be all the exercise your knee needs. If you stop all that exercising, and just use it daily in your living, you will have a quicker and less painful recovery.

 

[liam2015]

my surgeon tried to tell me the same thing about being "stuck" at a low r.o.m. if it didn't get to a certain level by 12 weeks post op until he did a bit more research and agreed that i could still continue to gain r.o.m. i started physio at 6 weeks post op, not through insurance (paying privately) ~ she has nothing to prove to insurance or anyone and has never said there is a limited window to gain r.o.m. i am gaining r.o.m. slowly and accepting that everyone's bodies are different and heal differently. i've pretty much stopped going to p.t., haven't gone for 2 weeks; working on the exercises i think help me (stair lunges, step-ups and walking up and down the stairs). i might go back for treatments, (massage, etc.) and maybe new exercise if i feel like it. i loved the treatments; they felt good and therapeutic. i think you're doing the right thing by cutting down on going to p.t. and working on your home exercises; gives you more time to ice and elevate.

 

[SusieShoes]

If PT is helping you, and your knees don't object to what you do there, there's no harm in it and possibly much good. It's only aggressive PT and too early use of weights and strength training machines that cause the inflammation that slows people's recoveries down. My OS discussed PT (I didn't want to do any) and he agreed the "Window of Opportunity" for gaining ROM was a myth. His point was PT might help me with other things, like balance, trusting my knees, and gait. So that's what I used PT for.

Once I could walk well and no longer needed a cane (at six weeks), my OS said I could stop PT. I would get stronger and better on my own simply by walking and using my new knees.

For what it's worth, I think recovery is ever so individual. A person who’s willing to make his or her own decisions can direct their own recovery: they know what works best for them because their body tells them what's working. They can make things like PT work for them, rather than blindly follow instructions that may not be suitable for them or their knees. PT is not one-size-fits-all. How can it be? Every person's knees are different. I had two knees that were very different from each other. Who better than me to direct what was working and what was not? I talked with my PT guy (got to like him, even) but I often overrode his suggestions.

You'll figure out what you need, and you will find ways to get it. Listen to the knee.

 

[Pheebs52]

@Irelandliz, I am a "Slow-Bender." At your stage, if I remember correctly, my flexion was around 60 degrees.....dismal. I brought this up with my OS at my 9 week post-op visit because I was worried about it and wondered if an MUA was in order. He said," No, we can do that anytime if need be. Let's just see how you progress on your own over time." Well....I am almost at 5 months now, and my flexion, while not *stellar* is 110 degrees. I expect it will continue to improve, though slowly. This whole recovery process has been very s-l-o-w for me, but, it keeps improving. My extension is zero, but it has been since the beginning. With this degree of flexion, I am able to ride my exercycle, walk fair distances, (one hour to 90 minutes if need be) and generally use stairs in a normal, foot-over-foot, style. My house has a lot of stairs I must navigate to go out, do laundry and use the family room, so that's been a real plus. I can also finally walk my dogs without fear of falling; phew!

I have found that exercycle really helps me loosen up more than anything. Just 5 minutes on the bike makes a world of difference to me. If you don't have one, you might wish to consider getting one when you're a bit further down the road in healing. I couldn't so a full revolution until about 14 weeks post-op, but once it happened, all became much brighter.

I did go to PT, but I have an exceptional PT person who has never hurt me. I also have other issues (back and hip) which complicated my walking ability, so it was truly essential for me. I still go, but less frequently, but again, his practice is different than most. On a typical visit, he will do heat on the quad only, ice on the knee, massage, gentle stretching, the bike and gait training, followed by more ice. For me, the gait training has been invaluable.

I'll bet you will be ready to drive by the time your sister arrives. That's 2 more weeks, and I know I found big improvements each week at your stage, as have many others here! Walk on!

 

[kmak81230]

Hi Irelandliz. I agree with the others ahead of me so will try not to duplicate too much. If PT is not working for you, no need for it. I personally love PT but I also, like @Pheebs52,go to one that does not push the knee, believes that aggressive exercise leads to a slower recovery, and focuses only on functional movement (like balance and gait - and, now that I'm 5 months past surgery, strengthening the muscles that help support the knee like quads, hamstrings, and glutes). Even though it has been beneficial for me, 3 x week would have been much too much. I now go 2 x month and only have a handful of visits left this year. The exercise or stationary bike is excellent for gentle stretching and walking, as others have said, is really one of the best PT exercises you can do. I am also a slow bender and straightener but am confident that both will come in time (at 5.5 months my best guess at flexion is 115 and I am not yet at 0 on extension). Hang in there!!!

 

[Irelandliz]

If PT is helping you, and your knees don't object to what you do there, there's no harm in it and possibly much good. It's only aggressive PT and too early use of weights and strength training machines that cause the inflammation that slows people's recoveries down. My OS discussed PT (I didn't want to do any) and he agreed the "Window of Opportunity" for gaining ROM was a myth. His point was PT might help me with other things, like balance, trusting my knees, and gait. So that's what I used PT for.

Once I could walk well and no longer needed a cane (at six weeks), my OS said I could stop PT. I would get stronger and better on my own simply by walking and using my new knees.

For what it's worth, I think recovery is ever so individual. A person who’s willing to make his or her own decisions can direct their own recovery: they know what works best for them because their body tells them what's working. They can make things like PT work for them, rather than blindly follow instructions that may not be suitable for them or their knees. PT is not one-size-fits-all. How can it be? Every person's knees are different. I had two knees that were very different from each other. Who better than me to direct what was working and what was not? I talked with my PT guy (got to like him, even) but I often overrode his suggestions.

You'll figure out what you need, and you will find ways to get it. [emoji4] Listen to the knee.

Thanks Susie I so appreciate your messages and the information that you share in them. My husband asked me to give the physiotherapist a few weeks at least to try and help me and to guide me as to how I can really help myself.

He is a gentle man and doesn't use force of any kind, otherwise I'd be out the door for sure lol Today I had my second session and he did express his concern that my flexion was only at 70 degrees so he did massage my leg and around the scar where I noticed I am having some puckering and a bit if lumpiness. He has me sit on the table with my legs over the side and puts a bolster behind my right calf to make up for the deficit. He then puts his hands in front and behind my ankle and asks me to try and lift my leg against the pressure of his hand. It is actually so much easier to do that, than the foot sliding the other home care physio had me try to do. The moment I don't feel comfortable with him I will stop but for now I do feel as if he may help me.

Thanks again Susie [emoji254]


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[Irelandliz]

@Irelandliz, I am a "Slow-Bender." At your stage, if I remember correctly, my flexion was around 60 degrees.....dismal. I brought this up with my OS at my 9 week post-op visit because I was worried about it and wondered if an MUA was in order. He said," No, we can do that anytime if need be. Let's just see how you progress on your own over time." Well....I am almost at 5 months now, and my flexion, while not *stellar* is 110 degrees. I expect it will continue to improve, though slowly. This whole recovery process has been very s-l-o-w for me, but, it keeps improving. My extension is zero, but it has been since the beginning. With this degree of flexion, I am able to ride my exercycle, walk fair distances, (one hour to 90 minutes if need be) and generally use stairs in a normal, foot-over-foot, style. My house has a lot of stairs I must navigate to go out, do laundry and use the family room, so that's been a real plus. I can also finally walk my dogs without fear of falling; phew!

I have found that exercycle really helps me loosen up more than anything. Just 5 minutes on the bike makes a world of difference to me. If you don't have one, you might wish to consider getting one when you're a bit further down the road in healing. I couldn't so a full revolution until about 14 weeks post-op, but once it happened, all became much brighter.

I did go to PT, but I have an exceptional PT person who has never hurt me. I also have other issues (back and hip) which complicated my walking ability, so it was truly essential for me. I still go, but less frequently, but again, his practice is different than most. On a typical visit, he will do heat on the quad only, ice on the knee, massage, gentle stretching, the bike and gait training, followed by more ice. For me, the gait training has been invaluable.

I'll bet you will be ready to drive by the time your sister arrives. That's 2 more weeks, and I know I found big improvements each week at your stage, as have many others here! Walk on!

Thanks Pheebs, I hope you're right about the driving I am getting a bit claustrophobic not being able to go anywhere! And I know my sister is already panicking about driving on the right lol

You mentioned an exercycle is that just a little one that sits on the floor and you pedal or do you mean an exercise bike? My husband has a spinner bike but I am so far away from being able to do anything like that for now in fact I'm laughing as I'm typing this I do however think that one of those little ones may be a good idea!!

While your flexion was still so low were you still using a cane? I find I walk a bit better with a cane than without - I limp badly without it and I think it's more psychological than anything - I just forget to heel/toe my foot! My husband calls me Blackbeard, all I need is a parrot on my shoulder [emoji23]

Thank you again Pheebs for your input [emoji259]


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[Irelandliz]

Hi Irelandliz. I agree with the others ahead of me so will try not to duplicate too much. If PT is not working for you, no need for it. I personally love PT but I also, like @Pheebs52,go to one that does not push the knee, believes that aggressive exercise leads to a slower recovery, and focuses only on functional movement (like balance and gait - and, now that I'm 5 months past surgery, strengthening the muscles that help support the knee like quads, hamstrings, and glutes). Even though it has been beneficial for me, 3 x week would have been much too much. I now go 2 x month and only have a handful of visits left this year. The exercise or stationary bike is excellent for gentle stretching and walking, as others have said, is really one of the best PT exercises you can do. I am also a slow bender and straightener but am confident that both will come in time (at 5.5 months my best guess at flexion is 115 and I am not yet at 0 on extension). Hang in there!!!

Thanks Kmak, my husband feels I need to try the PT for a few weeks at least so I am going to give it a go but with the understanding that I am not going to limp out of there every day and that I am in control at all times as to how much I can do. BoneSmart has helped me understand that I do have this control as weird as this may seem - before I would have just gone along with whatever I was told to do irrespective of how much discomfort I was in.

Thank you again for your insight [emoji259]


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[sistersinhim]

It sounds like you're using good, common sense in your PT! That's being a smart cookie!

To answer a post, just come down to the bottom and start writing. You don't have to quote the whole post. Of course, if there's a line or two you want to quote, you can highlight that part.

 

[Irelandliz]

It sounds like you're using good, common sense in your PT! That's being a smart cookie!

To answer a post, just come down to the bottom and start writing. You don't have to quote the whole post. Of course, if there's a line or two you want to quote, you can highlight that part.

I think it is because I am responding in Tapatalk, it must be including the message as a default. My apologies [emoji51]


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[sistersinhim]

Oh, sorry. I don't know anything about tapatalk. I use a laptop.

 

[alexthecat]

Sistersinhim has it right! In Tapatalk if you select a previous message, it will be quoted your response, but you don't need to do that. You can just scroll to the bottom of the page and start writing your response in the box where it says "quick reply".

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[Jockette]

My husband, athlete and former high school basketball coach for 20 years, had a very hard time with the concept of my wanting to stop going to pt. We’d only heard literally everyone we knew say you had to go to therapy and do your exercises.

He did agree though that I was struggling with pain with new things they added at 3-4 weeks post op, and reluctantly agreed with me that it was counterproductive. He’s had sports injuries where it hurt to start getting back to playing again, “but that’s what it takes”.

His biggest fear was what if I have a problem in the future with the knee and the surgeon be mad and maybe refuse help because we had defied the pt order.

So, like you, I kept going, but I did cancel some appointments and backed off the exercises I was doing at home, and said no to some things, thanks to finding Bonesmart about that time.

I was discharged from pt at just before 8 weeks post op because I had met all the milestones. So my husband felt better the way it worked out.

Knowing what I know now, about the ones on here that did no exercises or PT, and had excellent results, I have already told him that if there’s another knee replacement in the future, I will not go to PT and he needs to start processing that thought. He seems ok with that now.

 

[Irelandliz]

Hi Jockette, that's it exactly - I know it has to be a pain for my husband to come home from work and take me to PT and to the doctor and to get the groceries etc so I think all of that could be motivating his trying to keep me going to physio.

I do want to drive sooner than later so although he doesn't know it, lol, as soon as I can bend my leg a little bit more so that I can first get into the drivers seat and secondly control the brake and accelerator, I am stopping PT and I'm just going to walk in my neighborhood and do the few simple exercises at home. That feeling of pushing my knee is just awful!!! I feel like it's going to split open [emoji33]


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