Bilateral TKR Analysta's BTKR diary

[Dearjr]

I have leg press. Knee squat. Abductor and adductor machines

 

[Celle]

Crouches, squats and weights all put a lot of strain on a recovering knee. They are best left until at least 3 months after surgery.

 

[Jaycey]

Today they had me roll this tool against my ITB for just six minutes, using as much pressure as I could. Upper body workout! Then tough stretches where I have to maintain crouches, donkey kicks (lots) and a variety of creative and grueling ways to move up and down. An hour of this stuff, on top of a half hour of manual manipulation.

Sounds like way too much - is this person a personal trainer by any chance? This does not sound like post TKR physio.

your PT is starting to scare me lol. I'm starting outpatient therapy on Thursday and I seriously couldn't imagine doing the things you are doing. Of course I'm only 3 weeks post-op but still.....yikes.

Please don't be concerned about this - it is not the norm. PT should never hurt and you should never let anyone push you into doing anything. In fact many people don't have physio post-op.

 

[kneeper]

Yikes! Sounds like the way I got tendonitis with my first knee and they didn't even have me do this much. I didn't think it was too bad at the time but the effect was cumulative. Take it slow @bdink21 and work individually with your PT.

 

[Josephine]

I mean, there's cutting of skin and fascia and bone, but I always wonder about the rest of the damage which seems to be mainly extreme stretching. I assume there are lots of individual cells being torn? Or just stretched? I have this theory that the longer the various things are in a hyper-stretched situation, the more damage happens.

It's also about how much the tissues are handled or how long the wound is open allowing the tissues to dry out. I can always tell a good and careful surgeon by the lack of pain his patients experience post-op.

I think the speed of the operation had to do with the technology; the mfgr gives the surgeon a bunch of customized jigs (cutting blocks, whatever) that make the cutting and drilling go super fast.

Actually not. I've seen surgeons take 2-3 times longer than normal with these customised devices. Of course with great experience and practice they can get faster but that's nothing to do with the gear.

 

[Josephine]

I'm finding that the PT sessions are a workout of their own these days.

Well it shouldn't be! There is no need to feel you have to fight nor even work hard to regain your ROM. It's there, waiting for you to allow you swelling and pain to subside so it can show itself. I suggest you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

I have leg press. Knee squat.

These were to two things my surgeon advised me against because they can cause the tibial component to come loose. To much sheer force is bad for your implant security.

 

[Wanttobebiking]

Hi Analysta,

I was reading where you had said that your PT measured both active and passive ROM, what is the distinction? Mine just measures extension and flex.

I have used the IT band roller before. Ouch! Today at PT my IT band was tight so my therapist said she would massage it. I thought, wonderful until she started working on it---it was tight but it feels better now.

 

[Dearjr]

Passive is what you get
And active is the pt pushing it

 

[Wanttobebiking]

Hmmmm. My PT has never pushed my knee to get more ROM.

 

[Jamie]

Hmmmm. My PT has never pushed my knee to get more ROM.

You have an excellent therapist then. That type of thing is really not necessary and can actually be counterproductive in recovery. Most of the time ROM is less because of swelling. Even if your knee doesn't look swollen, there can be fluid inside the rather compact knee compartment. When the swelling is gone, you'll have your ROM. It's there...just waiting for the swelling to end. And that can take quite a while for some people and even longer if a person keeps the knee irritated with aggressive exercise, activity or "pushing."

 

[bdink21]

@Dearjr I'm pretty sure you have that backward. Active ROM is the ROM you can get by bending or extending yourself using your muscles. Passive ROM is what you get when someone moves your leg for you without you participating in the movement.

 

[Dearjr]

@bdink21 you are correct
I'm dyslexic!

 

[Pumpkin]

Here they are:
PROM = ROM that someone else gets.
AROM = ROM that you get by actively using your muscles.
AAROM = ROM that your get using your muscles, with help from someone else. Allow only to the point of discomfort.

 

[analysta]

It's not fun but it DEFINITELY makes a difference. I wouldn't allow it if I weren't seeing clear results.

 

[gaelan01]

I think BTKR is the only way to go, honestly. The pain isn't greater ... it's just in two places instead of one. And the sense of relief ... ALL that bone-on-bone pain is gone, not just half of it ... it was profound and exhilarating for me.

Yes, Yes and Yes......thanks for this Analysta, Do appreciate your story and optimism. My BTKR is scheduled for September 14th....and I am so ready to get rid of the bone on bone burning pain!!!

 

[analysta]

I think that saying my PT sessions "feel like a workout" is a good thing overall. Rolling that IT band roller along my ITR did two things - my active flexion was a couple degrees better afterwards, and I was tired because I had to use both my arms to properly roll it with enough pressure. After all the inactivity of the past seven weeks, feeling sweaty and hot was terrific. And getting to do things like that for a whole hour was a privilege. Each exercise was slow and focused on different muscles each time, and I got to use upper body muscles (pushups against a wall to stretch the calves, abdominals doing leg lifts). At no time do they make me do exercises or stretches that hurt my knee (or anything else; it's really no worse than a good yoga or tai chi session); in fact at the end of each group of moves I generally feel like I could do a lot more and they don't let me.

Also, I think there is sometimes some confusion about what aspects of PT should and shouldn't produce pain. I'm not sure I agree that "PT should never cause pain." It depends on what facet of PT you're talking about.

When I (me, Analysta) talk about painful aspects of my PT, I am ONLY talking about the massage and manipulations (like what WantToBeBiking described). They hurt because the PT is using pressure point manipulation to make muscle knots go away, or manipulating the patella in order to make the ligaments looser, or massaging the scar to break up little adhesions in the incision. Actually, only the pressure point stuff hurts seriously; the others are a good kind of hurt.

That's about half of my usual hour, or a third of it when I luck out and get 90 minutes of PT. The rest of the session is two things: exercises and stretches. These shouldn't hurt much (i.e. there's discomfort and there's hurt). Stretching too far can tear ligaments and tendons and even muscles. Over-exertion of individual muscles can do the same, and can cause swelling. I don't need MORE swelling, I take it easy.

@bdink21, don't let my stuff scare you about starting PT! As far as I can tell, most people's TKR PT is just the exercises and the stretches, and not the manipulations. For exercises and stretches you have the right to stay in the comfortable zone.

@Wanttobebiking, I think it's really useful to know how far you can flex your leg actively, and how far it can be flexed passively (not to the point of pain!). Do you think you can get your PT to measure both? You can have a disappointing active flexion number but if you find out that your passive flexion range is actually 120 degrees, you can feel a lot better about your future!

@gaelan01 --- yeah! talk to you on the 14th or 15th!

 

[Wanttobebiking]

I think partly why my PT has never measured my ROM passively is because it has always been good. I am now at about 130 7 weeks out. So I kave been lucky but I have also made recovery top top top top priority. I am also lucky because I only have 30 minutes of PT, :cool: and that gives me more time to walk. I am also a wimp. Don't like pain.

 

[analysta]

@Wanttobebiking that truly is amazing ROM.

 

[Wanttobebiking]

Thanks. Of course, like most of us, I would like more. I think my non-TKR knee is about 134 or somewhere close to that. My TKR knee was probably 110 just prior to surgery, but I am a bike rider, so I think that kept my ROM decent anyway prior to surgery.

Sure is a tough surgery and rehab. I wish my knee felt more "normal."

I like reading your thread. You really put a lot of thought into it.

 

[analysta]

Tomorrow I'll be 8 weeks out and I think I'm going to stop PT. It has been a huge help (in my humble opinion) (certain parts of it) but I don't think I need it any more, although I plan to continue simple stretches and light exercise from home. Anybody think this is a big mistake on my part?

The thing is that the PT folks want to amp up the exercises each time I go and I feel I'm verging into the "Overdo" area a bit. Rather than push back at them, I think I can do the exercises and stretches at my own pace at home and at work where I will stay very aware of possible strain. It feels like, for me, delaying the tougher exercises (bike resistance, squats, whatever) until at least the three month mark (as people here have advised) is going to be my schedule.

The part of therapy that has done me the most recognizable good, which is the hands-on manipulations and pressure point work, no longer seem to be needed. I am aware of no pain points other than overall stiffness and the usual (but gradually ebbing) general pain when I go from sitting to standing or use stairs. That will take care of itself in time, I think.

I am one of those extremely lucky people who was walking without any aids on the second day and was at 117-0 ROM by the time I left the hospital. I attribute this (probably faultily) to a very quick and skilled surgery, no patella work, no general anesthesia, good pain management regimen, a ton of determination, previous yoga work, a good sense of balance, and random luck. Also, I think a BTKR might innately be easier than TKR for quick mobility because both legs are the same ... there's no sense of lateral assymetry, or at least there wasn't for me. Nevertheless, despite that amazingly quick start, I'm probably not that much further along than many in terms of overall progress at the 8 week mark. My knees swell if overworked and there's a ton of tightness; I still prefer stairs one at a time and and there's NO WAY I will attempt an emergency sprint across the street. My expectations have always been that this will continue for half a year at least, and I don't mind that. The thrill of now merely having muscle/tendon/ligament pain and not the former awful arthritis pain will keep me happy and patient.

So, as I said, am I possibly making a mistake? What should I look out for; what will tell me when I'm ready to go independent? Should I instead continue the PT (they are super-nice people) and ask for a lighter progression, and consider their oversight to be a good thing to hang on to? (My prescription covers a lot more sessions.)