TKR Back home in PA

[jmark87]

Today marks five weeks, post op. You folks have been so helpful in my new knee adventure that I have been tempted to ask again for your opinions and advice from your experiences. Now that I am on my own as far as rehab goes, I need to find some balances in my activity. First of all I chose to stop wearing my compression stockings, as I don't think I need them or getting any benefit from wearing them. The next question I have is about the pain meds. I have been taking one tablet at 10:00PM and another at 3:00AM, to be able to sleep. I am using Percocet that says 5-325MG. I don't know what that means, I think they are 2.5 MG.
My knees always seem to be very tired and stiff. I don't take any pain med during the day because I don't sleep much at night and always fall asleep during the day while watching TV. I try to do two 45 minute sessions of stretching and leg lifting exercises that I got from the hospital and the PT. I elevate and ice about four or five times a day. I will soon use the Gym and Pool. How do I get myself on a better schedule of exercise and sleep. Maybe some of you have gone through this. Can not get comfortable in bed, spend most of the night on the lounge chair. Thank you again for your time and input.

 

[referee54]

Those sleep issues are nasty and pesky! I had them, and many others had them, as well. It was not like I was in pain---I just could not get comfortable ---and I wandered around the house looking for one good night's sleep! I tried the couch, the guest bed, the futon, and I even threw the futon mattress onto the floor and tried that! Ironically, it was on one of my late-night wanderings that I found this site!

Do not worry about it---do not fret---all of this is normal! Just take those naps and try not to get frustrated---your sleep schedule should return down the road. I ended up taking Ambien for ten days---they re-established my sleep pattern and I never looked back. Others used Benadryl and Tylenol PM---along with melatonin.

Hang in there---these sleep issues will fade away!

 

[Ditzzeechick]

Sleep when you can, try to use the pool every 2-3 days while continuing to stretch at home. I did not give up meds until 10 weeks. I occasionally use Tramadol when I overdo it, I rarely have any pain. My knees, even with pillow between them still have that weird feeling when I sleep on my side.

 

[skigirl]

At only five weeks out, I think your legs are swollen and stiff because you are in pain. I also used the 5/325 Percoset--that is 5 mg of oxycodone and 325 mg of Tylenol. I cut the tablets in half when I thought it was too much. You could try taking a half tablet every six hours and see if that helps. I also use Tramadol (which is name branded Ultram) which is a milder pain med and does not have as many side effects.

The pool does help relieve the swelling. I am still using my compression stockings to control the swelling. I just wear one on my tka leg. oops, you have two , don't you. I think you need to rest right now too. Two 45min workouts is a lot of exercise, plus whatever else you are doing. Iwent to pt three times a week for an hour or so. You are doing more. And my rom is 140--so don't get tricked into thinking that your rom will disappear if you take a day off to rest your knee. K

 

[jmark87]

Well today was an experience. We went to the new health club pool. I was not sure what to do so I did a lot of walking and swimming on my back so I could kick my legs. Then I saw a lad on the other side of the pool walking backwards in the water. I went over to talk with hin to see if he was rehabbing some part of his body. Turns out he had a hip replaced and was doing this kind of water exercise for it. Hips are supposed to be a lot easier that knees, to rehab. He had some major problems with his. He said at one point it swelled up more than twice the size of the good hip.

Then I got a brain storm. I can't wait to get on my recombent bike to go ride on the flat and lever bike trails. I got my bike out of the shed and my wife was supposed to hold it upright so I could see if I could crank the pedals backwards, over the top. She wasn't there and I didn't want to wait for her to return. It felt just, SO RIGHT. Well that was, SO WRONG. I pushed off and when my left knee went over the top, I thougt it was going to explode. Obviously I am not quite ready for riding the bike. But it is in my near future.

Does ony one know what particular movements to do in the water to rehab my knees?

 

[jerseychick]

John, check to see if the health club has jog belts that you wear around your waist so you can jog in the water. You can water jog up and down the pool in the deep end. It's great for your knee and to begin to work on cardio.

 

[Ditzzeechick]

John-
One more time ;) These exercises are what my PHYSICAL THERAPIST told me to do (with pics included on a couple of sheets of paper) when I use the pool:

I recently joined my local gym and began using the pool. I found just walking up and down and then swimming on my side while slowly kicking my legs helped tremendously. Also, the pool probably has kick boards and noodles available for use. I take a noodle (long styrofoam floatation device) and push it down in front of me in the water to create more resistance, it helps me to work on balance too. Then make a U with the noodle, place ur bum in the u and bicycle. Use the pool steps to do stretches or hang on the side of the pool and kick legs, put stomach against side of pool and lift bend foot up so you are bending knee, turn sideways and do scissor kicks while holding onto wall. Anything you did in PT can be done in the pool using the wall, steps or a noodle/kick board. Also, if you gym has a recumbent elliptical machine, give it a try. I found that it made a huge difference in my ROM not to mention it's a wonderful cardio workout without being jarring to the knees. Best of luck!

I also walk backwards, water provides resistance. Good luck....

 

[jmark87]

Well I guess I am one of those people that don't learn very easily. I know to NOT push myself, that is why I quit PT and decided to work on my rehab myself. I set up this test for myself to see how I was progressing. I decided that the morning that I could get up and walk down the stairs without feeling the pinch in each knee on each step, that I must be on my way to recovery. Well this happened on Monday morning. I got to the bottom of the steps and had a big smile on my face. I told my wife that I am on my way now. So what did I do? I went to the pool to work out. I walked forwards and backwards and swam around for awhile. Then I sat on the bench that was on the bottom of the pool. I laid back and cranked my legs as if I was riding a bicycle. I did 100 revolutions. Then I walked around some more. Then back to the becnh and another 100 revolutions. When I got home, after dinner, I walked about eight blocks around our house.
So Tuesday I didn't do much but rest up. Wednesday morning I knew I was in trouble. The legs and knees are now very stiff. I am not sure how to get back to where I was on Monday but I am very discouraged on how this worked out. I think NOW I know to NOT push myself too hard. Or do I?

 

[pclane65]

Hi John, Try not to get too discouraged. You simply over did it and will have to take a few days off to rest, ice, elevate and take some pain medication. I am about a month ahead of you with a RTK. As time passes you will be able to do more and "pay less"! That is the beauty of it...we will get there... often in spite of ourselves. Good luck and take it easy on yourself.

 

[Morning Glory]

Well, you know what you did wrong and you know it will get better. Just take it easy, ice, elevate & use your pain medication. I know the Patience part of recovery is tough. Hope your feeling better.

 

[skigirl]

John, A day of resting with your knees elevated and you will be fine again. But, be careful of repetitive motions. You do not want to do 200 bicycle rotations. So, 10 bike rotations, walk across the pool--front, back and sideways. 10 bike rotations. Then with a flotation belt on "cross country ski " across the pool, frontwards and backwards.

In the deep end with a flotation belt---run to the edge of the pool. Kick off with one foot, then run again.

Your workout should not be more than an hour and don't do the same thing over and over. If the pool has some warm water, do some gentle heel slides and bending. Stand on one step and lean into the second step. Good luck. If you google water aerobics you will see lots of info. Kelly

 

[jmark87]

OK, I hope I learned my lesson on not pushing my knees too hard. I rested up and now I have gone back to the Gym. I do a few leg presses, extremely light weight looking for flex not muscle building. Then a 3 minutes of eliptical and 3 minutes of stationary bike. On the bike, if the seat is all the way back, I can get over the top on the pedals. This is just a stretching warm up. Then I go into the pool for one half hour of walking, kicking and some swimming.
My question is, should I be doing the heel slides and pulling back into the discomfort zone and holding it for count of 10, repeatedly? Is this the only way that I am going to get more ROM? Each morning I expect to be able to descend the eight steps and not feel the stiff pinch in each knee. This coming Tuesday I will be starting my eighth week post op. I know it is a 12 month program but I think I should be seeing more results by now. I will admit one thing. I have not been faithful with my list of exercises that I got from the hospital and PT. I have been substituting working around the yard, washing vehicles and the gym/pool. What do I need to do to loosen up these knees and get more ROM so I can ride my recombent bike outside?

 

[jmark87]

Sorry to bother everyone so much. I just don't know where to turn. If things don't get better I think I will call my OS nurse to discuss this.


From what I am reading, I think I am doing too much. I am starting the 8th week on Tuesday. I am walking, working around the yard and going to the pool every day for a constant half hour workout of walking and kicking. I feel worse now than at my 5th week. My feet get stiff and to sit on chair with feet on floor, it bothers me. Walking slower now and my legs bother me.
I am think of taking about 2 or 3 days off to rest and see if things relax and feel better. The knees do not look swollen but there may be some swelling inside. I do ice a couple of times a day and massage my legs and feet often.
Do you feel it is a good thing to take a few days off and not exercise?

 

[bottomshollow]

John, I think it's very possible that you are doing too much. Walking is good everyday; working around the yard maybe a couple of times a week; going to the pool for 30 minutes workout--maybe every other day would be better.
Are you elevating when you ice? For how long? Should be at least an hour. Do some ankle pumps while icing and some circular motion exercises for your ankles. Sitting in a chair with feet on floor will continue to be uncomfortable for at least 2 more months. I am 8 months post op (doing very well) and my knees still get stiff from sitting any period of time. But stiffness goes after taking two or three steps.

And, YES, take a few days off from your regular activity. Rest, elevate and ice, and do only gentle stretching and bending a few times a day. See how you feel after this---if there's definite improvement in how you feel, then you've been overdoing---and it's such an easy thing for any of us to do.

 

[Janet2012]

John, It seems some people just do things backwards. The idea is to do a little, and if that is okay, do a little more, etc. So many go the other way and do too much and then try to step down until they get to a point where it isn't too much. Faced with standing at the bottom of a ten step staircase, we will call this ten steps of difficulty. Do one step, and when that is okay, do two steps. Some folks go for it, and say, let me see if I can do ten steps, and it's way too much. After recuperating, they say, okay, I'll try only nine steps, but it's still too much, and takes another few days to recuperate, and then they do 8... I'm guessing that the person that starts at the bottom and moves up the steps is able to conquer those ten steps of difficulty without repercussions SOONER than the person starting at the top, having to recover, work down the steps and finally going up again. Hey, this sounds familiar... anyone see a tortoise or hare around here?

 

[jmark87]

Thanks again for all your replies and support.
I think I just discovered a new exercise for leg flex. I was using a large exercise ball between my back and a door, to do mini squats. Then I sat on the ball and rolled back and forward to put a slight bend to my knees. Have others used this method?

 

[jerseychick]

Hi John,
I think it is a good idea to take it easy for a few days and see how your knee feels. At 8 weeks you are doing a lot more than I was, it sounds like it may be a bit too much for your knee.

Yes, you can sit on a ball and roll back and forth-great exercise for flexion. I also sat in a chair with wheels and rolled back and forth across the kitchen and then stationary rolled back and forth to work on flexion. It also strengthens the hamstrings.

Another good exercise for flexion is too sit on a chair or couch and use a small weighted ball and roll it back and forth using your foot. When you get to the point of discomfort hold it for a minute or two. I think a regular small ball would also work.

 

[referee54]

Even the strongest and the best athletes take time off from their workouts, and keep in mind that they are not recovering from what can be described as an assault and battery-type surgery on their knees.

You need to give your muscles and the knee joint itself a time to rest and to heal. If you are working on this too much, your knee will fight back and you will slow recovery. Look at it this way---even runners, cyclist,s weight-lifters, etc---all have "off days" built into their workout routine.

A rest day is just as import to your BTKR recovery as is a trip to the gym. You can get some exer-bands and do gentle stretching, or you can do some gentle bike riding, but you need to give your knees a time to rest, too.

 

[Josephine]

John, I am going to give you some direct and absolute advice here. Read carefully ....

I do a few leg presses, extremely light weight looking for flex not muscle building. Then a 3 minutes of eliptical and 3 minutes of stationary bike. On the bike, if the seat is all the way back, I can get over the top on the pedals. This is just a stretching warm up. Then I go into the pool for one half hour of walking, kicking and some swimming.

This is way too much for 8 weeks out.
You should do
NO leg presses yet
NO elliptical, just stationary bike and no more than 5 mins
NO kicking and swimming in the pool yet, just 30 mins of GENTLE walking

My question is, should I be doing the heel slides and pulling back into the discomfort zone and holding it for count of 10, repeatedly? Is this the only way that I am going to get more ROM?

Heel slides is pretty much ALL you need to do. It sounds like you do it perfectly but you only need to do it about 4 or 5 times a day and 5-10 times each session.

Each morning I expect to be able to descend the eight steps and not feel the stiff pinch in each knee.

Don't expect anything! Just let it be a surprise when it happens. I took me nigh on four months before I could go upstairs normally, 5 before I could do it coming down. And that's pretty normal.

I know it is a 12 month program but I think I should be seeing more results by now.

Who told you that? Actually it's closer to a 6-12 month programme. Nothing's cast in stone so the less goals you set, the less you will be disappointed.

I will admit one thing. I have not been faithful with my list of exercises that I got from the hospital and PT. I have been substituting working around the yard, washing vehicles and the gym/pool. What do I need to do to loosen up these knees and get more ROM so I can ride my recumbent bike outside?

It's more what you DON'T do that loosens them up. All that activity is way too much for 8 weeks out. WAY too much. Throw the exercise sheets away and just concentrate on more gentle activity. Your knees are still healing and to do that they need rest not activity.

From what I am reading, I think I am doing too much. I am starting the 8th week on Tuesday. I am walking, working around the yard and going to the pool every day for a constant half hour workout of walking and kicking. I feel worse now than at my 5th week. My feet get stiff and to sit on chair with feet on floor, it bothers me. Walking slower now and my legs bother me.

That's because, as I said before, you are doing too much. Your legs are still at the 'angry tissue' phase where they are struggling to heal and need more rest than activity.
(getting the message yet? )

I am think of taking about 2 or 3 days off to rest and see if things relax and feel better. The knees do not look swollen but there may be some swelling inside.

LOTS of swelling inside! I shall be giving you some articles to read, you've probably had them before but a little revision doesn't hurt!

I do ice a couple of times a day and massage my legs and feet often.

Twice a day is hardly worth the effort. Better than massaging is elevation while you are icing, have your feet up "toes above nose" for at least an hour at least 4 times a day. Can't beat it for getting on top of swelling.

Do you feel it is a good thing to take a few days off and not exercise?

That's not the best way, much better is to reduce what you are doing each day - considerably.

Now let me give you some specifics:
Progression of activity for TKRs this suggest what you should be doing on a weekly basis. You will note that on week 6 onwards it says (you can convert a lot of this to more masculine activities of course!)

Weeks 6 and onward
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out.

Activity: ironing, washing, meal prep but get someone else to clear up after, wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, not you!!

Bed making and changing sheets, cleaning bedrooms etc., can wait until about week 8 by which time, all things being well, you should pretty much start getting back to normal. But if it takes a bit longer, don''t worry about it.

Note the "START getting back to normal! And this is for ONE knee!

Swollen and stiff knee: what causes it? you mentioned swelling inside - this explains it
Elevating your leg to control swelling and pain proper way to elevate
Knee Replacement - Where Am I in Recovery?

These two explain how long it takes for our bodies to heal
How Long Does Healing Take ......
Chart representation of TKR recovery

 

[referee54]

Is this the only way that I am going to get more ROM? Each morning I expect to be able to descend the eight steps and not feel the stiff pinch in each knee.

The one big thing that will help with ROM is to be patient and understand that ROM can be gained slowly---over time---and through gently working the knee.

As for descending the stairs---after my BTKR, that was one of the last things that I did---about four months later.

as Josephine says, don't worry about it---let it be a surprise. Everything will come back---even better than before---but you will reach "total recovery" on your knees' terms and schedule, not yours. Trust me, I know how you feel and have been there.