TKR Back home in PA

[Josephine]

OK Jamie, I get what you're saying, but then why do any exercise at all in the first weeks? Why isn't recovery completely about rest and elevation and icing so that you get the swelling and inflammation down?

Actually, my surgeon (and many of his colleagues) totally forbid any physio for the first three weeks in order to do just that. Simple exercises are the order of the day, foot rotations, ankle pumps, gentle heals slides and some walking to the bathroom and kitchen but nothing more. Even after that, the physio is very gentle and includes a few more heel slides, some straight leg lifts and short periods on the stationary bike once a day. His MUA rate is one of the lowest in the country. Knee recovery - UK style

I was actually surprised that Josephine recommended as much exercise and walking for John so soon after MUA, but then when I was hurting, even during very first weeks post op, the doc told me "Ice for twenty minutes, no more." Jo says ice for an hour each time.

Actually I recommended 'at least an hour of rest, icing and elevation' so there was no emphasis on icing. However, having said that, I iced for hours at a time. I would put my cuff on and leave it until it got warm! Then if it was still hurting, I'd refresh it and ice it some more but not always. It just depended - there's no cast iron rule about it. But in the early days, I certainly wouldn't ever have only iced for 20 mins at a time - hardly worth the effort!

I also didn't realize that inflammation causes adhesions. I thought that was just an individual thing, some people get them, some don't.

The phrase is that inflammation CAN cause adhesions, not that it will. The reason being that inflamed tissues are hot and dry and if you read my article on MUA and adhesions, you will note that this is a contributory factor in their development. MUA (manipulation under anaesthetic) and adhesions

Recently, someone here in Pennsylvania told me that the PT was bending the he** out of her leg so that she didn't get adhesions. Go figure.

That's rather putting the cart before the horse! Most people don't make adhesions, they are actually quite rare. But for some reason, PTs in the States - according to what I've read on here - seem convinced that adhesions are inevitable and that if extraordinary amounts of energy aren't put into this, the knee will freeze like concrete and never move again! They also seem unable to tell the difference between ordinary stiffness caused by swelling and adhesions, seeming to think that any sign of stiffness is inevitably adhesions which it's not. Plus which, adhesions take some time to develop, like about 10 weeks or more. Mostly stiffness prior to that is from inflammation and swelling. Swollen and stiff knee: what causes it?

I don't think I am getting the connection between pain meds and inflammation. I assume the inflammation comes from working the knees and not icing/elevation.

Inflammation in the early days and weeks is caused by the surgery. It's a natural reaction to the trauma just like when you twist your ankle or drop a hammer on your toe, they will swell because of the damage. The surgery is a major trauma and so the resultant swelling will be major. Swelling causes pain because of the pressure and pain itself causes swelling as well. So taking pain meds for that pain/discomfort will remove one facet of the vicious circle.

If you are on pain meds I would think that you would have a tendency to over work since you don't feel the pain. How do the meds help keeping down the inflammation, that was the question?.

Well, yes you can but that's why you need to remember that and have a schedule of GENTLE exercise. It's also why I am always saying "to the point of discomfort ONLY, never to the point of pain". See?

 

[juniper]

Slowly, I get clearer on what is causing what--swelling, pain, adhesions. Thanks for being will to repeat yourself and redirect us to library.

 

[Dog Lover]

Re: Too much, what do you think?

The short answer is yes! Unfortunately many PT have either never had surgery or quickly forget what recovery is like. Tell your PT he put your recovery back instead of forward and that you would prefer the soft tough versus brute force.

A bit of icing might ease things John. Hopd you feel better soon!

I also find that can be a big difference between the actual physical therapist and the physical therapy ASSISTANT (PTA) I make sure I work with the PT at least once a week. And always make sure she is the one to measure me. Many places don't make it clear who is the PT and who is the PTA. BELIEVE me, those five years of education do make a big difference. I am certainly not discounting the knowledge an experienced PTA may have, just saying that here is a difference.

 

[juniper]

Actually Dog Lover, I meant Physician's Assistant. I never worked with a PTA. That's not true. Once, late in the game, a PTA followed me while I did the exercises pretty much on my own. She didn't touch my knee. But the Physician's Assistant, who I liked a lot as a person, gave me advice which ended up encouraging me to push way too hard. So hard to know who to believe. That's what I think John is struggling with right now. He hasn't been on his thread for a few days. Hope he's doing okay and not too discouraged.

 

[jmark87]

CONFESSION: OK folks you were all right. I was working too hard to achive more flexion. I had the MUA done on 7/19. While under anesthesia the surgeon was able to get 130°. Awake I was only at about 100°. I continued to work out in the gym and swim in the pool and did not see much improvement in flexion until 8/06. On that day I seemed to have turned the corner and could notice some improvement. I continued with my workouts and swimming and could see some gradual increase in flexion. I could tell this was happening because at times I could adjust the seat on the stationary bicycle forward and also on the leg press. On the press I started at a setting of #13 and now I am at #9. Today 8/13 I was able to ride my own recumbent bike around the street for about ten minutes. So there seems to be a bright future for my knees anyway. I was just so worried that it would never happen and was really getting depressed over the whole thing. So the rest of you out there, keep smiling and keep working, it will come.

 

[juniper]

John, I was concerned when I didn't hear from you. So glad things are turning around. Stay in touch with us. Keep healing. Jane

 

[jerseychick]

Great news! I was just thinking about you, glad you turned the corner.

 

[referee54]

That is excellent news and a wonderful post! I was concerned about you and I am happy---very happy---to read of your progress!

 

[larryf]

Great news. It seems with most of us the biggest obstacle we face is being patient. Everyone tells us it will take as long as it takes and yet we still expect it to happen right now. I know myself, I awake every morning expecting to be fully healed and am disappointed. But when I slow down and compare where I am with where I was, I know it is getting better almost every day. Slow and steady and SOMEDAY I will get to where I want to be.

 

[bottomshollow]

Gosh, Larry, I believe you've got it! By golly, you've got it! And it will continue to get BETTER & BETTER!

 

[jmark87]

DON'T GIVE UP HOPE. I am writing this because I got to the point that I was questioning having both knees replaced at the same time. I was having lots of problems, discomfort, trouble sleeping and most of all, I could not gain any more flex.Sitting for periods of time was so uncomfortable. It would bother my legs and feet. I had to undergo MUA. I assume you know that this is Manipulation Under Anesthesia. That was difficult to do and it put me back several weeks in recovery
I had BTKR on May 15, 2012. Somehow I thought this was going to be a little troublesome for about three months and then everything would be back to normal. Boy was I wrong, thinking that. At three months, post surgery, I had only gained about 90 degrees of flex . Every time I started to feel pretty good, I would overdo exercising and would have to stop for a week for my knees to heal and stop hurting. I thought things were never going to get any better. My surgeon told me that the things that were bothering me were temporary and would go away. I felt he knew what he was talking about but it was not very reassuring to me

It was at four and one-half months that I believed that I had turned the corner and things were starting to get better. I can now ride my recumbent bicycle for short distances. Walking is much, much better. I can even put my pants on standing up like a normal person. My next Dr. visit is on November 26. I plan to stop in at the PT and ask if he would measure my flex on both legs. I feel that they are possibly at 120 degrees or better. I will post a short note at that time and let you know how I made out

I hope that the sharing of my experiences might give some of you the encouragement to keep going. There are better days ahead. I am anxious to be able to ride my bike for miles. I would like to get back on the court, to play senior volleyball. I can't wait for next summer to ride my Boogie Board in the waves, at the Jersey Shore. I am now 76 years old and have lots of stuff I want to do. That is why I took the step in having my knees replaced. It is up to me to get them back in shape. I am now at five months and I still don't have my strength back in my legs. It is still difficult to get up out of a chair or restaurant booth. My knees still bother me in bed and I am still using Tramadol pain pills. No I am not completely out of the woods, as they say, but I can see a light at the end of the tunnel. I just hope that it is not a train. I know this is a twelve month deal and I am optimistic about my future.

Good luck to everyone out there. Thank you for this Bone Smart Forum

 

[referee54]

That is a great post filled with even greater news!!! I know how frustrated you felt and how many ups and downs you had! You have persevered and hung in there, and you are now reaping the benefits! I am very happy to read of your successes and of you wonderful lifestyle---and for even better days ahead!!!

Keep coming back and posting of even more successes---folks who are going through similar hardships and frustrating times need to read of your triumphs and of the better times that lay ahead!

 

[kneesrus]

Excellent post John. I especially like " I am now 76 years old and have lots of stuff I want to do. That is why I took the step in having my knees replaced"
Keep chasing dreams,
David

 

[karmigirl]

John,
What a wonderful post, and wonderful and uplifting news about how you are doing. We need to see these type posts more often from those of us that are further along in recovery, It can give such hope to the newbies.

 

[BJ Mac]

Thanks for your post John, that is very encouraging.

 

[juniper]

John, thanks for writing. I've been wondering about how you are doing. I am at nine months and still struggling but seeing the light at the end of the tunnel as well. Keep posting. I keep trying to figure out what makes the difference for me. Last Monday I felt great, thought I was turning a corner, and then, maybe the weather turned, maybe my work (teaching five classes every day) is just too hard, but I was back to limping with every step. I am so ready to be back to my life. Went to the gym today, went for a half hour on the stationary bike and now...ouch. I wish I knew how to pace myself. It sounds like you are. How?