TKR Back with a question

[Jockette]

I never did figure out how to stay on my medicine schedule and take one before PT, as the timing did not coincide. So I stuck to my schedule.

I didn’t always feel it at PT either. But if I did, those were the times it took 2 or even 3 days to again feel as good as when I walked into PT. Even before I found Bonesmart it seemed counterproductive to me. Thankfully I know better now!

 

[SusieShoes]

I’m going to ditto “even if not aggressive, PT has us do a LOT” statement. That’s so very true! My PT sessions lasted an hour. In that hour there were ten different exercises and repetitions of those ten. And I refused every exercise I considered too much on its own. But you add all those gentle exercises and reps up and... that’s a lot of movement for a new knee! And you better believe they made my knees sore. Every. Time. One time I finally told PT guy I didn’t want to do any exercises that day, my knees were too sore. So we did a few stretches and bends and some nice relaxing massages that I found far more helpful than any exercises. At least my knees didn’t ache that night.

PT isn’t just a series a gentle exercises; it’s the grand total of those exercises. So take that into account when deciding how much to do.

Also, good for you remembering that it’s best to take pain meds after, not before, PT. It can be a bit of a schedule breaker, but if possible do it that way.

 

[Jockette]

I agree that at PT too much is done in a short period of time. Those same movements, and maybe even amounts, spread out through the day is better, which equals ADL’s (activities of daily living)

So, once again, normal activity is key to success. Not x amount of exercises x times a day.

 

[jakeleg]

Thank you.
Maybe that has something to do with why I am so tired today. I visited my workplace and people asked when I would be coming back. I was reluctant to say I am so tired I have no idea when I will feel like coming back.

The pain is one thing but the fatigue has really got me puzzled especially when I hear about people who are up and doing things and are going back to work after 6 weeks. I don't want to think it's my age. I just don't seem to have the energy or motivation to do anything and today I'm not depressed so I'm buffaloed by how tired I seem to be. I'm still stiff from yesterday so I'm icing and elevating right now.

Does anyone else know about 6 week fatigue?

 

[Celle]

the pain is one thing but the fatigue has really got me puzzled especially when I hear about people who are up and doing things and are going back to work after 6 weeks.

Do you remember this article, from the post-op reading list?
Energy drain for TKRs
The reason why you're still so tired is because almost all your body's energy is still being directed towards healing your knee. There isn't much energy left for anything else.
The energy drain is real and it can last for months yet.

There may be some people who go back to work as early as 6 weeks, but most people need almost twice that time.
We recommend taking about 12 weeks and then doing a Phased return to work , if possible.

 

[jakeleg]

Went to PT today. Once again everything was normal - the pain, the swelling, the purple. I can't bend to ride the bike so I do 8 minutes of slow partial pedalling. Then I get treated/massaged by the PT. The knee bends are ok, then he gives a push and hold for a couple of minutes. I did deep breathing to get through those. It was tough, but I don't think unreasonable.

Did errands for an an hour or so and a few hours later I crashed. Oh, how I love those naps. This is my 2nd hard time at PT so I'm hoping for some progress that I can recognize soon.

I don't know if my posts help anyone. I think I write to encourage myself. Right now my leg is like concrete and aches. What a myriad of sensations the body can produce.

I filled out papers for FMLA which is to protect my job. I work part time and think I'm going to try to work an hour or two next week just to see how I do. I am so grateful that I can take the time I need. Happy Thanksgiving and smooth recovery to all of us nursing our new "drumsticks".

 

[Jockette]

You don’t have to let them push your knee like that and hold it there. They did that to me also but I hadn’t found Bonesmart yet so I thought I had to let them. They told me to hold my breath, too. It is not good for your new knee even though they will tell you it is.

Next time around I will not let anyone push my knee like that.

 

[sistersinhim]

The knee bends are ok, then he gives a push and hold for a couple of minutes. I did deep breathing to get thru those

Remember that you are to never let anyone push on your knee. It obviously was painful if you had to breathe through it.

Right now my leg is like concrete and aches.

This is because your knee is not ready for what it went through today.

 

[jakeleg]

I continue to read that pushing bends and slides by PT is not a good idea. How do you explain their allegiance to doing things that hurt? I don't think they want to hurt us. I think they believe in what they do. Is there a powerful PT lobby that I don't know about? Do they have lobbyists in the UK like we have in the US? I like rolling the big plastic ball and have no pain with that. In fact, I like everything but heel slides and bends. The latter I do very gently in hopes of staying flexible and not losing ground.

I'm waiting for the day or week or month that the magic happens. I'm walking well until the fatigue hits, icing, elevating and staying positive most of the time. This is a full time job mentally. I have so much compassion for those who have had many surgeries-problems.

I had meniscus repair on right knee 1/16; rotator cuff surgery 6/17; TKR 10/17. I have been fortunate. Prior to meniscus my only surgery was tonsillectomy when I was 23, a flight attendant living in NYC. When I woke up I told the nurse that I never had anything hurt so much in my life. She said " Well, I hope you never have a baby" and left the room. She would be a delight in orthopedics! I'm glad I don't have PT until next Monday. Sweet dreams everyone.

 

[jakeleg]

Today I am tired and sore. I am really paying attention to discussion of ROM. My knee is so tight and purple. I went to PT yesterday and thought I would benefit from the rest today.

I sometimes wonder how much of the fatigue is healing, too much PT, discouragement. This TKR procedure has so many components.

My daughter told me about her friend, a doctor who weights 300lbs and is back at work at 4 weeks. I could not do it! I have a hard time not comparing myself and not worrying about ROM. I believe I walk very well, but I get tired and knee gets purple. I am going to bring this up at my next PT session.

It doesn't make sense to me to go to therapy and then be in bad shape for the day or two. I was hoping to be more encouraged at 6 weeks. Pardon the whining, please.

 

[Celle]

I continue to read that pushing bends and slides by PT is not a good idea.How do you explain their allegiance to doing things that hurt? I don't think they want to hurt us. I think they believe in what they do. Is there a powerfull PT lobby that I don't know about? Do they have lobbyists in the UK like we have in the U.S?

The PT therapists are just repeating what they were taught. Unfortunately, they were taught the wrong way. Some refresher courses for PTs are now teaching a gentler way, similar to what we recommend here on BoneSmart.

Of course, there is money in PT - it's big business - so they want you to keep coming back for more treatment.

Some places in the UK recommend similar PT to the sort you've experienced. Others don't. It all depends on what they were taught.

The important thing for you to remember is that you are in charge of your knee and of your therapy. Only you have the right to say what will happen to it. Whether you pay directly or indirectly through your insurance, you are paying the PT therapists. You are the boss. You don't have to please them. They have to please you.

Today I am tired and sore. I am really paying attention to discussion of ROM. My knee is so tight and purple. I went to PT yesterday and thought I would benefit from the rest today. I sometimes wonder how much of the fatigue is healing, too much PT, discouragement. This tkr procedure has so many components.

To continue what I said, above, you have the right to refuse treatment, so stop allowing your knee to be treated like that.
CONSENT: what it means and how it can be used
Saying no to therapy - am I allowed to?

Remember what we told you in the recovery reading information:

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

Give your knee a holiday from all this over-exercise abuse. Stop going to PT for at least 4 weeks, so that it can settle down. Cut back any exercises you're doing at home, too, and just walk around gently. Spend most of your time resting, icing and elevating your knee, so it can heal.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

My daughter told me about her friend, a doctor who weights 300lbs and is back at work at 4 weeks. I could not do it! I have a hard time not comparing myself and not worrying about ROM. I believe I walk very well, but I get tired and knee gets purple. I am going to bring this up at my next PT session. It doesn't make sense to me to go to therapy and then be in bad shape for the day or two.

Doctors are notoriously bad patients and either this doctor didn't have a knee replacement or he/she is doing the knee a disservice, for which he/she will pay in pain later.

Of course it doesn't make sense to keep on subjecting your knee to treatment that makes it sore, swollen and stiff!. Take charge of your recovery and stop subjecting your knee to poorly-informed treatment.
You have plenty of time.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

For what it's worth, 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.

By the way, I moved your post from the thread discussing ROM into your own thread, so we could talk about it here.

 

[Jockette]

@Celle I just responded to jakekeg on the rom post. I’ll see if I can switch it to here.

 

[Jockette]

@jakeleg Whine all you want, a lot of us who did PT were hurt by it and came to the same conclusion as you did, what is the point when it makes us hurt more. There are some good PT’s out there, mine was middle of the road, not overly aggressive but they did do some agressive things. And I thought the same thing you do.

Talk with them and tell them you want it gentle, and if they have bent your knee to get more rom, tell them you will no longer allow that. If they argue and/or make you feel bad, look for a different group or just don’t go.

As far as your daughter’s friend going back to work at 4 weeks, unless she knows him really well and trusts what he said, it may not be true, and if it is true, it may not be a good as we picture. Whenever we hear something like that we picture the person pain free and no limitations. He may have been in a lot of pain at work or after he got home, etc. etc.

I posted about my bowling and it gives the impression that I am doing great in my recovery. I’m not, I’m still struggling. Yes I bowl twice a week, but my approach to the line is not what it was before surgery, I don’t bend my knees, I bend from the waist when I throw the ball, my average is still lower than before surgery as well as my ball speed. I get a lot of gutter balls, something I only did occasionally before surgery. And my ball is only 8 pounds, which is very light for an adult.

This recovery knocks the socks off most of us. It’s one if the hardest things we’ve ever done. It is so frustrating for us when we are hurting and struggling to recover and come to accept how much we had no idea what we were getting into (because no one would tell us the truth about recovery unless we found Bonesmart before surgery, which many of us don’t) And then the medical professionals place unrealistic expectations on us, and PT’s hurt us when we are at our most vulnerable.

It’s just so hard. Try to relax, follow the Bonesmart way of recovering, and hang out here with us for the best support ever!

 

[jakeleg]

Warning: I just read this and it's everything I have been thinking and doing. If you can stand to read it all, any responses would be appreciated. I decided to let it all out because when people ask me how I'm doing, I try to give a brief answer. Nobody wants to hear it. It's kind of like when my husband died. Those who had lost a spouse could truly understand. Thank you for this website.

I was just trying to decide whether to cry or eat some breakfast, then I read your post. The doctor is a woman who sits at a desk. She can probably ice, elevate and nap with the door to her office shut. So much for that comparison.

I think my knee and scar look good. My knee does not look that swollen, but it is still too tight for my comfort. In the mirror, my knees look almost the same. I have not resorted to using a tape measure yet. I think that might be a little to obsessive.

I had ROM of 114 last week with a push from PT. Two days ago when PT pushed too hard, he did not tell me ROM and I didn't want to know.

I am reminding myself over and over that it takes time. I do gentle heel slides on my own. I use my massager on my very tight quad. I massage coconut oil on my knee and all around it. I can lie on my bed and straighten my leg an inch or two over my head. I can do that better with my "new leg" than my "old leg". My calves seems very tight. Most of the pain is gone except for aching which happens with fatigue. Occasionally I have pain across the top of my foot which affects walking. I don't know where that comes from. I slept with out my Venapro wraps for the first time since surgery. No one has told me how long I have to worry about blood clots. As you can tell, I am looking at every little thing to encourage myself.

Since the swelling does not seem too bad from the outside, is the tightness caused by tissues, etc. inside? I forget about the trauma that I cannot see. (I am just thinking out loud/online).

I say I could not go to work now. I wonder if I say that because I don't have to. I am fortunate to have the freedom to take a longer break than many. I am going to do a one hour class next week. I can sit and stand as I need to. All in all, I will be out and about for 2 -3 hours. I have done that much before and come home exhausted....so we'll see.

I am also going to PT next week and will tell them no pain or push. I like the heat and stimulation they do after exercises. I have used my own TENS device one time. I put the electrodes in the exact places that PT did and used for a shorter time. I wish I could get a massage every place except where it would hurt my knee.

I have been doing been doing chiropractic for almost 40 years and have been Rolfed completely at east 3 or 4 times. Has anyone reading this ever been Rolfed? I am a Rolfing addict. Read about it online, if you are curious. It appears that I have lived a very self indulgent life! Maybe that is why I am such a bad sport about this. At the same time I am so grateful for it all.

Before my husband died, I asked him, "Jack, what to you do when you are lying here not asleep? He said, "I think about what a wonderful life I've had, all the wonderful people I've known and I pray. Mostly, I pray." I love him for saying that. His was a very full life - much sadness in his youth and much joy overall. Years ago, an older woman told me that life was about making memories. That helps me to try to do the right things and be grateful. This too shall pass. Again, thank you to all who post.

 

[jakeleg]

I am slightly weepy today, not for any particular reason. The swelling is tedious. I ice a lot more since I have been reading here. My knee looks good, but gets purple and tighter within 5 minutes of being up. I do all my ADLs, but I don't exercise much because I think my last 2 PT sessions were too forceful.

 

[Jockette]

This is definitely the place to let it all out! We understand and have either been through it or are currently going through it.

Tears come very easily in this recovery, we’ve been through major surgery, aka a major onslaught attack against our body, no matter how well our mind knew the procedure was necessary and done with precise skill of our surgeon. I think our subconscious still reacts in a way that it feels attacked. I cried a lot in the first couple of months, and still cry easily at 8 months.

It’s a tough recovery, and you’re right, after the first month or so, our friends don’t want to hear it, even though they ask. I live in a 55+ community so there have been many knee replacements before and 2 after me, and I find even they don’t understand why I’m “still having problems “ even though it’s been months. Actually, I’m not having “problems” just a normal recovery which they seem to have forgotten about. None of them know anything about Bonesmart so they ask if I’m doing therapy and my exercises, etc. I’ve given up trying to explain about the gentler recovery that Bonesmart advises, they think you can’t possibly recover without PT. So now when they ask I just say I’m doing good and they’re happy.

I know on here we tell it like it really is.

We will all get through this in time and thankfully we here did find Bonesmart!

 

[Celle]

Since the swelling does not seem too bad from the outside, is the tightness caused by tissues, etc. inside?

You will have swelling inside as well, even if your knee doesn't look swollen on the outside. It's a very small space inside your knee joint and it doesn't take much extra fluid to have an effect and make it hard to bend.

I had ROM of 114 last week with a push from PT. Two days ago when PT pushed too hard, he did not tell me ROM and I didn't want to know.

I'm glad to read you're going to tell the PT "No more pushing". It's bad for your knee and in any case the only numbers that count are the ones you get by moving your own muscles, not the ones the PT gets by bending your knee for you.

I am going to do a one hour class next week. I can sit and stand as I need to. All in all, I will be out and about for 2 -3 hours. I have done that much before and come home exhausted....so we'll see. I am also going to PT next week and will tell them no pain or push.

I think you're being too ambitious with that plan.
It's still only about 6 weeks since you had major surgery. Your new knee is still only a baby - not even a toddler yet. You're expecting too much, too soon from it and from yourself.
Remember, this is a year-long recovery. You can't bounce back from it in just a few weeks.

Read this article again, to see what your level of activity should be: Activity progression for TKRs

 

[Josephine]

My dear girl - you really must read your posts before you make a new post! You're not listening to what people are saying to you! So at risk of repeating it all again - here goes!

You should never take a pain pill before exercising. You need to feel the pain to know when to stop.

Totally agree with this.

With a ROM of 102/0 you don't even need to be doing any more heel slides.

I also agree with this. YOU DON'T NEED ANY MORE THERAPY!! Got it?

How did I miss the sentence that said don't take a pain pill before exercise?

Then read it again - NO pain meds before therapy!

I don't know what happened to me at PT yesterday. It did not seem that the therapist was doing anything too forcefully. boy was I stiff the rest of the day.

You need to rest a lot more! You're still in the throes of the energy drain so NO THERAPY, NO exercises at home, NO shopping, NO housework!

Do remember: when you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered pro-actively designed, heuristically programmed, dynamically structured recovery programme'.

think I'm going to try to work an hour or two next week just to see how I do

No, no, no! Far too early for that. First you need to quit PT and all exercising and then get a handle on the bruising, tight band phenomenon ("Tight band" feeling across the front of my knee), the fatigue and depression. THEN you can think about returning to work. You also need to read this article Phased return to work

 

[Josephine]

Just as an afterthought, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[jakeleg]

I guess I really need some straight talk. I have read on other posts the questions you ask. I'll be glad to answer.
I'll probably wait until tomorrow because I had to go out today and of course I stayed too long so I am icing and elevating as I dictate my reply. One of my self-imposed obstacles is that when I read about people who've gone back to work and are doing all this wonderful stuff at 4 weeks and 6 weeks then I think there's something wrong with me because I have a hard time lasting 2 hours. I don't want to be out more than 2 hours. I don't want to go back to work. I wonder how they do it. I am very impressed by all of you who are advisors. I guess you read every post that comes up and can really see when someone is struggling. Someone asked me today how it was going. My answer was that it's just so tedious! I'm tired now and to ready cry again. Someone told me that crying removes toxins from our body so I tell myself it's good for me emotionally and physically. I hate to admit, but I dread telling my physical therapists that I want to discontinue. I guess the old fear of being weak is a lot stronger than I realized. Thank goodness I have two more days to take it easy and undo any backsliding that I have done by going out for 2 hours. What is your opinion about getting a massage. of course, I would keep them away from my knee and anything near my knee that hurt. There is a person in my apartment building who does massage so I wouldn't have to do anything but walk to and from the elevator. My gosh, I feel like such a big baby. I'm ready to go to a sleep just to escape my own brain.