Banjaboy's recovery thread<

[little red canoe]

TKR is hardly simple elective surgery.
Your regimen seems excessive
You probably know what not to do now as your pain has lessened since Monday. It's a clue you have been doing too much
Those standards are outdated. I read them from 2005.
What not to do would seem to be suspending weights and so many reps. I do lots of the same exercises but no squats and just starting hamstring curls 3 sets of 10 with 2 lb weights. 7 weeks out

 

[banjaboy]

What standards are you referring to? The exercises themselves? Both surgeon, private physio and hospital use them so what else can I go by? Read a couple of books and they too use the same regime. It is elective surgery, I'm not sick as in illness, that's what I meant to say. I'm just a patient, no skills in medicine, all I can do is go by what the pros tell me. I'm not looking for a one week recovery, just hope my progress will be ongoing. What I need to do is isolate the exercise that causes the pain, it's very difficult after doing 5 or 6 different things to figure out exactly what is causing it. Aug 23 surgery puts me today 3 months, everyone says I'm doing great. Perhaps it's a perfect storm, the clicking started as a bit of the swelling went down then the terrible pain, I was thinking they were related but perhaps not. I will post again after my appointment with physio later today.

 

[banjaboy]

Josephine, correction, hamstring stretch, technical term for what I do is a lunge, sorry for the lousy description earlier

 

[little red canoe]

You said simple surgery. It's not
The Canadian standards are what you cited so please don't feign ignorance. They are online
Remember TKR is a relatively new surgery so advice needs to be current
I'm sorry but that sort of PT is not what is prescribed around her. And around here has a large catchment area the whole state. The half a dozen surgeons do nearly 2000 surgeries a year

I'd think it more likely it's not a specific exercise you are doing but the high reps and weights overall. All you need to do is back off and re engage more slowly

 

[Josephine]

1 pain is not an issue at this moment, it's probably a 2, several days ago it was a solid 8

I see

2 as for med's, I take a couple of Ibuprofen, extra strength probably twice a day, I have a high pain threshold I think.

You didn't answer the question which was " how much are you taking (in mg please) and how often?"

3 swelling is between slight and moderate but varies with physio

Okay

4 115-130/0 and 130. Right now, below 90 as because of pain, I can flex it more but only with pain.

What ever you do, do NOTHING that causes you pain. It only makes matters worse.
Plus your ROM is excellent and at 12-13 weeks you really don't need to fret.
You're there, you've made it to the Holy Grail!

5 I iced up until a couple of weeks ago as I was doing so well. I have a polar breg unit.

Okay

6 elevation is something I rarely seem to do, my fault,

Well, it's certainly not my fault! But if you don't feel you want to do it, that's fine.

7 I live alone so I cook for myself, vacuum as req, I shop okay, walking is okay, no pain when walking, only in the non op knee as that is in need of replacement too.

that's okay. Can't put life on hold, can we?

My comments in bold
stationary bike at home 20mins twice daily - I suggest 10 mins once a day and none at all at the weekend!
shallow squats 2 sets of ten, hold for 3 sec - no to squats of any kind! Dreadful exercise! Stop them
straight leg lift in chair with 5lb weight on ankle,2 sets of 10 twice a day - another no - to weights! NEVER use weights. Stop them
Small roll under knee 5lb weight on ankle, lift lower 100 of those once a day - see above. And 100 a day? are you crazy! Stop these altogether!
Heel and toe lifts, 3 sec on toes, 3 on heels, 20 of those twice a day - these are also like to cause problems. Stop them!
Stretch by squatting with surgery leg leading then move forward to stretch quads. 5 times, 30 seconds each time, twice a day - same again - stop them!
lunges 5 times, hold for 10 seconds.......twice a day - same again
leg suspended under thigh 5lb weight on ankle 5 mins -same again and never use weights!

They come out of the Canadian standard recovery guide after knee replacement - I don't care if they came out of the Holy Bible! They are rubbish and bad karma!

I hate to whine to her about this, simple elective surgery but it's no less valid to me you know?

Well you know what? It's NOT 'just' a surgery, it's a major, life changing event and major MAJOR surgery that none of us (yes, including me!) could ever be adequately prepared for. So don't beat yourself up about it, my friend. You are totally and incredibly allowed all this!

I have total confidence in her, she is a professional, university degree in it, recommended to her by my surgeon.

None of those three things would endear me to such a person who would have you doing 100 weighted half leg lifts, especially on a patient who already has excellent ROM and actually doesn't need any exercising at all any more! For this is the truth of it.

I am paranoid about losing ROM, heard so many horror stories!

I've heard no-end of horror stories about the opposite. Read this PT: the seriously grave consequences of doing too much of it.

I'd also recommend you read this too BoneSmart philosophy for sensible post op therapy

I have done nothing in the way of working out since Monday and fear it may return if I start working it again.

Exactly so. And I can promise you it will. In spades!

 

[banjaboy]

You are quite opinionated lol! That's fine, not criticizing you at all Josephine, I appreciate your frankness lol! May I ask if you are a medical person? I did read your quoted comments on what not to do. The question is, what should I do? I really do appreciate your help and hope my probing is not interpreted as criticism, I'm just dying to get well Josephine.

 

[Josephine]

I'm just dying to get well Josephine.

Oh dear me, I do hope not!

May I ask if you are a medical person?

You could say! I am an orthopaedic trained nurse who has been practising for 55 years and still working! If you've browsed the Library, you will see that 99.5% of the articles are written by me also the articles on the website. I attended conferences regularly to keep myself up to date and am considered a specialist of sorts by my peers and colleagues. I spent most of my career in the operating theatre where I mostly worked in orthopaedics and especially joint replacement. I have been a lecturer on this topic and written articles and text books. I am currently member of several committees and research groups.

So I hope you'll agree that I am allowed to have an opinion! That's also how come my posts all bear the logo "Nurse Director, BoneSmart".

 

[Roy Gardiner]

You are quite opinionated

That's applied to someone who's basically arrogant and wrong; Josephine, however, is assertive and correct, which is rather different

I agree with Josephine. She is a distinguished medical practitioner, I am an undistinguished athlete and BTKR alumnus who understands the difference between mobility/recovery exercises and athletic training. The exercises she calls you out on are almost all training, not recovery. Training an injured body will only make injury worse. Don't do any more of these at all until your pain is gone.

Your flexion and extension are fine, but if you must you can do exercises on the bike for ROM

• Set the bike to zero resistance

1. Set the saddle at a point where a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
2. Gently turn the pedals.
3. Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.

• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.

Here is a bit more chat and some pix https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/page-3#post-423701

See also my sig below for extension stretches

 

[banjaboy]

You have me wrong Roy, if you read exactly what I wrote it was not a fair comment to edit and just post a couple of words. This is my health here, I came to this site for help and guidance. I would never question anyone's credentials, I was asking her for qualifications to advise recent post op people. If this is not acceptable then I will no longer post. She certainly didn't take it as a knock to her. So thanks and I will move on. [emoji106]

 

[Roy Gardiner]

Beg pardon, no offence intended, rather a joke (hence the smiley). But clearly didn't work, I apologise.

 

[banjaboy]

Josephine, thanks for your help just got flamed by someone and a really rude email from some, how they got my email I have no idea. I was only trying to establish your credentials, simple as that, the internet is full of experts, I only wanted help. I thank you for your advice and will have to search elsewhere I guess. Do you have any suggestions re good resources for me to use.

 

[Josephine]

banjaboy, don't take offence at Roy, he just has a wry sense of humour and doesn't mean any harm or critique. And he knows as well as you do that I had no problems at all with you asking me about my credentials. It just intrigues me that more people don't!

But I'm really concerned that you got a rude email. In fact, very concerned. Would you be kind enough to forward it to me here so I can see it? My email here is Josephine@farmortho.org.

But please don't leave us. I can honestly say I know of no other forum quite like BoneSmart.
We are unique and our advice and information is generally very straight forward and helpful.
With my staff, I work very hard to keep it like that.

 

[newlybionic]

banjaboy I have taken Josephine's advice even though it was not what I was taught in school for nursing getting my RN. I can tell you I listened to the 'professionals' after my first TKR and all I got from it was pain, swelling and poor ROM. With my second surgery I followed the Bonesmart way. I did go to PT but I avoided lunging, step ups and any weight training at all. We did gentle straetching, short stationary bike rides and adjustments for my gait. I have a flexion of 130. I've been working and on my feet up 12 hours a day which I went back to 12 weeks post op. It really does work. You've seen that by cutting out the exercising you were doing for a few days that you are feeling much better. Walking and taking care of what needs to be done at home (I live alone too) has been the best therapy in the world for me.

 

[KarriB]

Anytime there is a change in protocol it takes a while for all parties to get on board. This is what's happening with TKR recovery. A friend had TKR surgery at Mayo Clinic and was prescribed no PT whatsoever and her ROM is great. My revision OS has said that when I get my left knee done there'll be no PT for at least a month as the soft tissue doesn't react well to it. Our new joints are just fine and for the most part, stable as your said, but it's the soft tissue that is taking umbrence. With my RTKR my PTs did use weights, but not until 4 months after surgery.

If you take a break from the weights and squats nothing will happen to your ROM and can pick up in a few months after your soft tissue has settled.

 

[ACDCJen]

@banjaboy

I'm so sorry to hear that you had such a setback at this point. I can only comment on my personal experience with outpatient PT. I loved going, but I would find it very difficult to walk correctly and bend for a few days afterward. I stopped going last week in order to prepare for my RTKR in 3 days. I have really noticed that my knee feels much better, my ROM and movement is pretty good. I still have my up and down days, but on the whole, it's been pretty good. I made sure to get print outs of the exercises and I bought some of the smaller equipment for my own personal use (therabands, exercise/balance balls, balance half-ball...) I feel that this process has worked for me.

I hope your knee starts feeling better very soon!

Jen

 

[banjaboy]

Thanks for all your comments and encouragement, I'm not going to blow this site because of a misunderstanding and a nasty email lol!

Went my PT yesterday and we had a total meeting of the minds re treatment. My silence and ability to tolerate pain made her feel I needed more work. I went through my exercise sheet with her and no more open chain therapy. When she explained it I could see the logic. Now all my exercises are closed chain. Had a nice 1½ hour visit with her and that included perhaps an hour of exercises including 15mins on the bike. Left with normal workout muscle pain but no joint discomfort. I think we are on the same wave length.

ROM measured at 125, that will do me for now, that's with no pain. I'm gonna try and figure out how to send pics and will send a day post surgery pic and one of today to see the scar, it's amazingly small.

 

[little red canoe]

A question; What are closed chain exercises? Its wonderful to have a "pretty" scar .. Me too. I have no idea of posting pics from my phone.. I can do that with a computer...lost on the phone!

 

[banjaboy]

Best way is to Google it and that way you will get the full explanation, not my attempt but it makes sense to me and I feel good today and not in pain after my last workout

 

[banjaboy]

A couple of pics, one is 2 days post op, second one is today, 3 months later

 

[ACDCJen]

@banjaboy

Your scar looks great!!! It is pretty like you said. Mine usually keloid and get thick and ropy. Oh well. I always say that if I have to go through this much pain, I better have something to show for it!



Jen