TKR BoneSmart Works!

[mendogal]

What a great 'workout' you had! It's nice to have a PT that knows how to rehab a knee replacement.

It's funny how it's always the PT *aide* who actually listens to me and adjusts the session accordingly instead of, like the PT, having preconceived ideas I have to shoot down!

 

[mendogal]

Oh! I never posted pix of my problem area at the top of the incision, where an uncomfortable skin fold is evident when standing and walking, and there is a palpable lump the OS ascribes to fascia sticking to the quads.
I tend to agree because when activating the quads the lateral side is clearly not transmitting as well. Doing massage several times daily as well as focusing on increasing the contractions on the lateral quads.
You can see the difference with camera unmoved when I stretch the thigh upward to tighten the affected area.

 

[CricketHip]

That's an interesting skin crease there. Does there seem to be more swelling there, could that be part of the issue? My right THR has a puckery incision line. Sometimes I notice it and it's annoying aesthetically. in fact I noticed it this morning and grumbled a bit about it. It's like they cut up too high into my groin area.. ugh.
But it doesn't hurt or restrict, just gives a twinge to my vanity, whatever is left of it.

 

[sistersinhim]

Do you think that could be an internal stitch that hasn't dissolved yet? It certainly does look like something is pinching it together.

 

[mendogal]

Do you think that could be an internal stitch that hasn't dissolved yet? It certainly does look like something is pinching it together.

The OS medical assistant, to whom I emailed pix three weeks ago, thought that it was internal stitch catching at things. The OS thinks adhesion, which because of the effect on the quad, it may be... either way the counsel is to continue massage, which does seem to verrrrry slowwwwly be improving it .

 

[mendogal]

That's an interesting skin crease there. Does there seem to be more swelling there, could that be part of the issue? My right THR has a puckery incision line. Sometimes I notice it and it's annoying aesthetically. in fact I noticed it this morning and grumbled a bit about it. It's like they cut up too high into my groin area.. ugh.
But it doesn't hurt or restrict, just gives a twinge to my vanity, whatever is left of it.

Nope. Definitely not swollen, it is a palpable knot which is also definitely not a myofascial trigger point.
And yeah, this is also a more puckery line than my first TKA! Not winning any beauty contests... oh... wait... I wasn't entering any! )

 

[mendogal]

Today is post op day 56, 8 weeks since my R TKA. This past week's milestones:
Walking my half mile on uneven sidewalks without the walking stick!
Driving and doing a couple of errands solo and, just yesterday, also without the walking stick!

I'm now doing all my usual indoor activities except standing at the painting easel. I'm doing short periods of garden chores that don't involve squatting (I skip the long walk those days!). I haven't yet returned to the gym to see if my short legs plus flexion allows using the stationary bike (the one at PT is accessible).

Of course there is still swelling, so I ice and elevate. Stiffness with sitting remains a problem but I don't have a problem with morning stiffness, yay!!! The problematic lump/skin fold slowly improves. I had a few nights of decent sleep without herbs/meds but mostly still need something.

 

[EalingGran]

Sounds very encouraging!
Just be careful on those uneven pavements. I was very slow to give up the stick, but I had had a few falls prior to my surgery.

 

[mendogal]

Sounds very encouraging!
Just be careful on those uneven pavements. I was very slow to give up the stick, but I had had a few falls prior to my surgery.

Thank you. My martial arts training involved 20+ years of purposely falling and rolling at least 100 times per class (not an exaggeration); my balance is excellent, and when environmental issues or klutziness has led to falls (a grease spot on a metal sidewalk plate, catching the edge of my deck between garden slip-in and foot!) ingrained skills have kicked in automatically. It's why I used to teach seniors both "defensive walking" and how to survive falls! Fear of falling can actually foster poor body mechanics.

 

[Layla]

It's why I used to teach seniors both "defensive walking" and how to survive falls!

Interesting! Never heard of defensive walking. It’s peaked my interest.
Surviving falls interesting also. I’m going to do some online searching…

 

[mendogal]

It's why I used to teach seniors both "defensive walking" and how to survive falls!

Interesting! Never heard of defensive walking. It’s peaked my interest.
Surviving falls interesting also. I’m going to do some online searching…

Defensive walking is my own term! I developed a curriculum because I was getting very elderly people interested in my surviving falls course who I knew were too frail to handle the latter.
I developed the learning to fall curriculum at the intersection of martial arts and being a RN working with seniors. At the time I started teaching it as a volunteer at our aikido school, I knew of two similar programs taught by judo practitioners in Europe. I ended up teaching it locally several years, sharing my curriculum with other aikido practitioners, doing a presentation at an international seminar, networking to share best practices, etc. There is currently a program in Virginia and in Hawaii that I know of https://www.kupunaaikido.org/
Next year I may be volunteer teaching Defensive Walking at the local Senior Center.

 

[mendogal]

It's why I used to teach seniors both "defensive walking" and how to survive falls!

Interesting! Never heard of defensive walking. It’s peaked my interest.
Surviving falls interesting also. I’m going to do some online searching…

Oh here's an old article about my course

Ukiah Aikido presents ‘All Fall Down’

“All Fall Down: Learning to Survive Falls” is a six week series at Ukiah Aikido for fit folks “of a certain age” who may be experiencing some balance problems, or have f…

www.ukiahdailyjournal.com

And here's a great article about how widespread it is in the Netherlands!!! My experience was similar: once seniors gently learned to relax into a cushioned fall they got giggly and had fun! I even had us playing Ring Around the Rosie to fall down!
I have a subscription to the Times so this is a gift link, no paywall

Afraid of Falling? For Older Adults, the Dutch Have a Cure (Published 2018)

The Dutch, like people elsewhere, are living longer than in previous generations. Courses that teach fall prevention, and how to fall correctly, are gaining popularity.

www.nytimes.com

 

[EalingGran]

This is really interesting. I like the term defensive walking! What are the main principles?
I am frightened of falling- particularly of grazing my knee and it getting infected. So I wear a light knee sleeve if I am out.
I stuck with a stick until very late ( over 6 months) because Central London is so busy. But now I am more confident without. I am hoping I am less likely to fall now my leg is straight. I also gave up my varifocal lenses as I thought they didn't help when looking down.
One of the big risks here is young people just not looking where they are going because they are on their phones!!

 

[mendogal]

This is really interesting. I like the term defensive walking! What are the main principles?
I am frightened of falling- particularly of grazing my knee and it getting infected. So I wear a light knee sleeve if I am out.
I stuck with a stick until very late ( over 6 months) because Central London is so busy. But now I am more confident without. I am hoping I am less likely to fall now my leg is straight. I also gave up my varifocal lenses as I thought they didn't help when looking down.
One of the big risks here is young people just not looking where they are going because they are on their phones!!

Here in the USA "defensive driving" is a foundation of driver's education, and a key component is to be always scanning, using peripheral vision, at all distances, rather than locking vision onto the next car or next ten feet. I apply that to walking along with developing an awareness of body use while walking and yes safely negotiating stairs with bifocal or varifocal lenses.
When I got bifocals in my 30s, my optometrist specifically counseled me to move my whole head downward so the distance portion of my lenses would keep the stairs in sharp focus. Decades later, teaching my course, I discovered literally not one senior student had been taught that. I had one who was falling a lot in her split level home. It turned out her balance was totally normal - it was gazing down through the reading portion of her lenses that was disrupting her. What a lesson!

 

[mendogal]

This is really interesting. I like the term defensive walking! What are the main principles?
I am frightened of falling- particularly of grazing my knee and it getting infected. So I wear a light knee sleeve if I am out.
I stuck with a stick until very late ( over 6 months) because Central London is so busy. But now I am more confident without. I am hoping I am less likely to fall now my leg is straight. I also gave up my varifocal lenses as I thought they didn't help when looking down.
One of the big risks here is young people just not looking where they are going because they are on their phones!!

Frankly, were I living in a big bustling city, I'd be staying on the walking stick much longer as well! I'd call that prudent!

 

[mendogal]

Wore myself out!!! But not the knee, for a change!
Yesterday on my early morning walk (while it's 62 F instead of 95 F...) it felt so good at my usual.turning back point that I kept going at a slow steady pace, and ended up doing 8/10 of a mile!
After breakfast and a rest, off I went to my volunteer position at our nonprofit disaster center for the first time postop. Usually I do a three hour shift each Friday, but I committed only one hour yesterday, *maybe* as much as two hours next week.
Well after lunch I got into the recliner... my eyes closed... and I slept two hours. Then I was in bed sleeping from 9:45 PM until 7:30 AM today... and darn near fell asleep in the recliner again this afternoon.
But the knee is none the worse for any of it!

 

[Jaycey]

Sleep is good! Sounds like a lot of activity. Great that the knee did not complain!

 

[Layla]

Happy Two Month Anniversary, mendogal!
You're doing great and it's only going to get better.
I hope your week is sweet!
@mendogal

 

[mendogal]

Post op day 63 milestone!!!!
At the gym this morning, on the recumbent bike, with the seat pushed so far back my short legs were tippy-toeing the pedals on extension... gentle reader, full circles were accomplished!
No resistance was used, and going forward was much easier than going backwards... note that "easier" is entirely a relative term, and no it wasn't.
Probably made glacially slow circles for two minutes.

 

[mendogal]

Progress note: at 6 weeks I did 1/2 mile walk in over 20 minutes. Today I did the same walk in 12 minutes, approaching my normal pace, with a focus on proper heel toe stepping and engagement of the R quads (I lightly touch any muscle needing activation with a few fingers, very effective!)