TKR BoneSmart Works!

[mendogal]

Hi @MSuki
I was born very nearsighted so was in glasses at 4 years old and then into bifocals in my early 30s. I added separate middle vision computer glasses about 10 years ago.
My surgeon agreed with my desire to keep being somewhat near sighted. She somewhat improved my vision in the first surgery, and on the second, gave me even somewhat better. The upshot is, for close up work, reading, and most middle vision I don't need glasses. I have new plain distance lenses in my glasses for videos, driving, etc.
The orthotics... an adjustment but not so far on muscles. I walked over a mile in them yesterday, day 3, and there's a new soft tissue pain at the base of two toes on one foot. It's unclear if the problem is the orthotic per se or if the shoe isn't the right fit for it. I definitely have to buy new shoes.

 

[MSuki]

Glad I’m not the only one. My husband had his both done for distance and most people I know did the same. He needs glasses to read a menu at a restaurant and usually doesn’t remember to bring them in so I have to read it to him. He thought it was a little odd that I had my first one done for reading distance. I still have a little twinge of sadness at losing the 2-3 inch focus I still have in my cataract eye…but I’m looking forward to having better arms length vision.

My doctor thinks my left eye is dominant (upcoming surgery) but I really think it’s the other way around. Those tests they do for dominance were somewhat inconclusive. Either way, it has been difficult working having one eye with a cataract needing surgery and in the other eye I have a large clump of floaters in my line of vision that has been there 15 plus years.

I think you have a medical necessity to go out and pick up about 5 pairs of new shoes so that you can be sure to find the best fit! Too bad insurance won’t cover it!

 

[mendogal]

Weekly PT report: today it was Stump The PT.

He can't find a reason for my ongoing swelling or the localised pain with sitting or generally with knee flexed, while there is none of this localized pain with standing or walking. He feels, as do I, something (tendon or scar?) grating alongside the lateral patella during flexing, though the pain is higher and lateral to this. I suspect a tendon issue, on zero basis besides gut feeling. It's very possibly related to my flat feet, and that it will slowly resolve as I increase my orthotics use.

Today Andrew confirmed my patella isn't doing anything it shouldn't, and did a slump test to rule out a nerve issue. He did the proprioceptive neuromuscular facilitated stretching on me.

We agreed that in addition to stretching calves and quads and strengthening glutes with theraband I will add modified squats only to a degree they don't trigger the pain.
And I will consistently set timers to limit sitting. This is great on days it's nice enough to take walks and do yardwork. Other days it means my house will be much cleaner than usual!

My appointment with the OS is in four weeks.

 

[mendogal]

I forgot yesterday's milestone!!!!
I returned to tai chi.
I did the full hour without stepping away to rest or stretch.

When I left aikido and took up tai chi around seven or eight years ago, my bad R knee didn't tolerate standing (and weight shifting and carrying my weight on slow moving weight transfers for more than 30 minutes).

So here's another way my life has Most Definitely Improved!!!!!

 

[kiwicurls]

@mendogal , that’s great! I also hope to return to tai chi later this year. It leaves you feeling so good, doesn’t it!
So pleased to hear your life has definitely improved!

 

[mendogal]

Thank you @kiwicurls - I know you'll get there!!!

 

[MSuki]

Sorry you haven’t been able to pinpoint the issue causing pain. I think though that you have someone who is really serious about figuring it out though which ups your chances significantly.

 

[AnnYo]

I agree with @MSuki and I also think you're modeling for the rest of us how to be proactive and address things that are a problem while maintaining an upbeat and optimistic attitude.

 

[mendogal]

Thank you @MSuki and @AnnYo !

 

[mendogal]

This week's report...
I am adjusting to my new orthotics. Walked 2 miles non stop a few days ago, walked 2.5 miles non stop today to meet a friend for lunch downtown. My knees are reacting but adjusting to them - I know because my 13 month old knee was hurting a bit for a few days and is starting to abate.

In PT today Andrew did PNA stretching of my problem child R lateral quad. Also he had consulted with my old shoulder PT who is an amazing resource: because that lateral quad has never seemed to fully activate and is significantly smaller, how to provide strengthening without flaring this darn inflammation?

The suggestion was to basically stand with a yoga ball between the backs of my knees and the wall, and do quad sets against that resistance. We had to tweak it quite a bit - move my left leg out of this system and move the ball and my R leg so my medial quads and glutes weren't doing work we wanted the lateral quads to do. And it WAS effectively working them without causing pain or delayed inflammation!

 

[EalingGran]

That's a really interesting exercise! I am going to try that myself. It's my medial quads that I need to keep working on- but always interesting to find new exercises.

 

[mendogal]

I walked (slogged!!) 5 km this morning in rain and on muddy ranch and vineyard trails as a benefit for our local humane society and I did NOT join the ODIC!!!
Turnout was great - gotta love rural communities' spirit!
My knees didn't give me a moment of complaint.
My quads and hips feel mild aches which I think resulted from continual re-tensioning to prevent slipping on shallow mud (had my Leki walking stick in hand) plus pulling up out of sticky deeper mud.
Saw cows, calves, donkeys, goats, and one adorable Pacific tree frog.
Next goal is four miles.

 

[kiwicurls]

Ooh, I looked up McNabs and they’re gorgeous dogs!
Congratulations on the 5km walk! That’s wonderful. I’m glad the orthotics are helping too.

 

[EalingGran]

Great report @mendogal! Doing a long country walk is great progress.

 

[mendogal]

Walking San Francisco and ortho surgeon appointment report! Part 1...
I bused to SF Sunday and returned home today, my husband meeting my bus in Santa Rosa to drive us to my ortho appointment and then home.
My friends live about 2/3 of the way up very steep Bernal Hill (when I moved to SF in the mid 1970s there were still unpaved streets in Bernal Heights and no garbage pickup; still no street cleaning trucks).
We walked up the hill via a lot of stairs through the community garden (allotment for our UK friends) then circled the hill on foot. Lots of chatting with people and petting dogs and watching birds including a pair of great horned owls. Altogether I was climbing walking, standing, walking, descending for 2.25 hours and both my knees and my feet in the orthotics were fine!
Harder was sitting at her house and then having to climb and descend her stairs. From ground floor to bedrooms in these hillside houses is 2.5flights of stairs!

 

[mendogal]

Ortho report. Xrays excellent. My main concern was for him to render an expert opinion on if my R leg lateral pulling, swelling, and quads/ITB pain is primarily inflammation from a tendonitis or if, despite great ROM, scar tissue (which is palpable) - since tendonitis would need more rest and TLC.

His verdict is scar tissue and related atrophy of the lateral quads (atrophy noted by my PT) and he feels literally any and all strengthening I can tolerate is the path forward... Plus ice like crazy afterwards!

I now feel comfortable proceeding with this plan. Will ramp up activity and see PT again next week.

 

[mendogal]

My younger knee is now ten months old!

Having been told by the OS a week ago that it's scar tissue, not tendinitis, affecting my lateral quads, I now feel secure to go full speed ahead on trying to loosen the scar tissue and build back the markedly deficient lateral quads while doing bilateral strength training ***as tolerated***

To break up the scar tissue plus do trigger point on my thighs I'm sitting and using a wooden rolling pin instead of getting down on the foam roller. It seems very effective.

Walking in the neighborhood and outdoor yardwork is baseline near-daily activity. With the weather good, I'm challenging myself to walk further or in harder terrain at least once a week.

I'm going to the gym twice a week to ride the recumbent bike (it stretches the scar tissue more than the upright bike) and one of those days I'm doing four upper body machines.

At home, I'm doing standing quad sets against significant resistance twice a week plus glutes and a little core work once a week. And I go to an hour of tai chi once a week, practicing a little at home most days.

I see PT this Wednesday and will ask him to do good PNF thigh stretching and try me on the leg press machine. We're probably coming to the end of formal PT.

 

[EalingGran]

Seems like a good plan. Good luck!

 

[sistersinhim]

You know your body well and know what to do and how much to do it! Good going!

 

[NeedaThneed]

I appreciate your updates as I’ve been dealing with something similar (on top of the other issues). It seems I’ve grown a band of scar running from top outside edge of kneecap over to where the IT band would contact side of knee. But trying to break it up just creates inflammation still. It’s a tough balance trying to stretch it out without making it angrier. Long cranks on a bicycle seem to give it a gentle stretch for me (but other knee issues still prevent me from using a bike).

For many years before surgery, I have been prone to very tight lateral quad knots that pulled on my kneecap and caused pain…and the theracane to dig deep in the area beside the IT band and all the way up the muscle was a game changer! It bought me time for my patellofemoral joint. Foam rollers weren’t specific enough, and a lacrosse ball too risky. I also have what is called a myofascial ball. It’s 5” diameter and has some “give” to it and a textured rubber coating; this makes it gentle enough to use near the joint…but it does get into some really good trigger points that the foam roller misses.

I too am trying to bring my lateral quads back to life. I think cycling is really good for that. And also some of the standing one leg yoga poses really work mine! Glad you have a creative PT as what works for me doesn’t necessarily work for another. Just sharing …to maybe commiserate?