TKR Can lost ROM be regained

[Majic]

@Josephine Thank you for all your advice. I haven't followed up the second opinion route, as my knees themselves cause me no trouble, and everyone who examines them says how good they are. I have however followed up your recommendation of a good Chiropractor. I have found a wonderful one in Cheltenham who has been treating me for some weeks now. She does a lot of massage and some acupuncture each time I go.

I am now not particularly stiff and managed to walk 5 miles of the south west coastal footpath while on holiday in early September without pain except for the last quarter of a mile on roads. It was the first time I had walked so far since my knees started to bother me. I have also had one pain free day since so things are definitely looking up.

My main problem is that although I have regained the flexion in my right knee, the left is still a long way behind although it has gained a little. I am doing stretching exercises every morning and a little bit on an exercise bike. Is there anything else you could suggest? I still take paracetamol 3 x day, would it be better to take it at night as well, and are there any exercises you could recommend?

If anyone else is reading this what has worked for you?

 

[Josephine]

I am doing stretching exercises every morning and a little bit on an exercise bike. Is there anything else you could suggest? Are there any exercises you could recommend?

Most members on this forum will tell you I suggest no exercising at all! From what I've seen on this forum and in real life, exercising causes far more problems than it resolves. Like many others here, I never did any exercising for either of my TKRs. I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

I still take paracetamol 3 x day, would it be better to take it at night as well

The maximum dosage per 24hrs is 4,000mg being 2 tablets every 6 hrs. I suggest you take that amount for the time being.

 

[Majic]

@newlybionic hi there. Have all your muscle and shin problems cleared up now? If so what did you do to help them?

 

[newlybionic]

I am still struggling to gain full muscle strength but slowly but surely it’s been getting better as I have been walking and standing more. My work requires a lot of time on my feet so I have been working only 30 hours a week for now. I am taking gabapentin which has helped me. Both knees are stiff all the time but not much pain at all.

 

[Roy Gardiner]

On another thread, @Majic said:

"@Roy Gardiner I have just read your 2 and 3 year updates with some envy. I still have a lot of pain almost every step from tight ligaments and occasionally muscles which suddenly tighten.
You motivated me so much during the early days, and I was convinced I would be like you and make a marvellous recovery, but it was not to be. I did recover at first and was virtually pain free before I firstly caught shingles inn May 2016 spent some time in bed, and took a long time to recover. I lost some ROM and developed patella tendonitis. I had a lot of hydrotherapy and was making a good recovery, when I was given a drug to prevent osteoporosis which is known to cause muscle and ligament problems, which turned my mild and well controlled epilepsy into a severe form which caused me to black out frequently and with no warning. I was banned from swimming, hydrotherapy and riding a bike. A year and a half later having had my drugs adjusted my epilepsy is giving me no trouble at all, but my ligaments are tight and painful. I have just restarted hydrotherapy. My ROM has dropped a lot and I have pain coming down stairs and getting out of chairs without using my arms. I try to use a static bike for a few minutes every day, but despair of ever getting out on mine again. My husband has covered it up with a sheet!!
You are the most positive person I know on bonesmart and being a Brit will know that the weather at the moment is not the sort to try a bike in. Could you give me any advice on how to get back to cycling again? I only cycle short distances, but do need my bike as I can't drive and even the Doctor is a mile walk each way. In the Cotswolds the buses are not very frequent, so despite the pain I do walk an awful lot.

I don't however have any trouble with my knees, they seem fine. It's the rest of my legs."​

Epilepsy, for one, is far outside my expertise. Indeed I can't advise on anything medical outside my range (a sensible BoneSmart rule). I'll try as far as I can.

You are correct IMO not to ride outdoors now; I probably won't be out until March.

It sounds like you have simply lost muscle tone and that your ligaments have tightened up through lack of use. I suggest you go back to a basic stretching regime, which you can perfectly well do with your static bike as part of the scheme. Treat the bike as a stretching machine, not an exercise machine, as outlined here, my standard guide for the static bike:

If your leg is stiff and swollen then using an exercise bike for training is not a good idea; but you can still use one for mobility exercises.

• Set the bike to zero resistance
• Set the saddle low enough so that 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.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

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

Then get back on the road, short rides of course, round about March.

PS. 'most positive' eh? I like that

 

[Majic]

@Roy Gardiner Thanks for the reply. This is what I have been doing, 2mins up to three x daily. Perhaps it is now time to lower the seat again, although it is already lower than my road bike. However it is not going to be level surfaces when I go out as we live in a very hilly place, at the top of a fairly steep slope. Great going out, not so good coming back. By the way I haven't got and never have had any swelling. Thanks for taking an interest anyway. My epilepsy is better now than since I was about eleven, so I intend to start swimming soon.

 

[Roy Gardiner]

By the way I haven't got and never have had any swelling

My mistake, sorry.

For stretching, my take is yes keep lowering the seat so that it's tough to make that first revolution.

Depending how long that slope is, maybe get off the bike at the bottom and walk up?

Sorry I can't be more help.

 

[Majic]

@Roy Gardiner Hi Roy, I know it's a long time since I posted. Things have looked up a lot. I have got most of the ROM back in R leg, not all in L one. I am dancing quite a lot ,walking a lot and swimming once a week.
I still haven't risked my bike but hope to soon.
My epilepsy drugs were adjusted 5 times, so now I haven't had a fit for so long that I have got my driving licence back and recently bought myself a car.
I hope you can help me with another matter. I seem to remember that you are the one who kneels a lot. I was told that I wouldn't be able to kneel, so haven't. I still need to stretch a lot as my muscles are still tight and painful and I still need to take paracetamol regularly. Since my ops I have longed to do Yoga, but always assumed that I couldn't because of not being able to kneel. Several Yoga teachers have told me it would be impossible.

I have now discovered that our local yoga teacher has had a TKR herself, 7 years ago,and has been teaching Yoga and kneeling ever since. She had it done in Holland and was never told not to. Have you had any problems caused by kneeling as I am thinking of giving it a go.
Jackie

 

[Roy Gardiner]

I can kneel if I want to, but normally I don't want to. It used to feel gross; not painful but 'horrible'. After many years it now just feels awkward. It's the only real hangover from my BTKR. I am pretty sure that if I persevered I could re-learn to kneel comfortably, but I really don't want to enough to take the time.

Not helpful, sorry...

 

[Benay]

I like to be able to kneel. I'm four weeks post surgery today, I'll talk to PT and see what time is a good time to try it.