TKR Can't straighten leg or walk eleven weeks post op

[JamesAB]

Of course, Josephine. Any advice wellcome. Thank you.

 

[Jaycey]

At physiotherapy today I was able to walk significantly better at the parallel bars.

This is good news! Slow and steady is the best way to go through this journey.

Don't think I want any other procedures if suggested by surgeon until I feel fully healed and I can see result.

Probably a very good approach. It's your recovery, your way.

 

[Jockette]

I’m glad you had a good PT session!

 

[Celle]

How well could you walk before this surgery, @JamesAB?
What walking aids did you use?

You see, we'd all been thinking that not being able to walk was solely the result of your November surgery, but it turns out you had previous problems. In that case, your progress is likely to be slower than that of many others.

 

[JamesAB]

I have always walked with a pronounced limp but got around without aids until the knee problems when I used a stick then (for speed) a walker. I would hope to get back to using, at worst, A stick.

 

[Jamie]

I'm happy to hear that you are making progress. I agree that it seems like a good idea to hold off on any other procedures while you are steadily improving, unless there is some medical reason not to wait.

 

[JamesAB]

BTW, Josephine, I did say in my very first post that my lower leg had also been "rotated."

 

[Josephine]

Yes I remember!

Here are the questions then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[JamesAB]

Dear Josephine, I hope the following is sufficent information.

1. Pain level: At rest 1. On putting weight on leg 5 upwards.

2: No pain meds required.

3: No swelling on awakening. Slight swelling knee, lower leg and foot only occurring as the day progresses

4. 95° Bend. Can't fully straighten leg maybe 15° But before op., due to disability ~5°.

5: Not icing.

6: Elevating once or twice a day if appreciable swelling or calf muscle hard.

7: Well, I spent 6 hours doing ironing, Sitting down, yesterday. Sitting down 99% of the time. I do stand, with support, and stretch several times a day.

8:

I do a whole selection of Pilates chair and floor exercises at least once daily. Although originally for lower back pain, various leg stretches, bends and flexing are now included or emphasized to assist knee problems. I see a Pilates instructor once a week. Each exercise is repeated 15-20 times. In addition the leg is manipulated for several minutes using a rubber spiky ball whose proper name completely escapes me!

I attend physiotherapy for half an hour once a week. The physiotherapist manually stretches the leg, flexes the foot, to stretch, and messages muscles and nerves around the knee and calf. At least half the time is spent attempting to walk at the parallel bars. I can just manage to "flow through" with some steps. I can also just about put my heel on the floor if I lean back a bit. I am quite flat footed with the affected leg. This in part due to my disability which includes (did I mention this?) at least one dysplastic hip.

I tried to upload a word file of my exercises but it wouldn't attach.

Thanks for you help, Jim.

 

[JamesAB]

Ooops, sorry for the essay. :-(

 

[JamesAB]

Oh, I've also got a mini peddler which I use from time to time. It used to hurt knee to use it but not now.

 

[Josephine]

6: Elevating once or twice a day if appreciable swelling or calf muscle hard.

But for how long?

I do a whole selection of Pilates chair and floor exercises at least once daily. Although originally for lower back pain, various leg stretches, bends and flexing are now included or emphasized to assist knee problems. I see a Pilates instructor once a week. Each exercise is repeated 15-20 times. In addition the leg is manipulated for several minutes using a rubber spiky ball whose proper name completely escapes me!

I attend physiotherapy for half an hour once a week. The physiotherapist manually stretches the leg, flexes the foot, to stretch, and messages muscles and nerves around the knee and calf. At least half the time is spent attempting to walk at the parallel bars. I can just manage to "flow through" with some steps. I can also just about put my heel on the floor if I lean back a bit. I am quite flat footed with the affected leg. This in part due to my disability which includes (did I mention this?) at least one dysplastic hip.

Don't apologise for the essay - correct it!

 

[JamesAB]

I stand corrected!

Question 6
Elevation once or twice a day for 30 minutes

Question 8 Exercises
One main session a day lasting an hour which includes Pilates exercises.
Knee specific exercises:
Sitting
Leg stretch x20
Leg bend x20
Ankle flex x40
Thigh lift x20
Trigger point ball (rolling foot over) x5 minutes (massaging knee and lower leg with) x5 minutes
On floor lying down:
Straight leg lift x4 most I can manage - should increase with time
With knees bent and feet on floor, raise lower leg to horizontal x4
Standing with support:
Stand up as straight as possible and stretch leg x5
Getting down and back up of floor is hard so only one session a day. Any of the sitting exercises may be repeated during the day as and when I feel needed.

Physiotherapy approximate times:
Manual leg stretch x5 minutes
Manual calf stretch by pressure applied to ankle x5 minutes
Massage around knee x5 minutes
Walking at parallel bars x15 minutes



I hope this is sufficient for your needs.

Thanks and kindest regards, Jim

 

[JamesAB]

To clarify calf stretch: physiotherapist applies pressure to ball of foot so as to stretch Achilles tendon etc.

 

[Josephine]

Thank you so very much. That's much easier to read!

1. Pain level: At rest 1. On putting weight on leg 5 upwards.

That's quite high for 12 weeks out.

2: No pain meds required.

I beg to differ. With a pain score THAT high, you need something. Not prescriptions drugs. Maybe just Tylenol. I suggest 1,000mg 4 times a day at 6hrly intervals.

3: No swelling on awakening. Slight swelling knee, lower leg and foot only occurring as the day progresses

You did note that swelling is a form of pain? According to this chart Swelling/pain comparisons, slight swelling equals a pain score of 2 which should be added to your overall score. Making it 7.

4. 95° Bend. Can't fully straighten leg maybe 15° But before op., due to disability -5°.

Okay but not terrific for 12 weeks out.

5: Not icing.

okay

6: Elevating once or twice a day for 30 minutes if appreciable swelling or calf muscle hard.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

7: Well, I spent 6 hours doing ironing, Sitting down, yesterday. Sitting down 99% of the time. I do stand, with support, and stretch several times a day.

Okay

Exercises
One main session a day lasting an hour which includes Pilates exercises.
Knee specific exercises:
Sitting
Leg stretch x20
Leg bend x20
Ankle flex x40
Thigh lift x20
Trigger point ball (rolling foot over) x5 minutes (massaging knee and lower leg with) x5 minutes
On floor lying down:
Straight leg lift x4 most I can manage - should increase with time
With knees bent and feet on floor, raise lower leg to horizontal x4
Standing with support:
Stand up as straight as possible and stretch leg x5
Getting down and back up of floor is hard so only one session a day. Any of the sitting exercises may be repeated during the day as and when I feel needed.
PT
Manual leg stretch x5 minutes
Manual calf stretch by pressure applied to ankle x5 minutes
Massage around knee x5 minutes
Walking at parallel bars x15 minutes
I suggest you stop doing all these exercises because they are causing the problems with pain, swelling and restricted ROM. This is something I see all too frequently and especially at this stage of recovery.

It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[JamesAB]

Dear Josephine,

Thank you for your reply which I have read with interest.

When I first had my replacement and indeed prior to it, I was very strongly exhorted to do lots and lots of exercises. Indeed the day after the operation, as I am sure you know, a physiotherapist was exhorting me to walk, which I couldn't and still can't do.

So, your recommendation to virtually stop exercising comes as somewhat of a surprise. However, based on your experiences, I put great weight on your opinion.

The problem for me is that I am wheelchair-bound and I need some form of exercise to not only prevent but reverse muscular atrophy which I have experienced. This atrophy was due to the fact that I stupidly stopped Pilates exercises, which had successfully eliminated severe lower back pain, in the first weeks after my knee replacement. Not only did I then suffer muscle atrophy but my back pain returned.

I have therefore restarted Pilates and I am glad to say, my back pain is diminishing and general strength returns.

I have been putting some emphasis on those Pilates exercises which could, I thought, help my recovery from the replacement. While I need to retain the exercises that help my general strength and mobility, I will only do very, very mild exercising with the leg just to keep it mobile.

I note also your comments on icing which I shall apply.

Very many thanks and Best regards,
Jim

 

[JamesAB]

Saw surgeon today. He was quite happy at my progress and will see me again in six weeks. For the first time, admittedly hanging on to the banisters, I was able to step up two stairs. I consider this a milestone!

 

[Jockette]

That’s a great report!

 

[sistersinhim]

Yippee!

 

[Josephine]

When I first had my replacement and indeed prior to it, I was very strongly exhorted to do lots and lots of exercises. So, your recommendation to virtually stop exercising comes as somewhat of a surprise.

It comes as a surprise to a lot of people!

The problem for me is that I am wheelchair-bound and I need some form of exercise to not only prevent but reverse muscular atrophy which I have experienced.

Sorry, I dodn't know about that but obviously, my advice about stopping all exercise would exclude anything connected with that.