MUA Christina’s 2nd TKR Recovery

[Geoffa]

KnitChica,
One question if I might.
How is the recovery of your quad muscles going?
My recovery has been very good but I am still limited by quad weakness, I am 3 mths.
Both my GP and OS have recommended ADL as the best way forward a particular point made that the whole upper leg muscle structure has to recover as naturally as possible. Opining whether my PT practioners were current with the advances in TKR surgery in regard to the optimal recovery!
Neither mentioned ROM!
This is consistent with the philosophy of Bonesmart.
Just some iconoclastic thoughts!!

 

[KnitChica]

@Geoffa Thank you for your awesome & iconoclastic thoughts! And you asked a great question...but, I’m truly not sure how well my quad muscles are recovering. I can tell they’re weaker than they were pre-op, but haven’t noticed any significant change since then.
It sounds like you have both an awesome OS & a GP. That’s wonderful! That makes sense of their recommendation of how the whole upper leg needs to strengthen thru ADLs.
While I believe that my OS is a talented & conscientious surgeon and he came highly recommended, he is of the “push past the pain” philosophy.

Blessings,
Christina

 

[Geoffa]

KnitChica,
After much hard work I am finally getting some quad profile back. An example of progress is stair climbing on the balls of your feet without stretching discomfort, I won't say pain, I finally achieved that a week ago.
Been working in the garden doing ADL and now sitting down icing watching the race that stops a nation, The Melbourne Cup.
Zero pain it is worth the effort!!

 

[KnitChica]

@Geoffa In your description of stair climbing, are you describing basically walking up the stairs on your tip toes to strengthen your quads?

 

[Geoffa]

KnitChica,
Yes you are correct, I tried to step as close to the front of the tread as safe as possible. I found this technique allowed me to adjust how much I loaded my quads and do it in a controlled way, maybe only one step at a time. We have a multi level home on a very steep block paradoxically this, while challenging, is really good for recovery particularly walking up hill really helps extension. All things in moderation though.
Good luck.
Geoff

 

[KnitChica]

I feel as if I am in such desperation!

I’ll reiterate some items from my previous posts....I’m 12 wks post op right TKR (left knee was replaced last year). With this knee, I’ve never gained beyond 95 degree flex/6-8 degree extension.
At approx 9-10 wks post op I discontinued formal PT.
Last week (@ 11 wks post op), I had a MUA performed (yes, I know the opinions on MUAs...please don’t judge me!).
During MUA, OS flexed knee to 120 degrees. Currently, I can reach maybe 105. The 1st few days post MUA, I felt great...knee felt more fluid, stairs & walking were easier, extension even seem somewhat improved (I know MUAs are not done for extension).
Over the past 4 days, everything is going downhill. The knee itself is so stiff & painful. My extension is painful & has decreased in degrees. Flex degree May still be at 105 or so, but it’s more difficult to reach it. I have such a hobble or limp now because of the extension stiffness.
I have not been back to PT since that 9-10 post op time.
At home now, I’m doing gentle heel slides, 10 min a day on a pedal bike, gentle extension stretches, in addition to all my ADL. I’m also going for a 20-25 min walk per day. Although, today the pain was too intense to walk. I’m still icing & elevating.
I’m terrified that I’m slipping into an abyss of forever crippled. I was (and am) an active 62 yr old woman.
I want to to continue to hike, kayak, bike, snowshoe.
Can I please have your thoughts??

 

[Jockette]

Please tell us the date of your MUA and we’ll add it to your signature.

Over the past 4 days, everything is going downhill. The knee itself is so stiff & painful. My extension is painful & has decreased in degrees. Flex degree May still be at 105 or so, but it’s more difficult to reach it. I have such a hobble or limp now because of the extension stiffness.

An MUA is an intensive procedure, which is why they give you anesthesia. It reintroduces trauma to your knee that is trying to heal from the trauma of the original surgery, thus the pain and swelling you now have, which makes you feel things are going downhill. Give it time to heal from the MUA and things will improve.

 

[Pumpkin]

10 min a day on a pedal bike, gentle extension stretches, in addition to all my ADL. I’m also going for a 20-25 min walk per day.

Sounds like you may be doing too much to soon after your MUA. These two activities are probably enough right now in addition to your ADLs.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
Add the bike and walking back in slowly, doing half of what you have been doing.

 

[KnitChica]

lease tell us the date of your MUA and we’ll add it to your signature.

My MUA was Nov 4th.

 

[Jockette]

Thanks, I’ve added the date to your signature.

 

[Jamie]

I agree with Pumpkln. The fact that you were doing okay and now are sliding backwards indicates you are doing a bit too much for so soon after this procedure. Although it's not surgery, there is a lot of trauma to your soft tissues in an MUA that needs time to heal. It is important to move during the day, but not to overdo the activities and exercise. It's tricky sometimes, as there is a fine balance between the two. You are doing the right thing by icing and elevating your knee. You also might want to take something like Tylenol or and NSAID (if this is some you can tolerate) while you're experiencing pain.

You mention "ADLs." What exactly are your activities? This could be part of the problem too if your "normal" activities include things like housework, going to work, taking care of family, cooking, running errands or anything that involves periods of standing.

Try not to despair. You are very early in your recovery. And your MUA has set you back a bit, so it's almost like you have to start the recovery clock all over again. But it will get better. Listen to your body and respond accordingly every day. When you have pain and discomfort (or stiffness and less flexibility), that's your cue to scale things back for a few days and then gradually increase what you're doing.

 

[KnitChica]

@Pumpkln thank you for your wise words. I will try to not do both the pedal bike & walking. I want to do it ALL, though, thinking I’ve got to keep this knee MOVING before it possibly forms adhesions again.
I’m scared of going backwards; as it seems everything is right now.

 

[KnitChica]

@Jamie thank you so much for your helpful response.
You asked about my ADLs....While I’m not back to work (I actually just retired in April from the medical field), my ADLs involve all my day: laundry, yard work, lighter cleaning (haven’t vacuumed yet), meals...just about everything, I’m guessing. My daughter, son-in-law & two grandbabies (3 yr & 15 months) all live w/me while they purchase a house. So, I do plenty of my ADLs with the grands.
This is just so terrifying how much I’ve fallen back since the MUA.
And it’s scary for me to actually DECREASE activity. I believe you, tho, when you say that’s what I need to do.
One item, at least for right now, I’m still going to walk everyday, but I’m not going to try to increase the time/length of walk everyday (as I have been). I’ll wait to increase until my pain, stiffness decreases some. I like the pedal bike...but I’m going to do a time limit on it.

 

[sistersinhim]

Your ADL, (activities of daily living), are really extensive. That explains your increased swelling and less ROM. The forced bending of your knee has caused more inflammation. All those soft tissues that were still healing have been further traumatized. Those tissues have to heal from this latest injury. To better heal you need to do fewer activities and more resting, elevating, and icing. With your daughter with you, she should be taking over most of the chores you have been doing, giving you more time to heal gently which will be a huge help to your poor knee.

 

[Jamie]

Your explanation of your ADLs says it all. This is a time that you need to keep the focus on you and your healing. With everything you listed, I'm wondering when you have time each day to rest, ice and elevate?

Please explain all this to your family. It's great you're helping your daughter while they are planning to buy a home. But, as a group, you need to brainstorm how you can carve out time to take care of yourself for the next couple of months. Your body is not going to like trying to heal plus doing all the home chores and babysitting two young children. That's a lot for a healthy person!

Continuing to walk is fine. I like your idea of alternating it with the bike. You are right to not push to extend the walks. Just do whatever time and pace works for you and doesn't give you pain or swelling afterwards.

Your ROM is there. It's internal swelling that's causing a reduction in your flexibility. It's temporary and should improve if you will lessen your activity levels.

 

[KnitChica]

@Jamie I realize how extensive my ADLs sound....i really am resting (not enough, I know) & icing!
I begin thinking that, this far out (12 wks post op) that I sound be “biting the bullet” & charging thru. I forget about that stupid MUA 10 days ago & how much havoc it can wreak (even if it ultimately helps me).
And my daughter & son-I -law have really been a great help. My daughter cooks almost all our meals. It’s ME....I begin to feel like I’m being lazy & need to contribute more or be more involved. The MUA has definitely set me back, so I AM cutting down my idea that I need to be going gung-ho.
I had a deep tissue/skeletal type massage today. I believe it will be beneficial. The massage therapist also recommended more rest, more ice, to drink more fluids.

 

[Pumpkin]

Glad to hear the massage was helpful and your therapist reinforced what we are recommending here.
Rest, Ice, and Elevate.
Your job right now is to heal, so you will be able to help your family once your are healed.
You have been doing for your family all of their lives, now it the time to let them do for you.

Here is an article you may find interesting about letting go.
Nurturing mother: how to let go and accept help

 

[Jamie]

You're not alone in feeling that you should be doing more. We ladies (nurturing mothers that we are) often cannot take off that "caregiver" hat and allow ourselves to be cared for completely. Keep fighting that urge. The article Pumpkln linked for you is an excellent way to reset your brain. Maybe print it out and post it where you can read it frequently will help. Just know that you're not the first BoneSmartie to have the feeling that you "need" to be doing more.

 

[KnitChica]

@Jamie & @Pumpkln you are both so correct in stating how difficult it is to take off that “caregiver” hat & just let my body HEAL! In addition to those thoughts, for me, are also the thoughts that “if I relax too much or remain too inactive, then I’m going to relapse & never get my ROM”.
This whole recovery & rehab is as much mental as it is physical!!

 

[Pumpkin]

Don't forget you can do these two gentle activities for your ROM a couple of times a day.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .