TKR Cyclist - Managing My Recovery

[Roy Gardiner]

What do you ride? I have a Trek 4.5 Domane. I just bought it last month as a sort of prize to myself for going through the TKR.

https://bonesmart.org/forum/threads/cycling-club-pix-of-our-bikes.12812/

I thought the pedaling might help with ROM

I thought biking would increase the ROM, but it hasn't.

https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/page-3

My comfortable ROM is about 95 degrees and has been since mid-Feb.

What exercises are you doing to improve it?

 

[bikerchick1958]

Don't worry too much about your flexation right now. You're only 3 weeks out and your knee is probably swollen up like a balloon. At that point I think I only had about 50 degrees.

I still get odd cramps when I ride. Lots less than at first, but the muscle on the outside of my lower leg is screaming right now after just a 36 mile ride. As always, my knee is telling me to be patient.

I didn't look at any Specialized bikes because my local shop doesn't carry them. I preferred the Domane to the Madone because it has a more upright position and it has a very cool floating seat. It's a really comfortable, fast bike. Not to mention good-looking.

 

[bikerchick1958]

Hmm, still not sure how to reply to a specific message. Roy, I continued in pt until late April at which point the therapist said that she thought I was just stuck. I've done lots of riding with the pedals set higher than is comfortable. I also did this immensely uncomfortable thing where I lay on my stomach, put a strap around my foot, and pulled. All that seemed to accomplish was to make my leg ache. I think I've gained about 5 degrees in the last month from biking, but for all the discomfort it has caused, I should have gotten about 50 degrees . I am seriously hoping the MUA gets me up to 120 degrees so I can clip into my bike.

 

[bottomshollow]

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[patbike]

Well, I am three weeks out tomorrow and have my 2nd outpatient PT.
I was lying on my back this am holding my leg(upper thigh) in the air and letting the lower portion (calf) flex down gradually with gravity. I found that if I inhale expanding my stomach and then exhale slowly the calf will drop/flex a few more degrees and stay there with a little pain but not significant. I will see my out patient PT tomorrow and ask them if I am actually achieving anything with this maneuver. My overall opinion is that this is gonna be a longer haul to get rom back then I anticipated and there isn't much I can do about it. I do think that walking which i can do will help me keep some fitness level so I will be able to cycle when my healing and rom improve. I am gonna ask the therapist if there are any limits on walking. I have a nice sloped road near my house that I can walk up slowly. Just not sure about how far I can go without it being counter productive. The hill is steep enough to get my heart rate up as well as work my quads and perhaps gluts. My guess is that I should just try it for a few hundred yards and see how I feel .If I dont get any unusual swelling or pain I assume I can increase it.

Question for the experts and those with much experience. Is walking detrimental to the healing process in anyway? walking up hill vs flat terrain.

 

[referee54]

My overall opinion is that this is gonna be a longer haul to get rom back then I anticipated and there isn't much I can do about it.

Yep---many of us reached the same conclusion---these TKR recoveries take longer than we would like them to, but there is nothing we can do about it---we are on the knee's schedule, not ours.

Is walking detrimental to the healing process in anyway? walking up hill vs flat terrain.

I would walk on flat terrain in the beginning, and I would listen to the knee. Keep the knee happy---too much walking and you will feel it later on. Strength and stamina take some time to gain, so you walk a little bit more and slowly gain distance and time. Listen to the knee---you will know when you go too far. Again, take it easy and do not push things.

The other activity that I would do when I would walk is to concentrate on your gate. When you walk, make sure that your gait is correct---"mechanics is muscle memory"---so when you get tired, your gait may change, and you want to keep it normal. It is important to stop before you get tired.

 

[patbike]

I am getting great support from your posts and I would appreciate your tagging me on any bike or recovery related posts that you make to other so I can learn more from you.

Biker chick I went to the bike shop yesterday and saw the domane 5.2. I am gonna research the 4.5 as well.
thanks for the feedback.

 

[referee54]

I didn't look at any Specialized bikes because my local shop doesn't carry them.

We are lucky to have two excellent LBS's around here---one carries Trek, Cannondale, and Specialized---along with Surly, and the other carries Raleigh, Giant, and Surly, too. I have a Specialized as well as a Giant.

 

[patbike]

referee54

Hi ref54, you mentioned local bike shops. I am planning to get my first road bike as a reward. I have been road biking on a giant talon and other mountain bikes for around 10 years. I'm 3 weeks out from ltkr. I notice that if i stand on my pedals I cant quite make a rotation. Assuming you still bike, how long did it take you to be able to pedal a rotation and how did your riding progress?​

PatBike

 

[referee54]

Oh, yes, I still bike---I get in about 120 -160 miles a week in during the summer and fall months. Since I had my BTKR in November, the only cycling I did was on a stationary bike. To be honest, it took me about three to four weeks to get a full rotation while sitting on the saddle---I am not sure as to how long it would have taken me to do it standing up.

I really didn't get on a real bike until about the end of March, as the weather can be pretty nasty for a while here on the Southern Shores of Lake Erie. By the time I got on a real bike, I was pretty close to be completely healed.

I would imagine that your quads are still very tight and the muscle may be a bit weak, so it may take some time to loosen up the quads---as well as to strengthen both the quads and the hammies. That may take some time, as stamina and strength are normally the last to be attained completely. How tight are your quads and hamstrings?

Even when I got on the bike being close to about 89%---it took me some time to build up my stamina and build up the miles. Now, centuries are not a problem.

 

[patbike]

referee54
I don't think my quads are tight however I will ask my PT to give an opinion when I see them tomorrow.
I assume you are thinking that they get tight due to lack of exercise? If that is the case it may be too soon for them to have gotten tight. I'm encouraged by your return to biking. Do you remember what your rom was post surgery and for the first 3 or 4 weeks?

ty
patbike

 

[referee54]

My ROM at three-four weeks was only about 90*---maybe even slightly less, as I had adhesions that I had to take care of. My progress after my BTKR was very slow---five months after my surgery, I still had a very, very slightly limp. It was not until about eight months that I felt really, really great.

 

[Roy Gardiner]

.If I dont get any unusual swelling or pain I assume I can increase it.

That's true of any exercise; do the thing, wait 24 hours. If no pain or swelling, do a bit more -- not double, just 10% more.

In my opinion only, one is better off doing less to avoid swelling compared to doing more for training and risking swelling and pain.

 

[patbike]

I asked the PT today if my quads were tight and what that meant. She said that (if i understood her) that they were probably tight and that is why i cant get complete extension yet. She also said that they were probably cut during the surgery. I did not know to what extent they were cut. She told me with the usual caveats about pain and swelling that walking on level ground was fine. Walking on hills not good yet as I would probably be walking incorrectly and in hill walking I would not tend to fully extend. I'm not sure on this.
I was able to rotate the pedals just fine on their recumbent and upright exer-cycles. When I got home I tried my real bike which is set up in a stationary roller device and I could rotate the pedals but not as smoothly and raising my seat did not improve tings. I am guessing that the pedal arms are shorter on exercise bikes than on my mountain bike so I will measure their pedals next time I get to PT.

I will see them again on Friday. she also said not to sleep with my leg bent and to try to keep it straight at night.

 

[Roy Gardiner]

She also said that they were probably cut during the surgery.

I doubt that. Josephine sorry to tag you I know you read everything.

 

[Hopper]

Hi patbike - I'm just wondering how far you are walking now? I joined the ODIC yesterday - half an hour and a bit if standing around was obviously on the border of comfortable for my knee.
I can't peddle yet that's for sure but the bend is becoming easier just through normal stuff like sitting at the table etc - I try then to get a little extra bend each time.
I love cycling and spinning but I think it may be another couple of weeks before I get the rotation. Who knows?
It sounds like you are really pushing for it. That new bike is beckoning!

 

[Josephine]

She also said that they were probably cut during the surgery. I did not know to what extent they were cut.

There is an 9old technique, now fallen out of favour, where the quads were snipped just above the knee to allow better access to the joint. This was in the days when we used to make 10-12"incisions as well! Well, it soon became pretty clear that this action of pure convenience for the surgeon was quite the opposite for the patient and caused problems during recovery. So it was dropped. I believe there are a very few surgeons who still think it's a good idea but they are mostly the kind of chaps who appear not to keep themselves up to date. Largely it's considered a contra-indicated technique though there is a place for it in complex revisions where the extra access is required.

However, this "quads snip" technique is still spoken of by PTs as it it's regularly done and on some websites probably not updated for years or written by people who have used those websites as a reference resource. But it's a technique spurned by most modern thinking knee surgeons.

she also said not to sleep with my leg bent and to try to keep it straight at night.

If this is the same PT that mentioned the quads cut, then she has her thinking seriously out of whack! Trying to sleep with newly operated upon knees is agony and having a small bend doesn't impact upon the ROM at all. It's a natural position and having the legs totally straight is not. You can check out the best practice here elevation is the key.

 

[referee54]

I was very active right up to the day that I had my BTKR. I was still teaching and working at the produce farm; while baseball season had long ended, I was still moving around du, but the cortisone was wearing off. I have to tell you through, in just a matter of a few days, how surprised I was to see how much my leg muscles had atrophied. They were incredibly weak and incredibly tight. It took me quite some time to get the stationary bike to go 'round and 'round---and then it took longer to regain the stamina in the legs. my quads and my hamstrings were weak and tight.

 

[patbike]

Ok, Weds Am. I know my surgeon is at the modern up to date end of the spectrum (and this is basically all he does)so I'm sure he didn't cut my quads if that is considered out of date except in special situations. I will follow up out of curiosity when I speak to the PT Friday.

Walking- I am probably walking about a total of 1/2 mile to a mile if you count all the running around I do.
I think I will try a few yards on my street which has an incline. Not as my primary walk but just to get a little exercise. In the nursing facility they had me walking walkinjg daily up a 12-15% long driveway (75 yards)
once or twice a day and I didnt feel any specific discomfort because of it. That was over a week ago and they had me do it first in a walker then with a cane. They took my cane away a week ago and told me to only use it if I'm on hills or uneven ground so I have not used it yet. I have some hiking sticks (like ski poles) which I will get out today to take on the hill.

Sleeping- Last nigh I did pretty well and didn't put pillows under my knee but just between the two knees when I was on my side.

Pain- Yesterday Tuesday I went to PT and also did some exercise at home as well, plus I drove to town and did some walking.
I had taken a pain med 10 mil hydrocodone at 1:00 am tuesday to help with sleep and then 15 mil at 9:00 am tuesday to help with PT. I did not take any more and I noticed at around 4:00 PM that my knee wasn't hurting but I had an un comfortable antsy feeling in my upper body sort of like when you are getting the flu.

I decided that it might be the 3 weeks use of hydrocodone that was making me uncomfortable so I decided not to take it, although I continued to feel antsy. Also yesterday I called the dr to see if any issues with taking ibuprophen and I got a call back that it was ok up to aroud 800 mg per day, I think. So last night around 6:00 I took 2 ibuprophen and then 2 more around 1:00 am Weds. This Am (9:00) I don't have any pain and I wont take any until later today and then I think just 1 pill. I also don't feel antsy and I think that may have been the hydrocodone but hopfully I am through with that now. I am gonna ask my dr about tylenol as well because I may need it if the ibuprophen does
not work or if I decide not to keep taking it as it seems a little contoversial.

Pedals and Bike
When I returned to town yesterday I stopped at the PT office and measured their pedals and they are the same as mine so I am not sure yet why I have difficulty turning my pedals when I can turn theirs easily. Something amiss

Fitness
I don't know how much fitness I will loose during my re-hab but it is what it is. If I can start a little walking I think I will keep some. But the knee is the priority so I'm not gonna do anything that results in residual pain.

Hopper you are a couple of days behind me but you say you had a PKR. Is that a partial? My sister had full return plus with her partial and she was in pretty bad shape. She can sit on her heels now.

Appetite
One thing I haven't mentioned is that I haven not had much of an appetite since the surgery. I noticed this AM that I was around 171 and 3 weeks ago I was around 184 when I went to the nursing home. It is ok because I'm 6' and I wanted to loose a few pounds anyway that had come on during the winter when I wasn't exercising too much. But I think the loss of appetite may be related to the hydrocodone? Also I may be loosing leg muscle which is not desirable but might be inevitable.

 

[patbike]

referee54
Ref, where are you now with your bike rotation?