TKR Cyclist - Managing My Recovery

[Roy Gardiner]

I lie on my stomach and bend my leg up toward me and assist it with the other leg or a belt. I find these the most uncomfortable exercises and I wish I could get more positive about them. They don't cause swelling but they do hurt and progress is sooo slow.

Don't do them then. There's a million ways to do flexion exercises, choose one you like, even my skateboard one if you fancy it.

Final comment, I also read that TKR is 40% the surgeon and 60% physical therapy.

I am not at all sure about this; IMO the surgeon has to get the job dead right for recovery even to be possible, they mess it up and you haven't a chance. I'd give that a 100% non-negotiable rating.

And here in UK there's very little emphasis on PT or pro-active recovery work, people just get on with life when they can and 'get better'.

Maybe though it's a difference in emphasis, perhaps to get to 140 degrees or more then extensive PT is needed; I'd buy that.

 

[Hopper]

I like my PT here in the US - but I've insisted on no forcing on the bend etc. My main physio has gone along with me but another has disagreed and probably found working with me a trial as he said if I was his full time patient he'd have pushed my leg more to get flexion. He even said I'd end up back in hospital!
Well, after five weeks of physio they are surprised I've suddenly got to an easy 110 and between 1 and 3 extension. I didn't have that before the op.
It would be more if they forced it but why force it?
It's come along just suddenly this last week. I think walking a little more, doing everyday things, bending my knees up in bed......just simple stuff has helped. I do quad and other muscular exercises, stretching, a little upper body strength work in the gym.
My knee feels so much better this week but I'm still going gently.
I don't do anything that my knee doesn't want to. I listen to it carefully. I was an athlete and am used to monitoring pulls and minor twinges etc.
I think my going steadily may be why I'm not taking pain meds and have only a little discomfort when turning over at night.
I'm very keen to get back to normal activities and some sport. For me slowly does it as I don't want to compromise my implant at this stage. I just feel I want it to be sound and secure and healed with some good old basic muscular support built up around it before I do any great distances of any sort on it.
Hence I'm doing muscle building exercises that don't put undue stress on the knee. I'm keen to get peddling but I'm not quite there yet. I can wait.
I'm aware this is a very different approach to Pats.
Perhaps its more British or more female?
I do know I will get back on my bike and I will be chasing your butt Pat. Just not quite yet!
Keep up the good work.

 

[patbike]

Just an update. I am approaching 8 weeks out and my knee seems to be progressing fine. I get an occasional minor twinge on the inside of the knee an inch below the kneecap. It is not anything much and it usually only happens if I am rolling around in bed trying to get comfortable. I gave up the 5 to 10 mg of night time hydrocodone about a week ago and wile I can't prove it I think it was causing me more general discomfort then anything to do with my knee. I am certain the meds were making me feel really icky every afternoon in my stomach, chest and head. The feeling has declined over the week and I am feeling and hoping that it may be totally gone today. My appetite is still a little picky which is not like me and as I mentioned I did loose a bit of weight which as a side benefit probably makes the cycling a little easier.

I am still trying to keep the icing going with elevation and of course the PT exercises of which I have about 6 or so. My extension was 1% with assistance and after warm-up at my last PT but it still needs to go to about - 2or - 3 to be where the other is and to lock properly. Although it feels like it is just abut there. I wonder if the mechanical joint has a limit on how much it will extend to the negative side (a question for my surgeon). I was telling Hopper that my cardio fitness, that I was so worried about does not seem to have been effected much. My wife and I are on a break in the mountains and I have been riding on a uphill course along a river and only really felt tire on the third outing yesterday so I took it easier but heart rate and breathing wise I was averaging 90% max heart rate for over an hour with no issues. The cycling definitely seems to help with the flexion although knee bending is for me the slowest part of the recovery so far.
In any case i have no complaints and I am so glad that the sport I enjoy is knee friendly.

I may give it a total break today and and just have a big batch of pancakes for breakfast and then just go for a little drive and then a short hike in to one of our favorite lakes up here named Upper Sardine (In Lakes Basin near Downieville Ca)

 

[Ppaluigi]

Hello and thank you for a point of reference as I am now four weeks out from a LTKR. Granted no two people are alike but we are both avid cyclists eager to return to this passion. After eight weeks, what is your pain level after a workout? Yesterday I completed 36 complete revs on a stationary WITHOUT PAIN and became excited about the accomplishment hoping this is a harbinger of progress to come.

 

[Roy Gardiner]

Just keep on doing effort-free ROM exercises until healing is complete.

Me, BTKR 6 Dec 2011, now riding without knee pain. 62 miles today, everything bar the knees now hurting/tired.

 

[patbike]

Ok, I'm in the mountains for a few more days. Yesterday I cycled uphill for about 12 miles (no pain) then wife picked me up on the road and we drove up the hill and did a up hill 2 mile hike to a lake with a three mile return. Lost of rocks and up and down. Knee was starting to get a little sore but not painful on the way back and I iced it at the cabin last night. This am it is still a tiny bit sore but that has now diminished. There is no pain when walking today. I wont hike much today perhaps just a mile.



Pat

 

[bottomshollow]

patbike, you are really having an amazing recovery. Makes the rest of the knee crowd envy you greatly. However, enjoy it to the max!!!!

Take care and keep us posted. We care.

 

[patbike]

I'm taking it easy today. Just a dip in the river or lake as soon as wife stops doing her jig saw puzzle

 

[patbike]

8 weeks today. Did a 15 mile along the river again with nice uphill grade and then back.
After that went for a short hike. My observation after 10 days in the mtns with some riding and some hiking is that the
hiking can cause some knee soreness while the biking even though somewhat strenuous does not seem to irritate the knee. Overall feel better than last week. I have been active and the joint feels fine but some soreness after hiking as mentioned. Biking is amazingly painless.
Appetite still weird in that food that I used to like is not as attractive. I assume this will change back to normal over time.
Haven't been using any pain meds day or night for over a week although I still feel some discomfort at night and have to move the knee to new positions to get back to sleep. Have PT next week so will be interesting to see how the range of motion is coming along.

 

[Tennis Nut]

Gee, I'm impressed with your 15 mile ride and no pain. I rode just 3 miles this past Sat. And am still sore but also went out in boat Sunday, did elliptical and stationary bike, leg machines and seated leg press Monday and walked yesterday. I'm 6 weeks out now but last couple of days have been tough. Extension and flexion are great and PT kicked me out 2 weeks ago after saying I was the quickest recovery they had ever seen. If that's true, then why am I hurting after biking? Hate that and wanted to get back to it and tennis ASAP. I usually wake up aching about 4:00 a.m. And days have been good till lately. I'm on aleeve, Tylenol and tramadol. Haven't been on Percocet since the end of week 2. So have any of you had little set backs like this? Guess I will take it easy over the 4th and get back to the gym Friday or sat.

 

[bottomshollow]

Tennis Nut, Doesn't take long for muscles to lose tone---and look at all you did, for Pete's sake!!!! Even without surgery they might very well be sore. Not everything is the result of our surgeries. You need to ease into these things by finding a level that doesn't cause much soreness then add slowly to that level.

 

[Tennis Nut]

Bottomshollow, the pain seems to be more in the medial side of the joint and underneath instead of the muscles. Sort of like the tendinitis I used to get in my knee and also like deep aching in the bones underneath. I thought I had "eased" into things by gradually going from 5 mins on the elliptical, after a warm up on bike, to 15 mins on elliptical. I may have been pushing thing by using the leg machines and seated leg press. I'm a little worried and hope I haven't damaged anything. It's hard for e to retain myself but after this episode, I certainly will. And u are so right about losing muscle tone. My calf looks like a toothpick. LOL. But overall, I think I've overdone it.

 

[patbike]

Tennis Nut, I have been in rehab mode for about 3 weeks more than you which I'm sure is significant.
I stayed on pain meds til about week 6 which was probably longer than I needed. My theory was I wanted to be pain free for PT and exercises. I think I stayed on them too long and that they made me feel icky. I still have discomfort at night but not enough to bother with anything. As far as bike riding I had some discomfort and the occasional quick pain when I first started taking the bike out around week 3/4 if I recall correctly. But now having biked a reasonable amount and done some rough terrain hiking in the mountains I am of the opinion that the hiking causes some soreness but biking alone does not. I'm home as of tonight and will only be biking for a while so I will get to confirm my theory.
I think a ride greater than 25 miles at this point might cause soreness and swelling so I plan to progress slowly over the next several weeks. I am glad to hear that your join flexibility is doing well as I know it can be difficult and I am having trouble making progress with increasing my flexion and extension. I might mention that I still have a little pain if I stand up to pedal but the pain goes away if I stand a little straighter or lean way forward. It is in between the two positions where the pain is. I'm learning to anticipate it and stand so it does not happen as much.

This was a lot tougher surgery in many ways then I anticipated (I only learned about Bone Smart after the surgery)
but as I look back from the 8 week point I can begin to see the light at the end and overall I am feeling good about things.

 

[Tennis Nut]

Patbike, I stopped the narcotic pain meds after 2 wks but am still taking tramadol. Seems like that's just a bit stronger than Tylenol. I have felt like something was wrong with me still being in pain at this point but I guess not. I wasn't cycling the last couple of years before surgery so lost some muscles whereas you probably kept on biking and can get back to it quicker. I did play tennis but only by wearing an unloader brace and getting acupuncture and pain laser treatments every week to control pain.

I'm going to hang with the biking because I think in the long run, that's the single best activity one can do for knee recovery. I stood up one time and that was enough for now. Sat right back down. LOL. It's just nice to have this forum and be able to ask other people about what they are going through. It is much tougher than I thought it would be and every time I have a strange or different pain, I get upset and worried.

 

[patbike]

9 weeks out tomorrow. Haven't been to PT for three weeks due to schedules and trips but I went today. My extension and flexion have stalled at around -2 degees and 120 respectively. At Pt she moved it to about 125 degrees but I cant go that far on my own. I no longer take pain meds because while there may be some discomfort at night there is not enough to keep me awake. . PT gave me some new exercises that may not be so uncomfortable and will help with
my ROM. I see the Dr next week. My joint is still just a little warm and it pretty much looks like it did before the operation which is a little swollen where the quad meets the knee.

I am enjoying biking and look forward to getting back to normal strength and fitness but I don't feel like I am too far away so loosing fitness is not really a pressure for me. I would just like to get my original range back or more and then I will be happy. I don't have any hiking planned for about 8 weeks which is good as I think hiking for 5 or 6 moles on rough terrain is a little counter productive right now because it is full weight bearing whereas biking is much easier on the knee.

 

[Tennis Nut]

patbike

What kind of new ROM exercises did the PT give you? Imfinished PT two weeks ago and feel stalled out like you at 120' or so. I've gotten really sore and achy from going out to dinner, too much elliptical maybe, and who knows what else. Did you see a big lessening of discomfort between 7 and 9 weeks? I'm 7 weeks today and want to bike but no way I can do hills. Tried a small one and got too sore. Frustrating.

 

[patbike]

My experience is that biking in week 7 and 8 was not causing pain with two exceptions. When standing I get some discomfort which I am able to eliminate by changing position and 2nd I think that one needs to increase the mileage slowly (assuming the pt/dr has cleared you for biking). I started out in the early weeks with 10 miles on level and worked my way up slowly to 15 to 20. I think that walking with full weight on the joint leaves you with more post activity pain than biking does because you are putting full weight on the joint.

The new exercise for flexion is to lie down perpendicular to a wall and then scoot your rear end up to within a couple feet of the wall and then put your bad leg up on the wall and slide it down and hold for 5 seconds then slide it up and then down again. It is like a heel slide on the floor except it is on the wall and is gravity assisted. She wants me to do two sets of 10 a day. For extension I loop a big red rubber band around a pole and tie it to make a 2 foot diameter loop. Then I put my foot inside the band loop and move my leg back so that the band is tight against the back of my knee but with my knee bent. Then I extend my knee against the resistance of the band until I get the knee as far back and as straight as I can using my quad. It is best to put a towel between the back of the knee and the band so the band does not cut into the back of the knee.

Right now my TKR is the same temperature as my leg and thigh but my good knee is cooler than my leg. Just to give you an idea of where I am.

 

[Tennis Nut]

I will have to give the heel slide on the wall a try. I've got an exercise similar to the other one you're doing for extension. Sounds like you're just doing great. Congrats!

 

[saultlooser]

Hi patbike, I haven't been on the frum in a while. I have stopped my meds 5 days ago (slow release tramadol). I seem to remember when you stopped your meds you were having trouble sleeping. How long did that last? I find my knee hours just enough at night to wake me up. Trying to figure out what I could take to try and manage to get a full nights sleep. I want to return to work next week but won't be much good to anyone if I'm not sleeping.

 

[patbike]

10 weeks ouy now...
I took a couple of aspirin for about a week, but not sure it helped. what was best was several pillows that I could use so one knee was not resting on the other knee and also so the tkr knee could rest on a pillow rather than the mattress.
I have been off the meds for almost a month and the knee does not give me sleeping issues. If I do wake up and it is uncomfortable then I just roll to the other side,move the pillow and all is well. By the way my knee is still a little sore at times and a little warm during the day but not when i wake up. I hope to see the PT in the AM for my weekly session and then the Surgeon tomorrow for my second (a couple of weeks late) post op check-up.