TKR Dearjr's new knee

[Dearjr]

I see where u are coming from but I thought the pt helps strengthen the weak muscles and help in balance. These things I can't get just sitting down and standing at work

 

[Dearjr]

Can anyone tell me what their experience has been with the feeling of a band around knee when flexing. I'm 6 weeks out. Does it have to do with the kneecap being 1/2 numb?

 

[PolarBear60]

This is different from the tight band feeling, usually experienced after a period of inactivity?

What I sometimes feel is a sensation of the inside of my skin moving as I flex. I figure that's the internal fascia moving and preventing (or breaking up the beginning of) adhesions.

 

[Dearjr]

@PolarBear60 it seems to be felt when I flex during sitting down and if I flex too much in general. After inactivity it's just stiff feeling. I figured the band feeling is from the scar tissue in the quad being stretched but not sure

When does the knee feel like having no knee??

 

[PolarBear60]

I'll let you know when I get there. I'm sort of close, but I figure it will be several months before I forget it's there.

 

[analysta]

DearJr you and I are contemporaries and I can at least tell you that that "tight band" feeling is there for me too, big-time. Not quite as much as a couple weeks ago though. It's much worse after being immobile and after being overactive, but there's a middle ground that's nice. I can get to the middle ground with the exercycle, but I won't claim that will work with everybody.

I agree with you about physical therapy doing things that going back to work cannot do. I have been getting an education in knee/leg musculature from my PT (I even bought a medical-grade anatomy book by Netter) and the number of muscles and their slightly different uses is jaw-dropping. Keeping them balanced is very important. And, the surgery "knocks out" some muscles and they sort of have to be restarted, one by one. The important one for me was the articularis genus which is very small yet does the important job of pulling one of the bursas out of the way ... and that little muscle was just not bothering to do its job post-op. The PT jump-started it with massage and exercise and ... what a difference.

 

[Celle]

I see where u are coming from but I thought the pt helps strengthen the weak muscles and help in balance. These things I can't get just sitting down and standing at work

6 weeks out is still too early to be doing strengthening exercises. Your muscles are still being used as you walk, so they will gradually be regaining strength, and walking is truly the best exercise for a TKR recovery.

Can anyone tell me what their experience has been with the feeling of a band around knee when flexing. I'm 6 weeks out. Does it have to do with the kneecap being 1/2 numb?

2 articles from our library for you:
"Tight band" feeling across the front of my knee
Numb area after TKR: how long will it last?

 

[analysta]

I respectfully and modestly disagree, Celle, even though you are a forum advisor (I'm very nervous about this). I have had nothing but success with minor strengthening work, and knowing that muscles can atrophy with just a few weeks of inactivity (for example being in a cast), I think it's important to do that strengthening as well as stretching. I'm not talking about serious weightbearing exercise, but toning activity that works with all muscles, not just those used in walking. Every muscle has a countermuscle and furthermore every muscle has subparts which have subparts which have countermuscles. Walking does exercise certain muscles (and puts a load on the knee which often causes a lot of discomfort later) but walking is an unbalanced exercise and good physiotherapy will work on the whole system and help the countermuscles keep pace with the main ones. In the end, I guess I believe that although there are clumsy and clueless physiotherapists, and unsympathetic doctors, that their long-term immersion in the subtleties of healing and their reliance on science actually does make their advice worthwhile, more often than not.

 

[Celle]

It's quite OK to disagree, @analysta . Every knee is different and every recovery is different. As well, there are almost as many theories on recovery as there are orthopaedic surgeons.

However, Dearjr (whose thread this is) has gone back to work much earlier than is usually recommended after a TKR, at a stage when his soft tissues are still in the early stages of healing. I am concerned that the extra stress of PT on top of this will inflame those healing tissues and possibly slow down his recovery.

Yes, there is a time when PT can be very helpful (provided you have a therapist who does not push too hard), but true strengthening exercises are still inappropriate at only 6 weeks after surgery.

 

[Dearjr]

@PolarBear60 hope you get there soon and I'll follow you...how far out are you?

@analysta i agree with you for the most part. Even though I go to work I am sitting and moving aittle and no real exercise. I get stiff and swollen and the knee feels constricted. I the morning I started to do 10 - 15 mins of recumbent bike and it loosens me up.
How far out are you?

@Celle i agree with you in some points. I did go back way early and my os said it would not affect my final outcome with my knee. He said it will stay swollen longer but as it heals it will get better. He wants me in pt to strengthen and flex me.
My routine is pool work on Tuesday ...treadmill with some resistance squats and steps ...all in water
Thursday and Friday on land. Usually bike for 10 mins then balance board front and side Machine to push legs out and in Squat machine laying on back with only tkr ending 1/2 way. 4 inch step up
And sideways and then heel slides massage stim and ice
I did walk this weekend and got swollen from that too. But I think the strengthening has helped me use my quads and I can alternate feet up and down steps with holding on
I know I'm only 6 weeks out but as all I'm very impatient for the 6 month mark!

 

[analysta]

Hiya, I am 6 weeks out, i.e. July 20. I went back to work at 2 weeks with no assistive equipment, though I was walking slowly and carefully. I was half time for the first day, then full time, and now am back to my usual 10 hour days. I do computer work. I get up and walk once an hour if I can remember to. And there are meetings of course which means walking. I have various things under my desk for various amounts of leg straightening and elevation. Sometimes I go into a conference room that has a couch and lie down for a half hour or so with my legs up, but haven't needed to do that lately. I have an excellent chair (Aeron) that allows me to recline deeply or sit up straight. Adjusting it to a really low position made a big difference when sitting (legs don't dangle) but getting out of such a low chair is a bit of a hassle and I have to grab the desk. In my experience, so far, sitting is much easier on my knees than walking and it's not that much worse than lying down.

At the end of Friday my knees are more swollen than at the end of Monday but I take it real easy Friday night. Recumbent bike is a godsend; I do it 10 minutes morning and evening (zero resistance) and am convinced it makes a difference; it gets the lymph and blood moving.

 

[Dearjr]

So you really are my contemporary. Same time of surgery !
I went back at 3 weeks and am a pediatrician so I sit in the room and get up
I also got rid of cane and walk fine. I feel like I limp but people tell me minimal if at all. I guess I just feel it
To go to next room. My knee swells by the time I work for an hour but it gets better when I ice at lunch and after work
My longest day is Monday 930-8 pm lunch to ice and I try 530 also
Still having trouble sleeping. Longest stretch was 3 hours.
What kind of knee did you have
Big incision?

What kind of pt do u do?

 

[PolarBear60]

I'll be at 19 weeks on Tuesday. Squat work in water works very well and helps tremendously with reducing sit-to-stand pain. The 10 minutes or so on the recumbent bike are a good idea to help loosen you up in the morning.

 

[Dearjr]

@PolarBear60 my os said by 6 months I should feel good with the knee. In the meantime I call it discomfort. It's not real pain but stiffness and that darn band. I can sit and stand well without discomfort unless I am sitting a while. I enjoy the pool therapy
I like my bike too
I'm going to try my elliptical It is good for the knee as I bought one which has a nice glide instead of stepping

 

[analysta]

yep we are practically twins, dearjr.

People tell me I walk normally (to their eyes) but my PT says I don't. I definitely feel like I have to re-learn walking --- use the knees, use the heels, swing the hips a little. All are things that I quit doing long ago. I wish the PT people had systems like those used to analyze golf swings so they could show me that I'm not leading with my knee enough or whatever. An overlooked business opportunity for somebody.

Because I had both knees done, I don't limp, I just go slow. Or, the limps are cancelling each other out, or something.

I had a Visionaire implant which is pretty cool (see my home thread) and my surgery took only 45 minutes per knee, which I'm starting to understand is really short. I am convinced that has made a big difference post-op. My incision is 6 inches; I think that's average. No staples, just glue. And the patella didn't need work, which I also think has helped.

I sleep really well thanks to the vicodin (I think) but my med alarm wakes me up very 4 hours (currently 5 hours) so sleep gets broken up, but I fall asleep again quickly because the alarm happens before the pain starts to get bad enough to keep me awake. In the last three weeks, not once has pain woken me up except for when I tried experimenting with a half dose. Big mistake, that was.

For PT, the exercises change constantly; they really mix it up at my PT place. Right now there's a lot of stretching because they think my gait indicates tight calves and achilles tendons. They don't do the exercycle because they know I do it at home. The most important part of PT IMHO is the first half of the hour which is manual stuff - massage, deep massage, and other stuff I don't have a name for. The PT is awesome at identifying pressure points and working them out individually, and pushing on the patella to make it move more. It hurts at the time but 36 hours later that particular point of pain is gone, gone, gone. So I'm a believer now. They do NOT push me to the point of pain for any of the stretches or strengthening exercises, however.

 

[Dearjr]

I still have my left knee to do. It was better than right knee. I had rom in right of 85. Now I have 116. Left is somewhere around 110
Never had real pain in it. Just discomfort and couldn't walk up or down steps alternating or ride a bike
Now I could! Even though it doesn't move freely yet...do you have that feeling
I don't know why I wake up at night. I don't feel pain but maybe turning Over and feeling the hypersensitive side of my knee. The other side is still numb. I only take Motrin at times now. I have a seven to 8 inch scar and had 32 staples. I think my surgery was an 1 1/2 and I had a smith and nephew legion put. Yours is smith and nephew too

My pt does some massage at the end like 10 mins scar and knee and flex
I get a new pt fresh out of school this thursday. I saw her a week ago and she pushed my knee back and it hurt. I have to teach her to be gentle

 

[analysta]

I absolutely have "that feeling" though if I understand you right I had more pre-op pain than you, lots more. There's pain now, but it is a completely different pain from the bone-on-bone pain. I remember the first time I stood up in the hospital - THAT KIND OF PAIN WAS GONE - WOW! I know I am going to get through the current stiffness and swelling pain and back to things I used to do.

New PT fresh out of school .... hm. No offense to them, but experience counts a lot in their field, from the point of view of us patients. I hope she has fresh new ideas to counteract the lack of experience.

 

[Dearjr]

Maybe what I call discomfort is what others say is pain. I can move better and can sit better although if I flex too much I feel pulling. I can't wait for the free feeling to come!

I'll let you know if I can mold my new pt. She is very sweet though. Sometimes new ones want to impress and spend mor time with you! I hope that happens to me

 

[analysta]

Yes if you get to her early enough in her career maybe you can steer her toward the kind side and away from the cynical, the-heck-with-the-patient's-feelings side.

I think what you're describing is discomfort and you're lucky and getting off easy. I think I experience the whole gamut and pain ... is pain. I do think there are people who can't even tolerate what you and I call discomfort, though.

 

[PolarBear60]

I call it discomfort too, even though it's a type of pain. To me, discomfort illustrates a level of pain. For me, it's in the 1-3 range. Usually 1-2.