TKR Desperately seeking ways to improve flexion after week 12

[karwask]

Thanks so much everyone. I have not yet figured out how to respond to individual people yet so please forgive me.

There's so much insight here and ways of thinking about things that were outside of my thinking that are incredibly helpful.

The idea that I can suggest that they not measure me every time is interesting and something I'll consider. I did not realize the difference between scar tissue and adhesions and having that distinction is helpful. Being reminded that this is the long haul is always helpful pretty much every hour or every day would be good. I do have a protocol for teaching myself to kneel similar to what was suggested here starting on a couch or cushion or something and also it's suggested that I not even start to work on that till down the road which makes good sense to me. Yes, I know that in the end it's painful just because the knee is such a thin skin and there is the scar there and having a pad would be helpful or just doing it for a short period of time. I'm grateful that I only had one knee done so I can always kneel more on the good knee and have that option. Many of my friends had both done at the same time and do not have such an option.

Interesting about Pilates and being able to do so much of it. There were a couple of years there where I was doing reformer pilates three times a week and totally loved it. For sure that's a wonderful way to keep on moving and staying flexible.

Okay, I'll stop there. Thanks again so much everyone for all the help and support. Especially because this is the long haul and it's easy to get tired along the way, having a place to check in that is helpful and supportive is beyond measure.

Karen

 

[EalingGran]

Once you are able to get down on the floor, have a look at my pilates teacher's free classes on YouTube ( Google Katja pilates). The side lying glutes strengthening one is knee friendly with no squats.

 

[benne68]

I have not yet figured out how to respond to individual people

If you would like to reply to someone, just tag them in your post by putting the @ sign in front of their user name (no space), as I've tagged you here:

@karwask

 

[karwask]

@EalingGran

Thanks so much for that Pilates resource. I will take a look. As much as I've been focused pre-surgery on a regular routine of progressive strength training, I would love to add Pilates back in there along the way.

 

[karwask]

Okay folks, a little update today and one really big question.

I had my fourth PT appointment today and it seemed to me that we finally hit the sweet spot. We did some warm up activity which was very helpful, we did do measuring before and after and then ran through my exercises. I felt it did a good job of giving us the insight we need in terms of my progress but at the same time did not make me horrifically sore and it was not horrifically painful. With that said, exploring with the PT about what to expect going forward, yes, the process of gaining flexion and extension is going to push against the edges and will be painful to one degree or another, something I can accept, just not necessary that it be excruciating.

So, my big question at the moment has to do with sleep and the need to keep the knee straight. I checked in with the PT and he confirmed that it's still important, very important, that I try to keep my knee as straight as possible at night. He suggested that not doing so will hinder my ability to eventually get back to full extension.

He admits that this is very difficult. He suggested that lying on my side which is something I have been able to do, is not a good idea because there's no way to do it and keep your legs straight at the same time. I don't mind sleeping on my back but not the whole night through with no relief from that.

So my question for you all is how accurate is this? How shall I think about the necessity to keep my leg straight at night?

Thanks as always for any insight that you all can provide.

 

[Jockette]

The following is taken from the article about elevation from the Bonesmart Recovery Guidelines:

For a KNEE REPLACEMENT, it's also not a good idea to try and elevate with your leg totally straight like this as it stresses the muscles at the back of your knee tremendously, which can cause pain instead of helping it.

You may hear that you should try to keep your legs straight when elevating in order to help with your leg extension. But when you have a swollen, painful leg already, this is not helpful and can be quite uncomfortable, if not torture!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

It is fine to have a slight bend when sleeping, or elevating, which is much more comfortable and will not hinder regaining your extension. It is also fine to sleep on your side if you are able to.

 

[Jamie]

Sorry, but I don’t agree with your therapist. Extended periods of having your leg straight in recovery tend to cause soreness. You’re early in your recovery and you have plenty of time to get full extension. It’s always the last thing to recover, so patience is important.

You can choose what you do about the therapist’s suggestion. If you want to do something different, there is no need to argue with their suggestion. Just smile and nod and do what you prefer. There are some exercises you can do for extension and that way you don’t have to try and sleep in ways that might not allow you to get the good rest you need at night.

 

[EalingGran]

checked in with the PT and he confirmed that it's still important, very important, that I try to keep my knee as straight as possible at night.

suggested that lying on my side which is something I have been able to do, is not a good idea because there's no way to do it and keep your legs straight at the same time

The physio I saw in hospital said something similar. My surgeon was standing behind her and winked at me.
After she left he basically said this was rubbish and the knee did not have to be kept straight at night.
He said to sleep any way that was comfortable and it would be fine.
I slept on my side from fairly early on ( can't remember exactly when).
I used to put a thin pillow out to rest the top knee on as I found it more comfortable to rest the top knee on something. I also used the opened jacket of my Aircast Cryocuff to rest my operated knee on. When I woke in the night I would refresh the iced water.
I also got some zopiclone from my GP for sleep and alternated it with diphenhydramine ( a non prescription sedative antihistamine) to help with sleep in those early weeks.
Sleep is so important for recovery and I definitely wouldn't do anything that made it more uncomfortable and harder to sleep.
I never had any problems with straightening my knee despite sleeping with it slightly bent.

 

[mendogal]

Yet one more voice of reason here. We must sleep when and how we can.

I had excellent early return of range of motion due to having joint laxity but even so I absolutely didn't tolerate lying with my legs extended for several weeks. In fact with my second knee I ended up most nights sleeping with the Lounge Doctor for the first couple of hours before repositioning to just one or two pillows with zero pressure behind the knee.

 

[sistersinhim]

I'll add my 2-cents worth. Sleeping with the leg perfectly straight is definitely not required for you to regain full extension. As Jamie said, it is normal for the extension to lag behind the bend, which is fine. The best way I helped my extension was to walk with a longer stride, with a heel to toe gait. This helps to stretch out those large soft tissues in the back of the knee. If you try this, be sure to have something to hold on to because this can cause you to lose your balance in the early recovery days. This activity really helped me to improve my extension, and without pain, too!

 

[ferddword]

@karwask - we are 4 days apart and seem to be going in parallel with our recovery. Last week (the 3x before he was gentle and did mild exercises) the PT pushed and pulled my knee to get “numbers” which caused increased swelling and pain, I decided to opt out of PT for the near future and just do exercises and daily living on my own. And for sleeping get in where you fit in. I’m with everyone else don’t need to have a straight leg while you’re sleeping.

 

[ferddword]

@karwask - correction we are 2 days apart.

 

[benne68]

I'm another one whose surgeon told me to ignore the PT. His instruction was: "do whatever is most comfortable at night so you can get good restorative sleep."

I slept on my side and let my knee bend into a position of comfort with both of my recoveries -- and I have great extension in both knees.

 

[karwask]

@sistersinhim and everyone else here, thank you thank you thank you thank you thank you thank you. Especially like the attention to the walking gait which is something that PT is having me do and how to utilize that to help progress my extension, very helpful thanks.

Yeah, I so appreciate the specifics and all your input. I did decide that for part of the night I will try to keep my leg straight for a period of time as I can tolerate it but for a good deal the rest of the night I will shift from side to side in order to be comfortable and get a good night's sleep. Also, in sitting in the recliner for a good deal of the day, there are plenty of opportunities to have the leg be straight for periods of time as tolerated.

Also I am now very diligent about doing my exercises three times a day and there's plenty of times in there that we are working on extension so not just sitting around doing nothing.

Once again, I can't thank you all enough for being so helpful and supportive. It's pretty lonely here and hearing all the stuff one here is from all the different places one hears it can be confusing, overwhelming and scary. I like it that at least two of you mentioned the wink, wink, behind the instruction and yeah.

I'm feeling so grateful for the help and support. Let's all just carry on and get on with it then. That's the plan anyway.

I hope you all get a great night's sleep.

Warmly,

Karen

 

[Elf1]

@karwask happy to hear you're going to put your knee however you best can sleep. My doc has been going ok, you need to get totally flat, you need zero and you're at five. I had other injuries resulting in a surgery to that same knee about 8 months prior to my TKR. I've had a little harder time getting to zero but will eventually.

Told Doc I have a habit of laying on my side in bed watching TV and I stretch my leg out as straight as possible and then bring my other foot up to my heel and push the stretch a bit further. Seems to.help.me get a more complete stretch and doesn't hurt. I will tell you that if I sleep for a couple hours or more with keeping my leg perfectly straight I'm going to wake up hurting, and bad! It also gets really stiff and doesn't want to bend, walking can be difficult. I've basically learned to keep a little bend in the knee, which is how I've normally slept my entire life.

 

[Layla]

Karen...you are the sweetest! Always so thankful and full of gratitude.
You'll never be lonely here, so stop by as often as you like to share your progress and allow us to encourage you and cheer you on. Here is a visual of the heel-toe walking as a reminder.

Happy Thursday! I hope it's a good one!
@karwask

 

[karwask]

Hi All,

Just wanted to check in and see what you all might have to say about how it's going now. I'm just starting week 10. I'm still doing physical therapy once a week now.

I'm doing my warm up (stationary bike) and workouts three times a day and doing a few miscellaneous things in addition to that. Most of the focus is still on improving range of motion but we've now added in a little bit for strengthening the quad and starting to work on being able to step up and step down. I am a long way away from being able to walk stairs normally.

I know the philosophy here is that we don't have to rush our recovery and focus too much on the numbers but I feel as if I've stalled and I'm very worried. For the last 3 weeks I've been somewhere in the range of motion of 112 to 115 flexion. Generally speaking, the PT folks like to get people to about 120 just as a normal baseline for functioning. My goal, is to be able to get into my sit inside kayak, be able to row and hike and hoping for as much as 130.

So my concern or question is if I'm continuing to do the same things and not seeming to progress what sorts of things do I need to do to change it up to start to progress again?

I will see my PT on Friday and check in with her and see can offer anything substantial? Is it a matter of frequency, duration, intensity of the exercises I'm doing?

When I called to ask the orthopedic facility if there were any kind of devices that the surgeon might prescribe, (I found the Flexinator online and was curious to see if that's something they might prescribe)and she could hear the frustration in my voice, she started to make noises about manipulation under anesthesia MUA.

I am so not interested in that!

So, as always, any thoughts, insights, and lessons from your own experience about how you progressed, much appreciated.

 

[Jamie]

An MUA is usually not appropriate for someone with 110 degrees of ROM or more. Exercises that gently challenge your knee done on a consistent basis will help you gain more flexion in your knee. But, be aware that it may take a year or more for you to achieve the maximum flex. Your therapist can give you specific exercises that will help you get to where you want to be.

 

[Jockette]

I'm just starting week 10

At “only” 10 weeks post op, you are still very early in this year long recovery. You still have a lot of healing to do, which will increase your ROM, and that takes time.

So, as always, any thoughts, insights, and lessons from your own experience about how you progressed, much appreciated.

Try to relax about your ROM and let your body heal on its own timeframe.

 

[Layla]

I feel as if I've stalled and I'm very worried.

Please don't worry. You're still early into recovery. Hitting plateaus is common. It all takes time and you're doing it right. Be proud of the progress you've made and know there is more to come.