TKR Desperately seeking ways to improve flexion after week 12

[karwask]

Hi All,

June 24, 2025 RTKR was a great success with early healing, pain and swelling under control pretty quickly.

Since then I have regained almost all my extension but I'm struggling to meet my flexion goals. I need to be able to get back into the cockpit of my kayak, and I'm a long time rower, among other things. In order to be able to do these things, and get my life back, I calculate that I need to get to at least 130 flexion. I'm still doing PT and when they measure me, so far maybe I can get to 120, the goal for this week is to get to 125 and I don't know yet. I've been very diligent with my PT at home, basically hurting myself three times a day everyday since just after surgery. I have found after trying many different things that heel slides with a strap is the most effective thing to try to make progress.

I know the emphasis of this group is not to focus so much on the numbers and not to let PT hurt you and the idea that you can continue to gain progress for a long period of time not just in the 12 week window that is often referred to.

With that said, at this moment in time, I am not meeting my own goals and I consider myself to be essentially crippled if I don't make additional progress, being worse off than I was prior to surgery which is a terrifying idea.

So, I'm looking for very specific advice if anyone has it? As much as I understand, in order to continue to improve my flexion, I must do something to push against restricted tissue. I don't think there's any way around this but I'd love to hear a contrary opinion if there is one. So doing things like being in a pool, or doing particular exercises like leg presses, or walking, or even getting on a bicycle which I do three times a day every day to warm up, and a whole assortment of things are all wonderful and great and part of recovery but none of those things will push against the restricted issue to help me improve flexion.

So far the PT's that I'm working with don't seem to be in favor of doing deep tissue massage things or massage guns or anything like that but I will ask them about it. I think their point of view is that it's not especially effective. If anyone here has experienced the contrary I'd love to hear more about it.

So as best as I can tell, the only thing that can make a difference and it is getting later in the recovery process, is to push harder against that restricted tissue and in that respect hurt myself more or let the PTS do it to me and let them hurt me more. Or undergo an MUA which I'm not interested in and has very mixed results as best as I can understand.

So, again, if anyone has any insight specifically about finding ways to make flexion improvements pushing against the restricted tissue, please let me know.

Thanks so much for your consideration.

Karen

 

[Jockette]

In order to be able to do these things, and get my life back, I calculate that I need to get to at least 130 flexion. I'm still doing PT and when they measure me, so far maybe I can get to 120, the goal for this week is to get to 125

I’m afraid you have misunderstood the healing process after a TKR. We cannot set a goal of a certain ROM number for a certain date. Our knee does not heal on our schedule, it has a schedule of it’s own. The best thing for our peace of mind is to accept that.

You are 3 months into a recovery that can take a year or more. Give your knee some grace and time. You may have to wait until next summer to really enjoy your kayak.

I've been very diligent with my PT at home, basically hurting myself three times a day everyday since just after surgery.

This is not a wise way to rehab your knee. I’m actually surprised that you have a ROM of 120, doing this every day.

Read the following article, I hope it will help you reset your expectations.

https://bonesmart.org/forum/threads/tkrs-and-our-fast-food-society.6427/

 

[mendogal]

Our bodies don't really care about our personal priorities and heal on their own time.

There's nothing to suggest you have scar tissue, which is what an MUA addresses. It won't do anything to a slowly healing knee except massively traumatize it.

Please just have patience and trust your body.
The "window of opportunity" is a myth. Here's why.

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[benne68]

As much as I understand, in order to continue to improve my flexion, I must do something to push against restricted tissue.

So as best as I can tell, the only thing that can make a difference and it is getting later in the recovery process, is to push harder against that restricted tissue and in that respect hurt myself more or let the PTS do it to me and let them hurt me more.

Oh my goodness, this is not the way to recover from knee surgery. Someone has been giving you terrible advice.

You are barely even 3 months into this year-long recovery. The fact that you are already at 120-degree bend is excellent and bodes well for full recovery. (As you can see from Mendogal's post, some people take much longer.)

However, the soft tissues in your leg have only just recovered from the trauma of surgery (it takes 12 weeks -- at least.) If you have been pushing and pushing, you've caused swelling INSIDE the knee (even if you don't see it on the outside). Your knee is not going to bend any further until the swelling goes down -- and, continuing to push is likely to make the swelling worse.

You cannot rush this recovery. Please go back and read through the advice our staff has shared with you. The best thing you can do for your recovery is to take a step back and give your body more time to heal.

 

[Jamie]

I really want to caution you on your approach to your recovery. Continuing to push your knee past the light pain point on a continuing basis can result in Chronic Regional Pain Syndrome (CRPS) which actually could cause you to have long term or permanent pain in your knee. We’ve had a few members who suffered from CRPS and, believe me, you do not want to go down that path.

I’m not sure where you got the idea that there is a “12 week window” for recovery, but this is just not true. Yes, your incision can heal in that time, but there is a LOT more to healing than that. And it involves a commitment from you to observe the one year time frame that just about any surgeon will tell you is the case.

When you push into the “hurting” stage, your body is telling you it is being injured. This does you no good and most of the time results in inflammation and swelling. Even if you’re not seeing swelling in your knee, it is internal and continues every time you push like this. Please stop pushing yourself so hard. Take to heart that your body is trying to heal on its own schedule which you cannot control. You cannot rush your body. You can only delay improvements by continuing to punish it this way.

The “one year” recovery guideline is real. I suggest you focus on more gentle movements for your exercises such as heel slides just to mild discomfort and water walking in a pool. Cycling is also good since yiu have access to a bike. Even those should not be done to excess. Once a day is fine. Then just go about your normal activities the rest of the day. The idea is just to keep your knee fluid and moving, not push to pain or beyond.

The suggestion that you wait until next summer to kayak is a reasonable goal. Pushing yourself to try and do that now is not. Likewise, your feelings that you should try deep massage or a therapy gun are not good ones. It’s a good thing your PT has declined to do that for you.

You’ve been lucky to attain the ROM you have with all you’ve been doing. Please now realize that a year recovery is reality and treat your knee more kindly in the coming months. As you say, your current approach has not given you the result you thought you would have. It’s time to do things differently and I seriously hope you give the suggestions we’ve provided a try for at least a couple of months and see if you don’t experience some gradual improvements.

 

[EalingGran]

I've been very diligent with my PT at home, basically hurting myself three times a day everyday since just after surgery. I have found after trying many different things that heel slides with a strap is the most effective thing to try to make progress.

I really think that hurting yourself three times a day ; or even once a day is counterproductive.
It leads to swelling, even if it is not that visible, and inflammation which will ultimately lead to more stiffness.
I never pushed to pain. If it hurt I stopped.
I gained flexion for many months with a gentle pilates based approach and lots of walking.
I think I even gained a few degrees, from 140 degrees back to 150 degrees after my first year. The only things I can't do now on my operated leg are to hold my ankle in a standing quad stretch and to sit with my full weight back in child's pose.
Be kind to yourself and try to be patient.

 

[karwask]

Hi everyone. Thank you so much for your patience and taking the time to so diligently explain to me, once again, another way of looking at this.

I would love more than anything else to believe that if I just continue to do gentle stretching over the long period of time it will all work out. I'm perfectly happy to wait until next year to get back in the kayak not an issue.

Thanks so much for the specifics of examples of progress of particular people. I wish I knew a little bit more about exactly what protocol they used if they were not pushing against tissue so much as I thought was what would be necessary for continued progress. Just to say the tissue is so restricted as it is it's so difficult for me to believe that doing anything gentle over a long period of time would make a difference.

If anyone can share a little more about that, it would be most helpful.

I would be a really happy camper if I can just settle in and do a more gentle version of what I've been doing and can trust that things will work out in the end. As it is, with all the emphasis on gaining range of motion, the PTs have been very specific and not doing anything to address strength so that whole area of focus has been completely ignored which is certainly not helping my overall recovery. For example I am not even close to being able to walk up and down stairs and it will be quite a while given that that has not been the focus to date.

Okay, thanks again so much everybody for taking the time to weigh in and again for being patient with me. Much appreciated.

 

[Jamie]

Stairs can take a long time to do foot over foot, so try not to worry about that right now. It would be okay as part of your gentle exercises to do some squats with a chair. That exercise works the quads enough to start gaining a little strength.

The restriction in you knee right now is one of two things - adhesions (which are not common and you likely don’t have) and internal swelling (which is much more likely given how hard you’ve been pushing your knee). When you have internal inflammation from overdoing things, your very small knee compartment has fluid that must be removed by your body before you can realize the ROM that is there. Think of how easy it is to bend a hose if it is empty and how much more difficult this becomes when it’s full of water under pressure. Inflammation for overdoing things signals your body of an injury and its response is to send fluid to the area to help with healing. As the inflamed tissue improves, your body’s lymph system will remove the excess fluid. But the lymph system does not operate quickly. There is no “pump” to get things moving quickly and it depends on muscle movement, gravity, and a series of valves to move excess fluid to your torso area where it is processed out of your body through the kidneys. Sometimes lymphatic massage can help with this, so if you can locate a therapist that could do this for you, it might help…..as long as you’re accompanying this with a scaled down exercise routine that brings you only mild discomfort and no serious pain.

 

[mendogal]

It's not just gentle stretching, though that's good.

Walking, especially practicing a good heel to toe gait, heart and eyes aimed at the horizon, allows the legs to fully work - good for range of motion and starting to strengthen.

Seated heel slides, done very slowly in time to deep slow breathing, are helpful. Take a few within your comfort zone, then go into the uncomfortable zone. It's not a matter of pushing or struggling so much as learning to slowly breathe and relax into the stretch. Hold it for a couple of full breaths, release. Do a few more. Not into pain, but learn to be relaxed in that gray zone of discomfort. (Lessons learned over 20+ years of relaxing into martial arts pins.)

I agree that semi squats at three months are appropriate for both range of motion and getting quads, hanstrings, and glutes better activated. For me it was doing ten minutes of yardwork three times a week - a natural way to semi squat so long as one is as fixated on one's own good structural form as on the weeding or pruning!

Sequential stairs is a challenge from a purely neuromuscular perspective: it's not so much range of motion as balance, strength, and proprioception to negotiate the very complex series of muscle firings required to move in space while continually shifting weight. It can take some of us a while for traumatized nerves and muscles to communicate smoothly enough to accomplish this.

 

[EalingGran]

Take a few within your comfort zone, then go into the uncomfortable zone. It's not a matter of pushing or struggling so much as learning to slowly breathe and relax into the stretch. Hold it for a couple of full breaths, release. Do a few more. Not into pain, but learn to be relaxed in that gray zone of discomfort

This is really the key. It's about listening to your body and not pushing past pain, but breathing into a stretch. And when you get a little progress- not overdoing it.

 

[Layla]

Happy Three Month Anniversary!
Three months in is still really early in the entire scheme of things, even though it probably feels like everything is moving in s-l-o-w motion. The best progress will likely come as you ease off a bit and let your knee settle, rather than pushing it.
Gentle consistent movement, like walking, stretching and light exercise gives your body time to heal and gradually regain strength and flexibility. A slow steady approach will bring the biggest gains in the long run. Trust the process. A great Thursday and weekend to you!
@karwask