Diane's Knee Quest finally the real deal

[dianehelen]

Hi wonderful, smart, strong , caring, supportive Bonesmarties!

I have been learning, ranting, reading and venting on the forum for over 2 years. I had a nightmare of a hip replacement, and its taken me 2 years to get over the fear of another joint replacement. But as many have gone before me, have said, you KNOW when you get to that place, where , as one member put it so eloquently, "your world is shrinking" from what you are limited to because of the pain, I have been on a quest these last 6 months to start changing that.

I have another pre op thread, but @Celle has graciously said I can start another one, to begin my real countown in earnest, after my sometimes exhausting, always frustrating, and sometimes shocking search for an OS I feel good about. (you can read about it, if you have not, or want to in the link in my signature below)

Well that has FINALLY happened. My surgery is scheduled for August 17 2016 with a very good OS. I am still very scared and apprehensive, but feel this is what I must do. I'm attaching what my left knee looks like, any comments or additional explanations, other than what the doc said, are welcome

And now for my first, of probably many questions. One of the things in the booklet the office gave me was some pre surgery exercises to start doing, to whatever degree I can. Have any of you been given theses or similar exercises to strengthen lower body/legs prior to surgery? And if you did, did you feel it helped any in your recovery?

I am attaching the image of these excercises

And lastly, something I know will be discussed in detail, and that is what seems to be a common disconnect between the doctors and PT people, and those of you IN THE TRENCHES that have gone both routes. The minimal or less PT . It seems to make logical sense to me to NOT overwork a newly injured knee, and several of you seemed to have done just fine with little or no PT. How do you go about convincing the doctors and PT that this is the path you choose? I know this will come up as I get closer and just want to prepare myself best I can.

ok, enough going on from me for now...

Once again, I appreciate this forum so very much and look forward to continuing my journey from pain, to more pain, but eventually to less pain, and more life.

 

[Celle]

Hi again, @dianehelen
I can see from your X-Rays that you knee needs replacing. @Josephine may choose to comment further.

I was fortunate that both the surgeons I had for my knee replacements believed in the gentle approach to recovery, so I didn't have to convince them. That gentle way worked for me each time. It makes sense to me, too.

I guess when it comes down to it, what happens to your knee is your choice, so possibly the best approach is to do it your way and politely tell your surgeon (if he asks) that you would like to try it your way for a while. There isn't much point in trying to convince him.

 

[Gigi32]

My OS had me do the heel slides and knee extension exercise pre-op. I also was encouraged to ride the bike to increase flexibility. These were the same exercises I did when I came home. I never had any formal PT, but that's the way my OS prefers it. I would see the PT in his office who would measure flexion and extension when I went for checkups and I got good ROM within 4 months on both knees. I would think it would be your choice as to whether you have formal PT or not. You certainly have the right to let a PT know what you're willing to do or not do. So, not accepting PT doesn't mean you do NOTHING. Everything you need to do can be done on your own at your own pace. As others have said, just going about your normal daily activities (after the first few weeks) will allow your knee to resume normal ROM.

 

[Josephine]

How do you go about convincing the doctors and PT that this is the path you choose?

You will never convince them you are right as they are entrenched in their own thinking. However, the trick is not to discuss it with them in depth. Just say no and mean it. If pressed, say you'll give it some thought!

I was pretty much left to my own devises so never had to do that battle. I did, however, tell my surgeon at my 6 week follow up, when he was expressing delight over my excellent ROM, that I had done no exercising whatsoever and he never batted an eyelid!

I know it's going to be tough and you might have some contests but remember this - it's your choice and you have an absolute right to make that choice. They have no right to force it upon you if that's not what you want.

 

[dianehelen]

Hi again, @dianehelen
I can see from your X-Rays that you knee needs replacing.

heehee ya think??? Thats why Im doing this now. The pain from this has severely impinged on my quality of life.

Thank all for the great and gentle ways to approach PT. I like @Josephine idea of smile and sorta say yes, but do what you want

 

[newlybionic]

When told by PT to do exercises so many times a day I just smiled and only did what I wanted to. They all thought how well a job they were doing because I was progressing so well. Fortunately my home PT as very gentle this time but in the past I have cancelled sessions when I didn't want to have them come. I won't do anything in PT that hurts.

 

[Josephine]

I like Josephine, idea of smile and sorta say yes, but do what you want

You got it!

 

[PolarBear60]

Even though the VA would not refer me to orthopedics for what so obviously needed doing, they would refer me to PT, who with only a look at my X-rays before meeting me marveled that I was walking under my own power into their area. He gave me exercises similar to what you posted and suggested just what your's suggested -- if I could do some of these before surgery (the VA PT understood I had civilian options, and he assured me they would love to get a hold of my knee, because the need was so obvious), it would help me afterward. I did the exercises, and I did feel some benefit from them. He also prescribed offloader braces, which helped prior to surgery.

In my case, my OS was not hard over on PT, but he uses a PT office that practices a reasonably gentle approach. At least, their philosophy is, "If it hurts, don't do it." I don't think my OS would have cared if I went or not. I did choose to go, because I felt they helped me with areas I was concerned about.

Josephine's suggestion to not engage them in things you don't want to get confrontational about is ideal. A non-commital answer acknowledging what they are asking you to do is fine. Or, as a mentor once told me when I worked for a difficult boss, "Yes, Sir" is an acknowledgement, not an agreement."

I tended to do many of the exercises assigned, but I spread them throughout the day and did just a few at a time. You'll find what works best for you. Always listen to your knee. It really will tell you what it needs.

 

[dianehelen]

Thank you so much @PolarBear60 , that's encouraging to hear some prep exercises can help. I have been trying to do some a few times each day

I also swim a mile 3 times a week, in fact just got back from todays swim with my swim buddy. I am trying to concentrate on some scissor kicks and other kicking during my swim that may seem helpful. Does this make sense, can doing some of this in water seem beneficial?

 

[PolarBear60]

You're way ahead of me with swimming. My PT folks didn't have a pool available to them, but when I arranged with a local motel to use their pool a couple times a week in the morning last summer, my PT folks were enthusiastic in their support and gave me a list of about ten exercises to do on my own. I got water resistant Bluetooth headphones, found an album on my phone that ran for an hour, and changed exercises with every song. (Warning, this may be more strenuous than some people would like. Listen to your knee).

I'm not sure what to recommend regarding kicking for you. Swimming was recommended for me way back in the mid-80s, but even back then kicking hurt too much, so swimming has never been an exercise that worked for me. If you feel it's helping you and it's not too painful to do, go for it. Toward the end of my stint with pool exercises, I was able to tread water with some light leg action, so maybe this year kicking will be available to me for the first time in my adult life.

 

[dianehelen]

@PolarBear60 I have been swimming for exercise for a few years, since its about the only exercise I can do with my crummy knees. I have a membership at a gym and go with a friend who is also physically challenged from having polio as a child and its the only exercise she can do too, we are a good team. I also have a waterproof mp3 player with headphones, and I could not swim for 2 hours without music. I swim with a mask and snorkel and I have about 400 songs and they just play in order, and it really just takes me away. I LOVE music and all my favorites are on it.

As for kicking, or anything in the water, its the only place I feel normal, and not in pain. I do a gentle flutter kick, and just glide thru the water, like Shamu ;)

Were you doing this after your knee replacement, or before in prep for it. My surgery is in August, and I have been swimming for a while. Just trying to add to my swim, some extra quad strengthening

Do you recall what the exercises were that they gave you to do in the water?

 

[PolarBear60]

Diane, I did my water work after my knee. I hadn't considered being able to do it, because the local public pool didn't have any special hours where kids wouldn't be playing, and I didn't want to drive 40 miles to the town that did have pool hours like that. Then my husband suggested I check with the two local motels which have pools to see if they had any options available. I figured I had nothing to lose, checked with one, and the owner said before noon for $5 a day. That seemed fair to me, so that's what I did. I met a couple other ladies rehabbing, too, but their approach was much more relaxed and more social than mine, so I timed my work to be finishing up when they arrived, so I could be social for a few minutes, but my work out was done.

 

[PolarBear60]

Diane, this is from page 20 of my recovery thread:

It's a standard selection of exercises from the PT Exercise Vault (I don't know what it's really called, but everyone seems to have access to the same source.)

Exercise Name, Common Name (Description)

These are done in neck deep water for about 10% of body weight or chest deep water for about 25% of body weight

Gait -1, Forward Walk
Gait -2, Backward Walk
Gait -3, Side Step
Gait -4, Grapevine Walk (Cross one leg in front, bring back leg out to side, then cross first leg behind the other and front leg out to the side)
Gait -6, March
Gait -9 Toe Walk
Gait -8, Heel Walk
Gait -16, Heel to Buttock, Knee to Chest (My heel gets nowhere near my buttock!)
Gait -15, Kick (Lift one leg, bending knee to right angle. Straighten knee. Lower leg.)

These are done in waist deep water for about 50% of body weight.

Lower Body -7, Hip Horizontal Abduction / Adduction, Knee Straight ( Lift right leg forward to comfortable height, knee straight. Move same leg out to side, then back to midline. Alternate on other leg.)
Lower Body -8, Hip Lateral Abduction / Adduction to Midline (Lift right leg out to side. Keep knee straight. Pull leg down to start. Alternate on other leg.)

Lower Body -17, Squat (The photo shows this at chest height. I do it at waist height or lower.)
Upper Extremity Pattern -3, Breaststroke (Straighten arms in front of body at chest level, thumbs down. Pull arms apart and out from midline. Bend elbows and move hands to chest, thumbs down.) My PT said I didn't need to do these, but I like the total body aspect of it, and it's a good, relaxing cool down for the lower body.

These are also on the printout, but I don't do them.

Lower Body -24, Toe/Heel Raise
Total Body Movement -2, Lunge to Side
Total Body Movement -1, Lunge Forward
Gait -- Racewalking

If you need the instructions for any of these, just ask. I included them when I thought it might not be clear, but what's clear to me may not be clear to you. Some of these I won't do on dry land, but find them helpful in the water.

 

[dianehelen]

wow thank you @PolarBear60 I may try some of these

Didnt you have an LA Fitness near you to join, instead of going to a motel? its indoors and open and available all the time, and is like 25 bucks a month.

If I did not have access to water, Id be lost. Have always felt at home in water, and now with my age and bad joints, its really the only place I can move, other than getting in and out of my chair or bed at home after watching way too much tv ;)

 

[PolarBear60]

I live in a small town of less than 6000. If I need a fitness center, I have all I need personally owned. I just don't own a swimming pool (nor do I want one). We have two grocery stores, two motels, a couple of high-priced gas station/convenience stores, a Pizza Hut, two fried chicken places, a Dairy Queen, a Sonic, and a half dozen Mexican restaurants. We are big time with both a Family Dollar and a Dollar General as well as a CVS drug store. The closest Walmart is 15 miles away. Everything else is 45 miles away (in a different direction). I have a veterinarian near by (with 10 cats, that's important), but all my medical is 45 miles away.

 

[dianehelen]

So I need to share a few thoughts and get some more ( I know it sounds like a broken record) encouragement from this community about the "Bonesmart Mantra for Knee Replacement Recovery"

I have 3 good friends who have undergone either 1 or 2 TKR's. And every time I try to discuss what I learn here they try their best to negate it. My one really good friend who actually is a retired trauma nurse, had both knees done 6 weeks apart, and keeps telling me how critical PT is, and even if it hurts, to keep doing it, or you wont heal and recover well. She also tells me ice is only good for short periods of time as it stops blood flow, and can increase healing time. Lastly she tells me sitting for long periods in a recliner is not good, even if elevated. UGHH It just infuriates me and worries me. I mean she DID eventually recover and do ok, but I really do NOT want to have to endure more pain than this is already going to give me. I have seen over and over on here that those who follow the "mantra" really DO seem to do better. How can I combat this constant negativity toward that from someone who is not only a good friend, who has gone thru knee replacements, but is a medical person?

My other friend had one knee done, and needs the other done, but says the pain and PT were too much to bear and she is putting off the other one. I try to tell her to come here and read that there is a different/better way, but she is not a computer person much, and is of the old school, of believing whatever the doctor or PT person says, is the best (only) way.

My third friend , had her knees done by the wierd doc,. who I was not comfortable with, but she says her recovery was remarkable, from the so called special way he does the surgery. Im writing her opinion off for now.

Also, I have a question for @Josephine about the photos in the articles about elevation. Where can one find that foam wedge that has the sorta wave, which was indicated for a correct elevation. All I can find is the straight incline or the one with the angle to it.

I know Im still over 2 months out, but I really want to be as prepared as I can before the time comes

Thanks all

 

[dianehelen]

@Josephine would this be a good/correct device for post surgery elevation?

http://tinyurl.com/Elevationfoam

 

[newlybionic]

You can get that wedge from a medical supply store.

As for the nurse, I went to nursing school quite a number of years ago and that was what was taught then. A lot of OS were also taught that in their training. Since no medical trials have been completed and published they will probably keep the old school teachings until they can see something to change that. Going into my TKR I was under the same impression that they were but I have found with my two surgeries that the bonesmart way has produced a much better outcome and I will tell my OS that so maybe he will see their are other ways to have a full recovery without excessive pain.

 

[dianehelen]

@newlybionic Do you think there would be any merit in printing out some of the stories and recoveries here as well as the articles, and showing them to my surgeon?

Also, now that I am looking more.. I see quite a few around for less, like this one:

http://tinyurl.com/elevation2foam

 

[Josephine]

That pillow will be okay so long as you realise that you will only need it for 2-3 weeks at the most. If you'd bought it before surgery it would have been more worthwhile but now I think it's just better to stick with the pillow stack.

As for printing stuff off and showing it to your surgeon, well you can if you like but you will very likely only get a lecture the same as you got from the nurse 'friend'. Their minds are set and you won't ever convince them otherwise. They really believe what they are saying so I really would bother or run that risk. If anyone else tries to lecture you a) just don't tell them about BoneSmart and b) just turn a deaf year to their outmoded lectures!

You should read this post from Suz

I was extremely apprehensive about jumping the PT ship. All of the symptoms it left me suffering through convinced me to give Josephine's advice a try.

I am only 8-days ahead of you in my RTKR and my swelling has decreased quite a bit since locking myself into the recovery advice here on the forum. From the information I studied on bonesmart, I dismissed all PT 4wks ago. I now let my knee determine what it does each day. Which isn't much more than motivating around my house! My surgery knee is not too far from being the same size as my non-surgery knee! That certainly wasn't the case 4wks ago when I was being swallowed up in PT pain!

Interestingly, I'm walking off from my recliner without my cane 70% of the time. I just forget to grab it- that's how flexible my knee has become!

I share these accomplishments to hopefully encourage you that the advice you are getting from the veterans of this forum is sound! I haven't had narcotic pain meds in 4wks either- not by choice- my surgeon recently decided his patients would be just fine post-op on anti-inflammatorys. Had I not had this site- I would have probably been looking pain meds on the street- I was in so much raw pain-!! Just kidding about that- but Josephine advised me on an alternative to the narcotics (I needed)- and once again, her advice was spot on!

Spend as much time as you can reading in the recovery journals here- or the excellent articles they have in their library. Because of the information I found here- I am now not only seeing the light at the end of the tunnel- I'm feeling it as well!