TKR Fall during exercise session

[Jamie]

Long-term therapy can be mentally draining, so your feelings are understandable. Why don’t you talk to your therapist (assuming you like them) and let them know how you feel. Tell them you’d like to take a bread and to give you some specific stretching exercises to help increase your ROM that you can do at home. Then take a few months to see how you do. You can always get another order for PT from your surgeon or your GP and go back if you feel that would be more beneficial. But I suspect that at this point you know what will help your body. It is possible to get additional ROM for even a couple of years after surgery.

Not being able to do stairs well if pretty normal. It’s one of the things that certainly can take a year or more. But you also mentioned your gait not being the best. If it’s just needing to walk slower for now, that’s okay. But if you’re actually limping as you walk, that’s another matter and you may need to continue your therapy after a little break to help with that.

 

[benne68]

my ROM seems stuck at 105--though my PT before the current one said that 105 would suffice for most activities of daily life.

That is true. Here are the degrees of flexion required for some common daily activities:
- 65° to walk,
- 70° to lift an object from the floor,
- 85° for stair climbing,
- 95° for comfortable sitting and standing
- 105° for tying shoelaces

That said, keep in mind that those ROM "measurements" are not very accurate. Because of the tool itself, there is a lot of room for human error, which is why it's better to focus on function.

 

[Jockette]

That said, keep in mind that those ROM "measurements" are not very accurate. Because of the tool itself, there is a lot of room for human error, which is why it's better to focus on function.

I agree, and yet, that inaccurate/due to human error tool, carries so much authority as to how our recovery is progressing.

 

[FraidyCat]

Any thoughts on the essentiality (or lack thereof) of bike exercise would be welcome.

I never did any bike exercises or formal PT- just regular pilates and my ROM is excellent.

I've met/heard of others who also didn't do PT and did fine without it. Leads me to wonder whether I've wasted a lot of time (not to mention money) on PT. Pilates isn't something I've any firsthand acquaintance with. I think one of my friends did it, though not post-TKR.

 

[FraidyCat]

I typed a reply to your message and then it seemed to disappear. Will try again:

I've met/heard of a few others who didn't do PT but still did fine. Makes me wonder if I've wasted a lot of time (not to mention money) with it. Re: Pilates, I've no firsthand acquaintance with it, nor have any of my PTs, or the surgeon/his staff, ever suggested it. Are you in UK? It may be less popular in the US.

 

[FraidyCat]

I bought a bike on FB Marketplace for $35. It's an upright, because that was what I was looking for, but I'm pretty sure there were recumbent bikes too. It's very basic, and it's all I need. It's a gamechanger having it in your house.

I've racked my brains as to where in my house I could put recumbent bike but haven't succeeded in identifying anywhere as of yet.

 

[benne68]

I can see your first post to EalingGran, @FraidyCat. You might want to try refreshing your page and looking again, then delete one so it's not here twice.

 

[FraidyCat]

The bike is simply a tool you can opt to add to your toolkit.
To increase ROM, you would want to set both the seat and youself in such a way that it's actually your knees, not your hips, that are doing most of the flexing. May take some trial and error to find the right seat/pedal distance.

Are you doing seated heel slides? I always recommend doing them VERY slowly, in time with slow deep breathing and maximum possible relaxation (You might warm up the quads with a short walk first as you want them to really relax into a slow stretch with the heel slide).

Do a few within your current comfort zone. Then go just into the gray area of discomfort, not pain, continuing slow deep breathing and relaxing into it for 5 seconds. Only do four or five reps into discomfort.

Doing it this low stress way you could easily do it three x day.

I'll ask my PT about the heel slides. Thanks for the suggestion.

 

[mendogal]

Pilates has been very popular in the USA for around 20 years as a movement based technique for developing core strength. Before that it was mostly used by dancers and others whose professional work benefited from it.

 

[benne68]

Hi @FraidyCat

Checking in to see how you are doing. Let us know.

 

[FraidyCat]

Any thoughts on the essentiality (or lack thereof) of bike exercise would be welcome.

I never did any bike exercises or formal PT- just regular pilates and my ROM is excellent.

Hi @FraidyCat

Checking in to see how you are doing. Let us know.

Thank you. I think my new PT, at the third PT outpatient facility I've been to since October, may be helping more than the two previous ones. The facility is connected to a gym that has many machines, including a recumbent bike and a leg press. She also has me practicing balancing. She's very young and earnest; my immediately previous PT seemed kind of burnt-out, and the one before her was demoralized because the hospital was relocating almost the entire department to a location that she wouldn't be able to access without a car. The new PT is also proactively communicating with my health-club trainer.

 

[Layla]

Sounds like the new PT is a good match for you, FraidyCat.
Fingers crossed you're able to work together as a team and you make the progress you're hoping for.
Happy Weekend!
@FraidyCat

 

[mendogal]

Good news @FraidyCat !

I am going to make a suggestion for after you're successfully discharged from PT and continuing at the gym.

Many exercise routines and yoga are shown to improve "measures of balance" in PT labs. However Tai Chi is the one that was demonstrated to reduce the incidence of falls by seniors in the community.

I remember when the original study done in Australia was published many many years ago. There's now been so many studies and they point to a major reduction in fall rates, especially with Yang style Tai Chi.

I have been practicing for eight years and love it! It's like a moving meditation.

 

[Jamie]

When I worked for the Marine Corps many years ago, they were using Tai Chi for the Marines to stay in condition and gain strength and focus. The Marines kind of made fun of it at the beginning (you know….tough guys need to run lots and lift heavy weights!), but they became believers after a few months of the training.

 

[FraidyCat]

Good news @FraidyCat !

I am going to make a suggestion for after you're successfully discharged from PT and continuing at the gym.

Many exercise routines and yoga are shown to improve "measures of balance" in PT labs. However Tai Chi is the one that was demonstrated to reduce the incidence of falls by seniors in the community.

I remember when the original study done in Australia was published many many years ago. There's now been so many studies and they point to a major reduction in fall rates, especially with Yang style Tai Chi.

I have been practicing for eight years and love it! It's like a moving meditation.

I appreciate the suggestion. However, I tried Tai Chi some years ago and thought I was going to lose my mind with boredom--it's just not my thing. Granted the instructor had too large of a class, so wasn't able to give participants the attention they needed, but in my case I'm not sure it would have made a difference.

 

[FraidyCat]

Sounds like the new PT is a good match for you, FraidyCat.
Fingers crossed you're able to work together as a team and you make the progress you're hoping for.
Happy Weekend!
@FraidyCat

I've now been going to the new PT for a month and not sure if I'm making progress. The PT's theory is that my slow progress with stair-climbing and being able to walk farther and longer without discomfort is due to weakness of the quad and hamstring muscles. However, in my last few sessions with her, and with my personal trainer at the gym, with whom she's communicated, my knee cap and hip-crease area have developed a mild but persistent throbbing that I didn't have before. They both keep telling me this soreness is not only OK but somehow a sign that muscles are being "awakened" and that this is a good thing. It feels as though, in trying to alleviate one form of discomfort, I've acquired another. Perhaps too many repetitions? In a couple of cases, three sets of 15 reps. And alternating treadmill speeds from faster to slower, to the point that it feels like I'm struggling to keep up, though objectively speaking the the higher speed isn't particularly high.

 

[benne68]

It feels as though, in trying to alleviate one form of discomfort, I've acquired another.

I think this is a common experience. I can tell you that it happened to me.. After working on exercises for my glutes, I developed pain in my hamstring! My PT changed my exercises, noting that, as one set of muscles get stronger, the weakness in other muscles becomes more apparent. Then, as we worked on the hamstring, my quad started to hurt. It seemed never ending, but I did improve with time.

That said, if something continues to cause you pain, you should back off that exercise for a few days. When you go back it, do fewer reps. My experience has been that building up to a new exercise a little at a time, slowly, over several weeks let me achieve my goals without pain.

Slow and steady. And remember that this recovery takes a full year.

 

[Layla]

Hello and Happy Sunday!
Your quads may still be rebuilding strength. If there is any swelling or stiffness, that may be a hinderance and both can last for a full year, normally easing over time. There is a fine balance between doing too much before you're ready, which can cause setbacks, and not doing enough can slow progress. Please let them know when you're struggling and see if you're able to modify your routine. Easy Does It and a good measure of Patience will get you there.
I hope you have a good week, FraidyCat.
@FraidyCat

 

[mendogal]

I've never heard of kneecap pain as a sign of muscle reactivation.
It's possible that in working your quads this regimen is overstressing the patellar tendon, which is connected to the quadriceps tendon.
You might ask them specifically. Them examining the angle and possible turning in or out of your hip and/or knee and/or foot during exercise may reveal a needed adjustment in how you do the quads exercises.

 

[benne68]

Checking in to see how you are feeling this week, @FraidyCat. Please give us an update when you have a chance.