TKR Feel so alone

[Flash1955]

Hi
Can any one help me with the following question please?
When I do my extension exercise (Laying flat with my ankle on a rolled towel or sitting on a chair with my ankle on an opposite chair) I get the most awful pains in the front and side of my knee. When I move my knee from the above positions the pain is even worse, is this normal?
Thanking you in anticipation x

 

[Qdogpa]

Had similar experiences weeks ago, so I would say it is normal...my pains were the kneecap itself, just under and below it...also the inside medial section...

 

[Jockette]

In the beginning of the Bonesmart Recovery Guidelines it says, if it hurts, don’t do it.

You might be doing this extension exercise a bit incorrectly. Here are some tips:
If you want to do exercises, these are the only ones you need:
Extension: how to estimate it and ways to improve it
Heel slides and how to do them properly

Extension can be very slow coming for some of us, so don’t push it. As you heal and whatever swelling you have goes down, your extension will improve. Walking is also very good to encourage it.

 

[Flash1955]

Thank you Jockette. I have looked at the links you sent and I am doing exactly as they say. The extension has never improved from day 1 post op so perhaps the severe pain that I experience when doing these exercises might indicate an underlying problem. I will try and contact the hospital physio dept and request a call back as they are still closed due to Covid. Thank you for your help and advice, this group has helped me so much and made my journey towards recovery much easier

 

[NightQuilter]

Flash, I am just wondering ... as you describe the two extension exercises, it sounds like in both cases the knee itself is not supported. I do recall similar responses in the early days of my recoveries. Could it be that the construction done in those parts of the knee are still healing and may not yet be ready for that level of stretching? Perhaps putting the rolled towel under the knee and working on lifting your foot for now might be less stressful on your knee and would still allow you to more gently strengthen those healing muscles and ligaments before working on stretching them. Just a thought....

 

[Flash1955]

Thank you NightQuilter for the advise, I will try doing the exercise the way you suggested.

 

[Jockette]

At only 2 months post op it’s really too early to worry about, or work at, your extension. I did no extension exercises and mine came along fine, in time.


Regaining our ROM, both flexion and extension, is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

It seems that some surgeons and PTs put too much emphasis on regaining ROM right away, and they forget that each knee is unique and will heal in its own timeframe. Some also believe in a “window of opportunity“ which is not true. My ROM was still improving 2+ years after my surgery!

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

bonesmart.org

 

[sistersinhim]

My extension was slower coming in than my bend, too. I found walking with a longer stride, heel to toe helped to stretch those huge muscles and tendons in the back of the knee. My extension didn't improve overnight, it was a while, but it did improve. I did no exercises either for it, just the longer stride walking.

 

[NightQuilter]

I hope you are doing well Flash - less pain and more gain!

 

[Flash1955]

Good morning, another lovely sunny day in Cheshire.

I am now 3 months post op.

My surgeon did his monthly call to me and he asked me to send him pictures of my knee showing extension and flexion. He is not happy with my extension (leg will not straighten properly) and has arranged for me to have a knee brace. So, Thursday I have an appointment for measurements to be taken then will need to go back in a week for fitting.
Have any of you lovely members had the experience of wearing a brace and did it work, I am worried about having it.
Before my op I was able to fully straighten and bend my knee and now I can’t do either and wish I hadn’t had the op.

 

[Sara61]

I'm surprised that your doctor wants to put you in a brace after just 3 months, seems very early days, he extension comes with time, mine greatly improved when I stopped PT and just did my day to day activities and walking with a decent sized stride using my heel to toe method.
My Surgeon in Portugal actually told me not to do PT that the knee would work fine and recovery will take up to 1 year.
I would seriously think about putting a brace on your knee...but at the end of the day the decision is yours xx

 

[Jaycey]

I am worried about having it.

Your decision of course but I would be worried as well. This recovery can take 1 year or more. If you had full extension pre-op, all you need it time. I can see no reason for a brace - especially so early out.

 

[Jockette]

I agree with the others,for some of us ROM, both flexion and extension, can take a while. I had limited ROM my first year but it greatly improved after that first year.

3 months is still early days in this year + long recovery. Where you are now is not where you will end up.

Just because a treatment has been recommended doesn’t mean you have to do it. You are allowed to make the decision.
Saying no to therapy - am I allowed to?

Usually, we just need to allow our knee the privilege of sorting itself out. It will, if you don’t push it to do more than it’s able, at each stage.

 

[sistersinhim]

He is not happy with my extension (leg will not straighten properly) and has arranged for me to have a knee brace.

It's too soon to have a brace. From what I've read they are extremely painful. Your knee and you do not need to go through that. My extension was slower coming in than my bend. Walking with a longer stride, heel to toe, helped me more than anything. It took a while but it is now completely straight. Yours was straight before your surgery and will get straight after the trauma and swelling to your knee goes down.

 

[Jamie]

When a person has a bad knee, the muscles, tendons and ligaments readjust themselves to accommodate the position of the damaged (arthritic) knee joint. Some become shortened and others lengthen all in an effort by your body to correct for the misalignment that comes when you lose knee cartilage. For some, once the knee is replaced and put back into proper alignment, it can take a while for these soft tissues to stretch or contract back to normal. This might be especially true if your knee was badly out of alignment prior to surgery or misaligned for a long period of time.

These tissues don't realign quickly and it can take months in some cases for a person to regain their full range of motion. This is okay and certainly three months is well within the range of normal to still be "working" on your ROM. There is no "window of opportunity" where, if you miss it your knee will "freeze up" in that position, never to gain any better movement. Some of our BoneSmarties take a year or more to get their ROM.

You're never alone in your recovery. You have all of us here in your BoneSmart family ready and willing to support whatever decisions you choose. You don't have to accept the brace at this time (or ever) if you don't want it. You can tell your surgeon you would prefer to work on your ROM yourself for a while longer and then you can discuss it again. Here is an article in our BoneSmart Library that talks about extension and provides some ways to nudge it along. It's all about stretching those tight soft tissues - gently and consistently. Theoretically this is what a brace does. But you can do it yourself without the discomfort of a brace.

Extension: how to estimate it and ways to improve it

 

[Celle]

To add to all the advice everyone else has given you - it's not at all unusual for extension to take longer to achieve than flexion. We've seen it happen time and again here on BoneSmart. Those big muscles and tendons at the back of your leg need time to adjust and that needs to happen slowly and gently.

Since you had full extension before your surgery, there's every reason to believe that you will achieve it again.

 

[NightQuilter]

Again, your decision. I concur with the thought it may be too early. I did not have a brace, but my husband did after surgery to reattach torn quadriceps to his kneecap! They won't stay up. They tend to be heavy and since your thigh is bigger than the rest of your leg, gravity does its thing. He had to create a rigging with straps holding it on to a belt he had to wear all the time. It didn't last long!