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[TKR] Getting back to hiking and climbing.

Discussion in 'Knee Replacement Recovery Area' started by rustic, Dec 3, 2018.

  1. rustic

    rustic member
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    I have been very active in outdoor recreation all my life. Rock climbing, hiking, skiing, etc. I used to do quite a bit of running as well (including a few ultra distance events). I was doing tons of vigorous activities (skiing, rock climbing, and hiking) with minimal pain right up until March of this year, when it swelled up unexpectedly while on an ice climbing trip. The swelling did not go away.

    X-rays showed "end stage arthritis, bone on bone" in my left knee. This was a total surprise to me. I didn't believe it. I waited a month, and went for a second opinion elsewhere. They confirmed the situation, and an MRI showed that the bone ends were inflamed. Complex tears of the meniscus, that probably happened as a youth (circa 1977), had caused that knee to wear out prematurely. I guess that I was lucky that it didn't hurt for those 40 years. But, it really hurt now!
    Preemptively, I went to a PT, for two months, which really helped in the long run. Getting as strong and flexible as possible before surgery really makes a difference. I couldn't hike at all, but I exercised and rode my mountain bike religiously for the 2 1/2 months before surgery.

    I had my left knee replacement on Sept. 25, 2018. I had various troubles while in the hospital (bladder retention, uncontrolled pain, reactions to certain meds, etc), but nothing too serious. I had been well warned that "you will be miserable for 6 weeks," and that came true. At 6 weeks, I had fairly good range of motion, but still lots of pain and swelling. I could walk without a limp (but in pain) across a parking lot, but still could not drive my stick shift. I tapered off of oxycodone in the sixth and seventh week (very uncomfortable).

    Now, at 9 weeks post op, I'm progressing slowly but steadily. I can hike a mile comfortably (but slowly). I go "foot over foot" up and down stairs without any assist (with mild pain). Riding a stationary bike for more than 10 minutes makes the knee swell up, as does standing still or hiking two miles. I ice twice a day, and use Voltaren/diclophenac cream, to keep the swelling reasonable. Elevating (really high!) that leg for an hour before bed seems to help a lot.
    My therapist measured me at 129/1 on a really good day when I wasn't very swollen. I'm the persistent/methodical/determined type and will be able to improve on that.

    I'm amazed at how much strength and endurance I lost in just two months. But, I'm hopeful that I can make a true comeback and do some things better than ever before. I've already started snowshoeing some, and am working towards being able to do indoor rock climbing within a month or so. Next year I hope to be climbing outdoors and hiking the Grand Canyon. I'm very open to questions, and will be posting my updates here.
     
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  2. Kiwigirl62

    Kiwigirl62 member

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    @rustic great update of your recovery so far. You are about 6 days behind me and my recovery has sounded rather similar. Very old injury from years ago that just got worse. Have always been able to cycle without pain and walking long distances was OK until about 6 weeks pre surgery which went down hill fast.

    I also have taken a measured practical approach to recovery as too fast just sets me back. Still ache most days with some muscle/tendon/ligament but its all a stretching process which I know time will help along with lots of stretches and self massages t help it along the way.

    Just went for first outdoor cycle the other day - felt a bit weird and was definitely slow compared to pre-op. Also over did it a bit but pulled up agtr a day - so back to the slow measured approach with this too. so glad I am over the 6 week mark. HOping to start some country walks at about 4 months slowly as I have a 15 day hike/walk planned for 12 months post op.
     
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  3. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Welcome to Bonesmart! It sounds like you are doing quite well! I will leave you our recovery articles. Following these will help you to have a less painful recovery.

    Knee Recovery: The Guidelines


    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
    4. PT or exercise can be useful BUT take note of these
    5. Here is a week-by-week guide for Activity progression for TKRs


    The Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?

    Energy drain for TKRs

    Elevation is the key

    Ice to control pain and swelling

    Heel slides and how to do them properly

    Chart representation of TKR recovery

    Healing: how long does it take?

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds

    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

    While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
     
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  4. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    I had a friend who had both knees replaced 6 weeks apart who did a 120 mile bike trek a few months later. He does charity rides for MS. At age 70 he biked across the country. He had great surgeries. Go easy, if you push your knee you'll have to take the kind of rest that someone like you wouldn't probably go along with. My brother in law has pushed and pushed his hip replacement and created a chronic pain situation, and then he tries to solve that with more exercise. Going slow is a small investment for a great outcome. Sounds like you're off to a very good start.
     
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  5. kmak81230

    kmak81230 post-grad

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    Great report - congrats on your recovery!
     
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  6. rustic

    rustic member
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    Thanks for the encouragement everyone!
    @Kiwigirl62 Yes, we do seem to have quite a bit in common. I have a bunch of those localized tendon and ligament pains as well. Most of my walks will be "country walks," as I live in the country, far from pavement.
    Yesterday, I snowshoed 1.7 miles (farthest yet). Wonderful blue sky. Lots of icing and elevation in the evening.
     
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  7. DIYSteve

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    Sounds like you are on your way. Our respective backgrounds have some commonalities, e.g., hiking, skiing, ultramarathoning, climbing. It'll be interesting comparing notes in the future.

    Your ROM looks great for 9 weeks. Your flexion is way ahead of mine at 4-1/2 months (100 or so). For whatever reason, my strength and conditioning came back faster than I anticipated. I was walking 5 flat miles at 9 weeks, followed by a gradual improving trend re everything other than flexion. I'm now able to hike 10 miles w/3,000' verts without too much difficulty (notwithstanding the slow flexion progress). I'm ready to try some mellow skiing.

    We all progress at different rates and in different ways. Best o' luck to you, and keep posting your progress please.
     
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  8. MtnSearcher

    MtnSearcher junior member

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    welcome. You're complications and recovery sound similar to mine, but I'm only now getting up to around a mile walking at 4 months. Part of that is that terrain here is pretty challenging, part is that my knee still swells a lot. Now that winter is here, I'm going to join a gym to use the indoor walking track. I think a flat track where I can walk faster might help. 1.7 miles on snowshoes sounds great!
     
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  9. rustic

    rustic member
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    Great to have some other outdoor enthusiasts here! I'll enjoy following your progress. I'm jealous of the long hikes @DIYSteve is doing, but I'll get there eventually.

    I got a huge boost in motivation yesterday. I went to the local indoor climbing gym. I wasn't sure I'd be able to climb at all, but wanted to get "back on track" with my pre-tkr schedule. I used to meet my wife there every Tuesday. At a minimum, I'd belay her so she could climb, and I thought that I would do floor exercises in between her climbs (while she rested). I got curious after a while though, and I (cautiously) tried an easy route on the wall where they teach kids, and it felt good/healthy. Full body movement felt so good, after more than two months without it. Climbing is slow and controlled, with no impact.

    I ended up doing the kids wall several times, and then moved on to the main walls, and did two solid climbs (overhanging, but with plenty of holds). When a tall step-up was required, I just did it with the other leg. My leg swelled and hurt a bit more than normal that evening, but not enough to get me into the "overdoing it" club;)

    I have a 40+ year history with rock climbing and it is important to me. This early experiment bodes very well for my future prospects of continuing that into the future.
     
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  10. beachy

    beachy post-grad

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    Congrats on getting on the floor and especially for getting up!
    I'm still afraid to lay on floor in case I can't get up. Guess I should get over it and try. Best way to stretch and exercise!
     
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  11. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Wall climbing...Wow! You are doing great!
     
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  12. rustic

    rustic member
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    @sistersinhim Thanks. It turned out to be easier than stairs in some ways. Pulling with your arms lightens the force on your legs. Think of step ups at the gym. My quad is so weak that I can only step up about 8-10 inches right now unless I push off with the other leg for momentum. But if something was right there (like a bar or rope) to grab, I can step up 30" or more by pulling with my arm(s).
     
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  13. rustic

    rustic member
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    Middle of the 11th week post op. Physical therapist used an interesting skin temperature measuring device. Non-contact, it measures infrared radiation. My left (surgery) knee was 93F. The other parts of that leg, and the other knee, were all 83F.
    Anyone else using a fitbit or other activity tracker? It makes it easy to relate total daily activity ("exercise" plus general activities while on your feet) to how your knee reacts. Like how much swelling, or if it keeps me awake, or how stiff it is in the morning.
     
  14. rustic

    rustic member
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    Yesterday, I had another session at the indoor climbing gym. Got up the 40' wall 7 times. I'm climbing slowly, and carefully. Mostly it felt like a healthy stretch, but I had one bad "tweak" on the last climb. Should have stopped at 6.
    I had more kneecap pain than usual last night, and a bit of extra swelling. Today will be more of a recovery day.
     
  15. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    It sounds like you're listening to your knee and that's a good thing. You are certainly coming along really well!
     
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  16. rustic

    rustic member
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    Another week has gone by, and I'm continuing to see progress. These are incremental changes, but going in the right direction.
    Sunday, I was inundated with chores. Yard work, and firewood duties (cutting and stacking). Got over 10,000 steps on my fitbit, without doing any dedicated "exercise." That is too much time on my feet right now. So it hurt that night, and I had to do extra elevation and icing on Monday.
    By Tuesday morning, the swelling had abated and I went to the rock climbing gym for my third visit. It went well. 8 climbs on the 40 foot tall wall. If there are climbers reading this, the ratings were: 3x 5.7, 4x 5.8, and one 5.9. I had to do a few high steps that were a stretch, but that didn't cause any lasting problem. I think that it is a safe (and fun) way to build up my range of motion, and a bit of strength.
    This morning, I went for my longest post surgery hike. 2.5 miles on forest service roads near home, with a 250 foot hill in the middle of the route. Some snow/ice and mud on the ground, but nice blue skies with minimal wind.
     
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  17. rustic

    rustic member
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    I was doing great, but I got sick Monday. Cough, congestion, fatigue etc. My fever got up to 101, but is lower now. I have some questions: Anyone know what’s been going around, and how long it lasts?

    I’ve been mostly lying around resting and sleeping when possible and I thought the lack of activity might be a nice break for my knee. But, it actually has swelled up more than it had been. Not huge, and no extra pain, but a definite reduction in range of motion due to the swelling. Any thoughts on that?
     
  18. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    In my area we are plagued with upper respiratory problems. My friend is going on 3 weeks with hers, but it went into severe ear infections. Friends at church seem to be getting rid of it in a week to 10 days.

    Are you elevating correctly? When I broke my foot/ankle on the same side as my tkr, my knee was just shy of a year out. It hated not being used. Maybe that's part of your knee's problem. It wants you to walk around some. If the elevating doesn't help. Try to walk a little more. Or and ice, too!
     
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    Last edited: Dec 27, 2018
  19. rustic

    rustic member
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    Thanks for the advice, @sistersinhim.
    I made a couple of trips to the woodpile to bring in more firewood (it is snowing here), and then paced the living room for 25 minutes. Three sets of up/down the stairs finished me off. The mobilization must have got the blood flowing because the swelling got smaller with half an hour of serious elevation (almost vertical). All the side lying I had been doing just wasn’t good enough.

    Now, .. back to bed.
     
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  20. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    :yay: Yay, it helped!
     
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