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TKR Getting back to hiking and climbing.

skigirl

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So, just remember that a hot, inflamed knee needs rest, elevation and ice a lot more than it needs any exercise whatsoever.

I am not a great one to "do exercises". So, in the off season I bike a lot and hike a lot too. I sometimes do a spin class or two at the gym. One important thing is for core strength, I do two Pilates classes a week pretty regularly.

If I am going to do a class, i do yoga. But I have always done a two month "pre ski conditioning class that my PT puts on in his studio. It is a lot of fun with ski instructors and ski patrollers being most of the enrolees!! We do interval training---One minute of planks and then we rotate to side planks and then one minute of the other side. At three minutes we move to a different exercise. We do a lot of squats and use that Ride, Sally Ride song!! I like the class and it is fun---the first few nights we are drenched with sweat and by the time it ends---and ski season begins, we are racing through the exercises!!Biking is great exercise for the quads and so much more fun than doing an exercise!!

I took my bike outside (I have a 15 pound Orbea) at four week and I could ride up and down the street. By eight weeks I was riding 8-10 miles pretty easily, although I was still very fatigued at the end. I will stress that if my knee had become hot or swollen, I would have immediately stopped and iced the knee down and then decreased the mileage for a while. I started slowly and increased the mileage very slowly as well.

Also, what kind of shape are you in? I had my surgery in April--one week after the season ended, so I was in pretty good shape to start with, which is part of the equation. Basically, don't do anything that you cannot do easily and without repercussions like swelling and heat on your knee.
 

skigirl

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An even easier method is just to feel your knee---then, after PT or exercise is it hotter? then too much. is it the same? good work
 
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rustic

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So, just remember that a hot, inflamed knee needs rest, elevation and ice a lot more than it needs any exercise whatsoever.

I am not a great one to "do exercises". So, in the off season I bike a lot and hike a lot too. I sometimes do a spin class or two at the gym. One important thing is for core strength, I do two Pilates classes a week pretty regularly.
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Also, what kind of shape are you in? I had my surgery in April--one week after the season ended, so I was in pretty good shape to start with, which is part of the equation. Basically, don't do anything that you cannot do easily and without repercussions like swelling and heat on your knee.
Thanks for the information. I thought you might be doing a bunch of "wall sits" or something. The pre-ski class sounds great!
I was in pretty good shape for the year before my (Sept. 2018) surgery. Oct. '17 I hiked across the grand canyon twice in a day (50 miles, with 11,000 foot of gain). Jan 2018, I walked 80 miles in 24 hours. I did downhill skiing and ice climbing Feb/March '18. My knee started limiting me after that and I had to switch to mountain biking. To limit my "decline" in the months before surgery, I got in about 60 rides, but they were pretty short. I managed to go rock climbing 45 times in 2018, before Sept. That is good for upper body and core strength at least.

So, probably more fit than average TKR patient, and I didn't have a super long period of getting out of shape before surgery. But nine months of slow decline, followed by surgery and 2 months of serious decline caused me to lose incredible amount of fitness (both strength and aerobic). I'm dying to to start working towards getting that fitness back. It might take a year or more. I recently started doing strength training for the "rest" of my body, but it will be a while before I can do anything hard or long enough to start taxing my cardio system. I'm optimistic, and looking forward to the challenge.

On the hot knee topic: both my doctors and my PT's all said that a warm knee is common for TKR's and that it typically lasts up to a year. I think that is similar to what I read in the bone smart information section as well. It has been nice to see that the number of "hot days" per week is getting smaller, and that it isn't getting as hot. My knee might be hotter than average, due to some metabolic individuality. I have a tendency to get fevers when I have a cold, and my knee was starting to get warm from bone inflammation even before the surgery.
 

skigirl

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It sounds like you have a good idea of what you can do when---it is a process. The one advantage to this process is that it, for me, at least, was an end to knee surgeries, so no more rehab. I did have to have some adhesions removed about two years after my first tkr---and my doc was so firm about not overdoing it and making the knee hotter. It took a long time to rehab that, but I have not had any problems since. My PT was really good---he just said, look, we are going to take 8 weeks before you do any weight bearing exercise. At least we will know that we did the best we could. It was a good philosophy and a reasonable way to approach rehabbing the knee. I was just so annoyed that I had to do that extra 3 months of rehab.

I think you will be surprised how fast your conditioning comes back. I skied at 5 months and that was after the 2 month pre ski conditioning class. I was in really great shape and skied easily and better than I had with a wonky left knee. I did find that when we did a slow clinic, I was having a great deal of difficulty initiating my right turn, which was showing up in my skiing. I finally realized that I had been locking that knee to stablize it and all I had to do was bend the knee---and suddenly I was back to skiing like a pro!!
 

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A few posts back you mention "armor" for your new knee before doing anything too crazy. Any idea what you are going to use? Im 18 months out i bike and hike but not to your presurgery level. Ive had a a couple of falls and the new knee has been nice and sturdy and painless by the next day. Until about 8 or 9 weeks ago. I took a really hard fall and twisted my new knee and sprained the other ankle. I was down and icing for 4 days and it took a good 6 weeks for the soft tissue damage to heal and to be able to walk completely pain free. I suspect the new knee is hard and sturdy enough for falls but maybe harder on surrounding tissue during falls. Up until now I hadn't even thought of wearing knee pads. I think it's time for me to find some "armor." Any ideas?

On the plus side, you will just keep improving. At the 16 month mark I found i could bend the new knee further than my natural knee for the first time. And my stamina keeps improving. The cold doesnt bother the knee as much this year as it did last year either. Last winter I was 6 months out and found below zero temps made my knee slightly stiff no matter how I dressed. This year no issues with cold.
 
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rustic

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@Jajakio
Check out the "Rage hard knee" at sixsixone.com. I like the hard cap. I got something similar at a secondhand store.
I don't do hard singletrack. I like big hills on forest service roads.
 

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I've been wearing a wrestling sleeve-style kneepad when working in my shop as protection in case I whack something. I will likely wear it for off-trail hiking and scrambling in the mountains this summer, and maybe for spring/summer ski touring and ski mountaineering.
 
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I wear a neoprene sleeve in my shop as well, and at the climbing gym. I'll probably use the hard cap version when climbing outdoors.
 

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@rustic Does the pad you have allow much mobility, and does it fit under long pants? I have taken one fall and had swelling and pain for several days after.
 

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@rustic Does the pad you have allow much mobility, and does it fit under long pants?
I can't speak for rustic, of course. My sleeve-style knee pad, similar to Asics Super Sleeve, allows free mobility and fits under all by the tightest hipster pants, which I do not own ; ) . Be sure to get a the right size. Sizing too small could restrict movement.
 
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@rustic Does the pad you have allow much mobility, and does it fit under long pants? I have taken one fall and had swelling and pain for several days after.
I have a couple of the thinner sleeve types, and a larger one with a cap for protection.

The thinner ones go under almost any clothing, and they are soft enough not to pinch the skin. They are fabric-like and have a high percentage of lycra and/or elastic, which makes them very flexible. I have a pair by Zensa (very comfortable, but not very durable), and I also like ones by Mueller and KS7. I don’t like the ones that are mostly neoprene, because then don’t have much flex, and they don’t breathe. They pinch behind my knee, and they often come with a hole in the back to lessen that discomfort.

The bulkier one I have, with the cap, is still pretty darn flexible. Overall it is bulkier, but it has very thin/comfortable material behind the knee, and can be worn against the skin (like summer mountain biking), or on top of thin clothing. It has two (velcro) straps, so it is adjustable over a wide range. It would not fit underneath trim fit clothing.

I should mention that I have an even larger brace, that I got at the hospital months before I had surgery. Many of you probably have one. It has four straps, and plastic hinges on the sides, and a hole for your kneecap. It is made to control the position of the patella, and holds everything together pretty well. Not useful for anything in our discussion here (since your kneecap isn’t actually protected in a fall). I see people skiing with them quite often though. They wear it over their tights, and under the ski pants, and the stiffness is no deficit to skiing. When I get to that point, I might try it skiing and compare it to the others.
 

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@rustic Thanks. I had one of the hinged ones and hated it. It wouldn't fit under anything other than jogging pants, and if I put it over my pants leg, it was really uncomfortable. I have one of the thin, lycra sleeves, but I can't see how it would help protect a knee at all. I wear tactical pants a lot in the woods, and most of those have pockets for knee pads. I might try that.
 

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I don't wear any brace for skiing--I hated wearing them before my surgery!!
I hated wearing my hinged brace pre-op, but the sleeve pad is a pad, not a brace. I have not yet worn it for skiing and do not plan to, although I might wear it for spring/summer ski touring or ski mountaineering to protect my knee if it bangs into a rock or a tree.
 
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16 week update: Last week I had 2 indoor climbing sessions that went well, and did a couple of short snowshoe jaunts. Spent about 8 hours shoveling and sweeping snow around my shops and decks.
I still have plenty of random pains, especially from twisting motions. I elevate in the evening, and have to ice once in a while.

Last night I tried wearing an Ace bandage while sleeping. This morning, the knee felt better than average, and it flexed to 135 degrees for the first time.
 

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@rustic great update, yes i also discovered that wearing a light knee band while sleeping has my knee 'waking' up in the morning feeling great and defiantly easier to flex. Don't use for normal daily stuff or cycling but do for longer walks
 

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Is the type of band / sleeve you are using similar to a “copper fit” type sleeve?
 
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Is the type of band / sleeve you are using similar to a “copper fit” type sleeve?
Nope. Nothing that fancy, or as tight. Just a regular Ace elastic thing. Six inches wide, and 6 or more feet long. You wrap it around the leg a bunch of times. It is very easy to make it comfortable (not as tight as you'd do during the day), and they are very breathable. I got a few different ones during various Dr visits and while in the hospital, including a ten foot whopper that was good when my whole lower leg was swollen.
Note: This is a separate topic than the various things people use for sports-protection during the day, although there is some overlap. That switch might have been confusing.

@Kiwigirl62 I think the sleeves I use for rock climbing might be too tight to wear all night, but I might try to get a slightly oversized one and give that a try. Do you wear different sizes during your long walks vs at night?
 

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