PKR Having LTKR and praying for a successful outcome…”

[Jockette]

6 weeks out of surgery anyone will swell up after a day like that. Even after all that, 105 is great, AND 105 at 6 weeks under any circumstances is awesome! And you are normally better than that? More awesome.

This is why I will not go to PT with my next replacement. They say things that upset a recovery that is going along just fine.

Things come up that we have to attend, and we do the best we can under the circumstances. If it causes extra swelling, then we address that when we get home.

You’re doing fine.

 

[sistersinhim]

You are doing amazingly for 6 weeks. Most OSs hope for 90* bend at 6 weeks. Look at you after a day of work at over 100! Don't let anyone tell you that you aren't doing great, cause you are! You are doing right with your elevating and icing. With you having to work, it's the best thing you can do.

 

[NavyGunns]

@Doupie, I’ve never heard that statement before. By “freeze up” I’m wondering if your PT is referencing potential for your ligaments and tendons to tighten up due to limited movement? Hopefully @Josephine may be able to provide clarification.

As with your experience, I too find my knee get stiffer and loses some ROM on days when I visit the ODIC. At my point in recovery (12 weeks next Monday), I’m able to recover quickly (next day). I do find I have to spend some extra time stretching to get loosened up, but I don’t mind as it feels good. Main frustration is still the impact on sleep those visits to ODIC have .

 

[Jockette]

Oh I’ve heard the phrase “the knee will freeze”, early in my recovery, by my sister, who’s never had a knee replacement. Even before I found Bonesmart I didn’t believe it, but it did instill a bit of doubt. I can still hear her say it.

 

[sistersinhim]

Yes, we have so many experts that have never even had this surgery!

 

[Doupie]

@NavyGunns you are so right about the sleep I was up all night. Couldn’t stay awake so passed out at 10:30 then right back awake at 2:00, even after taking tramadol....
Everybody has an opinion on what I should and should not be doing. I wish I could lay around elevating and icing all day but unfortunately I live in the real world......
Occasionally my knee feels like it’s going to lock up, but then it just does what it does. I try to baby it as much as possible. I probably ice 4-5 times a day in some form, whether it’s the ice man or ice bags, etc....
Thanks guys I was just a little concerned yesterday and they hate when I tell them that Josephine never went to PT and was just fine...lol

 

[Josephine]

I’m wondering if your PT is referencing potential for your ligaments and tendons to tighten up due to limited movement?

Actually the reverse can be damaging too. That is, TOO MUCH movement can cause damage and even freezing up in the knee.

@Doupie I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Doupie]

Yes that would be fine...

 

[Smythe89]

I’m swollen today. 8 weeks post and I noticed my knee was tight coming down stairs... more tight than usual. I’m elevated with ice as we speak. 1 step up, 2 steps back

 

[Celle]

According to my PT Michelle, I’m doing way too much and if I’m not careful my knee can freeze up and I will have a permanent limp.... She was not pleased with my ROM of 105 and 3, but I saw her at the end of the day after attending a funeral which was outside and lasted about 30 minutes.

@Doupie, I’ve never heard that statement before. By “freeze up” I’m wondering if your PT is referencing potential for your ligaments and tendons to tighten up due to limited movement?

Don't take any notice of PTs' threats that your knee will "freeze up". There's no foundation in fact for the threat. It's just part of the spiel of some PTs who try to frighten you into doing what they want.

It is true that doing too much, too early in recovery, can cause increased swelling and slow down your recovery, but it won't freeze up your knee for ever.

There are some PTs who threaten that you only have a certain amount of time in which to gain ROM or your knee will freeze up, or set, for ever. That's also a myth.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

The sort of PT you want is one who will tailor your therapy to what your knee is ready for, and not expect it to conform to some theoretical time schedule.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Doupie]

1. Very little pain, only tightness, swelling and occasionally soreness, no higher than maybe 3-4

2. Tramadol 50 mg, extra strength tylenol 650 mg up to 2000 mg/day and I take 1300 mg tylenol, occasionally 100 mg tramadol when I overdue it

3. My swelling is moderate

4. ROM was as good as 110 now 105, 0 now 3 but I had a lot of swelling after PT sessions and end of day

5. Yes on the weekend 4-5 times a day for at least 15-20 minutes, through the week 2-3 times and I use an icepack and my ice man at the office while sitting

6. Yes, on the weekend 4-5 times a day for at least 15-20 minutes,through the week 2-3 times

7. Very little housework, (I hate it)...lol, I cook 2-3 meals on the weekend, mainly protein shakes through the week, sandwiches and take out. I went shopping this week for the first time. I admit I drove at 4 weeks due to an emergency but felt very good and then the next day over did it, because I thought I could....

8. Yes, I do mini squats, heel slides, toe raises/heel rocks, knee flexion, quad strengthening by pressing my knee down, leg raises

2 sets of 10 reps every day

twice a week, same exercises 10 reps, 3 sets
squats,
heel slides,
toe raises/heel rocks,
knee flexion,
quad strengthening by pressing my knee down,
leg raises
also I have to walk heel to toe and bend my knee while walking and sitting
She also wants me to go to the pool and gave me a list of exercises for that

 

[Doupie]

Here's pics of my knees and my scar, what do you guys think?

 

[Josephine]

6wks

1. Very little pain, only tightness, swelling and occasionally soreness, no higher than maybe 3-4

okay

2. Tramadol 50 mg, extra strength Tylenol 650 mg up to 2000 mg/day and I take 1300 mg Tylenol, occasionally 100 mg Tramadol when I overdo it

Okay

3. My swelling is moderate

Okay

4. ROM was as good as 110 now 105, 0 now 3 but I had a lot of swelling after PT sessions and end of day

okay

5. Yes on the weekend 4-5 times a day for at least 15-20 minutes, through the week 2-3 times and I use an icepack and my ice man at the office while sitting

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Yes, on the weekend 4-5 times a day for at least 15-20 minutes,through the week 2-3 times

Same as icing

7. Very little housework, (I hate it)...lol, I cook 2-3 meals on the weekend, mainly protein shakes through the week, sandwiches and take out. I went shopping this week for the first time. I admit I drove at 4 weeks due to an emergency but felt very good and then the next day over did it, because I thought I could....

okay

2 sets of 10 reps every day - once a day is plenty and none at all at the weekend
leg raises - x10 reps, 3 sets - a tip: once you can do SLRs you don't have to do them any more!
heel slides x10 reps, 3 sets - 30 twice a day is a bad way to do these. You should read this Heel slides and how to do them properly.
knee flexion x10 reps, 3 sets -whatever these are, you're already doing heel slides so don't need these as well
squats x10 reps, 3 sets - no squats
toe raises/heel rocks x10 reps, 3 sets - none of these either
quad strengthening by pressing my knee down x10 reps, 3 sets - not a good idea!

She also wants me to go to the pool and gave me a list of exercises for that - be careful as it's ever so easy to overdo things in the water. Gently does it.

Two more things:
It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Doupie]

Thanks @Josephine I prefer doing heel slides in a chair and will cut down on all the exercises at home and at PT. I realized that the best my knee ever felt and with the least amount of swelling was when I iced and elevated more and did absolutely nothing. I just got up to fix food and go to the bathroom. I’m presently icing and elevating now and will be in this position for the next hour....

My PT told me to only do 15-20 minutes of icing, any longer was bad. They are idiots...
Not sure what I can do while I’m at work, any suggestions? I know I can ice in the morning before I leave and maybe come home in the early afternoon, then in the evening but can’t get 4 in so is 3 times ok?

 

[SusieShoes]

Ice and elevate as much and as often as you can. If you can't do four times a day, then three will have to do but make it count. Nice LONG icing is the key.

The 15-20 minutes is a good guideline for non-surgically traumatized tissue. Now that my knees have healed, they don't tolerate much more than 15-20 minutes without complaining mightily. So if your knee isn't complaining that means the ice is doing good. Tissues that have been sliced and battered run hot, so can be iced for longer.

 

[Doupie]

I understand now, I can ice for hours with the machine because it starts to cool off and we have to change the frozen water bottles. @SusieShoes does the swelling and stiffness mean to not do anything because it doesn't hurt it's just uncomfortable?

 

[SusieShoes]

Swelling is normal during early recovery because surgically traumatized tissue undergoes an inflammatory response that causes the swelling. Swelling is what makes the knee difficult to bend (kind of like trying to bend a hose filled with water as opposed to an empty hose). Getting that inflammation and swelling to calm down helps with things like bending the knee and also the pain the swelling causes. The stiffness is your perception of the swelling.

The swelling and stiffness don't mean not to do anything at all. They are, however, your barometer for what is helping your knee (less swelling, yay!) or not helping your knee (more swelling, boo!). So if something causes your knee to swell more -- too much activity, a certain exercise, sitting too long at a desk, etc. -- that's your signal to do less of whatever that something was. On the other side, if what you're doing causes your knee's swelling to go down or even just not get worse, that's your signal it's okay to continue doing whatever it is.

Your knee is your guide. Swelling and stiffness (which is a form of pain) are how it talks to you. As languages go, pain is pretty straightforward!

 

[Josephine]

Not sure what I can do while I’m at work, any suggestions?

Get some coach's crushable ice packs - they're not the same as ice but better than nothing!

Then you can get a foot hammock to elevate a bit under your desk

Foot Rest , Portable Travel Footrest for Office New from $12.99

 

[Txmomgmom3]

The pt that I usually work with said I can ice as long as I find necessary. I told her I usually do 45 -60 minutes and she's like that's fine as long as it helps then go for it.