How Much Flexion is Too Much?

[Surfsister]

Woe is me!

Okay, not really. Kind of woe is me. We've lost our medical insurance and now I'm forced to pay out of pocket for physical therapy. Stop! Don't start typing yet. That's not the issue. Let me keep going.

So, here's the deal. I now go to PT once a week. My physical therapist is working hard to help me regain my ROM, which was limited before surgery. She said her goal it to get me to 125 degrees of flexion. She does not want me to gain more flexion than that. She said further flexion will essentially negatively affect the integrity of the implant.

Mind you, I probably didn't have much more than 125 before the surgery. Still, I'd like to achieve more, if possible. It may not be possible. I really don't know.

Has anyone else heard that too much flexion is bad for the joint? Before you bad-mouth my physical therapist, let me tell you I have no doubts about her abilities or knowledge. I'm glad I chose her as my physical therapist. But, #@$!, she's almost too good, too conscientious. I think the flexion issue should be left up to the patient.

Comments, questions, concerns?

 

[loggon]

You need to ask her why. Because most OS want you to get to the best you can.
She must have a reason. Also check with your OS he should have the final word.

Sorry to hear you lost your insurance esp. now.

Good luck and just ask her why and to explain to you and then also ask your OS.

 

[petuniafish]

Surfsister,

I had a PKR 4/21 and have a physical therapist husband. Neither of us thought it wise for him to treat me as husbands and wives don't listen to each other. I'm a nurse and he doesn't give a hoot about my advice, and sometimes I don't quite trust him. But in the end, for everything and everyone he's always been RIGHT.

My hired PT was very sweet but a hard***. She had me lifting the 3# wts with my affected leg at 2 weeks. I would cry for days after leaving there. Husband said she was PUSHING way too hard. At 3 weeks I was 125* and 4 weeks 138*.

When I told my husband and he watched me exercise, all he said was that 138* was WAY too much. And that I should bend to cause a little pain but not YEEEEE-OUCH pain. I can still do 138* at 6 weeks and it doesn't hurt so much, but he said 125* would have been just fine. He never said anything about greater than 125 negatively impacting, but my guess is that your PT is right on the money.
Nancy

 

[Jamie]

Surf, if you know what type of knee you have, you might check the company's website for information. I think different implants have different specifications. Jo will know MUCH more than I about all this and hopefully she will respond to your post soon. I'm just thinking in the meantime you could get some information on the web.

 

[Texas]

Hi Surf either way, wow you are doing great. Sounds like your husband knows his stuff and cares alot thats great. Just make sure you take time to relax and take it easy sometimes. Great job you should be very proud........Fantastic job......

 

[Surfsister]

Kim, now you've got me all confused. I didn't say anything about my husband. that was Nancy. And I'm at six weeks, not four. I hereby bequeath you Barb's afternoon nap again! :hehe:

 

[Texas]

Haha thanks for that sorry. Its early I guess. Anyway I was told I needed to only bend at 125. Last time I went it was so painful I asked her what was I bending she said 115 , I told her that was my goal...I wanted to stop...What are you bending now? You are almost three weeks ahead of me. Just wondering. I dont go to PT only every once in awhile for a ck up . Just something I couldnt afford anymore. I do rememeber telling you that ...lol

 

[Josephine]

Petunia has it spot on but there are limitations on some knee implants. Depends upon the design of the way the femoral 'rolls back' on the tibial. But Jamie is right, you can either check with the manufacturer or the OS. He should know - after all, he chose it!

 

[Surfsister]

Kim, yesterday she was able to get it to 112. She looked surprised when I let out a big cheer at that. I'm much more concerned about flexion than extension. My leg wasn't straight prior to surgery and I've been supremely athletic for decades. I had limited flexion as well. I'd like to achieve more than I had before surgery. However, if I come out of this surgery with the same ROM I had before, that's fine. I don't remember what it's like to be able to completely straighten or completely flex my leg anyway.

I'm awaiting a call from the physician's assistant at my OS's office.

 

[ship4]

I had not been able to straighten my knees in years. I was shocked at about 5 months out when I was showering, that I locked my knee! I thought what did I just do? Then realized I had not been able to lock my knees in years! You will get there....
Best,

 

[backbay38]

Surfsister -- my sense of PT's (and some surgeons) is that they just want you to be "functional". Whatever that means. For some people that means being able to bend enough to sit down and get up. For others it means deep knee bends and kicking your butt with your heel. So it's all in the person and the interpretation. If there are no physical limits on your implant itself then you should push it to it's maximum --- it's up to you if you want to do the work. For example - I wanted a Zimmer Hi Flex knee. Flexes to 150-55. But when my surgeon went in he said my knee was a real mess and he couldn't use that knee. But he said the knee he put in - also a Zimmer which is the company he works with - should let me flex to 135-140. Which I think I've pretty much achieved. And my PT also said before he sent me on my way at 2months "why do you need more flex; you can do most anything with what you have." At that point it was about 130-132 I think. he was probably right but I want whatever is possible with the new knee. So check the knee's limitations first -- and then if there are none -- go for it!!!
Stephani

 

[Surfsister]

I need as much flex as possible for surfing. Like I said, I've been racing bikes, swimming and surfing with limited flexion for years. But why not shoot for the sky when the sky's the limit?

The physician assistant called. I really like him. Even though he could not tell me anything definitive. He believed I should try to get as much flex as I could. He knew of no limitations on the knee. With that said, since I only go to physical therapy once a week and will be seeing the OS on June 16, I'll ask about it then. If necessary, I'll have the doctor write my physical therapist a note about the amount of flexion my implant can expect to reach.