Revision TKR if at first you don't succeed....<

[puppywalker]

It will be great, Jean - I can't wait! Our current pup (15 months) is leaving us on Friday to go to the Guide Dog Centre for his specialist training and the house will seem so empty, even though we have 2 pet dogs. Our next pup will be our 13th (we get them at 6-7 weeks and keep them until they're 12-14 months, so it's at least a full year for each pup) - I can't imagine doing anything else now and I'm so desperate to get back to it - it's been over 3 years since I could actually walk any of the dogs, my husband has been doing all the outside work and I do the indoor and obedience training. I think that's why I find this slow recovery so depressing at times - I want to go back to doing it all - I was never told just how long recovery would take and I merrily thought I'd be back to it in about 6 weeks! I get very frustrated that I can't do as much as I want. A 6 week old puppy can only walk for 5 minutes 3 times a day, so I'm hoping that as the pup's stamina increases, so will mine.
As far as getting on the floor goes - I made sure to wait until my husband was in, just in case I got stuck! But it was incredibly easy and it makes me wonder how much of our reluctance to push ourselves is real pain and how much is it fear of pain? I was the same going up and down stairs properly - I was so used to the way I've had to do it before that it took me a while to get up the courage to try doing it properly and it turned out to be not nearly such a big problem as I'd expected.
Joyce

 

[PolarBear60]

I think you're at a point where your stamina and the pup's will grow together -- the pup may be a good incentive. I agree about the actual pain versus fear of pain. I have a few things where I just don't seem to be able to do what I need to do. While I know the actual pain is less than it was a couple of weeks ago, I still hesitate. I'm doing a few exercises to help get me over the hump and moving forward.

 

[puppywalker]

Jean - do the muscles around your knee still ache while you walk? I seem to be getting an awful lot of backache as well when I walk. The actual knee joint is completely painless but the aches and pains are stopping me from walking as much as I feel I should be able to by now.

 

[PolarBear60]

Not when I walk. My pain is upon standing (and after a one hour session in the pool on Friday which included about 3-4 minutes of deep squats, that is markedly reduced this weekend) from a low seat. To be fair, I'm not walking for extended periods yet. My non-op knee is limiting me more than my TKR knee.

I have experienced some backache as well, especially at the 5-7 week point. Not so much recently, but I haven't been consciously trying to extend my walking -- too busy with other life requirements. I did the one hour pool workout on Friday, then yesterday I did quite a lot of yard work (broken into three sessions with rest in between). Last night, when I went up to bed, I realized I forgot to take my morning medications, including my Tylenol dose (took a normal dose of Tylenol and everything else). I woke up in discomfort at 4 this morning. I took another dose of Tylenol and gave it time to take effect. I thought I'd have to take a dose at 2 this afternoon, but so far, no problem (it's five now). More yard work today -- used all my weed whacker batteries and got most of it done. I'm so far behind!

I do a lot of short distance walking, and it's generally without pain. With all the other things I'm doing in day-to-day chores, I haven't added walking or even my recumbent exercise bike to the mix yet, even though my doctor says walking is the best thing I can do.

 

[puppywalker]

I've just made an appointment with a highly-recommended sports physio to try to find out why I'm getting the terrible backache recently. Probably to do with gait, I expect, but I can't figure it out myself. I've tried using an insole in the "good" shoe and it helped a bit but no matter how hard I try I'm still lurching to the right when I walk. Standing with the operated knee on the first stair, the ROM appears amazing - the leg goes right back with no pain at all, but heel slides lying down are still very limited, despite doing all the stretches and whatnot suggested by the NHS physio. Sitting on a chair gives slightly better results, but nowhere near as good as standing on the first step. Extension must be about 0 now as I can feel the back of my knee touching the bed or chair when I do the exercises. Walking outside with no aid now, although the backache is stopping me after about 10 minutes - I just have to stop and sit down for a few minutes.

 

[PolarBear60]

I hope you get some answers and suggestions on what can help.

 

[KYata]

I found if I slow down and concentrate on rolling heel through the toes with a shorter stride the back ache goes away. I am getting tired at that point and going back a few stages helps. I stopped trying to extend the length of my walks too, stuck to 30 minute walks for a month. All of a sudden I am walking for close to an hour, covering 1.4 miles still getting a mild ache but just doing what I described gets me home safely and out of the ODIC.

Some of my lurch was because I wasn't trusting my right TRK and that ankle wasn't going through the same ROM as the left ankle. I thought the lurch was me landing hard on the left but doing a soft landing with exaggerated roll from heel to toes didn't make a difference. It is all such a process. Shortening the stride works better than trying to get more ROM out of the right ankle for a more even stride.

I'd ask about the heel slides. Unless they are targeting some area not addressed by the stair stretch they are just another exercise.

 

[tigz]

When I really concentrate and walk s I o w I y (not that I walk that fast to begin with these days! ) I have no limp. But those times I'm trying to keep up with hubby in a store the cane is invaluable.

It'll all come, the proper gait, the speed.

Sent from my Nexus 7 using Tapatalk

 

[puppywalker]

I saw the new PT today and was impressed! She has 3 areas of concern - 1) the hamstrings are still terribly tight despite all the stretching of the last couple of months, 2) the IT band is also very, tight, and 3) she's very concerned about the amount of fluid in my legs and a large thickened lump of tissue to the inside of the back of my knee. She asked me to see my GP asap about this last. She said she wondered if there had been some kind of cyst there which has ruptured, hence all the fluid sloshing around, but that she wasn't qualified to make a diagnosis and that's why she wants me to see my GP. I do like people who are willing to admit that they don't know it all! She did a massage from my ankle to mid-thigh to try to move some of the fluid, but said that until the fluid problem had been resolved she couldn't do very much about the first 2 issues, but they would be fairly easy to remedy in due time. The massage was hard and quite uncomfortable, but was bearable and when she touched a couple of very tender points she eased off straightaway. I am now officially excused from heel slides and straight leg raises (yippee!) so long as I use my exercise bike and my son's treadmill set at a low speed and swim regularly as well as "marching" in the water and doing leg kicks. I am also banned from using my hands to push up from a sitting position and when I make a coffee (frequently - I have caffeine in my veins rather than blood!) I have to stand just on the operated leg from when I switch the kettle on until the coffee is ready to drink! I've also been advised to get an aerobics step as I have to learn to go up and down stairs without holding onto the banister and she reckons normal household stairs are too high to practice this on at first. She had me do 10 reps and the first few were very tentative and jerky, but by the time I got to number 10, it was so smooth I couldn't believe it.
She said that as far as she was concerned the new knee is just fine and all the issues are muscle and tendon related, and will resolve when I don't have a gallon of fluid gurgling around in there. I didn't really realise until we spoke about it just how much I had lost confidence in my body's ability to do simple actions and this is something that we are going to have to work on.
I came out feeling physically a lot more comfortable and mentally a lot happier that specific problems will now be addressed rather than just standard exercises dished out because that's what the book says - Neville the New Knee has never read the book! I'm looking forward to working by myself for the next couple of weeks and then going back to see her again - I never thought I would look forward to a PT session!

 

[PolarBear60]

I use an aerobics step at PT and rest my hand on a treadmill arm for balance. I'm using the step and one level and was just able to touch my heel to the ground last week at the end of my thirty reps. Pretty exciting progress for me. I imagine I'll graduate to two levels for my final week of PT.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[puppywalker]

I'm really confused and would appreciate any advice or comments. I'm now almost 4 months out from surgery. I can cycle on the stationary bike as long as I want with no bother at all, I have no pain at all during the night -very slight stiffness in the morning when I wake, but it wears off within a minute or two. Legs are still really swollen from knee to toes ( my GP says this is still a reaction to surgery trauma, but after nearly 4 months?!) I can walk around the house all day and do all my housework without any bother - laundry, vacuum, change beds etc, I can gallop downstairs sequentially, although going up is a bit more difficult but...As soon as I try to walk outside the knee and back are so painful that within 5 minutes I just have to sit down. I can't understand what is so different about walking outdoors when inside it's not a problem. I must be doing something wrong but for the life of me I can't think what. Any ideas?

 

[PolarBear60]

We're at the same place post-surgery, and your activity level mostly matches mine -- except that galloping down the stairs, really? So envious. Grin. My swelling isn't very noticeable, but I'm certain there's some there still.

I'm not doing much extensive walking outside, but I haven't noticed much problem with it for me. Are you walking on sidewalks, level ground, street, or across a yard? Uneven terrain is a minefield of possible problems, so you may be tensing up or more tentative, which could result in discomfort sooner. On the other hand, if you're walking on level ground, your outdoor stride may be different than your indoor stride, so it's using muscles differently, and they aren't used to it yet. Walking in the house typically would use a shorter stride, because of the types of distance you are covering. Outdoors, you're probably stepping out and trying to cover some ground. If that's the case, try walking a little slower until you get more comfortable, then gradually begin increasing your pace.

 

[KYata]

I backed off doing long walks just for exercise as I try to walk too fast and my striding and gait suffer so my back starts to hurt and I start rolling rather than striding straight. When my back and legs hurt before surgeries happened I switched to hiking where one gets loads of exercise because of the uneven ground and slopes. That is a bit too much for me right now still but a better strategy than power walking for me. For aerobic exercise cycling is definitely better than walking/hiking.

Slowing down might help, my dogs get to sniff a lot more now than I allowed before my legs started all this trouble. Dogs are great excuses. I HAVE to walk the dog, I HAVE to stop and let dog sniff. This works best with dogs small enough they cannot pull you over although newdog Bucky is trying to trip me up.

Taking the walk and turning around as soon as back and legs start to get uncomfortable then trying another walk in a couple days might help. You end up walking twice as far as is comfortable so are working hard, this isn't about giving in.

Switching to mall walking or shopping at one large store might help as you make short quick walks to various stores/departments then stand and move around a little in each area. We shopped Target and took a mid trip break at Starbucks, that sure helped. Should have put Strava on to see my path, be too funny to see all the little zigzags and likely amazed at how far we actually walked.

 

[puppywalker]

Jean - yes, I can zoom downstairs with full confidence, going up is a bit more of an effort, but there's a fair bit of me to haul up, so I think that's just a case of strengthening the muscles. What you said about tensing up is very interesting as I have become aware that I'm holding myself quite stiffly outdoors - I'm much more relaxed inside. I think it's because I'm expecting the pain outside, kind of bracing myself for when it hits and I'm normally a very in-a-hurry kind of person, indoors i tend to take my time more. That's certainly worth thinking about, thanks.
KYata - that's a really good idea about shopping in a mall - most of the walking I've done outside has been literally out of doors, not inside. My own dogs are rather large and walk at a good speed but I've just bought Haltis for them - do you have them in the States? - to try to slow them down a bit. They've both been trained as Guide Dogs so they don't sniff - they want to walk on as they were trained to. My new puppy arrives on 18 August - he'll be 7 weeks old, so at least the walks with him will be a good bit slower for a while at least! I think I'll maybe take a trip to our shopping centre tomorrow to see how I get on there. I tend not to go there unless really necessary as I hate shopping, but I'll just need to look on it as PT. And there are lots of coffee shops there....
Thank you both for the suggestions, they make a lot of sense.

 

[PolarBear60]

Consider taking a cane or a walking stick outside with you. Concentrate on relaxing and taking a leisurely pace. Maybe it will help.

There's a fair amount of me to lug both up and down stairs. My rate seems to be the same for both. Slow and deliberate. I'm encouraged that my speed seems to be affected more by my non-TKR knee than my TKR knee, so I have hope I'll be zooming up and down stairs a year from now.

 

[puppywalker]

I don't have any problem at all getting my operated foot/leg up onto the next stair, it's just the hauling up that's a bit more problematic, which is why I think it's muscular rather than anything else. Both the PTs I've seen told me to get rid of the walking aid weeks ago

 

[Celle]

If the walking aid helps you to walk without pain outdoors, I see no harm in using it.

 

[puppywalker]

I'm trying something new. I had a lot of balance issues with the cane as I've said before and I certainly don't want to go back onto crutches. I thought I'd give a walking pole a try (or is it called a ski pole?) Anyway, I've adjusted it so it's quite tall (just above waist height) and I can use it to balance, but it's too tall for me to put weight on it. I feel much safer than I did on the cane and early indications are that it helps a lot with the pain of walking outside. Early days yet, but so far, so good. It maybe looks a bit odd, and the PTs will no doubt be having a hairy fit but I'm way past caring about that if it lets me get around!

 

[Celle]

I am now officially excused from heel slides and straight leg raises (yippee!) so long as I use my exercise bike and my son's treadmill set at a low speed and swim regularly as well as "marching" in the water and doing leg kicks. I am also banned from using my hands to push up from a sitting position and when I make a coffee (frequently - I have caffeine in my veins rather than blood!) I have to stand just on the operated leg from when I switch the kettle on until the coffee is ready to drink! I've also been advised to get an aerobics step as I have to learn to go up and down stairs without holding onto the banister and she reckons normal household stairs are too high to practice this on at first. She had me do 10 reps and the first few were very tentative and jerky, but by the time I got to number 10, it was so smooth I couldn't believe it.
She said that as far as she was concerned the new knee is just fine and all the issues are muscle and tendon related, and will resolve when I don't have a gallon of fluid gurgling around in there.

I think that all the exercising you are doing has a lot to do with the swelling. Exercise bike, treadmill, marching in the water - and walking the dog - far too much! It's not necessary, either. At this stage and with the ROM you have, just walking and the activities of daily living are all you need. Concentrate more on icing and elevating and less on exercising, and see if that helps.

but heel slides lying down are still very limited, despite doing all the stretches and whatnot suggested by the NHS physio. Sitting on a chair gives slightly better results, but nowhere near as good as standing on the first step.

I know you're now excused from heel slides, but a bend is a bend is a bend . . . Bending your knee while sitting on a chair is just another form of heel slides. If your knee bends well doing that and on the stairs, why even worry about doing a heel slide in bed?

I feel much safer than I did on the cane and early indications are that it helps a lot with the pain of walking outside. Early days yet, but so far, so good. It maybe looks a bit odd, and the PTs will no doubt be having a hairy fit but I'm way past caring about that if it lets me get around!

I think you have a good idea here. Who cares what the PT says? It's your knee and you alone have the right to say what will happen with it. The ski pole sounds like a good way of stepping down and giving you the confidence towards eventually walking without any aids.

 

[puppywalker]

I've developed my own form of knee bends - when I wake up in the morning while lying on my side in bed, I bend the operated knee back as far as I can and then use the other foot to just push it a little further and hold for a count of 5. Absolutely no pain or discomfort and it loosens up the knee for getting out of bed. Despite all the good advice I've heard and read on this fantastic site, I'm still trying to push it to heal quicker - will I never learn? I never suspected for a minute before surgery that at 4 months I would still not be able to walk normally. Because I'm overweight the surgeon kept saying that he didn't expect such a good result as normal and it's very hard at times to think that maybe this is as good as it's going to get.