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TKR I'm back again

Glad you're back on track, Dolphin! Put yourself first right now, over anything else that steals your time. You deserve to feel better and get the most out of the MUA. It's been a long five months for you.

Yes...Motion IS lotion! Movement is important for maintaining healthy joints, flexibility and our overall well being. Movement keeps us flexible, keeps our muscles stretched and if you're not overdoing it, it can help decrease pain, hopefully in your lower back. I hope you're enjoying your day. It's going to be a scorcher in my area today, not my fave type of weather, but there's always tomorrow! :wink:

Keep moving, even if it's just a little. Every step counts! :yes:
@Dolphin5
 
The exercise I gave you is just a stretch and not a real exercise. As long as you don’t push so hard that you have pain, you can do them as often as you like. I would recommend at least 3 times a day.
 
I'm struggling mentally. Last night, despite taking two paracetamol just before bed I woke with an aching knee and was awake for over an hour in discomfort. So I'd overdone the exercises.

Question: how do I take it easier the next day? Today by the time i go to bed tonight I'll have done 11 sessions of the stand up/sit down exercises (10 each session).

Prior to the disappointing physio appt last Friday I was doing 20 heel slides every two hours starting 7.30 am, finishing 9.30pm so 8 sessions, holding each slide for about 7 seconds.

Since then it's been more like 6 or 7 sessions each day. Since the physio I've been holding the first ten slides for 12 seconds each, the last ten slides for 15 seconds each slide.

So how do I reduce these exercises after my knee is painful during the night? Do less sessions of the heel slides? Perhaps only three sessions in the day? Or perhaps reduce the time I'm holding each slide? Or just push the knee back less?

Mentally I'm finding it all very hard. Especially since the stiffness doesn't seem to have improved since leaving the hospital 3 weeks ago.

Feeling despondent.......
 
PS in the evening when I'm relaxing watching TV, am I better to have my foot on the floor with the knee back to the point of feeling slightly uncomfortable just to help keep the stretch there?
 
Dolphin5 said:
in the evening when I'm relaxing watching TV, am I better to have my foot on the floor with the knee back to the point of feeling slightly uncomfortable
Click to expand...
I wouldn't have my foot down in the evening when unwinding for bed as this could definitely be a cause of discomfort later on.
I used a rocking stool ( left over from my daughter nursing my grandson) to gently move my elevated leg whilst watching TV.
It was really pleasant and even 2 years plus later I still use it in the evening.
There are probably cheap ones on Ebay as they are quite bulky and people get rid of them after they stop nursing.
 
Dolphin5 said:
Mentally I'm finding it all very hard. Especially since the stiffness doesn't seem to have improved since leaving the hospital 3 weeks ago.
Click to expand...
I'm sorry you are finding it tough.
The key is gentle movement and alternating it with elevation and ice.
It's hard to listen to your body when you worry you are not doing enough - but pushing too much will be counterproductive.
Good sleep is essential for recovery. I persuaded my GP to give me some zopiclone which I used sparingly in the early weeks/ months. I alternated it with a sedative antihistamine ( Nytol) from the chemist and herbal Nytol ( valerian) to ensure I slept OK. I also used to sleep with my knee resting on the opened cool water jacket of my Aircast Cryocuff and refresh the iced water in the night from the tank if I woke.
 
The aching is likely soft tissue inflammation or irritation. Doing more isn't better especially if the tissue is inflamed.
Consider reducing all you're doing by half until the discomfort eases. Cut the sessions, cut the reps. Ice and elevate after each exercise session and use pain reliever as indicated or needed. Slowly build back to your usual sessions and reps and see if you notice a difference. Try not to get discouraged. This doesn't mean failure. Ups and downs are common, this takes time. Rest for now, without the guilt or frustration and aim for less tomorrow.
Slowly but surely you'll meet your goal.
@Dolphin5
 
Dolphin5 said:
I was doing 20 heel slides every two hours starting 7.30 am, finishing 9.30pm so 8 sessions, holding each slide for about 7 seconds.

Since then it's been more like 6 or 7 sessions each day. Since the physio I've been holding the first ten slides for 12 seconds each, the last ten slides for 15 seconds each slide.
Click to expand...

Here is a reminder of how Bonesmart recommends heel slides:

 
@Dolphin5 I had an MUA on 7th March 2025 due to scar adhesions. I had my TKR on 9th December 2024. Today, I am still experiencing slight swelling, slightly painful and all this is to be expected. Doing so much more now and the key is rest and ice when needed. The only exercise I have ever done is the stair lunge, then when sitting on a suitable chair, not the sofa, gently ease the knee back. Somedays I am at 100 flexion but more like 90 and to be honest, at this stage I don't even worry about flexion. Sounds like you are a little obsessed and perhaps try to get on with daily routines, gently. Still a way to go, but every week I am that itsy bit more improved. Time is the essence.
 
Jockette thank you for the reminder about the heel slides. Until physio last week I was doing 20 slides every two hours which made 8 sessions a day. Since then I'm doing more lIke 6 sessions a day. Upped the time each slide is held to 15 seconds. The physio told me to try and get to 30 seconds. However the thought of doing that and knowing that every two hours I'll be doing the slides for 10 minutes makes me miserable. Remember I've been doing these exercises for over 5 months now, with only a couple of minor breaks. It's getting hard mentally.

I'm still getting up for the loo about 5 times a night which means I'm gradually retaining fluid throughout the day. Normally I'm up twice a night but it's been months since that was the case. Perhaps as time goes on I'll retain less fluid which will mean the slides/flexion improves?

Andypandy your words are very encouraging in that you're sill improving 3 months after your MUA. You're right about me being obsessed about the flexion. Why? Because I need to be able to drive. My quality of life depends on it, I live just a few miles away from the sea but I can't get there to walk my dogs. There are so many things I can't do now because I can't drive. Recently one of my dogs needed the vet. Virtually impossible for me to get there. Fortunately my neighbour agreed to drive my car so I could put the dog in and we went to the vet.

What I find discouraging is that at the end of my 20 slides I'm getting the foot back 2 inches more than at the beginning of the slides. But two hours later it's back to where it was. That's where I'm getting despondent.
 
@Dolphin5 I started driving 4 weeks after my MUA, automatic. Didn't feel like it at all but once behind the wheel felt better. As long as you can do an emergency stop, relayed this to my insurance company, then you're OK. Little trips to start and I have to add, some discomfort. So it's not just the MUA, add this on to the TKR and it's a real roller coaster ride, a long one. Maybe try the lunge instead of so many heel slides.
 
Dolphin5 said:
What I find discouraging is that at the end of my 20 slides I'm getting the foot back 2 inches more than at the beginning of the slides. But two hours later it's back to where it was. That's where I'm getting despondent
Click to expand...
My personal opinion is that you are doing too many heel slides and holding them for too long. I never did heel slides past the first few weeks. I never did 20 at a time. I never held them for 15 or more seconds, and I definitely never did them every 2 hours! I found that some of the things my PT (and my surgeon, too!) told me to do, was not in my body’s best interest. Remember what that article said:

“don't over stress your leg, which is very easy to do. This is what happens when you do 10-30 reps in 3 lots 3 times a day. That much intensity is unwise. You get a much better effect doing them little and often. 5-10 reps is fine if you’re doing heel slides every hour or two during the day.”

If 3 sessions a day is too much, how much more is 6-8 sessions! If you feel you absolutely must do heel slides, I suggest just 5 at the most, at a time. I wouldn’t even hold them for any amount of seconds. Just gently bend and straighten your leg, not even to the point of discomfort. The important thing is just some mobility for the joint.

What you’re currently doing doesn’t seem to be working, so why not try something different. Waking your dogs is a very good all around exercise. It also gives your knee a gentle bend every step you take. Every time you walk somewhere in your house, your knee is getting that “good for it” movement. Let this be your PT.

Like you, I had a very tough first year. I had two major setbacks, one at 4 months post op, and one at 5 months post op, at which point I could hardly bend my knee. I finally let go of my ROM obsession, and just went about my day, and let the movements in my day be my “natural PT” Over time my ROM got better, as I stopped stressing my leg, and let it relax and heal.
 
Dolphin5 said:
What I find discouraging is that at the end of my 20 slides I'm getting the foot back 2 inches more than at the beginning of the slides. But two hours later it's back to where it was. That's where I'm getting despondent.
Click to expand...
You're back to square one due to rebound swelling and soft tissue tightness. Heel slides stretch the tissue and you gain ROM, but afterward swelling returns and you're back to where you started. Make sure to follow your exercises up with ice and elevation, if you're not already. Elevating the leg should help drain the fluid.
You want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there. Thankfully your knee has the range, it's not fixed in place. Look at that as a positive sign when your feeling frustrated. :thumb:
Hope you're having a good Thursday, Dolphin. Enjoy the evening!
 
Dolphin5 said:
I've been doing these exercises for over 5 months now, with only a couple of minor breaks. It's getting hard mentally
Click to expand...

From your own words, it's clear that what you've been doing is not working. Why not try something different?
 
@Dolphin5, I do think that you could reduce the number of times a day you do these heel slides to 3 times a day. It is good to try and hold them a little longer over time. But those time increases should be at least 7 days apart. If you’re trying to increase the time any more often, you may be adding to the swelling.

You are making progress. You are able to move your leg 2 inches farther back at the end of your session. The fact that it goes back after you quit the exercise is normal and can last for a while until you either get rid of the swelling or retrain your soft tissues (muscles, ligaments, and tendons). As Layla mentioned, this can be because of swelling. It also can be that it takes time to stretch out the soft tissues. They tend to want to return to what they think is “normal” which is why you do need to keep challenging your knee at least several times a day with either heel slides or the step lunges I gave you in Post #378 (scroll back up through your thread and you will find the post number in the top right corner of each post on your thread).
 
Hi all. I've read your posts three times, thank you. I did manage with my last two sessions yesterday to get the foot back 3 inches. I wondered if this improvement was due to only doing 6 sessions instead of 8 sessions. My first heel slides this morning only got my foot back an extra inch but the first ones of the day are harder. I guess this is due to the knee getting stiff during the night.

Two weeks prior to the recent surgery I stopped doing the exercises. My surgeon told me my knee was at about 30o so I'd regressed from 45o to 30o in those two weeks. I'm really worried about losing any ROM I now have due to not doing enough of the exercises.

I've increased the time I hold each slide fairly slowly, currently 15 seconds each. I'm doing the sit down/stand up exercises hourly, 10 reps. Interestingly my other knee, due to be replaced next year, has become stiffer. Is this a sign I'm doing too many of the sit down/stand up exercises??? Or is it good that I'm giving it some work to do!

My knees have ALWAYS been stiff so my situation is perhaps a bit different to other people's.

So much advice and so hard to make the right choices. I only went to the loo a mere 4 times last night, woo-hoo, so perhaps less fluid yesterday!

So I'm going to go back to doing lymphatic drainage which I've not done for about 2 months. I'll reduce my heel slides to 4 sessions today instead of 6 but will still hold each one for 15 seconds. I'll try and remember to do some of the step lunges.

I'll let you know how I get on. Thank you everyone.
 
Dolphin5 said:
I only went to the loo a mere 4 times last night, woo-hoo, so perhaps less fluid yesterday!
Click to expand...
Yay! Improvement!
Have you tried limiting fluids two to three hours before bedtime? If not, it may make a difference.
Also, avoid caffeine, alcohol, high water foods. Try elevating right before bedtime also, encouraging fluid to move before you settle into bed to sleep for the night. Good you're going back to the lymphatic drainage exercise, hopefully that helps too. Sounds like you have a plan, keep us posted on how it's going and enjoy the weekend!
 
Don’t try to do any stair lunges along with your heel slides 3-4 times a day. The stair lunges (if you do them) should be IN PLACE OF a heel slides session. The goal is to move your knee but not so much that it results in swelling.

The stand and sit 10 times every hour is too much. This is shown by the stiffness you’re feeling afterwards. Cut that to every 2 hours. The thing you can do every hour or so is a short walk around the house or yard of 5 minutes or less. Trips to the bathroom or kitchen count. It should be fine to do a short walk with the dog once a day for 10 minutes as part of your routine movement every couple of hours.

The improvement you noticed with your heel slides yesterday was likely due to reduced swelling because you cut back on the exercises. It’s a fine balance that you need to discover through trial and error. You’ll get there…..just keep listening to the messages like this your body sends you.
 
Something you might be aware of that I was not prior to all of my knee surgeries. Swelling. Yes, external swelling is obviously visible. But even if your luck enough to have the external swelling under control, there can, and probably still is, internal swelling. As long as you have any swelling at all, it hampers your ROM.

I say this not to discourage you, but rather to encourage you to not over do on your knee.
 
Hi all. I'm getting to the tearful stage. Yesterday both knees were bad and my dog walk was not enjoyable with the stiffness in BOTH knees. By the end of the day I'd done about 7 sit/stand but will cut that down even further today to perhaps 3 or 4 a day. The first heel slides at 7.30am was the 20 reps holding for 15 seconds. I only did 2 more later on. 10 reps holding for I think it was about 10 seconds.

It came to mind what I'd read on Bonesmart a while back about physios treating a TKR like a knee injury when it is not a knee injury but an implant in the knee. I don't think they really know what they're doing.

Do you know whether laser treatment would help my stiffness/ROM?

I'll walk the dogs today as usual which takes 35/40 minutes. I did increase the distance a few weeks ago by about 100 metres. I'm usually a bit whacked when I get home. I have a coffee and ice the knee. Yesterday I watered all my pots which takes 15 minutes, put washing out and cut the grass.

4 weeks tomorrow since the MUA/Arthroscopy. When I Google MUA it says recovery is a few weeks/few months but doesn't say much about the ROM improving in as much as how long that takes.

Layla I drink very little in the evening. One glass of water about 6pm. A few sips during the evening. Last night again I only got up about 4 times so perhaps the fluid is becoming less.......
 
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