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[TKR] Increase of stiffness and back of knee pain<

Discussion in 'Knee Replacement Recovery Area' started by roboknee, Nov 5, 2018.

  1. rustic

    rustic member

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    @roboknee and @andpeaches peaches
    I also use a fitbit (zip) to track activity level. 4-5000 steps is my "sweet spot" right now. Good benefits, without undue pain at night. Much more than that, and I get some extra swelling and it hurts at night (esp. in the hours before waking up).
    One of my goals is to get back up to an average of 10,000 steps a day without causing problems.
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Detail missing
    You missed out how many
     
  3. roboknee

    roboknee junior member
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    Hi all Christmas was so hectic!

    My physical therapy is done and I’ve really not been doing much in the way of anything but walking minor stretches and some massages. My quads are so stiff at times! I’m wondering what kinds of exercises I should be doing at this point?

    My therapist suggested to do my routine as best at home as I can 5 days a week. But I have to admit it has felt so much better since I haven’t been doing them! I’ve been walking a lot... average 5000-8000 steps/day.

    I am hoping to get back to cycling. Although I have tried to get on my stationary and it’s a hard go. Tonight I couldn’t even go all the way around so I rocked forward and back until I made a few rounds I set my timer for 5 minutes to start. Not doing any PT for two weeks wasn’t good. What is a happy medium for doing them? Robo
     
  4. traceys

    traceys graduate

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    Hello @roboknee
    That 2 week pt gap probably left you stiff. I can relate. My pt told me as long as I was moving it she was happy. Lol. So I am spending some time in my recliner with my TKR foot on the ground and rocking so it flexes and extends it passively. Then some simple stretches and ADL
    It’s such a balancing game! Lol.
    Brava on your step count! You have inspired me to pop my Fitbit on and see what I actually do as I’ve no idea.
    I’ll be honest - the holidays were ok but I’m so glad to be back to familiar routines now again
     
  5. roboknee

    roboknee junior member
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    @traceys
    Oh my I’m so glad I’m not the only one! I am so looking forward to this week of routine! I’ve had my daughter visiting for three weeks and of course she got on the plane not feeling well at all made it back to NYC then had to go to ER by the next evening! After many tests (appendix was first thought) she had an ovarian cyst burst. Stressful few days for me! She is on her way to mending. She was very happy with the results of my replacement she could see such an improvement. I visited her right before I decided to have my TKR. Being in NYC in June made me realizes how much I needed this surgery! It really was the deciding factor to have it. I didn’t realize how bad the pain and limping had gotten. I’m so glad I did it!! I just want to do the best I can during this recovery.
    Yes I think I’ve gotten to the point that at times I don’t think if it as much. I’m afraid I’m going to not do enough! Balancing act is right! Hope your routine week goes well!

    Robo
     
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  6. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    I expect all these steps is why your knee is stiff. You might not see swelling on the outside, but the inside is still swollen. That makes it hard to move. It sounds like you are doing more than your 4 month old knee is ready for. You're only 1/3 of the way healed and it doesn't take much to anger a new knee. Let it be your guide.
     
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  7. rustic

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    We've got several things in common. My surgery was also in September. I stopped PT as we were heading into the Holidays' craziness, and I'm continuing at home. I also love walking, and use a fitbit. Quad tightness and soreness is one of my main problem areas I'm working on as well.

    I'll list a few of the things that have been working for me. Of course, we are all individuals, but some of these things might help you too:
    1) My leg is the weakest when it is behind me, like when stepping down with the good leg (when the bad leg/foot is up and behind you).
    Parts of the quadriceps muscles across the hip joint as well as the knee, so it is important to stretch the hip too.
    I face away from the stairs (at the bottom), and put my surgery leg behind me, tip of the toe straight down on the bottom step. I try to stand as straight as possible, and then push my hip forward a bit so I feel the stretch at the hip as well as all along the thigh and across the knee.
    While I'm there, in between the stretches, I also try to push that toe down into the step, just for a couple seconds at a time (this hurts some, and I don't push too hard).
    Over time, I'm trying to build strength over a wider range of motion than I have now. A regular (8") step might be too high/low, for some. I started with that, and now use a 20" chair.

    2) Rollers. I use a foam roller to do the typical massage/release that runners do for the quads, glutes, side of thigh (IT band!!). Plenty of videos online. Try runnersworld.com if you don't know where to start looking. I also bought a pastry? roller (bigger diameter than a pie crust roller) at Goodwill. In bed with leg elevated, I roll out small trigger points in my thigh(s). Don't roll directly on the knee.

    3) I'm reluctantly, using my fitbit to keep me from doing too much, rather than its original intent. I've learned that I can stay around 5-6000 steps with no setbacks. I still do bigger days, because I love walking and this is the way to improve my situation, but I have to take a recovery day (4K or less) after those days. I suggest learning the range that doesn't cause any problems and push against that limit just once in a while if you want to keep improving your walking.

    4) I seek out uneven terrain when possible. The new knee screws with you neurologically, and building balance and stability back up is important.
     
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  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Excellent!
     
  9. roboknee

    roboknee junior member
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    @rustic
    That’s a great idea I really didn’t think of using my fit bit to help me keep track that way! Thank you.
    My quad is my biggest issue also at this point. It gets so tight on some days! I can feel the bunching up of the muscles so I’m massaging it at night on either side with the heal of my hands but the rolling pin sounds easier.

    Do you ice much anymore? I admit I don’t hardly at all. Occasionally at work mid day if I’m having issues.

    How often do you do your stretching?

    I’m trying my stationary each night starting this week adding one minute a night unless the next day I feel discomfort. Then I’m staying at it or eliminating the minute until it is no longer uncomfortable. I was so surprised how hard it was with not doing any stretching for two weeks. Which is my own fault.
    I will start on your method of stair stretching tmw. It sounds like I just need to figure a better routine. And keep with it.
    Not doing any stretching is not going to work. It feels like I’ve taken steps back.

    I was talking about it to my sister tonight she keeps reminding me that I’m still recovering and to be kind to my new knee.

    Robo
     
  10. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Sounds like you have the right idea on the bike.

    Using a bike to gain ROM is pretty simple:
    • Set the bike to zero resistance
    • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
    • Gently turn the pedals, through discomfort but without pain.
    • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
    • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
    • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
    • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
    Here is a bit more chat and some pix and how 'healing' and 'training' are different
     
  11. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    I'd say careful massage, stretching and not overdoing is a good plan. Your knee is only 4 months old and there is still healing going on. I didn't ice much either at 4 months--usually didn't feel the need to, but there were days...
     
  12. rustic

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    Icing is definitely a hassle. I do it about 4 times a week now, but it really fluctuates. I use Diclofenac cream sometimes. That seems to be have more benefit, and I reduce my icing frequency correspondingly.

    A lot of the day, I am going in and out of shops that all have a few stairs in front. I make extra use of those stairs, doing a quick stretch sometimes when I go in and out. So, I'd say that adds up to about a dozen times throughout the day. In the evening, while lying down watching a DVD, I elevate, ice or do the Diclofenac cream, do very gentle stretches, and use the rolling pin. I've watched more TV since surgery than in the previous 10 years, lol.
     
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  13. roboknee

    roboknee junior member
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    @rustic it’s doing so much better with the stretching I’ve been doing everyday. Thanks for the advice. It really depends on how much I have to walk for work that day. I usually do some stretching first then my bike for 7-8 minutes. It’s still a slow go and it takes a bit to get the full round circle but it’s better each time I get on. It sure is nothing like training as I used to spend hours on my stationary. Hopefully I’ll get that back some day. Well I really hope to get back on my road bike some day.. maybe this summer. My biggest fear is the twisting to clip out. Or falling. :bicycle2:


    @kneeper I’m much more kind to my knee now and try to only do as much as I can with how much I’m on my feet all day. Today I taught a cooking class with my 4-H kids and was on my feet with no break for about 4 hours and I sure felt it! Especially in my quads so tight! I should have taken a break to stretch out. After the class I finally did some gentle stretching which helped. But the stiffness remains tonight.
     
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  14. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    That's a long time to be on your feet at only 4 months. No wonder you felt it!

    That stiffness is telling you that your knee is swollen, even if you can't see it outside. The inside of the knee is a small area and any extra fluid will make it tight.
     
  15. rustic

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    @roboknee
    Last summer, pre-surgery, I switched to flat/simple pedals on my mountain bike, because I couldn't do the twisting move to escape the (spd style) pedal anymore. Also, I wanted to avoid pulling up with my leg at all. Having total choice of what shoes to wear was nice too.
    Now, there is a foot of snow on the ground, so I won't be biking anytime soon. When I do, I'll start out with the flat pedals that are already on there. I still have the other ones, but might not switch back.
     
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  16. andpeaches

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    :wave:Hi @roboknee ! And @rustic Happy new year belated to you both! I really enjoy reading how you’re both doing because we’re close in recovery, my knee still swells too after standing on it for hours so thanks @sistersinhim for reminding us we’re only 4 months! Some days it just feels like I can go forever and other days the knee shouts hey I’m still not perfect please! And for both of you bike riders... i will need your advice! I just ordered a Peloton bike! My biggest purchase in years! Hope it’s eorth it!
    Have great days to both!! :bicycle1:
     
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  17. roboknee

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    @rustic hi! I know I have my other pedals some where maybe I should change them out for the beginning.. a foot of snow!! Lucky, I love snow. I’m so cal no snow here it’s cold but not really!
    It seems (maybe) the cold is affecting my knee some what or maybe it’s just the nature of recovery but I haven’t been able to go round on my stationary for a few days I’m still doing back and forth I don’t want to stop. It’s a bit frustrating. I’m trying to ride before stretching I think I will try some gentle stretches first tonight to see if it helps. Boy this can be a bit frustrating! Trying one day at a time!

    @sistersinhim thank you for the reminder I appreciate it. I try to but am not very good at reminding myself that it hasent been very long in my recovery.

    @andpeaches
    :hi::wave: Happy New Year back at you!!
    I too feel those exact days! Today was not so good and I’m just not sure why? Sometimes I can figure out what I over did but this time it was just not a good day. I had a ton of those electric shock things near my scar and especially over my knee top. Then tonight it moved up along the scar to the upper part. It was a bit different to have so many. It’s little electrical shocks. To the point I had to rub it out to go away. Do you still have those?
    It’s so great you got a Peleton! How fun! My best advise is to start very slow. Don’t use any tension and no up hill climbing for now! Let me know how you like it I’ve been very courious how they are! :biking:
    Robo
     
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  18. rustic

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    @roboknee Do you have the seat way up? What kind of bike setup are you using?
     
  19. roboknee

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    @rustic I have a stationary up right.. the seat is all the way up I can do. I realized that the angle of the pedals makes for the top of the petal go round to be at least a 120+ flexation. That’s why after work without any pre stretch I just can’t get over the top. So for the last few days I’ve been either doing some pre-stretching. Or doing half circles until loose enough to go around. It seems to be working better.
    I think my issue came from being sick for a week and not doing anything for my knee. My dr because of my prosthesis put me on two different antibiotics! Which made me feel so sick! I’m better and the stiffness is coming along keeping up the peddling! :biking:
     
  20. rustic

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    I bought a mountain bike, to put on a stationary trainer. Both from Goodwill, for a pittance. No room in my cabin for that setup though, so it sits outdoors. I can only use it in mild weather, unfortunately.
    Sorry you got sick. I was sick around Christmas, which didn't worry me too much. But, I freaked out with paranoia after getting a deep cat scratch.
     
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