TKR Jennszoo Staged TKR, working on running again

[kmak81230]

Yeah for good sore Jenn! Glad you recovered quickly from your big day of activity.

 

[Jajakio]

Good for yoy, jennszoo. We both upped our game yesterday and didn't pay for it. We're coming along! I did a brief hour job yesterdsy. Im a real estate appraiser and did my first inspection. With two flights of stairs and all and like you was mildly swollen in evening but icing and a decent night and this morning am back to normal. We are actually improving bit by bit, isn't it great!

 

[SusieShoes]

Don't you just love how the new knees get their groove back quickly after you've reached this point in recovery? I'm so happy it doesn't take days to recover from minor swelling anymore. Overnight usually does it.

 

[Jennszoo]

I spoke too soon. Def in the ODIC today. Hit two stores (on the scooter for one) and halfway to bens school, the knee was done. Now I'm upstairs and the kneecap is killing me to move. Not a normal pain for my righty. After this kid gets it of the shower, I'm in the chair for the night. Ouch.

So weird how it takes 24ish hours to catch up from overactivity. Every time.

 

[Jennszoo]

Well, boo. I just read @Josephine post this on another thread and now I'm bummed.

A good way to check extension yourself is like this:
1. put your leg on a bench, seat, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand and wrist under, it's probably about +15
b) if you can get your entire fingers and hand under easily, it's probably about +10 degrees
c) if you can get just your fingers under, it's about +5
d) if you can get your fingers under but it's a push, it's 0

Seems I'm closer to 15 and not 5 extension because I got my whole hand to my wrist under when I stretched out on the hot tub bench yesterday. Definitely at zero on the left. What a buzzkill. Now I guess my Dr's insistence that I get back in PT makes a wee bit more sense. I was wondering why he was freaking out over 5 measly degrees.

I really like the one machine at PT where I get on and strap my knee in and crank it to my discomfort to both flexion and extension. It's the only thing I miss and maybe it did help me get to zero quicker. But I still don't want to pay $60/visit for that 10mins on the machine and to have to tell them no to all the strength and balance stuff they push one me the other 50mins.

So, BoneSmartie's....15 extension at 6w, still ok? I'm still good just stretching at home and giving it time and patience?

 

[kmak81230]

I'm not much better at 13 weeks Jenn. I'm being more proactive at home and don't have many pt visits left - also starting therapeutic massage next week. Just got on the floor and I can fit my whole arm under the non/op leg and that plus a garage under my new knee . I figure they have not been fully extended for probably 30 years so my muscles and tendons are really tight - probably gonna take awhile to loosen them up. Will look forward to hearing what the experts say

 

[Josephine]

Seems I'm closer to 15 and not 5 extension because I got my whole hand to my wrist under

Jennszoo, do read my article more carefully - I said is was PROBABLY that measurement. It's by no means and accurate way to measure anything.

Now I guess my Dr's insistence that I get back in PT makes a wee bit more sense.

No it doesn't make sense!

15 extension at 6w, still ok? I'm still good just stretching at home and giving it time and patience?

at 6 weeks you are miles away from any meaningful extension. Sometimes it can take another 8-12 weeks to get it to a good state. Maybe even longer.

I really like the one machine at PT where I get on and strap my knee in and crank it to my discomfort to both flexion and extension.

This sounds absolutely horrendous and you should avoid it at all costs. If I'm impassioned about not forcing flexion, I'm even more so about not forcing extension.

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.

But I still don't want to pay $60/visit for that 10mins on the machine

Well consider me to have just saved you $60 a visit! That's a lot, by the way! Ouch-ouch!

 

[Jennszoo]

Thanks for the backup, Jospehine. Sometimes a person knows a thing, but still needs that kick in the butt as a reminder.

The machine sounds horrid, but I liked it bc the stretching felt good on my hips, hammies, calves. I felt like it allowed me to get everything else stretched without stressing the knee joint. And I controlled it. But I'm seeing my therapeutic massage therapist on Monday. She'll get me loose!

 

[SusieShoes]

You can work just as effectively, maybe more so, on extension at home, Jenn. Have you read @Roy Gardiner's exercise thread? It's got some really good extension exercises in it that you can do easily at home. @KarriB posts about the ottoman stretch, which can be done with chairs or benches too, and I do that one a lot because it's easy to do while watching Game of Thrones (when watching a favorite show, I find it easier to forget about whatever my knees are doing).

Extension is frustrating! Among other things, it's slow. Slow to get improvement, slow to get to where we want to be. It took months for me to get Lefty to 0, and it's not even a perfect 0. It wants to revert. So I keep on stretching. I can tell it's there and want to make it stay there. But darn, what a frustrating thing!

 

[sandi4213]

Jenn, when I really started to worry about extension (mostly because the pt was worried) I started propping my foot on an ottoman for just a couple of minutes several times a day. I think I started with 2 and worked my way up to 10. I think that alone made more difference than anything pt had me do. I don't know what I am measuring now because I don't measure, but the PA at my os office said it looked pretty straight to her and I had nothing to worry about.

 

[rubyyarn]

This is most interesting about measuring extension at home. Learn something new every day here...

 

[KarriB]

Jenn, as Susie said I always let my TKR leg stretch out between the ottoman and chair that I used for recovery. I didn't know about BoneSmart, but it felt good (weird I know) so I did it a few times a day. You may be able to get a similar stretch depending on how far away the ottoman/chair is placed. Even before the infection my extension was good and I'm sure it was because of this stretch.

But remember you're not yet 2 months post op and extension can come later when swelling is gone. Once you're walking more extension will get better because that's a great stretch as well. In the 8 weeks I went to PT after the infection I never worked on extension there, just stretching at home.

https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/

 

[jaschembra]

I use Josephine's measurement tool as well. And lately, I've been sitting in front of the mirror to watch the space disappear as I gently press above my direct knee. I think I start around a 5+ and work my way, close to zero, but I can still get a finger under it. I use the ottoman effect that Karri speaks of anytime I'm sitting outside. Seems I can only take it up to 15-20 min (used to be much less). I too believe that once my swelling is gone, my knee joint will straighten even more. Slow and steady, you will get there.

 

[Jajakio]

My sister had her knee replacement 2 years ago and extension was rough for her. 3 months of PT to get to 2. She's 0 now though. So hang in there. I imagine it will come eventually.

 

[Jennszoo]

I think sometimes being a quick bender works against me with these over zealous professionals. With my left knee, my extension and flexion cane quick and since they felt the need to "do something" they started me on strength training too soon and set me back.

This time, flexion is good, the leg is way stronger than the other so, gotta "do something" - let's push on her knee for extension.

I've started cycling on the recumbent bike for 5 mins at the clinic where I work when I drop my son off at school next door. I'm walking more intentiinally, using long strides. And I'm officially going to tell that nagging voice to hush up! That's the plan for week 6!

 

[KarriB]

Sounds like a good plan!

 

[SusieShoes]

i think you hit the nail on the head, Jenn. If your bend is good, and you're doing well, or even better than expected, the tendency is for PT to pile on. In week 1-2 in rehab, my PT was just some bending and working on walking and steps. As soon as I got to outpatient PT, though... like you I had a good bend in both knees right off the bat, and strong quads, and could do all the things. So outpatient PT wanted to start right away, in week 3 only, with ankle weights and leg presses! Why? Because I was doing so well. Um... I kinda wanted to keep doing well, thank you. No strength training for me! My PT actually called me a coward. And I said, "Yep. I'm a lover not a fighter. If I don't love it, I don't do it."

Your plan is sensible and it suits you. And that nagging voice... it's not really yours, so you don't have to listen to it.

 

[flyaway79]

With my left knee, my extension and flexion cane quick and since they felt the need to "do something" they started me on strength training too soon and set me back

That's why I stopped PT at 9 weeks. My ROM was good so they started all these other strengthing exercises that would just make me sore and stiff for a day or two afterwards.

 

[Roy Gardiner]

I started propping my foot on an ottoman for just a couple of minutes several times a day. I think I started with 2 and worked my way up to 10. I think that alone made more difference...

I'm glad it worked for you, and what works is what counts, not what theory says. But (you knew that was coming didn't you...) for the benefit of other readers the theory says that a stretch should not be held for more than around 30secs, otherwise the body starts to react against it, not what you want. So if you want to work for 10 minutes (a good thing) then you hold the stretch for 30sec, then relax for at least a minute (move around a bit), and repeat.

 

[Jennszoo]

Thanks Roy. I like to lay on my belly and stretch my extension that way (mainly bc I'm just so, so tired of laying and sitting on my backside!) and I can't hold it much longer than 30 seconds. But that helps to think of :30 stretch, 1 min rest, repeat.