PKR JusticeRider’s rehab adventure

JusticeRider

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Hey all, I’m new to this forum although I have been lurking for a while. I had a left patellofemoral replacement on August 10th. I am 44 years old and have had FAI hip labrum repair twice on my left hip, an arthroscopic cleanup on my left knee and now the partial replacement. Really hoping this is it for a good long while! I want my (formerly very active) life back! This is the hardest of all the surgeries I’ve had. Pain levels are good now but I am worried about ROM and it has been stressing me out. I hike, backpack, snowshoe, trail run, and train horses and have a farm. I need 120 degrees of flexion to mount my horse. Right now I’m at about 80. I could use some encouragement (though I already feel somewhat better after reading up on ROM on this forum). My problem is everyone else is telling me I have 3 more weeks or else! I’m tired today.
 

Layla

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Welcome to BoneSmart, we're glad you decided to come out of the shadows and join us!
You're young and I'm sure with time you'll be engaging in an active lifestyle once again. Please don't stress about your range of motion, but allow more time for it to happen naturally as your body heals. Thankfully your pain is manageable. Try to ignore the comments of others especially those who have never experienced joint replacement themselves. I'm certain given more time you'll be where you want to be enjoying life again without the pain. Thanks for joining us!

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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kneeper

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80 degrees of bend after only a few weeks is good! Generally, listening to your knee--alternating rest & elevation, and gentle exercises, gradually increasing activity as you can handle it and so on, will get you there. Finding the sweet spot between activity (maybe challenging yourself a little bit) and giving your body a chance to let the swelling come down and your body's energy to be directed to healing, can be a challenge.

Don't be freaked out by the "deadlines" people tell you. My first PT was all "you might need an MUA if you don't get to 90 by x date." I got there, but not by overexercising, which many PT's seem to promote. The swelling had to come down before it was going to bend much. If you have a good PT they are worth their weight in gold. With my second knee I had a good PT who saw people as individuals.
 
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JusticeRider

JusticeRider

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Thank you Layla and kneeler. Yes, both the PA and my PT have brought up the specter of MUA. I REALLY don’t want to do that. I get sick from anesthesia and can’t take narcotics/opiates (think nonstop vomiting and disorientation ) so another procedure is the last thing I want! And in a lot of ways I’m doing well. I don’t want to punish my body because it’s not moving fast enough for a certain timeline if it’s not absolutely necessary. But the pressure is really stressing me out!
 

Jockette

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Right now I’m at about 80. I could use some encouragement (though I already feel somewhat better after reading up on ROM on this forum). My problem is everyone else is telling me I have 3 more weeks or else! I’m tired today.
The people who are telling you this are wrong.

My ROM continued to improve well into my second year post op, and even a bit more in my third!
 
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zdclimber

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Don't be overly concerned about ROM at this point. I had the same surgery as yours, my ROM progress was the following - at the end of week
1: 60
2: 80-85
3: 90
4: 105/110
6: 130
8: 140

Now at over 1 year, my ROMs for both knees are about the same - heel on hip. I remember I spend 5-10 mins gently bending my knee (to the point of some discomfort but never pain) from week 2 till I got about 130 ROM.
 
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JusticeRider

JusticeRider

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This is so encouraging you guys, thank you! My last PT session they pushed the ROM until I was yelling with pain and said they were trying to help me avoid MUA. Which I really want to avoid! But it feels wrong to hurt my body. Especially because my ROM the whole first week was about 45 max and now I’m up to 80. So it IS improving. I cancelled my PT on Friday and scheduled a massage
 

Zanza

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I felt that way at three weeks. I sat around doped up on pain pills wondering why I did this to myself. I've had major spinal surgery, and I had multiple fractures from a motorcycle crash, and this knee surgery was worse than both those things put together. But you know, what the guys on this forum say is true. It does get better. There is a light at the end of the tunnel and it's not a train. Just take it easy, use lots of ice and elevation, and take your pain medication on a schedule so your pain level doesn't get too bad. And don't let the physical therapist hurt you, and don't let the doctor do the MUA if you don't want it and you feel you're improving! It's your body, you're the one who has to live with it and you're the one who can feel if you're improving. Listen to your body, and you'll see, you'll start having good moments during the day, and then you'll start having good days.
 

Runningfree

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farm. I need 120 degrees of flexion to mount my horse. Right now I’m at about 80. I could use some encouragement (though
I am 2 weeks post TKR I have good ROM and can do most of the exercises I was given, except the knee bend. After joining BoneSmart and reading lots of posts I decided I was not going to push my exercises into pain, just to discomfort level. As a result my knee bend might not be good enough for the first physio appointment tomorrow. However, a friend suggested I use a child’s skateboard when I am sitting, to slide the foot back and forth. She used one and can now pull her heel up behind her, heel to bum. She’s 74. Not sure when her Knee was done, but an excellent result I think. While waiting for the skateboard to arrive Im using a plastic bag on the floor. After a few mins sliding my foot back and forth my knee goes further with ease. I will have a good bend in my knee eventually I am sure. I hope this helps.
 

jeano

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As someone who was riding her horses roughly 4 weeks after partial knee replacements I will dispute that mounting requires 120 degrees of flexion.

A mounting block will be your friend. It's easier on your new knee and easier on your horses back. If you're light and limber enough that the lateral pull doesn't wrench the horse's back you can probably vault on!

I trail ride extensively and have never had to walk home if for any reason I need to get off and get back on because there is ALWAYS something to serve as a substitute mounting block. Horse in ditch, me on bank, logs, stumps, rocks, car bumpers, you name it, I've made it work. I've taught 3 horses how to park next to almost anything and stand like statues until I'm up.

At 175# and nearly 69 years old I stopped worrying about needing a block over a decade ago. Ain't no shame in it.
 
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JusticeRider

JusticeRider

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Ok Jeano, you are right about the mounting block! Actually for the last year or so when I could no longer bend my knee much without extreme pain, I have been leading my horse up next to my porch upon which a mounting block sits. This gets me to the level where I can just put my leg directly over my horse! I have been riding bareback because just putting my foot in the stirrup was painful. But every time I rode out I had a little thread of anxiety knowing that if anything happened, I might not be able to get back on my horse. I grew up on the flat prairie where you might see ‘a tree’ on a two hour ride, so I still don’t feel comfortable being dependent on something to climb up on! But your point is a valid one, and I have a feeling I will be choosing the mounting block a lot more often after all this, even if the flexion is there.
 
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FCBayern

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Don't believe the hype about a timeline for ROM. Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. It took me a full year to reach 120 degrees of flexion, and I was still 4 degrees from straight. By the end of the second year I was over 140 and past straight. I've been hiking over rough terrain for miles, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.
 
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JusticeRider

JusticeRider

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FCBayern, how did you do it? Get the ROM over time I mean? Wondering what I can do, besides letting PT wrench on it or forcing it myself? I cannot wait to hike again, it is one of my favorite things!
 
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JusticeRider

JusticeRider

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Also, thanks in large part to this forum, I am trying to let go of worrying about my current flexion haha. So in that spirit, I have been thinking more about how grateful I am for all the things that are going well (and it’s really going well!) I am unable to take narcotics/opiates I am realizing. I have now been violently ill from Vicodin, codeine, oxycodone, hydromorphone, and tramadol. Tramadol also made me hallucinate! I tried the last three after this surgery and it went really badly. But that’s the bad news! The good news is that, after the first week or so, my pain has been really manageable with Tylenol and the limited amount of Ibuprofen I am allowed. In fact, yesterday I took no Tylenol at all, and last night I only took one Tylenol pm and slept very well. There were a several rough nights where I didn’t get much sleep, and a few where sleep was fleeting, but lately I have been sleeping through the night. That is priceless! Besides the knee bends, my other exercises are going well. SLR’s still don’t feel wonderful but I can do them. I couldn’t lift my leg without assistance for just over a week, so it is such a relief to know the message is going through! I am taking a few short walks throughout the day. I have a wraparound porch on my little farmhouse, so I go 2-3 times around the house 2-3 times a day. With that and my ADL’s I average about a mile a day, which feels very reasonable. And the best part is today I started walking in the house with no cane! I am using the furniture to steady as I go. I also got a massage yesterday where the therapist did lymphatic drainage to move some swelling along and got some very tight soft tissue in my hip and quads to release. I think that’s part of why I felt strong enough to skip the cane today :)
 

Jockette

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FCBayern, how did you do it? Get the ROM over time I mean? Wondering what I can do, besides letting PT wrench on it or forcing it myself? I cannot wait to hike again, it is one of my favorite things!


Here is his recovery thread:
 
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Layla

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Great update! It sounds like you're progressing nicely.

Jamie from admin once explained that It is our lymph system that rids the body of fluid (swelling). So 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.

I also got a massage yesterday where the therapist did lymphatic drainage to move some swelling along and got some very tight soft tissue in my hip and quads to release.

BoneSmart FA, CricketHip, is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval.
Be patient because it can take the body time to respond.

Something I read awhile back - After a sports injury or surgery, lymph vessels can become overwhelmed with the demand placed on them. When tissues are swollen, deep tissue techniques may actually cause damage to the lymph vessels and surrounding structures. Lymphatic massage is often the treatment of choice, because it helps the body remove proteins and waste products from the affected area and reduce the swelling. This helps reduce pressure on cells and allows them to reproduce faster to heal the body.

Please tag @CricketHip if you have questions about this useful exercise she's shared. She's always happy to help.

Best Wishes on your healing journey!
@JusticeRider
 
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JusticeRider

JusticeRider

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Great information, Layla! Thanks, I will try that. Jockette, thanks for the link! I really enjoyed reading FCBayern’s recovery, so thanks to FC for sharing your journey too!
So it seems like just going about your life can get your ROM back?
 

Jockette

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So it seems like just going about your life can get your ROM back?
Yes :flwrysmile:

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for 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. Normal activity is the key to success.
 
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JusticeRider

JusticeRider

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Hey moderators, could I change my thread title to JusticeRider’s rehab adventure ? Thanks!
 

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