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[TKR] Knee # 2 DONE!!<

Discussion in 'Knee Replacement Recovery Area' started by rah2435, Mar 29, 2018.

  1. rah2435

    rah2435 member
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    Tuesday morning. Today is Thursday and.... So far so good. There's a chance that my old may even have been corrected. But , I'm not jinxing myself. Lol


    Yay!!!
     
  2. Needhope

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    Congratulations on your replacement. Finally you can put that behind you and take it one day at a time going forward through recovery. I’m happy for you!
     
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  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Welcome to recovery again, @rah2435 !

    I'm glad things are going well.

    Here's your recovery reading again, as a refresher.
    Knee Recovery: The Guidelines
    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
    5. Here is a week-by-week guide for Activity progression for TKRs


    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

    Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

    We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

    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.
     
  4. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Your old what may have been corrected?
     
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  5. rah2435

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    Can you tell I'm till taking med? LOL! -
    Anyway, my leg length discrepancy. Doc said my legs are so close in length now that I am may not notice any difference, BUT - he added, let's wait until the "dust clears" to make sure. So far - It's still hard to put weight on it w/o the walker. However things are lookin' pretty good.
    Having lot's of pain still and some mean looking bruises. I know it's only 6 DAYS out but...frustration is setting in a bit. Otherwise - I'm doing well. I have a PT that come out to my house and DOES NOT PUSH ME AT ALL! Her attitude is - let it heal - then worry about ROM and strength. Sound familiar?! :)
    Also - keep taking pain meds, rest, ice, elevate.
     
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  6. Spex10

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    Off to a good start then!
     
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  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Yay! That's pt is a keeper! I hope your out-patient pt will think the same way. If so, you'll have a much better, less painful recovery!
     
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  8. rah2435

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    Well - I know I'm only two weeks out - but I'm having a hard time getting to 0%. Well past 100% otherwise but at about 10% straightening. PT is tell me to focus on this - stretches to just the point of a bit of pain.....
    Otherwise this leg is going SO much better still then leg one. There's still a good amount of pain and it's difficult putting my weight on it - but it just feels more steady. More "real"-like.... e\

    Any ideas for getting my leg to 0% so I can walk better?

    BTW - new PT and she does want to push a bit harder. Not too much but more than the first PT. I have to be careful to keep her in check :)
     
  9. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    There's no good way to push extension quickly. The knee doesn't straighten fully because the big, tough tendons at the back of the knee -- the hamstrings -- are shortened, probably from pre-surgical lack of use (the usual reason). To stretch these big tendons takes time and gentle, consistent movement. I say gentle because rough, aggressive attempts to stretch the tendons risk injuring them or the muscles to which they're attached. No need for that!

    The best exercise for straightening the leg is the one that stretches these tendons naturally: walking. The movements of normal walking actively stretch the hammies with every step... and it does so without risking injury. The more you walk, the stronger your leg muscles get, including the ones that stretch the tendons. Pay attention to making a full, long (but not too long) stride.

    Other good exercises include sitting on a bed or with your legs supported on an ottoman and gently (with just your own leg muscles) pressing the back of your knee down on the bed or ottoman. Do so, hold for a few seconds, release... repeat a few more times. Or you can sit with your heel supported by a table or ottoman and let gravity pull at your knee. This will feel uncomfortable, so only do it until it starts to hurt. When your leg is straight at last, full extension achieved, you will notice that it doesn't hurt to do this any more.

    One of our staff members, Roy, has written a good summary of some excellent extension exercises. Roy's ROM and Extension Stretches.

    Good for you keeping that enthusiastic PT in check! :yes!: It's not easy to do, but you know what's best.
     
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    Last edited: Apr 9, 2018
  10. rah2435

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  11. rah2435

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    Thing is though - it hurts in the front of the knee, not the hamstring.
     
  12. SusieShoes

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    So when you try to straighten your leg, the front of the knee hurts? Not the back at all? Then that would be the opposite of needing to stretch anything. That pain is most likely from swelling in the soft tissues of the knee. Your right knee is still a baby in terms of healing, so those angry tissues need time to become less inflamed. Once the swelling goes down you'll have far less pain. With less pain, and less physical impediment (the swelling), your knee will move better.

    You have good flexion already (excellent, really), so you're doing great!
     
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  13. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Rah, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
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  14. rah2435

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  15. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Here y'go then!

    It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how swollen is your leg compared to these?
    ai63.tinypic.com_eta39s.jpg

    4. what is your ROM - that's flexion (bend) and extension (straightness)

    5. are you icing your knee at all? If so, how often and for how long?

    6. are you elevating your leg. If so how often and for how long?

    7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    8. are you doing any exercises at home? If so what and how often?
    This is the most crucial question so please help me by using the format I have left as an example
    (which means please make a list and not an essay!)

    Exercises done at home
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each
    etc., etc.

    Anything done at PT
    - how many times a week
    - enter exercise by name then number of repetitions of each
    etc., etc.
     
  16. rah2435

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    1. Always difficult for me but - When NOT standing or walking about a 4. But it goes up to 7 or so when I walk around for just a few minutes or (especially) stand for a few minutes 0 putting weight on it. Mostly soreness, but also throbbing and stiffness. Not so much burning or stabbing.

    2. I'm taking Percocet every 4 hours.

    3. moderate

    4. 10-114 - at last measurement two days ago

    5. icing - Yes - ice packs - on and off all day long. Trying to keep about 20-30 minutes on and off.

    7. elevating - yes - up until this week (working from home now) I was keeping it elevated most of the time. Now - I try to take a break every two hours and elevate

    6. I am just getting around the house, up and down a small (7 steps) flight of stairs to go to the bathroom. No house work really. Still hurts to stand for over a few minutes. Using cane. Definitely not able to shop or go to stores. Not "allowed" to drive for another 4 weeks. anyway.

    8. yes - once a day I do my PT

    standing (holding on to kitchen counter):
    toe lifts - x20 time
    side leg raises - x20 each leg
    knee raises - x20 each leg
    mini-squats - x20

    sitting:
    ankle pumps - x20
    leg raises - x20
    knee raises - x20
    hamstring stretch using another chair - just 5 or 6 until it begins to hurt then I stop
    slides - x20
    push leg back with other leg - just 4 or 5 times

    laying down:
    straight leg raises - x20
    quad pumps - x20
    butt pumps - x20
    leg side to side (hip flexors) - x20
    leg raises with coffee can under knee - x20
    heel slides - x20
    hamstring stretch with big coffee can under ankle - push down with quad and hold for 5 - x20 times

    I think that covers it. Not too much walking.

    I see a PT at home three times a week and we go over these same exercises. She's concerned mostly about getting my leg to 0%. So we are emphasizing the hamstring stretch stuff.

    Thanks @Josephine
     
  17. rah2435

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    today measurements are about 10 - 120.
     
  18. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    So when at rest, it's a 4, yes? The others are about in keeping with two weeks out.
    Good
    And you did factor this in to you pain score, didn't you?
    10 I get but is it + or minus?
    You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.
    Make sure it's the same as icing.
    Jolly good!


    PT once a day

    toe lifts - x20 time - these are ill-advised
    side leg raises - x20 each leg - so are these
    knee raises - x20 each leg - and these
    mini-squats - x20 - and these

    ankle pumps - x20 - these you only needed to do while you were not very mobile. Given that you are now very mobile there is no further need to do them
    leg raises - x20 - a tip about SLRs - once you can do them, you don't need to do them any more!
    knee raises - x20 - can't think what these are but they don't factor in any exercise routine I've ever come across
    heel slides - x20 - push leg back with other leg - just 4 or 5 times - this is an easy exercise to do badly and this is badly! I suggest you read this Heel slides and how to do them properly.
    hamstring stretch using another chair - just 5 or 6 until it begins to hurt then I stop - these are only for when you have hamstring pain

    straight leg raises - x20 - see above
    quad pumps - x20, butt pumps - x20 - these are not really beneficial
    leg side to side (hip flexors) - x20 - these are really for hips
    leg raises with coffee can under knee - x20 - see above about leg raises
    heel slides - x20 - see above about heel slides
    hamstring stretch with big coffee can under ankle - push down with quad and hold for 5 - x20 times - contrary to popular belief, this does not help with extension

    Have you ever added these up? They amount to 340 reps per day which is way, waaay too many!

    I would seriously suggest you cancel her visits - for two reasons:
    a) it's too early for you to be embarking on such a rigorous regime
    b) this much will inevitably end up causing you pain

    And yes, I know I've reduced your exercises to zero but trust me when I say, your knee will recover very well all on it's own if you allow it to. I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine) and there are many others on here who did likewise.

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  19. rah2435

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    @Josephine First - THANK YOU SO VERY MUCH! It means a lot to me and all of of here that you give your time to us. So very appreciated!!
    yes
    oh yeah!
    +10 + 120 (I hope this is what you mean) - Want to get from +10 to 0 or as close to zero as possible.
    LOL! I don't feel mobile - I feel like a cripple. But I suppose you are right - can't expect too much for two weeks out......


    Wow! This will be tough. You know probably better than anyone that problems following a TKR are often blamed on the PT. It's called "our part" of the TKR process. Also, I think the therapist might get some blame if a person's ROM isn't where the doc wants it to be...

    thanks again,
    Rich
     
  20. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    You're wonderfully considerate, to be concerned about your therapist being blamed for failing somehow. Have you considered having a talk with your surgeon and asking about continuing rehabbing your knee on your own? Your flexion is excellent and you don't need a therapist for that anymore. The rest will come just with using your knee as you would normally. As for your extension... it could weeks or even months to stretch those tendons, whether you do it yourself or use a therapist. You can do "your part" of PT without a therapist. Maybe your surgeon will agree.

    If you want to stay with the therapist, perhaps find a way to cut down on the exercise or change it: do a stationary bike instead, or perhaps opt for ten minutes of massage. My therapist gave wonderful knee/leg massages. I told him I would not do leg presses no matter how much he wheedled, but I would gladly accept a massage. :) He agreed because it was better to have me keeping appointments than try to force exercises I would not do.
     

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