Knee flexion angle - 3 week post-op

[Creation]

Hi, I am new to this forum and just got a new knee 3 weeks ago. I am 46 years old. One of my struglle since the surgery has been knbee flexion. My leg has been really stiff. Last week I managed a 74 degrees in physio.

I saw my Surgeon last Friday and he said to do 1 exercise, he called it the turtle exercise! Sitting on a chair, I bend my knee until I find the treshhold between thightness, uncomfortable, slightly painfull but tolerable point and hold it for 2 minutes or until my body send the stong signal of that is enough relaxe the leg. He said that this will break down the scar tissues slowly and prevent my body from making new stronger ones. he said to do that exercise all day long ("200" times a day if I can!)

I know he has 20 year experience and knows his business but I am still so worried that I will not gain reasonable flexion before the window of opportunuity closes (I think its 3 months?) Being 46, I want to have my life back, and active life, I do not want to settle for a handicaped life.

My question: If I do that stretch exercise, can I expect my leg to bend to 130 at a certain point or am I a lost cause? My knee had a bad valgus angle on pre-op but I could bend to about that 120-130 before the bones bloked it.

note: Am also doing the wall exercise and yesterday I went to the pool and did all the knee slow stretching I could in all the position you can imagine!
Thanks:ThankYou:

 

[JackieS]

Sometimes folks go to two extremes in recovery, neither one does much good in the long run. You definitely don't want to give up and say things hurt too much to continue. Yet, you can't overdo things either.

The exercise he gave you will indeed help with the bend. I'm not sure about the 200 times a day, though! I think I'd mess up my count while under pain meds!

I think it might make you feel a bit better if I told you a bit of my own recovery story and outcome ...

When I had my LTKR done in May 2008, I had a blood clot settled right in the back of the knee. Due to that I had an extended stay in the hospital -- seven days. On the sixth day they let me get out of bed. On the seventh day, an hour before going home they tested my flex and had me do some stairs on crutches. NO PT in the hospital other than that final day. My bend was under 60 degrees when I left the hospital.

Due to the location of the blood clot, my out patient PT started out very slow. At a month, I was still under 80 degrees. I finally hit 90 degrees after more than two months. They figured that might be it. I continued exercising, but not really pushing with great emphasis ... a bit every day.

Now my bend is around 135, much higher than ever expected and I don't even think of the knee anymore. I'll be having the right knee done in a few weeks. The recovery may go fast or slow, but I do know that it's something you can't rush. And, I know that you keep on healing as the months go by. Don't push past what you deem your own physical limits, but don't give up!

A year from now, I'd love to read that you've decided it's the best thing you've ever done for yourself!

--Jackie

 

[liz3004]

Hi Creation

Welcome to bonesmart I too am fairly new on here so I wont try to give you too much advice on particular excercises .... Jo and Jaime and others will be able to help you there.

I can give you encouragement though. I was at about the same flexion as you at three weeks and although many people on here told me not to worry about the numbers ... of course I did :skeptical:

However.... just as everyone told me my Rom steadily improved and is about 95 now at 14 weeks. More importantly I feel I can do more each day and you will too.

You may have a very speedy recovery or you may be a little slower as some of us are but have patience and you WILL get your life back.

Please take no notice of the so called 3 month window. Lots of people on here will tell you first hand of their improvement much beyond 3 months , in some cases improvement is reported way after a year, so you have nothing to worry about.

Congratulations on your progress so far , keep posting on here, giving and recieving help and encouragement.

Liz ::

 

[RunA42K]

Hi Creation, you sound like me in the early days worrying if my knee would ever bend again. At my two week check up I was only at 62 degrees and my doctor also told me the same exact exercise as he told you in sitting in the chair and bending until I can't take it any more, but he did not say 200 times, he said every 10 minutes move the foot back a little more. We also do this chair thing in PT and far beyond anything else this helps me the most with flexion. Today I am 8 weeks post op. I saw the doctor again at 6 weeks post op and I was at ROM 106. He told me that the people he worries about are those who are 6 to 8 weeks post op and stuck around 70/80 ROM. Now my ROM is 114 and I can pedal a bike. The doctor says there is no reason that I can't get to 135/140 ROM in time, but it takes time, it does not happen over night. He told me he has a female patient with two new knees, one 5 months and the other 8 months out. Respectively her knees are 135/140 and still working to get them both to 140. There are people out there with more ROM than me in the same time frame, some less but every day I can see little bits of progress like when I go up and down stairs in my house, walking very steady and I can now walk across the grass in my yard. It will come, be patient!!

Hey Jo and Jamie...did you ever think you'd hear me talk like this?

Bonnie
RTKR 3/28/11

 

[Truivia]

I did that exercise and it helped a lot. I placed tape on the carpet and used it as my goal line. My goal was to get my toes behind the line. SLOWLY!!!!! It took me WEEKS to do this. I was 70 when I started it at about 4 or 5 weeks and at 8 weeks I was at 100.

By the way it is a "fable" about the window of opportunity closing. NOT TRUE!!! (usually) People here are still getting more ROM (range of motion) after 1 year

I think the Drs and PT rush us to fit their schedule :wink1:

Get comfy and read some of the stories here and you will find lots of great tips and very encouraging stories of success.

Please keep us posted how you are doing.

 

[zjrog]

Flex will come. For some later, for others, much sooner. Do not over do things, stay on your meds. Your body will tell you when its time to do more and when you no longer need as much of the pain meds. Everybody heals differently and in their own time.

My PT was certainly trying to make sure I wasn't going to form scar tissue, and my doc was set on the window as well. The big issue for now is the swelling and that will limit your motion. Ice it as often as you can and especially after therapy.

It gets better. Really.

 

[JennyI]

Welcome to another Canuck. I am five weeks post-op and will know tomorrow what my ROM will be. I was also around 74 at two weeks post-op. Last week (at four weeks post-op), I was told by my PT that I had to reach at least 90 and will slow gentle exercises I actually reached 92! I was so excited. As everyone on here has said, some reach a high level of ROM early and others take much longer. Everyone is different and it doesn't seem to matter whether you have been an athlete all your life or a couch potato. I have learned to be very patient (sort of), and I notice tiny little milestones every day.

What I have found is that reading all the folks' threads on here has been a boon - they have all been so helpful whether their experience has been good or bad. And their support is phenominal.

Don't worry too much. The ROM will come in time. Take care.
Jenny

 

[Creation]

I am overwhelmed by the number of replies in such a short time. Nice to meet you all! Thank you everyone. I just don't feell as alone in my little world anymore! Your comments are certainly helping me to accept the fact that I am a Turtle in recovery, and that I will get to destination in time.

By the way the "200" as not meant litterally but to insist that I need to do it as much as possible!

I do ice and elevate about every1 to 2 hours. I can feel it when its time because everything gets so stiff, can't bend and can't make it straight. I ice for 15-20 minutes and it makes me feel so much better.

Same thing with meds...my body tells me loud and clear its time (I am on meds that are short acting every 4 to 6 hours), I make it at about 5 hours.

One thing I am happy about is that over the last few days I have been sleeping better. The pain does not wake me up as much on every turn. This is good because I am more rested and more able to tackle the challenges of the day to come.

Again Thanks everyone:flowerysmile:
Creation

 

[jerseychick]

Creation...a big welcome to BoneSmart. Your ROM will come, you are just barely began your recovery. Here's the link to a thread I started...I hope it helps and answers some of your questions.
https://bonesmart.org/forum/its-worth-wait-for-rom-t11558.html?p=213921#post213921

 

[referee54]

Welcome to the forum! As for the "window of opportunity", I do not believe in one. Many of our forum members have gained ROM over the course of a year, or even longer.

ROM can take quite some time to increase---recovering from these types of surgeries---it is big-time major surgery---can take upwards to a year for somebody to feel "normal" again.

You will certainly not be a "lost cause"! I was in PT for nearly four months, and it took even longer for me to fully regain my ROM. Please do not put a time table on your recobvery---if yo do, you will become somewhat frustrated and impatient; patience is the key here


AS others have said, work to stay within your comfort zone and gently work the knee. An angry knee is not a fun knee, and when it gets angry you hurt and you swell and your ROM goes out the window! By keeping the knee happy, you will SLOWLY make progress and gain ROM

You also must remember that this type of recovery is like a roller coaster; you will have some good days,, some great days,. and some real trashy ones---I call them "clunkers."

I also urge you to take a look at the forum library--- a wealth of information is stored there. I also hope you keep coming back and posing other questions or concerns, as this forum has great people with a wealth of information and wisdom!

PS---stay on your pain meds and take them on schedule! Do not wait until it is too late! Please stay ahead of the pain.

 

[Josephine]

Lots of nice replies but they missed out the most important point which is that, as 3 weeks you are in the middle of the 'angry tissue' phase when your leg is still struggling to recover from the assault it just had - cutting, sawing, hammering and banging and then all being stitched up again. The body's reaction to that is to SWELL and once your leg is swollen, it can't bend because the swelling just acts like a plaster cast.

The most common post we have on here is ones exactly like yours and when people follow our mantra, they suddenly find - voila! - the flexion reveals itself because it was always there! Just the swelling and pain blocked it so it couldn't show itself.

So first you have to manage that swelling and the pain that goes with it. So are you resting, elevating, icing and taking your pain meds by the clock? No nonsense about trying to cut back or do without?

It can take 2-4 weeks to get your swelling and pain under control so don't be too enthusiastic about activity until then.

What you can do in the meantime is all this lovely reading which is the most crucial stuff you will ever read! The first group are essential articles, the second are addressing the concerns you voice and the third group is just informational. But read them now!
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Elevating your leg to control swelling and pain
Discussion on managing pain in TKR surgery
Using ice

Myth busting: The "window of opportunity"
Some suggestions for home physio (PT)

MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

 

[Creation]

Thank you for all the links, I have been reading them. This all great info and helps me confirm my gut instinct.

 

[Creation]

What about swimming and pool exercises?

I am a very good swimmer and was wondering if anyone has experience with exercises in the pool or even stretches.

 

[RestAssured]

Hi Creation and welcome to BoneSmart!

3 weeks and you are worried about ROM? The swelling in your knee is telling you, "Hey listen, I want to slow down and ice and elevate!" "If you don't let me do that, I will continue to cause you problems!":wink1:

Here is my advice for what it's worth!:th_heehee:

1. Stop all that stuff that the doc said about pushing your leg (about 200 times a day!) for a few days!:biggrin:

2. Get a couple of pillows and elevate that leg (toes above nose) and use ice and take your pain medication on schedule.

3. Don't worry about scar tissue! It doesn't form that fast, and ROM can still be built up even years later to larger numbers if you need to be a "superwoman". Most people find that 115-120 is pretty good.:wink1:

4. You will NOT end up handicapped, if you just lay around and let the body heal! Your leg has been sawed, cut, twisted, and everything imaginable! Knee surgery is major trauma on the body and you need to rest to let your body heal.:biggrin:

Good Luck and I wish you the best!

 

[Creation]

I hear you, I still think some exercise and gentle stretching is necessary. Muscles and ligaments need to be reminded their functions. I am not doing "200" repeats, that was just a way for the Doc to say, that it is important to do them as often as possible to maintain gain.

I "was" a very very active person all my life, and to sit down all day is very very difficult.

I am trying to learn more about my body healing and try to balance all the want and need to do.

Last night was good, this morning when I got up the swelling was really down and I had almost no pain...and last med where 4 hrs past due....I see that as big progress. But even with less swelling the thightness is there.

3 years ago I had an arthoscopy and part of my meniscus was taken out, my leg was not bending very far. I took 2 1/2 years to get the leg to maybe 130. What I have a hard time accepting is that until my body decides to cooperate, my life is less active and that is hard!

Creation
surgery 29 April 2011 LTKR

 

[zjrog]

I wouldn't do anything in the pool until the skin has healed and all stitches and staples are removed. Too many chances for infection... But once the doc clears you for the pool, by all means go at it. Working out and exercising in the pool is a great way to get moving, walk even run in a low impact way.

 

[Josephine]

Creation, nobody is telling you to do nothing! Quite the opposite. What we are saying is that you don't need to go at it hammer and tongs. Gentle exercise at regular times during the day is quite sufficient plus some walking around the house and into the garden. No long hikes or anything, better several short walks than one or two long ones.

And you might be a "very very active person", most people are, (certainly most BoneSmarties!) that's how they ended up with arthritic joints in the first place! Most people also find it difficult to sit and rest and get extremely frustrated with the inactivity but you need to take it on board that you are not in charge of this, your knee is and it will tell you loud an clear when you are overdoing it. But I think you got that message too already, didn't you?

I'm very pleased your swelling has reduced - you see, our philosophy does work! But that tightness is still pain - meaning post-operative pain - and internal swelling. Pain comes in many guises as you would have read in the Pain article. So take note and treat it as such which means all the usual: rest, elevate, ice and pain meds.

 

[jerseychick]

I agree with zjrog...no pool until fully healed. My OS said no pool until all the scabs have fallen off. You certainly don't want to get an infection.

 

[Creation]

My scar is fully healed and I got the OK from my surgeon to go in the pool. My question was more aimed at people's experience with exercise in the pool. What they do? What has helped them with the recovery?

Thanks
Creation

 

[referee54]

Hey, Creation---many of us were (and still are) very active! That is what makes this TKR so frustrating at times. Many of us have had arthroscopic surgery and bounced back very quickly---that is what makes this TKR so frustrating. Many of us have had the "no pain, no gain" mentality to rehab---and that is what make this TKR so frustrating. HArd work does not cut it when we want to begin to rehab our TKR's---working gently and smoothly and staying in the comfort zone helps keep the knee loose and slowly helps to build some ROM, some strength, and some stamina.

I still umpire HS and college baseball games---that is where I just came from tonight---and I have done so for 38 yeas. I reffed college hoops at the D-1 level and other levels for 17 seasons---sometimes running up and down the court close to 55-60 times a seson. I also reffed HS and college football and played college football---and I really enjoy cycling to this day. Man of us on this forum were and are very active---but this type of recovery is slow and one's patience will be tested.

I had several knee surgeries prior to my BTKR, and I worked like a demon to get back in shape---and it worked. The same approach to a TKR will backfire---the harder one works, the more angry the knee gets and the less progress one sees.

Take it slowly, gently exercises and ice and elevate, and you will see some solid progress down the road.