TKR Lane 47, December 12, 2016 <

[Josephine]

what is a realistic number that I should be planning to achieve?

Celle's information is spot on but I have to caution you that we don't 'achieve' anything. We get what fate dictates and have very little influence on the outcomes. However, your ROM is there right from the start, just waiting for all the healing, recovery and etc., 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. In my experience, exercises generally do more harm than good. Normal activity is the key to success.

 

[Lane47]

To be sure I understand, once my knee heals, (this must be in stages, or do I just seek totally healed). Is this the point where my full ROM will be available?

My normal activity is walking, standing, steps once or twice a day. My knee continues to feel stiff. My gait is very slow, and not normal, probably 18 to 20", where normal for me is 30".
I know most all say, exercise is not good. I feel I need a few gentle activities to add to my normal daily activity, any suggestions? My current ROM is 0 & 114.

Activity to improve my gait is all I seek? I tend to walk stiff legged, I try to go slow, take very deliberate steps, but with some daily activity, it's stiff legged, not a normal gait.

 

[Celle]

When you're walking, make a conscious effort to bend your knees, even raising them a little higher than you normally would, until bending becomes a habit. That will help to cure the stiff-legged gait.
It doesn't matter if you walk slowly. Your speed will increase gradually.

Try to lengthen your stride, too. That will also help with extending your leg.
Strike the ground with your heel first, then roll forward along your foot, until you push off with your toes, like this:


If you can watch yourself in a full length mirror, you may see what else you need to do, to improve your gait - or ask someone to watch you, to see if you're limping or doing anything else that you need to correct.

Are you still going to PT? (I'm sorry, I can't remember.) If so, ask your therapist to help you improve your gait.

 

[Lane47]

Thanks
Yes, go to PT twice next week.
I plan to ask about my gait.
It was suggested that I walk backwards, if I had a counter or rail to use for support.
My logic told me it was about bending the knee, but this is all new, and logic sometimes can get me in trouble.
I'll practice.

 

[Josephine]

To be sure I understand, once my knee heals, (this must be in stages, or do I just seek totally healed). Is this the point where my full ROM will be available?

No, it comes in baby steps (pardon the pun!) and little increases throughout the 3-6 months recovery period. Try to force it and it will take longer. Read this BoneSmart philosophy for sensible post op therapy

 

[Lane47]

When I move the skin on top of my non surgical knee (right knee) around, it is loose and very elastic.
When I move the skin around on top of my LTKR, it is tight, difficult to move at all. For example, if The skin was a plastic bag on top of right knee cap, I could move it 2 to 3 inches in any direction. Same bag on left knee it would be tight, with about 1 inch or less of movement in any direction. Will the skin become loose as knee heals? Will massage of this skin help? hurt? process of healing?
A neighbor, who happens to be a PT, said this skin tightness is what limits ROM, and that as skin becomes loose, ROM increases. Thoughts from forum on this tight skin?

 

[Josephine]

When I move the skin around on top of my LTKR, it is tight, difficult to move at all.

That's not surprising since it's a product of the trauma of surgery.

Will the skin become loose as knee heals? Will massage of this skin help? hurt? process of healing?

It will loosen as time progresses. As I've often said, leave it alone and it will sort itself out in due course.

A neighbor, who happens to be a PT, said this skin tightness is what limits ROM, and that as skin becomes loose, ROM increases

Sorry to be rude about your neighbour but that's just not logical! What limits ROM is swelling and if your knee is swollen, then it's likely your skin will be tight. But it's not the primary factor.
Oh these daft pet theories!

 

[Lane47]

My logic, which I use often, sometimes gets me in trouble. Makes perfect sense, if my knee is swollen, the skin is tight, ROM is limited.
When swelling diminishes, skin is loose, ROM is better.
I visit my doctor next week for 6 week follow up.
I want to ask him if he has studied or has thoughts regarding the "Bonesmart " approach to recovery.
How should I phrase the question? Will a simple reference to Bonesmart be enough?

 

[Josephine]

Makes perfect sense, if my knee is swollen, the skin is tight, ROM is limited.

Good idea, wrong conclusion. The ROM is limited because of the swelling rather than the tight skin!

I visit my doctor next week for 6 week follow up.
I want to ask him if he has studied or has thoughts regarding the "Bonesmart " approach to recovery.

You could just give him a link to the site but you could also tell him our protocols are in keeping with those practised at the Mayo Clinic!

 

[Lane47]

I'm sold on the protocol and want to interest him, as I think it would benefit patients.

Mayo Clinic reference should help.

 

[Josephine]

Oh bless you! I do hope you succeed.

You might also like to tell him that a group of university hospitals in the UK are going to do a research project on it later this year.

 

[Lane47]

What is the general opinion of the forum regarding the use of "Tens" like units. I have a Empi unit that I've had for years, I used it in the past on my neck and shoulder.
Does it help with healing, pain, etc? Or can / does it slow the progress?
I just pulled it out yesterday, charged the battery, and decided to ask first this time!

 

[Josephine]

I made this article to explain that, @Lane47 TENS machines for pain management
(The pretty knee is mine!)

I am a big BIG fan of TENS machines. They give excellent pain management - when used correctly - and obviate the need to take medications. I see the +/- as

1. TENS are safe and non-invasive and you're not taking any chemicals to achieve the end result
2. Time to effectiveness: TENS 0: Meds 15-20 minutes
3. Safe period of use: TENS limitless: Meds usually every 4-6 hours
4. Side effects: TENS 0%: Meds 90%!
5. Risk of dependence: TENS 0%: Meds significant

I've used TENS machines for years and am actually now on my fourth machine. I wore out or broke the others!
They are relatively cheap and easy to get (in the UK, anyway, I usually get mine off Ebay - and the electrodes)
What more can I say?

Does it help with healing, pain, etc? Or can / does it slow the progress?

As for these questions, the answers are
- it helps with pain
- the elimination of pain can have a beneficial effect on healing
- it does not slow healing

 

[Lane47]

Once again, thanks for the prompt, and very thorough reply. I plan to add the electric pulse machine to my daily routine. I do not call it a TENS, because it is something slightly different. I do think it's very similar, and look forward to additional pain management, while I continue to reduce my medication intake.

 

[Josephine]

I do not call it a TENS, because it is something slightly different.

Actually, I looked it up and read a lot about it. It is a TENS.

 

[Lane47]

Josephine, you are awesome, thanks so much.
My doctor described it as a STIM unit, but your research is correct, just a TENS unit.
I've used it once today, great results, rather short term, decreased pain for about an hour, but wow, no side effects, and immediate relief!

 

[LTKR4Xmas]

Hi Lane,

I'm reading your thread since you're a week ahead of me. Why did you say?:

I know to avoid the actual scar line with any lotion or oil.

 

[LTKR4Xmas]

However, your ROM is there right from the start, just waiting for all the healing, recovery and etc., 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.

During my rehab stay, one of my therapists was taking my ROM measurements and tried very gently to see if I could bend more than I was doing alone (in a manner which was amazingly not painful) and said "there is nothing preventing your knee from bending except pain; you'll be fine". That was very encouraging.

 

[Mireille]

@Lane47 Hello, I'm glad you're doing well with your recovery. I'm really interested in getting a TENS unit. Never thought about getting one until I read your thread. Do you need to use the electrode gel? Are the electrodes reusable a few times or do you need new ones for each session? Thanks in advance!

 

[Josephine]

No gel, just adhesive pads. I've used mine for many months. Once they start loosing their 'stick' you know to change them. I also always get mine from Ebay. Much cheaper!

But don't try to use this too early instead of pain killers. It's inadequate for that. Maybe after 6-8 weeks.