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TKR Larry’s LTKR Recovery

@Larryhg3 - If I remember my PT lessons correctly, the teardrop quad right above your knee helps your kneecap track correctly. When it's tight, it pulls your knee cap down (inward down vs up/down) and causes pain just below the knee. I had that pain when I first tried to use the leg extension machine after my RTKR. When you massaged that muscle, you probably loosened the quad and reduced the pain. I still work on stretching that quad muscle. I always feel like it's affecting my ROM, even though I have good ROM.
 
@Honeybee great to hear from you, miss my first recovery buddy. I agree that I must have done something muscular as the pain is virtually gone now. I have been icing, elevating and resting as well as breaking out my trusty TENS machine and positioning like Josephine shows in her post about tens. The effect was almost instant. I was able to do all my normal stretches for Righty yesterday. I do have a question for the forum though. Does anyone know where you would apply the TENS unit to help with IT band?
I am in my 11th week and have to say I am so glad to have both knees done. Sure I have bad days both physically and mentally but I don’t have that soul crushing arthritic pain all day every day. I am now starting to believe that I will be able have an active life again someday.
 
Since the IT-Band is fascia that connects muscle to muscle, I guess you'd connect the TENS around the point where the muscle hurts. I don't think it'll help the actual IT-Band. I was told to roll mine with the exercise version of a rolling pin. It helps some. I was told to picture the IT-Band as netting that has been pressed into raw hamburger (muscles and tissue). It's all meshed in and caught up in there. The rolling helps loosen some of those connections....supposedly.
 
Thank you very much Celle. My wife has a massager she uses on her neck, I used it on my IT band and quad on Lefty and on my IT band on Righty. Same relief I get when my PT rolls the heck out of my IT band. We have a winning scenario
 
Haven’t posted much on my own thread in a while so here is my latest update for those who actually follow my journey.
As I posted in a couple of other threads I spent some time in the ODIC over the Christmas holiday. As always we drove an hour each way to my in-laws on Christmas Eve. Dinner, presents, Christmas Eve Mass. No I couldn’t even attempt the kneeler, actually sat on the aisle with Righty hanging out the side so everyone else could kneel. But the stand, sit,stand made Righty a bit grumpy. We had Christmas dinner at our house so entertaining 10 people up and moving around most of Christmas Day until @5. Weds I paid the price for all of that.
Thursday I had an insurance assessment at PT my flexion remains 110 with extension of -3 so absolutely no change there. I was a bit depressed about it and didn’t even try to hide it. Which prompted a pep talk from my PT. Basically he let me know that I need to take my own advice and give myself a break. He is very satisfied with my ROM and the functional progress I have made to date. He is actually fighting with the insurance company because my ROM is good, my functional progress is good, but my biomechanical form (the way I achieve my functionality) is not there yet. The fear being that I am going to cause myself other issues because of coping mechanisms if I don’t relearn how to do things correctly. Who knew your heel should hit the stair below you first :rofsign:.
Yesterday was my father-in-laws 75th Birthday. We threw him a big surprise party remember that 1 hour ride each direction? Add in getting there 3 hours early to prep and set up and a four hour party followed by an hour plus to break down and clean up. Yup I am back in the ODIC. I even caved in and took a pain pill last night. Today both knees are giving me a very clear message that they are quite angry and want some rest.
So here I sit legs up and trying to make them happy. Hope you all have a Great New Years Eve.
 
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All hail king @Larryhg3
:cheers2:

I seriously hope you rebound ok. The holidays present us with so many commitments and we just extend ourselves too far. Time for some recovery for you!!
:ice:

Great numbers though. Your work is paying off. Congrats!!
 
I'm still not kneeling at mass, but I think I'm getting close. On the bright side, I made a LOT of trips up and down an 8' tall step ladder today while beginning the process of taking 400 (yes, really 400) ornaments off of our 12' tall Christmas tree. That caused no problems at all...so far. I have a 3-story house with some Christmas stuff stored on each level, but mostly in the basement and on the top floor. Should be a good "workout" for my legs. I might skip my workouts at the gym during this. I'm amazed at how well my knees are handling this. You'll be at this point soon!!!
 
Congratulations on going back to work! That’s awesome. It sounds like your recovery has been going very well. I will be watching your recovery process. This Tuesday is the start of week three for myself and right now I am trying to figure things out in regard to physical therapy and not pushing the knee to hard. Have a Happy New Year!
 
Your numbers are enviable! I'm a month behind you with abysmal numbers so far. I continue to hope! It sounds like you had a wonderful Christmas - your PT is right, give yourself a break!
 
I know @traceys is glad you have (reluctantly) taken over the presidency.
You have done so much over the holidays! No wonder you're the Prez now. I hope you at least enjoyed yourself with family and friends. And your rom will improve. Not that it's that bad now when you consider the swelling.
Happy 2019! New year and new pain free knees!
 
Weds will be 14 weeks for Righty. Last week I had my 12 week PT progress report. My ROM is unchanged for the last 4 weeks. My strength has gotten much better. The evil empire (insurance) has begun to challenge visits. He offered to “help” me which I firmly pointed out was not an option. Today we were able to pinpoint where my catch/pain point is on flexion. As I have mentioned I have a sizable scar on just to the inside of my new scar. My GP thinks that is a contributing factor to the slow healing incision. That scar is where I catch and where I have pain if I try to get past where I am now. I have had that scar since 1984. I see my OS on the 23rd for my next check up. I know that over time my flexion will improve, today my PT did some deep massage in that scar area. We are going to concentrate on that until the evil empire stops my sessions at which point I will continue on my own. Not the best news but I can honestly live with it. I wake up with less discomfort every day. I work all day with very minimal swelling. I want to be able to walk down stairs leg over leg without holding the rails, I want to golf, I want to walk trails(don’t consider what I do hiking). I can achieve all of those things.
 
I hate being at the mercy of a corporate institution who know nothing about me and haven’t gone thru it themselves. :headbang:

Glad to hear you aren’t losing ground tho in your recovery.
You have been such an inspiration to me on a daily basis. Cheering you on all the way
 
Hi Larry,
I'm 14 weeks on Thurs and the knee feels good. My back feels like :censored:, but I'll get that fixed soon.
I have no idea what my numbers are. Flex is good, but extension still not straight. It was 3 or 4 when I stopped pt. I keep working on it and know if will get there.

We've come a long way since the days of ODIC! Hope you get the flexion worked out.
 
As I was reading a couple of threads on BoneSmart it occurred to me that I broke my own rule. I allowed the insurance company to get in my head. I will continue my PT until they stop sessions. I will transition to ADL and conditioning 2x a week and continue to heal and achieve if not exceed my modest goals. I know that because I have read many accounts of that story here at BoneSmart. My focus coming into wasn’t ROM it was elimination of the pain that kept me from doing things I love to do. I am getting there, I actually have full days that I have no pain now. So my last 2 PT sessions have been focused on trying to achieve better ROM because the insurance company didn’t like that I have been at the same ROM numbers for 5 weeks. Well :censored: the insurance company approve the visits or don’t. Either way I will get back doing the things I love to do.
 
Yesterday was an interesting day in PT. My PT asked their manager to review my case and my progress. He was actually concerned that he was failing me. She had reviewed my case fully all the way back to before the first replacement in February. The first thing she asked was will you be okay if I gently mobilize and stretch your knees? She promised that there would be no passive pushing during this review. After mobilizing and stretching Lefty she asked me to bend as much as I could on my own and then extend 119 flexion 1 extension. Then she moved to Righty and mobilized and stretched him 104 flexion 4 extension. More importantly she was able to “feel” that the joint is moving cleanly and smoothly in both knees.

She then sat down and talked to both of us in a very kind but direct manner. Neither of us is doing anything wrong. I have regained about 85% of my strength based on testing. The knee is sound and fluid in movement so the knee is not the problem either. Righty has been injured since 1984, Lefty joined the party in about 2006. My soft tissue has been deteriorating for all of that time. When I went in for my first therapy evaluation after Lefty Righty measured at 100/16 and Lefty fresh from surgery measured 84/20. Her first suggestion was to not tell me numbers and to not set target numbers for me because they screw with me mentally. She then asked if I would be willing to try dry needling of the quad. They made my quad into a voodoo doll in a horseshoe around the top. Every time they found a trigger point with the needle (which didn’t hurt at all by the way) my quad would freak out quivering and pulsing then go quiet again no pain just a weird feeling. I think they put about 7 needles into Righty and she put 6 into Lefty even though technically he wasn’t in scope. We measured again Lefty got to 125/1 Righty got 111/4. Apparently they stick the needles into trigger points (basically knots of muscle too deep to touch manually) and release those knots a little. That is a very simplistic explanation obviously. Her recommendations
1. Lower my PT sessions to 1 a week focusing on identifying and needling trigger points and gentle manual stretching. Mostly because the evil empire is trying to wrap up my PT and we want to maximize the time we have allotted.
2. Have me begin gentle conditioning a second day of the week.
3. Use the remaining days to rest and stretch twice a day two quad stretches two hamstring stretches 3 repetitions held no less than 30 seconds no more than 60 seconds. This will reinforce the release of the trigger points (keep them from knotting back up).

Her opinion is that I should not plan anything around a ROM number because of the damage going in and the length of time reversing soft tissue degradation takes. She also pointed out that strength and functionality wise I am far further along than the normal which is why the evil empire is flagging my requests.

Finally we discussed how things are changing. I was told for easily 15 years that Righty needed to be replaced but I was too young. Over those 15 years Lefty deteriorated because of helping Righty but I was still too young. When they finally decided I could do it the uphill battle is daunting. That is shifting to if you need it you need it and results are improving. There are also new conventions (like dry needling) coming along every day to address long term injury and recovery. She pointed out to me that she has patients who have ROM in the high 120 but do not have the strength to climb stairs leg over leg or still use an aide to walk. Everyone is different and everyone recovers differently. When I am struggling mentally with my progress a great PT is too (looking straight at my PT) and they bring someone else in to take a look. “You 2 are rock stars. Larry never quits, puts on a happy face even when he is discouraged and sits down and cheers on other patients who are obviously struggling. Your PT recognizes your struggle Larry even when you are trying to hide it and knows when he needs a little help to move you forward. You are a great team and should understand that. I don’t believe you are ready to leave PT yet but if they deny further visits I believe you will be successful because you worked so well together.”

Today is stretching day and I have to say both quads feel way looser than I ever remember. No pain no discomfort even less wake up in the morning stiffness. I love my PT they actually get it.
 
Great update! I'm also getting great results with my PT, once a week, focussing on relaxing my quad. He uses a strong "thumper" type massager.
I leave his office with larger range of motion, and less pain than when I go in.
 
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