TKR looking for help

[Clipless]

I do- I take extra-strength Tylenol 3x/day, Percocet 1hr before PT, and fish oil 2×/day. I hope this is not a bad thing?

 

[sirj]

Ok my PT just left.. I'm 5 weeks post op from TKR my range of motion doing knee bends in a chair was measured at 90○.. I was told that was not good and from my prior posting of my situation your response ' was not only helpful but encouraging. Today I did the CPM Machine and got it to 105 range. It was tough but this Marine did it. Afterwards I was still measured at "AROUND".. 90○??? is there such a thing as your body healing so fast that you lose your range of motion if you don't exercise frequently? Anybody have any good ideas for breaking up this "scar tissue" quicker...

 

[Celle]

Three things, @sirj

1. 90 degrees at 5 weeks is not bad. In fact, it's about what most people achieve, so don't let your therapist worry you.
2. The degree of bend you can achieve with the CPM is not a true indicator of your ROM. It's called Continuous Passive Motion (CPM) because you are not actively using your muscles to achieve the degree of bend you get in the machine.

3. I did the CPM Machine and got it to 105 range. It was tough but this Marine did it.

   It shouldn't be tough and it shouldn't hurt. You are doing your knee a disservice by forcing it like that.

 

[sirj]

Three things, @sirj

1. 90 degrees at 5 weeks is not bad. In fact, it's about what most people achieve, so don't let your therapist worry you.
2. The degree of bend you can achieve with the CPM is not a true indicator of your ROM. It's called Controlled Passive Motion (CPM) because you are not actively using your muscles to achieve the degree of bend you get in the machine.
3. It shouldn't be tough and it shouldn't hurt. You are doing your knee a disservice by forcing it like that.

Ok so I'm alittle confused.. am I not suppose to "push it" in order to gain that ROM... I was told if I don't then I will lose all range of motion and be subjected to MUA

 

[referee54]

I took the liberty of merging your threads---we only allow one recovery thread---it makes it so much easier to track someone's progress or help them deal with their concerns or issues if we can quickly and efficiently see where they have been in their recovery.

 

[referee54]

Ok so I'm alittle confused.. am I not suppose to "push it" in order to gain that ROM... I was told if I don't then I will lose all range of motion and be subjected to MUA

That is incorrect---there is absolutely no "window" for ROM---many people (myself included), gain ROM up to a year and beyond.

The harder one pushes their surgical knee or knees, the more the knee becomes inflamed---and swells, and gets stiffer, and becomes more painful---you get the picture.

If you take your exercises only to the point of discomfort, you will see more progress (albeit in tiny increments.) Keep the knee happy---do not let it get angry (inflamed.)

Remember, this is not an athletic endeavor---you are not trying to build muscle mass or develop stamina--you are gently allowing the surgical knee to heal, recover, and it will slowly regain the ROM.

Pushing harder to regain ROM results in the "vicious cycle." You simply do not get the results that you want, so you think that you are not working hard enough---then you work even harder, and the knee responds with even more inflammation and pain. And then you contain to work even harder, and the results get even worse.

Simply break the habit of working harder and work smarter--ice, elevate, and take it easy and gently on your surgical knee.

 

[Celle]

Ok so I'm a little confused.. am I not suppose to "push it" in order to gain that ROM... I was told if I don't then I will lose all range of motion and be subjected to MUA

Whoever told you that is misinformed. What you were told is a persistent myth that should have died long ago.
There is no magic "window of opportunity" within which you have to gain ROM, or else all is lost.

These articles explain:
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS

Read this too:
Myth busting: no pain, no gain

Finally, these:
It's never too late to get more ROM!
It's worth the wait for ROM

By the way, no one can do a MUA without your permission, so don't be frightened by that threat.

Your knee is not lazy or out of condition and it does not need to be "trained" to recover.
It is wounded and it needs time and gentle treatment, in order for those wounded tissues to heal. Man, it's been cut open big-time, has had bone sawed out of it, had artificial objects hammered into it and has then been stitched together again. Is it any wonder that it doesn't feel like being very active?

Send your knee to boot camp now and all those wounded tissues will get more inflamed which, as Tim explained above, will do nothing but slow down your recovery.

All that is stopping your knee from bending more now is the internal and external swelling. Concentrate on getting rid of the swelling and you will find that the bend was there all the time.
- rest, elevate, ice and take your pain meds by the clock

All the exercise you need to do right now is this:
Heel slides and how to do them

 

[skigirl]

@Clipless just be careful if there is tylenol in your Percoset---mine had 325 mg in every tablet. You should not take more than 4000 units of tylenol per day, so count up what is in your Percoset plus the amount you are taking to see the big picture.

Sirj, I work with a lot of wounded warriors on the ski hill---so I am familiar with the "I am going to do it no matter what" mindset. But, just like all marines are not equal, all PTs are not equal either. some, study and learn the new material---some are still preaching what they learned 10 years ago. Just because a PT says something to you, it is not Gospel!!

Those of us who have had a knee replacement know that working too hard has its costs----I am an athlete and bounced back from meniscus and ACL surgery. I did not bounce back from TKR surgery---but I was walking more or less normally at 3 months. Just because we are advocating rest right now instead of pushing an inflamed and swollen knee does not mean that we will say the same thing six weeks from now.

My doc who treats a lot of athletes told me to find the balance---I told you the same thing, but I don't think it sank in---but I will tell you again. At your stage of recovery, I was told to rest with my knee elevated for two hours for every one hour that I was up. With my second knee I paid a lot more attention to rest in the first month. it paid off because by six weeks nearly all the swelling was gone.

Right now, you goal is to reduce the swelling in your knee. You don't need to "break up scar tissue" because it is more likely that your lack of rom is from the swelling. You are making the swelling worse by pushing on the knee until it hurts. Think of this---you cannot bend a garden hose full of water---you also cannot bend a swollen knee. Until the swelling goes down----rest, ice, elevation---and I used compression hose as well----you will struggle with bending your knee. This is a time to give in---to be active in reducing the swelling by resting.

 

[sirj]

Just by reading all of the comments I honestly feel that the advice I'm reading is the right way to go. Yes I do need to slow down, and I will. Thank you for your advice.

 

[sirj]

Whoever told you that is misinformed. What you were told is a persistent myth that should have died long ago.
There is no magic "window of opportunity" within which you have to gain ROM, or else all is lost.

These articles explain:
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS

Read this too:
Myth busting: no pain, no gain

Finally, these:
It's never too late to get more ROM!
It's worth the wait for ROM

By the way, no one can do a MUA without your permission, so don't be frightened by that threat.

Your knee is not lazy or out of condition and it does not need to be "trained" to recover.
It is wounded and it needs time and gentle treatment, in order for those wounded tissues to heal. Man, it's been cut open big-time, has had bone sawed out of it, had artificial objects hammered into it and has then been stitched together again. Is it any wonder that it doesn't feel like being very active?

Send your knee to boot camp now and all those wounded tissues will get more inflamed which, as Tim explained above, will do nothing but slow down your recovery.

All that is stopping your knee from bending more now is the internal and external swelling. Concentrate on getting rid of the swelling and you will find that the bend was there all the time.
- rest, elevate, ice and take your pain meds by the clock

All the exercise you need to do right now is this:
Heel slides and how to do them

Thank you for those links I definitely have a better understanding on how this healing process is suppose to go

 

[referee54]

Part of it deal with our work ethic. We have been taught from a very early age that, all things being equal, hard work will help us succeed and allow us to move forward.

In athletics, we acknowledge that the difference between two talented athletes is who does more with the talent that they have---in other words, who works harder to develop what they have?

Even my father helped me to develop this idea---he is a Depression-era man who, sending me off to my first job---"Give them ten hours in an eight hour day."

However, when it comes to recovering from a TKR, we have to toss all of this out the window. It is not about working harder---it is not about working like an athlete in training. It is not about working hard enough to eek out a few extra reps.

What is it all about is to listen to the knee, keep it happy, and gently allow it to gain ROM---do not force anything. If you work too hard, the knee will hold you hostage and show you who is in charge.

We are talking about basically doing a 180* from everything that we have been taught and what has been ingrained in us.

Trust me---trust us---it works.

 

[sirj]

Part of it deal with our work ethic. We have been taught from a very early age that, all things being equal, hard work will help us succeed and allow us to move forward.

In athletics, we acknowledge that the difference between two talented athletes is who does more with the talent that they have---in other words, who works harder to develop what they have?

Even my father helped me to develop this idea---he is a Depression-era man who, sending me off to my first job---"Give them ten hours in an eight hour day."

However, when it comes to recovering from a TKR, we have to toss all of this out the window. It is not about working harder---it is not about working like an athlete in training. It is not about working hard enough to eek out a few extra reps.

What is it all about is to listen to the knee, keep it happy, and gently allow it to gain ROM---do not force anything. If you work too hard, the knee will hold you hostage and show you who is in charge.

We are talking about basically doing a 180* from everything that we have been taught and what has been ingrained in us.

Trust me---trust us---it works.

You are exactly right like I wrote before after reading the comments I "felt" that this is what I need to be listening to. I was approaching this like training when I'm going to the gym and/or my SEMPER FI attitude.. the last thing I want to do is hamper this healing process. Yes the comments from my PT did concern me cause I looked at him as the expert on this subject but somehow I knew that I was pushing to hard... yes your right I need to re-think my plan A..

OK GUYS TIME TO STARTED PLAN B..

THANK YOU

 

[skigirl]

I am glad to read your comments---I was just as hardheaded as you were---and really I caused myself a lot of unecessary pain and strife. With my second knee, I rested more---bored YES, of course. But, it worked. I learned that I had to work just as hard at resting as I was working on getting that knee moving. Once the swelling goes down, the rom will go up right away.

At 8 weeks I could ride my bike outside---but at 4 weeks, I still needed to rest 50% of the day.

 

[PeterinMontreal]

Hi Siri, I just wanted to let you know that I am 51 years old...I had a TLKR 3.5 weeks ago. I too feel like you and am deep in the "Post-Op Blues". My range of motion is 90 degrees when forced by the physiotherapist...I am at about 85 degrees by myself. I find this particularly frustrating. I also find that the PT exercises make my knee inflame and get sore, so this week I am taking the advice of group members and am continuing to do light exercise to keep things moving but not enough to cause more pain. It seems to be working although ROM doesn't seem to be increasing, pain may be very slowly subsiding. I think as others are saying, we just have to be more patient...it's slow...uncomfortable and somewhat painful and we all just want to get better...take care...hang in there...we will make it.

 

[sirj]

Well the past couple of days have not been to bad. I've taken the advice on the people on this forum and decided to basically slow down. So on Saturday I didn't awake and start doing any exercises instead I took a little walk and enjoyed the sun as I did the same today and aftet each I focused on "iceing". Tomorrow I have to see the PT so just to get ready I'll do something light and work on the CPM before. I must admit though I'M SICK OF BEING IN PAIN... yes I take my meds and it's works but the late night wake-ups (which this one might not be to bad cause its how I found this site), the random shooting pain, etc, etc. I guess hopefully soon I'll look back at this and laugh..

 

[referee54]

Are you icing at night? I did---and many others---found relief by going to be with an ice pack on the knee or knees.

How long are you icing? Remember---you can ice for an hour or longer with this---just put a cloth in between the skin and the ice.

 

[sirj]

Yes I'm iceing ar night and sometimes I even use a heating pad in hopes of "loosening" up the muscles. Sometimes it works sometimes not. When I do ice it's usually up to about an hours at least 4 times a day after my little walk I noticed my knee did swell alot around the outside of my right knee. Today I will explain to the PT that we will be taking it easy cause I don't want to risk any further damage to my knee in which I've read on other people's post here.BUT it's like now the only reason I'm up cause my knee woke me up and now I'll be up that's what I'm tried of also the lack of sleep admittedly it has gotten better but I would love to have full night sleep again..

 

[jenng2003]

Nighttime is the worst. I have awful insomnia. I read or hang out on this forum. I don't do any pt exercises in the weekend, since I have a demanding pt and os. I will use the elliptical (I don't have a bike) just to keep my rom. It doesn't aggravate anything. Ice is the only thing that takes my pain away. The ice machine is my best friend. I use it all the time to help alleviate the pain. My OS gave me the green light to heat my hamstring, calf, quad, and hip. It definitely helps with the muscle aches. But ice is amazing.


LTKR. October 27th 2014

Sent from my iPhone using BoneSmart Forum

 

[referee54]

The two must frustrating aspects for me during my recovery were:

1. The length of time that it took for me to be fully recovered---just to lose a limp it took me over five months. It forced me to find a type of strong patience that I did not know that I had. Now, when I write to folks about the length of time that it may take to be fully recovered, I can reflect on how long it took for me.

2. Night time. I began to dread night, as I new that I would fall asleep for about an hour and be up the rest of the night. Not with pain, so much, but it was more that I could not get comfortable. I would wander around the house looking---hoping---for the magical place and position in which I would be comfortable and sleep would come.

If you are using some heat, make sure that you are using on the muscles only---and then gently stretch the muscles---heat bring blood flow, which warms things up, which can make the muscles more elastic.

Heat on a join, on the other hand, also brings more blood flow, heat it up, and inflames it even more---and creates more swelling.

after my little walk I noticed my knee did swell alot around the outside of my right knee.

You still may have internal swelling---it may not be puffy, but you still may have stiffness due to swelling.

HANG IN THERE!!! It will slowly get better.

 

[sirj]

WOW IT TOOK 5 MONTHS JUST TO LOSE THE LIMP..... I understand the fact and yes re-read the prior comments about how this Marine needs to slow down but 5 months is a long time. I adjusted my patience but I wasn't ready to hear that..lol.. yes the nighttime problems are definitely the worst. I belive I made rhe mistake of wrapping the heating pad around my knee instead of the muscles above or below. Honestly I felt great afterwards but then about 2 hours later it felt stiffer then before and after reading your comment on blood flow to the joint mat bring swelling could be the cause of this. THANK YOU FOR THAT TIP.

I find myself at a stage now where I'm trying to not always rely on my cane. 5 weeks post op is that pushing to much. I still swell up right after PT and short walks so maybe so huh... As you may have guess by now patience is not one of my strong suits I want to get "back into the game".. I'm glad I found this site it's not only informative but helps during my night time pains..