TKR MANIPULATION

[Jamie]

CityGirl, it is quite likely that you still have swelling that is inhibiting your ROM. This can be caused by too much activity before your knee is ready, undermedication for pain, or aggressive therapy. It can also just be a fact of life for some people as they go through recovery. At any rate, you'll be better off to wait a bit on that MUA if it's suggested and try to get your swelling down. Can you please provide answers to these questions for me? Once we have this information, it will be easier to talk more specifically about your situation.

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 compare this with the bone-on-bone pain you had before surgery!

)

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

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

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

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[Jamie]

You may notice that I have merged your two recovery threads. We like to keep our members' recovery posts all in a single thread. That way it's easy for us to go back and read your history before responding to a question or concern. In addition, the thread becomes a journal of your recovery for those who come along later and want to read about you. So, please post in this thread from now on when you want to give an update or ask a question. If you decide you'd like a different thread title at any point, you can change it by using the Thread Tools button at the top right of your screen or just post what you want here and we'll get it changed for you.

 

[dovemck]

Hi @CityGirl I had an MUA at 6 weeks when mg ROM was 65-70. You can read more about it in my thread (link in my signature). It's a decision for you and your surgeon, many here advocate waiting, I knew I was at a dead-end and was in a hurry to get it over with. If it is something you need to do then go into with full info and a positive attitude. I'm now ~12 weeks post TKR and ~5 weeks post MUA and now have 110-115 ROM and a 'freer' feeling knee.

 

[CityGirl]

1. Level of pain is 8.
2. My doctor recommended that I take over the counter Aleve, because he does not believe in prescribing a lot meds. This is during my outpatient PT. My physical therapist has sent notes to my OS that I do need some pain meds as this could be inhibiting my progress.
3. I use ice and heat. Ice 3 times a day for 30 mins. Heat all night. This started this week. Swelling has gone down quite a bit from last measurement from therapist.
4. Yes, when sleeping above hip. sitting even with hip.
5. Making beds, sweeping, cooking dinner once a week.
6. PT: squatting 4 sets 10 reps, cycling 10 mins, lunges 4 hold 30 seconds, marching for 3 mins, knee kicks with 3-5 lb weights 5 set 5 reps. knee slides 3 mins.
Home: walking, squats 3 sets 10 reps, knee slides on bed 5 mins. stretching: leg on husband shoulder as he pushes down my knee gently for a count of 45 seconds, 4 of these. Pushing my leg down on his should while straighting my knee for a count of 5 seconds 5 of these. lunges 5 hold for 30 seconds.

 

[kneeper]

If you're truly stuck MUA can be helpful. But don't get panicky. Many of us stall out a bit and then start moving again as the swelling diminishes. It's a fine balance between trying and doing your exercises and overdoing and causing more swelling.
I'm curious as to why you're using heat.

 

[dovemck]

Just my view

1. Personally I don't think you can rest or rehabilitate with a pain level of 8. Unacceptable. If your surgeon won't prescribe then get thee to your regular GP or whomever referred you to that surgeon.

2. My P/T sent a note to my surgeon and GP, they concurred and my GP now prescribes my pain meds in conjunction with my P/T. Surgeon is now out of the loop.

3. Heat huh? I didn't start that until very recently and it doesn't always feel very good. Your mileage may vary.

4. & 5.

6. Squats are INCREDIBLY hard on your knees and quads. Ouch! Kicks with 5 pounds of weights for how many reps?? No way. Leg on shoulder with anyone pushing down NO FREAKING WAY EVER. If you don't have extension then a few minutes of stretch isn't going to get it back. Long and slow - like an ankle up on a pillow, edge of table or leg of the couch (whilst you're laying on it) and try to let it stretch for 5 - 30 minutes. A count of five isn't really a stretch, you need a good 30 seconds to get all the muscles involved and that's why I'm not letting anyone press/push/pull on my knee. I have enough trouble with swelling without letting someone else - even a well meaning someone else push me a bit further than I can or am able to do myself.

Your P/T schedule is more aggressive than mine and I'm 12 weeks out. Even if you discount my MUA time, I'd be ~8 weeks out.

Honestly, ROM doesn't come with training and doing more reps, it comes from doing LESS.

 

[Celle]

I think the exercises are far too much for your stage in recovery.
No wonder your pain levels are so high!

You can't make your knee recover faster by working hard at it. In fact, you can actually slow your progress if you do too much.

I strongly suggest that you cut back on all that exercise and concentrate more on trying to reduce the residual swelling that is holding you back. Less exercise and more Rest, Ice, Elevation and Medication.

I've had 3 knee replacements - the last one only a few days after yours - and I never did all that exercise. My recoveries have all been good.

 

[Josephine]

The PT tend to push me to 95 but the pain is HORRIBLE.!!!!

Well, what do you think is the consequence of that? swelling !!! And swelling blocks your ROM big time!

2. My doctor recommended that I take over the counter Aleve, because he does not believe in prescribing a lot meds. This is during my outpatient PT. My physical therapist has sent notes to my OS that I do need some pain meds as this could be inhibiting my progress.

Aleve or naproxen, is an NSAID and a very mild pain med. You need better than that. If your doctor (surgeon, yes?) is being miserly with pain meds the approach your GP and see if he will help you out. At 6 weeks, I founf my pain increased by quite a bit for about 3 weeks.

3. I use ice and heat. Ice 3 times a day for 30 mins. Heat all night. This started this week. Swelling has gone down quite a bit from last measurement from therapist.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day. And I strongly suggest you don't use heat when your leg is swollen. It just increases the swelling and makes matters worse.

5. Making beds, sweeping, cooking dinner once a week.

Too much! Read this Activity progression for TKRs.

Your exercises - my comments in bold
squatting 4 sets 10 reps - that's 40 reps - far too much. If I were you, I'd refuse to do squats, they are causing your problem
cycling 10 mins - okay provided you have the seat very high
lunges 4 hold 30 seconds - NO lunges. They too are causing your problem
marching for 3 mins - no marching, too much for new knees
knee kicks with 3-5 lb weights 5 set 5 reps - okay for general health but not for this rehab
knee slides 3 mins - not sure what you mean by this. Do you mean heel slides? If so, how many at a time and how many times per visit? Whatever, do make sure you NEVER cause yourself any pain doing these. Go to the point of mild discomfort and no further.

Home:
walking - how far, how long, how many times a day?
squats 3 sets 10 reps - no squats!
knee slides on bed 5 mins - you mean heel slides? f so, how many at a time and how many times per day? Whatever, do make sure you NEVER cause yourself any pain doing these. Go to the point of mild discomfort and no further.
stretching: leg on husband shoulder as he pushes down my knee gently for a count of 45 seconds, 4 of these.
Pushing my leg down on his shoulder while straightening my knee for a count of 5 seconds 5 of these - never ever have anyone else push on your leg. Very counter-productive. Best to simply put your heel on a stool and let the leg hand in mid-air for extension
lunges 5 hold for 30 seconds - don't do lunges so they hurt you. Only ever to the point of mild discomfort and no further.

You need to lighten up on your activities. Let you leg rest and recuperate more. Why people feel they have to go at their leg like gangbusters beats me. It's an badly injured leg and it's primary need for good healing is rest, ice, elevation and pain meds! Read the articles you were left earlier.

You also need to give you knee at least one day of complete rest each week. You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[Shmi47]

Hi. I agree with the others. I had BTKR and one knee was at 115 and my other was at 85. It varies so greatly but I would think it is way too early. My PT says they would be happy if you were at 90. As long as you keep progressing I think you will be fine. Also I would be surprised if your os suggests this. Good luck and keep us posted.


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