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[TKR] Mireille's RTKR 4 months

Discussion in 'Knee Replacement Recovery Area' started by Mireille, Jan 5, 2017.

  1. Mireille

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    Hello everyone! First I'd like to say thank you so much to everyone as your stories and advice have been extremely helpful and comforting throughout this "ordeal".

    I had RTKR on 14 December 2016 so yesterday was my 3 week "newkneeversary". I had in home PT for the 1st 2 weeks and it was brutal, was not happy at all. This past Tuesday I went to outpatient PT for my initial assessment and my ROM was at 67, extension at 3. My PT seems to be great, was not concerned about my ROM and indicated we would be concentrating on muscle strengthening and extension.

    At that particular point, the swelling was 1cm when compared to my left knee. My main area of of pain and concern is muscle weakness in my calf, quads, abductors and psoas. I had a right hip arthroscopy 7 weeks prior to my TKR so my muscles were still recovering.

    All exercises that I do at home like straight leg raises, heel slides kill me, makes my knee feel like I have a tourniquet around it. I walk with a crutch and after walking around the house during the day, I get that tight feeling. On top of that, my groin hurts and I have to constantly massage my thigh.

    Is there anything else I can do?

    My first actual PT session is next Monday and from there on I will be going 3x a week for 6 weeks. Will my muscles go back to normal? I'm so worried that I'll never walk normally again. I cry every day out of frustration. I cannot stand to do exercises right now.

    I take oxycodone/acetaminophen for pain, now about every 6 hours, except during the night where I take it every 4 hours because I wake up with pain.I also elevate and ice but I honestly don't think I'm doing it enough because I can't stay still. I am going to commit to doing this a lot more often. Even if I'm laying down doing this most of the day.

    Thanks in advance! :)

    Mireille RTKR 14 December 2016
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @Mireille , and :welome:

    Firstly, please stop doing all the exercises that hurt. They won't help and they'll just upset your poor knee that is trying to heal after major surgery.

    It's much too soon to do any strengthening exercises right now. How can your poor knee be expected to be strong, when it's still wounded? You wouldn't start doing that to a broken leg, would you?

    Of course your muscles will all get back to normal, but it takes time.

    It takes a full year for complete recovery from a knee replacement. Your knee isn't lazy or unfit. It's wounded. Treat it gently and it will recover its strength, as you use it more in your daily living. Right now, it needs gentle rehabilitation, not training for the Olympics.

    Three times a week is too frequent for PT. Once or twice a week is plenty. There's no need to rush to recover, no deadlines you have to meet. In any case, it's not exercising that gets you your ROM (Range of Motion), it's time. Time to recover, time for swelling and pain to settle and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

    Did nobody tell you that you can'[t recover fast from a knee replacement? It's not like a lot of other surgeries. You won't be all better inside 6 weeks. By about 3 months, you will be feeling as if you are about 70 % recovered, about 80-90% by 6 months. Being relatively young doesn't mean you'll recover faster, either.

    I'm going to give you our recovery reading list. All the articles are useful and they're quite short. Read them and believe them, because they're true.
    First are the BoneSmart mantras ....
    - rest, elevate, ice and take your pain meds by the clock
    - if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. Exercise only gently
    - if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
    - if you won't die if it's not done, don't do it
    - never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
    - be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

    Next is a FAQ (Frequently Asked Questions) thread.

    And here are some very crucial articles
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?
    Energy drain for TKRs

    Myth busting: no pain, no gain
    Activity progression for TKRs
    Heel slides and how to do them

    Extension: how to estimate it and ways to improve it

    Elevation is the key
    Ice to control pain and swelling

    Healing: how long does it take?
    Chart representation of TKR recovery
    Myth busting: the "window of opportunity" in TKR

    Myth busting: on getting addicted to pain meds

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?
     
  3. Mireille

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    Hi @Celle , thanks so much for the quick reply. :loveshwr: I have read all the links and continue to read them in case I miss something, lol. Even though my brain understands all this, my irrational self thinks if I don't do anything, I will never regain normal use. I feel guilty if I don't do exercises or get on the CPM machine.

    My in home PT told me during the 2nd visit (1st week home from the hospital) that she had never seen such muscle weakness and called my OS so that he could see me. I went to his office the next day, literally 7 days post surgery and he told me that was baloney and that my knee looked fine and that it was way too early and of course my muscles were going to be weak after major surgery. He told me there was nothing to worry about.

    Then she kept pushing for straight leg raises, I thought I was going to have a "dangly leg because I couldn't do it. I finally was able to do them on my 14th day post op and it was excruciating. I could only do 5 and I thought my knee was going to burst. I stopped doing those 2 days ago. No more. I will take it easy and try not to put so much pressure on myself. It feels good to share because no one else understands what I'm going through. I'm so crabby, sad and frustrated and try to put on a happy face to make everyone else feel better. Thanks again!

    Mireille - RTKR 12 December 2016
     
  4. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    I agree with Celle, it's far too early to work on strength exercises. You're suffering and swollen because of the exercises. There's nothing you can do to hurry the healing process but a lot you can do to slow it down. All those exercises are slowing down your healing because they're creating swelling and a swollen knee can't bend because there's no room. Cancel PT for a while and see how you feel, you know what you're doing now isn't working and canceling can't hurt your knee.

    Think of your TKR as a broken bone, because it has been broken and putback together. Would you exercise a broken leg before it's healed?
     
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  5. Celle

    Celle FORUM ADVISOR Forum Advisor

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    And people wonder why we sometimes say that "no PT at all is better than bad PT"!

    Believe your surgeon, not that fool of a therapist.

    It beats me why some PTs are so discouraging to their patients and make them feel so inadequate. It's cruel, thoughtless and unnecessary.
    It makes me want to make therapists like that have a compulsory TKR themselves. Then they'd understand!

    You are going to do just fine. Your leg will bend and straighten as it's meant to and your muscles will grow strong again. All it takes is time. Lots and lots of time, unfortunately. This recovery is a great trial of patience, but it is worth it in the end.

    Here on BoneSmart, we recommend being kind to yourself and kind to your knee. Treat yourself and your knee gently. Exercise a bit, but never to the point of pain. The normal activities of your daily life are exercise, too, remember.
    BoneSmart philosophy for sensible post op therapy

    And, just in case you think you have to do everything your PT tells you, remember this: She works for you, not the other way round. You can call the shots. It's your knee, not hers.
    Saying no to therapy - am I allowed to?


    I'm looking forward to hearing how you are getting on. We're here to support you all the way. :friends:
     
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  6. mbrown

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    @Mireille I'm sorry you're having a tough time. Having your hip and knee done back to back is no joke. I'm on Day9 so I'm a couple of weeks behind you. You just have to listen to your body. You know the difference between pain and discomfort. If I have pain or swelling after therapy then I'm not gonna do that movement the next time at therapy. However, I'm not going to abandon it indefinitely. I'm gonna go back to it a session or 2 later and see how it feels.

    You used straight leg raises as an example. I did straight leg raises on day 2 post surgery and had no problem with them. Well, then on about day 4 it felt like someone was driving a railroad spike through my knee so I didn't do them. But I didn't abandon them. I came back to them on day 6 and they didn't hurt at all and I've done them for the last 3 days with no pain whatsoever.

    On ROM, I completely agree that you can't really push ROM. It's gonna come back at its own pace.
     
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  7. Jamie

    Jamie ADMINISTRATOR Administrator

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    Remember too that you have the right to request a different therapist if you're not happy with the one that was assigned to you. Or.....you could opt out of therapy and just do gentle bends and stretches several times a day on your own. That works too!
     
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  8. Spex10

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    Hi Mireille sorry to hear you're feeling so bad. It is so confusing when you are told two such contradictory ways of going on. Lots of gung ho PT vs well, none! Us humans sort of think we must try harder, do more and if we don't improve its our fault (well I do anyway!).
    I don't have any advice except to hang in there (like you've got a choice!). This current moment and all its difficulties will pass. Good luck.
     
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  9. skigirl

    skigirl SUPER MODERATOR Moderator

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    I think that the "brutal" PT is part of your problem right now. I think that many of the home health PTs seem to follow the plan for TKR rehab that is about 10 years out of date. If anyone "Pushes" your knee to get more rom, they are actually CAUSING swelling to occur in your knee---which decreases your rom.

    It seems like your outpatient PT will be more gentle. But everyone else is correct, right now you need more rest and elevation for that knee so that the swelling goes down and your rom improves. You are actually in charge of that yourself. So, make yourself comfortable with a good book and/or a movie and commit to icing your knee. My OS told me that I should spend two hours in bed for everyone hour up at your stage. I think that your anxiety is causing you to roam around too much.

    So, rest, elevate---do this for a week or two and then see where you are. Nothing is forever.
    Elevating your leg to control swelling and pain
    Using ice
     
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  10. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Yes.

    You will walk better than pre-surgery

    Please don't do exercises right now

    Excellent, your rational mind is correct, ignore the irrational bit.

    He's talking sense.

    Everyone here has given you the correct regime. When your knee is healed you can do strength and fitness training until your eyeballs fall out, if you want. But not until then.

    Now, you relax and watch telly. What's not to like?
     
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  11. little red canoe

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    Fitness PT comes later.. months later. I am just now at 13 weeks working on rebuilding strength without pain.
    Pain is a signal that you really should not ignore.
     
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  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'm going to give my comments though they'll be pretty much like the previous posts!
    This is misleading as there will be a lot of internal swelling in a knee so though your knee looks normal, it actualy does have a lot of swelling and swelling = pain!
    Then stop doing them!
    Massage isn't that bad but don't be too vigorous with it. Read this Acupressure massage.
    Oh gosh! At three weeks you think this? Honey, you could be in this misconception for three months!
    Of course, PTs seem to relish bullying people and making them feel guilty about this. Well you just remember that this just confirms that all we are saying is true and all they are saying is falsehood!
    I would imagine she did! Her job depends upon it! Read this BoneSmart philosophy for sensible post op therapy
     
  13. Mireille

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    Hi @mbrown , thanks so much for your suggestions. I hope you have a smooth recovery and things go well for you. I can deal with discomfort so I will continue to do gentle stretches and exercises but I will stop if it causes pain. For sure, I'll retry some of the other exercises again at another time and maybe I'll surprise myself. All we can do is try. I'm going to try to be more patient as I think that's probably what's driving me crazy. I'm not used to being idle so I'm constantly moving while at home, thinking the more I move the better it will be. Obviously that is not working for me and I'm going to heed everyone's advice and listen to my body. :snork:
     
  14. Mireille

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    Hi @skigirl, thanks so much, you hit the nail right in the head. I am roaming way too much and I now realize that. I can't stay still so I'm constantly moving from one room to another, I've swept the floor, loaded the dishwasher, cooked, etc. I know that I'm not resting or elevating enough. This stopped today, I am taking my time, icing, elevating and trying to control the urge to do things. Being idle is way out of my comfort zone and it drives me insane but at this point I'd rather be insane that in pain, lol. Thanks again.
     
  15. Mireille

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    Hi @Josephine, thanks for sending the links. I'm reading and listening to everything and will heed the advice. I'm thankful for the support of this group and the shared knowledge. It makes it a lot more bearable to know that I'm not "abnormal" and confidence that it WILL get better. :roseshwr:
     
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  16. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    Maybe you should print out the activity progression chart and post it on your laptop, fridge, etc. At 3 weeks you have a ways to go and although there's nothing you can do to hurry this recovery (such as moving more, cooking, cleaning) there's a lot you can do to slow down you're recovery i.e. Cooking, cleaning, etc. We all are not used to depending on others, but it's necessary in recovering from this surgery.

    http://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/
     
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  17. skigirl

    skigirl SUPER MODERATOR Moderator

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    Remember, you leg is not out of shape---it is injured and has had major surgery. Because our quads and hamstrings have been moved around during the surgery, they are weakened now. If you keep walking on the joint, your joint has to bear your full weight since the quad and hammy are not helping to support the leg.

    do things like quad sets to wake up your quads and just make yourself take it easy.

    Here is some of what I did; I learned to knit on you tube, bought stuff on line and had it delivered. made hats for all the granddaughters! Watched Downton Abbey from day one. Looked at videos of Jane Austen.

    I looked up some videos of old tv shows that I hear people talking about that I never have time to watch. Then, I got books from Amazon on my iPad and read a lot of mysteries.

    I just looked up some kayaking videos on you tube because my daughter had one in front of her house---they were helpful. I watched a lot of ski videos on you tube. and started watching a show called Britain's got Talent on you tube--so many of the try outs are hysterically funny.

    I had friends who took me out to lunch once a week--even though I had to put my foot on a chair. I walked my dogs---1/2 mile at a time.

    I did a little bit of jewelry. I watched some Soccer games---ugh, it all sounds so silly when I write it down. Most of all, try to keep yourself going with something. You really do need to sit and elevate for the first two weeks. I made myself do that and almost all of the swelling was gone when I started PT at week three.

    Here are some things that will make things worse. A PT who pushes your need to get extra rom!! This is a biggie, the swelling can last for weeks. For me, it was being on my feet in my studio---one night I was in agony--my knee needed more rest. So, at week 3---two hours down for every one hour up.

    You are doing something good for your body, you are healing. So many people try to rush this stage and some frantically exercise so that they can be first to recover---we ususally find them later with tendonitis---you simply cannot rush these first three weeks.

    take a topic and research it---Kayaking in Australia,in New Zealand. Beaches in Hawaii, how to change the oil in your car---you get the picture. Your computer is your friend right now.

    I even got some audio books so that I did not have to hold the ipad!! Have you listened to the HElP? or Lord of the Rings? or Pride and Prejudice.

    I am a reader, if you are not watch videos. Amazon prime was a good friend for those weeks when I had to order stuff on line since it was delivered in one or two days. I studied some art--oh yeah there are classes on Craftsy---cake decorating, knitting, sewing, quilting, painting---I took 4 on acrylic technique--oil painting, drawing. Now is the time to indulge your brain and find something new to learn.
     
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  18. UACats70

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    This is the same for me. Learned my lesson the hard way too. Wishing you a successful recovery.
     
  19. KarriB

    KarriB FORUM ADVISOR Forum Advisor

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    Watch The Crown on Netflix. So good!
     
  20. mbrown

    mbrown senior

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    Agree. It's very good
     
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