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TKR MoragsMum's Recovery

MoragsMum

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I have been completely thrown - in the very best way! - by finding Bonesmart today. Your stories are both harrowing and immensely helpful...My TKR (first) was on November 8th, and I've had two PT sessions a week since then. MY PT came to my home for the first 6, and on the second we went outside with a single crutch, later progressing to no support at all, and walking along the street for far too long. It left me with a swollen knee, and very exhausted. At the time I asked him what was he trying to prove, it's not as if I'm in some contest for the toughest 73 year old. I live in a very crowded city, with uneven pavements, people on bikes and found the whole experience terrifying. Yesterday I met with the OS, and told him it seems more within my capacity to walk gently around the block a couple of times a day rather than one arduous forced march. Happily, he agreed with me. Then today the PT placed 3 kgs weights on my knee for ten minutes!! Long story short, I am so heartened by everything I read here, and at our next session will start taking PT back to something more in line with what I've read here, a bit of teenage rebellion... Cannot thank you enough for all your input, and for this brilliant site. Wishing us all smooth recovery through more moderate PT!
 

Jockette

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@MoragsMum Hi and Welcome!

You are very correct that most of us are not in a contest to be the toughest, early in this recovery ( if ever!) I’m glad that we were able to give you confidence to speak to your PT about how you want your rehab to go. Well done!

You will notice that I copied your post and started a recovery thread for you. This is where you can ask questions post updates about your recovery.

Please tell us which knee you had replaced and we’ll add that to your signature. :flwrysmile:


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

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

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jockette

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Let us know if you would like a different title and we’ll change it for you. :flwrysmile:
 

eaglemom

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Please do read through the articles that are listed above. Remember the PT is working for you, not the other way around. You can also ask for another PT person, if your so inclined.

Please do not allow anyone to put any weights on your leg / ankle. It is way too early in your recovery to do that, if ever.

We are here to help. Your knee is in charge and ice / elevation are your friends.
 

Mrty2019

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With my other knee two years ago, PT piled free weights on my knee to improve my extension. The PT said the joint was really strong and couldn’t be hurt with all the weights. This just isn’t true especially with my baby knee. PT caused all kinds of set backs and after finding Bonesmart I quit PT. My OS said my extension would improve with time which it did.

My right knee experience has been so much better following Bonesmart’s gentle approach. Remember you are in charge of your knee not the PT.
 

hawk2go

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Ugh - unfortunately, PT seems consistently to be more of a hindrance than a help (or we just don't hear much from those people for whom PT is knee saver). I'm glad you'll talk to your PT armed with more info on the TKR recovery. Good luck and keep us posted.
 
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MoragsMum

MoragsMum

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Thanks so much for the Recovery Guidelines - will be reading them thoroughly over the weekend. It was my left knee, BTW. And thanks for your encouraging responses! Have to say that the aggressive PT recalls my days at school in the UK, with alarming gym/lacrosse teachers bellowing "You MUST do that exercise!" Adolescent trauma :)
 

Sara61

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Aggressive PT does more harm than good, we are healing from a complex knee surgery not a sports accident unfortunately many therapists don't know the difference and still use barbaric methods on our knees. Thankfully I'm fortunate my therapist is a friend and believes in the BoneSmart guidelines, he never forced my previous knee and was gentle and encouraging always, on my right knee- the hospital therapist on the other hand should be removed, :hissy: not sure what he was out to prove but thank god, I only saw him only the once, two days after surgery ( for us to get released from hospital we are obligated to have a session with him ) he was a rough bully and my knee/shin is still paying the price...I will only start PT after my staples are removed and I will go back to my gentle friend although to be honest, I'm sure my daily living activities are sufficient as I have no intention of ever running a marathon and I am in no competition with anyone, my knee will be allowed to heal slowly and so should yours xxx
 
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MoragsMum

MoragsMum

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Thanks so much Sara for your encouragement. I'm glad you will now be in the hands of a gentle PT, and wish you a smooth and 'user friendly' recovery! Indeed we're not cases of sports injuries - I wonder what they get taught in PT school about the (very) different kinds of patients... The first inkling I had that something is not right in my treatment was an article by an American ortho surgeon - these lines stood out particularly - 'So, how do you prevent a stiff total knee? It is not by walking around a lot. It is not by cycling the knee back and forth a lot. It is by gently and progressively stretching'. I printed it out and put it on the fridge door for frequent reference. Happy healing! xxx
 

Roy Gardiner

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Then today the PT placed 3 kgs weights on my knee for ten minutes!!
Don't go back. That's a rubbish thing to do.

Stretching

The Bible is Bob Anderson, Stretching, ISBN 0-7207-1351-X

Right at the beginning he states that stretches should be held for 10-30sec only. As long as you don’t break this rule never go to the point of pain, you can stretch as often as you like.

But Anderson emphasises that holding a stretch for many minutes is not the way to do it.
 

WFD

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…an article by an American ortho surgeon - these lines stood out particularly - 'So, how do you prevent a stiff total knee? It is not by walking around a lot. It is not by cycling the knee back and forth a lot. It is by gently and progressively stretching'.
By any chance do you have a link to this article, or even just the author and title? Thanks.
 
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MoragsMum

MoragsMum

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Certainly - he's Dr. Christopher Gorczynski, I see I can't post the URL, but I'm sure you'll find his blog. It's from a specific thread on stiff TKRS. What I like about his site is that on this specific question he answers hundreds of questions, with great patience and positivity, from people who are not, and may never be, his patients. Unusually altruistic!
 

Jockette

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I found the article and read some of it. While I like the part you quoted, he also wrote that by 6 weeks or so, the flex you have at that point is all you will get. Many of our members had continued increase in flex well past 6 weeks. Mine continued to improve well into my second year.

ROM will improve as you continue to heal and your swelling goes down.
 

Jockette

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I never did the extension exercise where you prop your foot on something and let gravity take over, and I can’t even imagine how some members can hang their legs over the end of the bed :yikes: because my knee wouldn’t even do it today, and my extension came back fine. In time.
 

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Everyone is a bit different on how they react to the bending and stretching exercises you can do following surgery. And each patient interprets "pain" differently.

Recovery is not without pain. It's hurts to do the stretches and bends. The point is to find the hurting point in your exercise where you are experiencing what we term "mild discomfort." This means you feel some hurting in the knee, but nothing that comes close to bringing tears or causing swelling after the exercise is done. When you hold the bend or stretch at this point for whatever is just to the point of becoming very uncomfortable, that is the correct way to do your bending and stretching exercises.

As for the leg hang to improve extension, again people are different. I found it very uncomfortable to place my heel on something and let gravity help extend the knee. But I found it much easier to lie on my stomach at the of the bed with my knee right on the edge (still slightly supported by the mattress). While I could only do about 15 seconds at the beginning, I was able to work up to this hang for 20 minutes or so after a few months. It was relaxing to me and I would even fall asleep in that position sometimes. You must relax your legs completely. And no weights are to be used as that is forcing the straightening. Gravity works just fine.
 
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MoragsMum

MoragsMum

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Thank you Jockette for your helpful pointers. Was glad to read that the 6-week limitation the surgeon mentions in his article is over-optimistic and plain incorrect. When I mentioned it to the OS in our recent meeting he said three months is far more likely. And I realize that longer is more realistic.
 

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