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TKR Moving forward.

I messaged my OS yesterday after PT. I heard back from them a little while ago. They say my gait was off for so long that it will take some time to get better. Regarding extension they reminded me how bad my the OA was medially and the trauma laterally. Also, pointed out the remaining swelling. They are confident that it will get better and have put in for more PT.
More PT... oh brother, I mean I have done well with it, but it has been uncomfortable afterward. I'm going to have to decide to do it or not.
 
If you lose a day the day after PT, the PT is overworking your knee.
Your choices are set firm limits with PT (lots of folks aren't comfortable with doing that!) or skip it and let activities of daily life, walking, and light stretching do the work.
Either really should be fine!
 
Hi Cycle-Path,
I hope the feedback from your OS felt reassuring. At least in the sense that you received some answers.
Now...whether to PT, or not. You may benefit from it if you set limitations. Don't do anything that hurts or push through reps that feel excessive. The therapist should be able to modify anything that feels difficult or causes you pain. Don't forget your old friend ice if / when you're dealing with discomfort.:ice:
A great rest of the week to you!:wave:
@Cycle-Path
 
@mendogal

Well, I've never lost a day, but it has made me sore and increased swelling. Between the two it has slowed me down, so that might count as a loss.
On another note. I was doing prone hangs today, which have never been comfortable for me with my knee totally over the edge of the bed, and I changed them up a bit. I put on a 2.5lb ankle wieght and kept my knee on the bed. It was much easier to control pressure that way and I could do leg curls easier when it got uncomfortable. It's hard for me to tell if the leg actually straightens more when doing them, so I took a picture. It sure looks like the leg is straight - hooray! This may be good news (see attached, my right leg) as the minor change might make a difference for me because I could really relax my hamstring while supporting the knee. It actually felt good.
Now for another potential realization today and I think i'm onto something here. After paying very close attention to every aspect of my stride I think my gait change is due to my calf. I have calf weakness in the tkr leg and it seems like it has gotten much worse. My ability to roll through and push off with my foot is barely functioning. I need to discuss this at my next session at PT and probably with my OS if the PT thinks it could be the case. Maybe a change in focus to include my calf at PT will help.
The calf weakness is due to an L5-S1 injury that required surgery back in 1999. It resulted in radiculopathy of my S1 nerve root. I've also got some sciatica, piriformis, and sacroiliitis from it. None of that is major, but I haven't been able to properly do my stretch routine since surgery and it may be hindering me at this point.
 

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Yeah, I call pain and swelling "losing a day!"

As long as the knee joint is fully supported, and as you're now two months post op, I think you'll be safe using the weight for very brief sessions. Do NOT let PT put ankle weights on you!

Good for identifying the chronic calf weakness due to old spinal issues. It's very likely your PT will have suggestions for waking up those muscles. I recall that after one of my knee replacements - forgot which! - I found my calf was "asleep" like my quads and had my PT help.
 
Be really careful with weights. I think they can be negative early on and put too much pressure on a healing knee.
I too had weakness on my healing side calf. I didn't really notice it until a few months in- as I concentrated on glute and quad strengthening.
A really good exercise for calves is leaning on a worktop and going up on tip toes. You can stand on one foot at a time as well. This is actually a really tough exercise and may be too much for just a few weeks. Go easy as it is really easy to overdo things if you are a person who is used to doing a lot.
 
@EalingGran
Thank you. I'll be careful. Doing it the way I show in the pic feels like it puts less pressure on my knee than doing them without wieght and my knee all the way over the edge of the bed. With my knee over the edge there is too much pressure and my hamstring will not release. I feel it refusing to let go as if protecting my knee. I'll do them this way for a bit and then try without wieght and my knee off the edge.

I'll give the leaning raises a try too. I cannot at this point do a single standing one leg raise with my right leg. Not one. I can hold my bodywieght with it in the locked up position, but I struggle to lower my heel before getting it halfway down. My heel just drops after getting partway. Hopefully it wakes up. If I have to totally restrengthen the calf this will take forever to correct.
 
Went to the gym yesterday. Had a good trip and kept it basic and very light like my weekly trips therapy.

One of the main reasons I went was to tinker around on the calf machine to see just how weak my calf is. It's a machine that I have never seen at any other gym except here. You use it seated with your legs out and put your feet on a platform that pivots. I didn't want overload my knee somehow, even though there is no direct load to the knee, so I did not do as much as I could have. Anyway, I could do ten seated toe raises with 70lbs easily. That's a relief. My calf isn't totally wasted and I won't be starting from zero build it up.

Other than that I walked 1/2ml in 10::30 on the dreadmill, peddled the bike for eight minutes with little resistance, and did leg extensions, presses, and curls with about 30lbs x 10 reps. That is very light wieght for me. My legs haul my 225lb body all over. Lol.

One thing I liked were the mirrors. I could see my leg extension with each exercise. It looked pretty darn good to me during presses and flexion with curls, but extension showed some weakness and incomplete lock out. Quad still needs some work, but it will come with time and patience.

My leg felt pretty good afterward. No increased pain or swelling although I did elevate and ice afterward. Total steps were at 3,950 for 2 miles.

It's not quite 6:00 P.M. yet today and I'm at 3,800 steps. That includes a 1/2 ml roundtrip walk to the mailbox to help with recovery/loosening up from yesterday. I've got some more ground to cover today, so it will go up. Depending on how I feel tomorrow I plan to hit the gym again for another round of light leg work.

Wish me luck trying to get moving again and getting this calf back in play.
 
Well I got my knee swelled up a little bit and sore. I got too aggressive working flexion yesterday morning. Simple heal slides laying down in bed after I woke up, but I was working it harder by bringing my knee over my chest and letting gravity pull for a little extra pressure. I skipped the gym because of that.

Why did I push it when my flexion is good? I noticed while cleaning my smoker Friday that more bend would be better. To do the job required getting pretty low and I was sitting on a stool. Getting up wasn't very easy at all. Oh well. Lesson learned.

BTW - I'm getting tired of not sleeping well. Flip flopping and uncomfortable all night long. I slept better for the first month than I do now. Somehow I need to get active and wear myself out without overworking my knee.
 
I overdid it too yesterday. My husband and son went to NYC without me (happy for them but sad to miss out), which means more chores at home for me. I walked the dog up our fire road too far - oh, wait, I have to go downhill to get home. :dogwalk:
 
@almostready?
I learned that walking down hill was harder about three weeks ago. Went to church, but got there later than normal because I'm moving a little slower these days, and had to park in a lower parking lot. I thought "no big deal" it's only a ~600' foot walk. Had no problem getting in the church, got a little uncomfortable sitting there by the end of the service, and then while walking down to my truck realized it kind of sucked.
 
I’m about a month behind you since my tkr. I am able to flex 130 degrees and extension is 1 degree. My PT is not worried about the extension and says it will continue to improve. She does not want me using weights for a while as not to injure my new knee. What has helped me with my calf muscle stiffness and extension as been lying on my back with my legs straight up above my hips and pulling my toes towards me as much as I can before releasing after a few seconds. I think this is very similar to standing on toes and then lowering your heel back to the ground as suggested earlier, it is just easier for me to do. I also am having sciatica and have some exercises I do and the seat cushion that was suggested on this site helps me with that also. My PT says that one of the best ways for my extension to improve is to give my full attention to my gait when I walk…..heel to toe. I’m increasing the distance I walk but when I started focusing on my technique I was getting a little sloppy which was throwing my gait slightly off. She also said that icing once or twice a day when I am not having swelling or pain can be very helpful and soothing to those agitated muscles from the surgery. The nights I elevate my leg and ice it for 20-30 mins even if it is not bothering me I find I sleep better. I get lazy and don’t want to get the ice machine hooked up I don’t have as good of a sleep. Sometimes I have to remind myself of just how much trauma my leg has had with having a TKR.
 
wofsie said:
My PT says that one of the best ways for my extension to improve is to give my full attention to my gait when I walk…..
Click to expand...
My PT has said the same. I'm pretty sure that this is why she recommended for me to use a treadmill and to set it a little faster than I'm comfortable with too.
 
You don’t need to set a treadmill faster than you’re comfortable with. Faster walking will not make your extension better, and could cause a fall, because treadmills keep moving. Just walk regular. Some members try to take a larger step, but I wasn’t confident doing that. Heel to toe walking, and Time, is what will help, no matter the speed, or whether it’s a treadmill or not.
 
Well I'm feeling better today. Still a little swelling, but nothing bad. Took a 3/4 mile walk around my front pastures with my dachshund, Droop. Felt just fine and Droop had some fun. Elevating and icing now.
 
My argument against treadmills for gait training - unless one really can't be walking outdoors or in mall or big store - is that the movement of the treadmill thoroughly elides the middle section of each step.
So it takes away 1/3 of the neuromuscularcognition process we're trying to experience in our post op rehab.
 
@mendogal
I agree and generally dislike them myself for the same reasons. I also just don't enjoy the monotony of them either. Five or ten minute sessions are tolerable, but walking or running a 5k is far beyond my tolerance level.
 
Well, here's my ~10 week status:

- Insurance declined my OS request for more PT sessions focused on my calf.
- Today was my last PT session. Did my normal 5 mn bike, 5 mn walk, and stretch routine to warm up. Worked leg press, leg extensions, and leg curls along with straight leg raises in all directions. Also, a bunch of steps (front & side) on a 12" block with backward steps on a 6" block. Then on to a final ROM measurement: 0 ext & 136 flex. ZERO EXTENSION!!! Whoop-whoop!
- Therapist says I'm fine to go at PT on my own.

I guess I'll do what I can at the gym and try my best not to overdo it. At the end of the month I'll see the OS again, so if my calf doesn't keep getting stronger between now and then I'll bring it up.
 
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