Bilateral TKR Ms Blue's recovery

[MsBlue]

Well, I went to PT this afternoon - first session since my depressing meeting with the doctor. And we PUSHED it. I started on the bike and was able to move the seat closer in after the first two minutes of "riding." Then we did some bending and holding using gravity for an assist. With that, we got (assisted) to 119 L and 105 R. Then a couple more exercises, and I laid on the table face-down, bent as far as I can do myself and then he (the PT) starts easing it back farther and holding with gentle pressure. That's a little tough - I have to remind myself to relax and breathe, and when I say "stop," he stops. I think we made some real progress - maybe about 120 L and closer to 110 R.

The best part is, I am not really sore. I was fine to drive home, and then iced for a while, but was not particularly swollen or in pain. It hurts while we do it (the bending and holding), but it stops when we stop. They are letting me use the bike on my non-PT days, so will be going back and doing that on my "off days" just to keep the motion going.

I feel like we made some real progress. I am determined to get this going well enough that I won't have a fight on my hands when I say I don't want the MUA. Because, as someone pointed out above, it is MY choice. And I don't want it. I think I can get there without it.

I will try that chair thing too. Another one I learned in OT is to sit in a chair and take a "pool noodle" (or foam roller) and roll it back and forth with your foot. I have also done that with a small barbell. That loosens things up too, but it's doing it at your own rate and tolerance.

 

[Pansy727]

Wow with those numbers you shouldn't need it.. Glad it's going well... I go to the dr tomorrow.. Im scared..

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[jbrooklyn]

Ms. Blue, that sounds great. Those numbers are excellent--and the changing numbers shows why we should not get too hung up on numbers. Same person, same knee, 90 one day and 110 another. You rocked it. So happy to hear. You needed an uplifting experience after that doc visit! This long haul is filled with ups and downs, isn't it.

How are you feeling today after pushing it? It's so hard to know what is a good amount of activity and what's too much. Since it did not hurt, hoping today is a-okay. Wishing you an up day.

 

[Josephine]

I can get to about 100 unassisted on the Left, and 110 with assist. I can only get to 90 on the Right, and 98 with assist. The surgeon is already talking about MUA. He's basically giving me 4 more weeks to show significant improvement

It's a bit early, especially at only 6 weeks.

maybe about 120 L and closer to 110 R.

See, that shows you don't need an MUA! However, you don't need all that pushing and pulling either. If you weren't doing so well I'd have something to say about it but I'll leave it for now.

 

[MsBlue]

Ms. Blue, that sounds great. Those numbers are excellent--and the changing numbers shows why we should not get too hung up on numbers. Same person, same knee, 90 one day and 110 another. You rocked it. So happy to hear. You needed an uplifting experience after that doc visit! This long haul is filled with ups and downs, isn't it.

How are you feeling today after pushing it? It's so hard to know what is a good amount of activity and what's too much. Since it did not hurt, hoping today is a-okay. Wishing you an up day.

Just want to be clear - anything over 90 on the right is an assisted number and anything over about 100 - maybe 105 - is an assisted number on the left. However, I sure wasn't able to do any bending before my surgery - maybe 90 degrees on a really good day before when assisted with a yoga strap.

As for today - feeling fine. I have actually tried something a little different which is ... no pain meds other than Aleve today. My knees are a little stiff, but not bad. I have every intention of getting back on the meds, especially before PT on Thursday. I just wanted to try it, because I wanted to see if would have any "withdrawal" symptoms. I have had some chills, but it is REALLY COLD (for August) in Chicago today - so I think it might just be the weather. I had a hot tea, have my little dog on my feet, and my computer on my lap, and I'm fine. I just wanted to see what a day without meds would be like (feeling kinship with my girl @LHop whose doc won't give her any!).

Thank you for the kind words and good wishes. It's so great to have a community where people really understand what you are going through. I will let you know how it goes when I see the PT again on Thursday.

 

[MsBlue]

I go to the dr tomorrow.. Im scared..

Please don't be scared! And, report back!

 

[jbrooklyn]

Great that you are feeling good, especially med-free (Alleve excepted), today!

 

[Rob 68]

Just want to be clear - anything over 90 on the right is an assisted number and anything over about 100 - maybe 105 - is an assisted number on the left. However, I sure wasn't able to do any bending before my surgery - maybe 90 degrees on a really good day before when assisted with a yoga strap.

As for today - feeling fine. I have actually tried something a little different which is ... no pain meds other than Aleve today. My knees are a little stiff, but not bad. I have every intention of getting back on the meds, especially before PT on Thursday. I just wanted to try it, because I wanted to see if would have any "withdrawal" symptoms. I have had some chills, but it is REALLY COLD (for August) in Chicago today - so I think it might just be the weather. I had a hot tea, have my little dog on my feet, and my computer on my lap, and I'm fine. I just wanted to see what a day without meds would be like (feeling kinship with my girl @LHop whose doc won't give her any!).

Thank you for the kind words and good wishes. It's so great to have a community where people really understand what you are going through. I will let you know how it goes when I see the PT again on Thursday.

Went through the same uncertainty about allowing the PT to apply "pressure," but once she did and I saw how careful she was, I was okay with it. And according to her, as long as you can show improvement and the potential to reach whatever magic number the OS wants (115 in my case), whether assisted or not, the MUA is almost certainly off the table.

I now consistently get in the 110's on my own, with a high of 116. Today's measurement was 114, which is exactly what she measured the week before my surgery in the evaluation visit. Keep turning the bike and stretching the knee, gently, at home, and you'll be fine. I found the bike to be my best friend, because it makes you feel like you're getting somewhere. Hang in there.

@Pansy727 - How did your appointment go today?

 

[Pansy727]

Go back in 3 weeks.. Will decide then if he needs to manipulate it

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[Rob 68]

Go back in 3 weeks.. Will decide then if he needs to manipulate it

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Good luck. I have a feeling you'll be fine.

 

[jbrooklyn]

@MsBlue, how are things?

 

[Celle]

Range of motion - I had my 5 week surgical follow up last week, and my surgeon is not happy with my ROM, particularly on the right. I can get to about 100 unassisted on the Left, and 110 with assist. I can only get to 90 on the Right, and 98 with assist. The surgeon is already talking about MUA. He's basically giving me 4 more weeks to show significant improvement

A ROM of 90+ at 5 weeks is perfectly fine. I don't know why your surgeon was disappointed. You were making normal progress and it's a shame that he now has you worried.

I have started doing lunges and trying to bend and HOLD on our stairs, and I'm using the yoga strap to bend and HOLD a couple of times a day. I dread it. It really hurts, and, of course, I haven't seen any real improvement just yet.

If it hurts, don't do it. You don't have to work hard to get ROM. In fact, you don't have to work at all. Did you ever read this?
TKR: work “smarter” and not “harder”

Glad your rash is resolving, but the ROM limitation is not good news, my friend--sorry to hear about this.

It is not a limitation of ROM. What MSBlue has is perfectly normal for her stage of recovery.

Well, I went to PT this afternoon - first session since my depressing meeting with the doctor. And we PUSHED it. I started on the bike and was able to move the seat closer in after the first two minutes of "riding." Then we did some bending and holding using gravity for an assist. With that, we got (assisted) to 119 L and 105 R. Then a couple more exercises, and I laid on the table face-down, bent as far as I can do myself and then he (the PT) starts easing it back farther and holding with gentle pressure. That's a little tough - I have to remind myself to relax and breathe, and when I say "stop," he stops. I think we made some real progress - maybe about 120 L and closer to 110 R.

Again, why all this pushing? What's the hurry? Didn't you know that you can continue to increase ROM for a year or even longer after surgery?
Working hard is not the right way to achieve ROM. You could even slow down your recovery, because too much work will irritate and inflame your wounded tissues that are trying to heal.

I feel like we made some real progress. I am determined to get this going well enough that I won't have a fight on my hands when I say I don't want the MUA. Because, as someone pointed out above, it is MY choice. And I don't want it. I think I can get there without it.

No need to have a fight. It's your knee and no one is going to make you have an MUA if you don't want one. It's obviously not necessary anyway and few surgeons even contemplate doing a MUA once your ROM is above 90.

I'm sorry to go on, but all this anxiety that some surgeons and PTs instill in patients about ROM numbers is unnecessary and unkind. Your knees will bend all by themselves, once the soft tissues are healed enough and the internal swelling has gone.
There is absolutely no need to rush, because there is no magic "window of opportunity" within which time-frame you have to achieve ROM, or all is lost. That's a hoary old myth that should have died long ago. Your knee won't set like concrete if you don't work at making it bend.
Read this: Myth busting: the "window of opportunity" in TKR

 

[Roy Gardiner]

He's basically giving me 4 more weeks to show significant improvement (Sept. 22 appointment to re-evaluate).

He doesn't decide, you do. They are your knees. He doesn't give you ultimatums or give you deadlines or examinations. Now, imagine you are a cartoon character of an exaggerated building worker/sailor/hooligan. "Go away" is not what he says.

As for the ROM, I have ALWAYS had more trouble on the right since the day of surgery. Even in the first days after surgery, I had a harder time with the right (and it was significantly worse than the left before surgery).

There's your answer. The right has adapted to reduced ROM before surgery, possibly over years. It will take a long time to correct.

I have started doing lunges and trying to bend and HOLD on our stairs, and I'm using the yoga strap to bend and HOLD a couple of times a day. I dread it. It really hurts, and, of course, I haven't seen any real improvement just yet. (It's only been a couple of days.)

Don't dread it. Oh, don't make it hurt it's counter productive.

Your bad knees have caused the soft tissues to shorten because of bone spurs, which the surgeon removed during your BTKR (ask him about them and how bad they were). The knees can work perfectly well, the stopping point is the tissue which needs stretching, little and often and gently. And you won't see progress over two days that's for sure.

Buy a rocking chair in a 2nd hand furniture store for a few dollars, sit in the (builder's/sailor's expletive) thing all day long, with your feet flat on the floor just rocking forward to the point of discomfort. No pain. Easy does it.

 

[MsBlue]

I went to PT on Thursday and was really sore. ROM moved backward instead of forward, but I just couldn't give any more than I did. I appreciate the above suggestion about the rocking chair. This morning, I am going to try a restorative yoga class - the teacher already knows my situation - and I may not be able to do anything but just sit there. We'll see. I'll report back later @jbrooklyn

 

[Celle]

For goodness' sake, girl, listen to your poor knee and take the advice of people who have actually had knee replacements.

Your knee is screaming at you for rest, not more exercise.

And you simply will not increase ROM by over exercising. Did you read this article I left for you before?
TKR: work “smarter” and not “harder”

 

[MsBlue]

@Celle Yes, I read it. And my knees don't hurt. They were stiff on Thursday, which may have been due to me walking too much on Wednesday. ROM was not there on Thursday, and we/I didn't push it.

I just took the restorative yoga class, and I feel GREAT. Had a much easier time walking up our stairs when I got home from the class. The class called for me to stretch some spots that haven't been getting much attention from me for a while - inner thighs, muscles along the front of the shins, and then some much needed "gentle twists" for the spine.

A few years ago, I was having terrible trouble with sciatica - it was on the right side, which has been (and remains) my "bad" knee. I did PT for the sciatica and got nowhere. So I started yoga - and it took a while, probably a 2-3 months for the sciatica to improve, and then other things started improving too. I took a yoga class the day before my BTKR surgery. And I believe that will ultimately be my road back. By resuming gentle practice and allowing the months it's going to take, I think my flexibility and ROM will come back.

 

[Slainte]

That sounds smart, @MsBlue . I plan to ease back in to physical activity in exactly that fashion - stretching and limbering and small increments in weight bearing. Will take the entire year of recovery, I am sure, but really want to avoid the setbacks I read about on other's threads. Keep writing about your progress!

 

[Roy Gardiner]

And my knees don't hurt. They were stiff on Thursday, which may have been due to me walking too much on Wednesday.

Stiffness is equivalent, really, to pain and the things that cause it are to be avoided.

 

[Celle]

I went to PT on Thursday and was really sore. ROM moved backward instead of forward, but I just couldn't give any more than I did.

My advice was based on your comment, above. That, to me, says that your knee was protesting at having done too much at a previous exercise session.

I agree that the yoga was probably a good thing and I think it's a safe way forward for you. Just take it slowly.

 

[MsBlue]

The PT did some deep tissue work on my right side and we managed to get 120 (assisted) on the left and 110 (assisted) on the right. The right is still significantly stiffer and tighter.

I missed the restorative yoga class on Sunday and so took the regular class. That was a mistake - too much stuff on the knees. I can do the hands and knees position comfortably, but there was a lot of movement from one knee to the other and up and down, etc. I got through the class just fine, but paid for it later. It's back to the restorative class for me for the foreseeable future!