TKR MSuki’s Fabulous Recovery Journey

[Layla]

My therapist who normally builds me up and tells me how great I’m doing suddenly got a little pushy on saying that I should be able to do steps by now

After I got visibly upset she started asking questions about where it hurt etc.

Since her behavior felt uncharacteristic, possibly she was just having a bad day and then realized she was a bit abrasive with you. Whatever the reason, it's understandable you were questioning your progress. I hope you understand how well you've been doing and build on that. I know you realize this, but keep it in mind that you're not going to heal 10 times as fast by doing 10 times as much exercise as prescribed. Continue giving yourself the TLC you deserve, go slow and easy and you will get there!

 

[mendogal]

After surgery or an acute injury....
Never. Push. Through. Pain.

 

[MSuki]

@sistersinhim and @Layla yes, I’m not sure why my PT was so pushy. I think I’ll have to assume she was having a bad day. Really I think she hurt my feelings more than anything. Seems like it is easier for me to overreact or let things upset me still, but I think that’s the stress of the surgery plus various issues going on with my mom.

@Jockette and @mendogal I know I can’t force it, but I do feel a little discouraged about the stairs. But the fact that I’m still sore from going up and down in the water where it is much easier is telling me I need more time. Or, maybe there is some muscle that needs to get more strength. I’m not 100% sure if I can’t do it because I need to heal or if I am doing it wrong, like not using the right muscle and then making it harder on my knee.

I walked downstairs today using both legs, and it did not hurt. I did possibly offload a little on the handrail because I was holding tight. But going up one step hurts even with deliberately not putting full weight on it. It just seems strange because almost everyone can do up before they can go down. So I’m going to tell the PT that no, I can’t do even 5 steps up a day just yet.

 

[mendogal]

Interesting question about muscle use.

Are your glutes firing like mad or being shhhhh quiet??

When the foot is on the next step up but has not starting shifting weight yet, both your knee and your hip are flexed.

The extension of the hip has to happen to power elevating you before the knee can straighten. The biggest muscles to extend your hip should the glutes (The hamstrings also play a role).

The muscle that extends your knee (straightens it) is the quads. Most of us do have quadriceps issues post op.

If you're primarily placing demands on the quads to try to haul you up, that is not functional body dynamics, and yep, your knee will hurt.

I suggest just ever so slightly initiating that weight shift with the foot up on the step but without actually stepping up, just to get a sense of your current muscle use. Then working to activate and strengthen your glutes and to slowly experiment on using fully activating glutes (aided by hamstrings) to start drawing your weight upward.

Getting your PT to check this might be an eye opener.

 

[Layla]

I think she hurt my feelings more than anything. Seems like it is easier for me to overreact or let things upset me still, but I think that’s the stress of the surgery plus various issues going on with my mom.

The situation with your mom is heartbreaking, I am sorry.

As you know through experience, this being your second TKR, we go through a lot of emotions leading up to joint replacement. First we struggle with the pain of a deteriorating joint, usually for months...sometimes even years! We have limited mobility, often suffer from a lack of sleep and grow increasingly dependent upon others for various reasons.

We make the decision for surgery basically putting our life and health in someone else's hands which makes us feel vulnerable and often anxious. Post op we may deal with the side effects of meds, which can trigger strong emotions. Many have concerns about the recovery process, fear over possible, but unlikely, complications sometimes accompanied by loss of appetite or lack of sleep. It's amazing what we endure on the road to regaining our health. Given some, or all, of the above, it's easy to see why you may be easily triggered. Give yourself some grace and hopefully your PT's pushiness was just a one off.

Navigating steps fluidly will come, continue reminding yourself that you're only two and a half months into a recovery that can take a full year. At this point, you're doing great. I hope you have a nice weekend!

 

[EalingGran]

Regardless, during my PT she had me do a whole lot of step ups, stepovers, and side step ups in the water. So I’m a little sore and my knee is a little unhappy but more likely from the step ups than from the dry needling

I agree with @Jockette and @sistersinhim Don't be pushed into doing anything that hurts. Too many steps too early will just make you swollen and sore for longer. I just used pilates for my recovery and never pushed myself to a painful level.
I have great ROM now at 14 months and can walk any distance I want at a good pace. The only things I don't do are running or jumping.

 

[MSuki]

I suggest just ever so slightly initiating that weight shift with the foot up on the step but without actually stepping up, just to get a sense of your current muscle use. Then working to activate and strengthen your glutes and to slowly experiment on using fully activating glutes (aided by hamstrings) to start drawing your weight upward.

@mendogal OMG I just tried this and initially I ONLY felt my quad tightening! Then I tightened my glutes and hamstrings as much as possible and stepped up twice. Only felt the slightest strain on my knee instead of the pain I was having. So sitting down now to answer this and I feel like my hamstring and glute are already slightly achy. Which seems a little ridiculous to me. I had that issue after the first time in the water where my glute clenched for a day and a little so maybe that was good exercise for it (ha ha). So I think I know what to practice and also maybe do those hamstring things where I bend the knee raising my heel. Pretty sure I’m not supposed to do leg curls on a bench yet…..

Some of these muscles are really weak from inactivity. I think I’ve worked on my quads more in physical therapy. Or maybe just used them more. I think my quads are better than the glutes or hamstring. As a test I just put on my shoes and tried wall sitting. Felt pressure on my knees but not pain, I did 30 seconds and was probably not quite at 90 degrees but close. Someone can chastise me if I’m not supposed to do that.

 

[MSuki]

@Layla thanks for the understanding. My mom got COVID a little over a week ago and is doing fine except that she’s shaky on her feet. She had 3 falls in about 12 hours so I hired a sitter to stay with her (she’s not near me). They had a little trouble finding someone at short notice willing to go where they are having COVID, and the girl they sent is young and I think inexperienced. My brother went yesterday and said he thinks she’s a college student. So she called me 3 times yesterday and then the med tech called and I got her to take her medicine. My knees were hurting enough yesterday that I took a pain pill even though I have been off them for a week. Ended up staying up until 3 am doing ice and also for some reason the hydrocodone keeps me awake instead of making me sleepy. Then at 8 something this morning they were calling me again because she was very upset that this sitter is staying in her room and following her around. They wanted me to explain to her again why the sitter is there which she likely won’t remember 2 hours later. So not a lot of sleep for me.

 

[MSuki]

@EalingGran @Jockette and @sistersinhim I have just realized something important. I think I knew it but wasn’t really focused on it. I have always sort of felt like I don’t have a problem with being pushed into things. I’ve always been sort of a rebel and not cowed by authority. I do tend to be a rule follower unless I really believe they are wrong but not afraid to disagree. I had to learn to stand my ground because my job was negotiating contracts for a major oil company for almost 30 years, then I was an auditor my last 8 which also requires dealing with conflict. But I am not good at walking away from a challenge so I think I have a bit of a pride problem. So I end up with the same result, because in the moment I’m not willing to admit I can’t do something. Even when I realize I probably shouldn’t. I feel like if I stop, especially if someone is watching me, I’m failing. And if I’m told I should be able to do something it really triggers that.

Probably need to pray about this! And also maybe mentally rehearse what I’m going to do when the PT is too much.

Lots of venting here but I feel so much better!

 

[mendogal]

Wow! I'm knocked out at your excellent self-insight into issues of personal challenge vs. self-advocacy. Funny how we all keep learning and growing as we walk this path of life!

I don't see anything *wrong* with wall sits; however, it seems from our experiment that prioritizing your glutes and hamstrings with some slow gentle strengthening is more important until they are as effective as your quads (When I did a deep dive 20 years ago into the research on why women athletes were more prone to certain knee injuries than men, over-reliance on quads to do certain movements rather than engaging glutes and hamsstrings was identified as a key gender difference!).

As for mom.... just sending a heartfelt ((hug)).

 

[sistersinhim]

Vent all you need to. We are here to listen and try to help. Many times just listening is helping! Try to put yourself in your knee's place. Don't use your emotions or mind, just try to think what your knee is feeling or thinking. I know that sounds weird, but it's worth a try.

 

[CatieViv]

I am so sorry about your mom. I know it's rough, especially being so far away. I am going to give my cousin a break next month. She is the main caregiver for her mom, and exhausted. Staying there is physically tiring for me and my knee. I don't sleep well there either. I certainly know she wouldn't be happy with a young inexperienced helper either.

I hope steps get better for you. I am able to go up normally but down I haven't tried yet. Still haven't worked my head around that one!

 

[MSuki]

Thanks all! I was a little low energy before posting today, but after all the encouragement, I looked online for some post tkr beginner hamstring exercises, got on the floor and did a few bridges, put my feet on a big exercise ball and pulled toward me, held onto the couch and bent my knee lifting my foot (that was harder) and then put a cherry on top by walking on my treadmill 1/4 mile for the first time. I have walked up to about 4200 steps in a day but not that much at one time. Last time I got on the treadmill I only went .15 before I stopped. It has been a long time since I was able to do that without pain, although now my calf in operated leg feels really tight. I went slow, 1.7 mph. Now I’m sitting in the chair with ice on my knee/leg, and heat on my back, and feeling great about it!

 

[mendogal]

A few bridges and the exercise ball are IME more knee friendly than the standing knee flexion.
There's a good reason! The bridges and the ball work both the full length of the hamstrings, upper and lower. Bridges can also work glutes if you focus on including them.
Standing and raising the foot behind you mainly just tightens the lower hamstrings while putting pressure within the knee.

 

[MSuki]

@CatieViv that is really good of you, your cousin is lucky to have you. Too many people struggle alone with caregiving and don’t have any family to give them breaks. I have some guilt about my 13 years younger brother being the primary caregiver. But, they wanted to do it and his wife was a professional caregiver. We paid them her salary so she wouldn’t have to go out to work and another 2500 room and board. I really found it difficult, it’s hard to be a caregiver when your knees are shot! It has been about all I could do to stay about a month every 6 months or so to give them a break. When I spent a cumulative 6 months at her house the first year after she first got sick, mostly alone, I was getting so depressed by the time it was over, especially the last 2 months when I was expecting to be relieved and there were unexpected delays. I could not do it on an indefinite basis. A lot of it is that (although only my close friends know it) I am an introvert and really need my time alone, but with the dementia my mom became incredibly clingy and needed me right there every waking hour.

 

[MSuki]

And now forget all that and check out the latest pics of my two oldest grandsons, just got these from their mom…..

 

[mendogal]

With bonus kitty!

 

[CatieViv]

Love the socks on the kit! Handsome boys! My niece and nephew (9 and 11) are in North Africa with their parents. I got to spend some wonderful time with them when they were home this summer. I was supposed to have my surgery June 21 but I didn't want to be recovering when they were here.

 

[AnnYo]

@mendogal , maybe you could share some of your glute and hamstring gentle stretch ideas with those of us who barely know which muscles those are!

 

[Jaycey]

@AnnYo You need to ask your PT or surgeon about any exercises that might be appropriate for you. Only they know your own situation which needs to be considered before any activity.