MUA MUA recommendations?

[Minstrel]

Hi Jamie,

Thanks for asking about my knee - few people do.

It has been 14 weeks (Feb 12.21) since my MUA (original surgery was Oct 23.20). I still have trouble going downstairs and this is not only aggravating, it's really concerning me. Is it the soft tissue around my joint that still needs to mend? The pain is not muscular; it is in my joint, especially beneath my knee cap.

Almost every day, I spend 10 minutes (by a stopwatch!) flexing and stretching my leg with my husband's help. Every second day, I do a series of exercises while holding 10 lb weights in either hand including:
- wall crunches (back against wall, feet about a foot away from wall and shoulder-width apart; lower myself until I can just still see my toes and then straighten, repeat 10X)
- forward lunges (both legs X 10)
- balance exercises: weight on just 1 leg and then extending other leg to a series of points around an arc from side to side (both legs) and extending my arms in front of me while standing with feet shoulder-width apart with eyes open and then closed to count of 20; same except feet are one in front of the other with eyes open and then closed to count of 20

A couple of times a week, I will go for a walk using walking poles and I have gone as far as 7 kms at one time. Upon returning home, I always use my ice therapy machine for a couple of hours.

I understand that healing takes time, but it has been more than 7 months since my surgery, more than 3 months since the MUA. My best extension/flexion measurements were -5 and 110 though not measured during the same session. The last time my left leg was measured was March 25.21 and it was at -2 and 110 (replaced March 2017), so the two knees are not that far apart. Difference is that I do not remember such pain/discomfort with my first replacement at this point in my recovery. In fact, back in 2017, I was back at work and walking for 5 hours a day after 6 months. I could not walk for much longer than an hour and a half now.

I really don't feel any reduction in the pain that I feel beneath my knee cap from a month ago. Is it going to subside with time? Is there still time for me to improve my range of motion?

Thanks for your help.

 

[sistersinhim]

I think you should just stop all the exercising and let your knee heal. What you are doing is not working for you.

 

[BBCG]

Wow, Minstrel, I agree with Sistersinhim: that sounds like waaay too much exercise for your newly MUA’d baby knee! I would not have gotten to the comfort level in either knee that I have if I had been doing that much! It sounds like your poor knee hasn’t had a chance to heal yet and you’re stressing it by making it do very hard things before healing has been allowed to happen... I’m also someone who can work hard at some exercise to get it where I finally want to be, but healing from the traumatic surgery we had isn’t in the same category this early in the year long process, it seems to me... I hope the moderators will chime in with helpful resources for you, because it has been the experience of some/many of us that the PT-promoted exercises and advice are not really in our best interest! Hang in there, as lots of us have been in similar straights, too. But, I bet you will hear from folks that you need to back off on all of those stressful strengthening exercises for a while, until your knee has time to heal, which all that exercise is preventing.

 

[Jockette]

Almost every day, I spend 10 minutes (by a stopwatch!) flexing and stretching my leg with my husband's help. Every second day, I do a series of exercises while holding 10 lb weights in either hand including:
- wall crunches (back against wall, feet about a foot away from wall and shoulder-width apart; lower myself until I can just still see my toes and then straighten, repeat 10X)
- forward lunges (both legs X 10)
- balance exercises: weight on just 1 leg and then extending other leg to a series of points around an arc from side to side (both legs) and extending my arms in front of me while standing with feet shoulder-width apart with eyes open and then closed to count of 20; same except feet are one in front of the other with eyes open and then closed to count of 20

The pain you have is your knee telling you it is not healed enough for all these exercises.

I understand that healing takes time, but it has been more than 7 months since my surgery, more than 3 months since the MUA. My best extension/flexion measurements were -5 and 110

7 months is only a little bit past halfway healed, on average. Those are decent ROM numbers for a knee that is still in recovery mode. I had a lot of improvement in my ROM in my second year, and even some more in my third year.

Lose the Work Ethic While You Are Recovering!

Lose the Work Ethic!!! Article by Referee54 (Tim) Many of us have a tremendous work ethic---and for several reasons. I can still remember, to this day, my father saying to me on the morning of my first day on a “real job”, “Give them nine hours of work in an eight hour day.” I believe that...

bonesmart.org

 

[Sisterpat]

Remember, your MUA re-aggravated an already painful knee. It will take a while to achieve a level of comfort and increased ROM. The advice already given is on the mark: slow things down. Spend some extra time icing and elevating and getting that knee not to be so angry.

 

[Jamie]

It's never a good idea to compare one knee to another. There are many variables that make each recovery unique. Am I understanding you correctly that the ROM in your latest TKR knee is about the same as your other knee?

Do you have access to a pool or a stationary bicycle? Both those would be easier on your knee for any exercise you do. But honestly, if you are having pain or swelling after you're doing a formal exercise or walking, then you probably do need to give those exercises a rest for a few weeks to let your knee recover. As folks have mentioned, your activities of daily living are enough to keep your knee moving. The pain indicates inflammation and what you don't want is to keep that knee inflamed and angry. Doing so risks you going from an acute pain situation to a chronic pain one.

Some knees are just slower to heal. You've been pushing that knee for months and the result has been pretty much the same. You might want to try something different to see if you can get a different result. You have nothing to lose by trying to slow down a bit and it just may allow you to get over this constant pain you're having.

 

[Minstrel]

Thank you all for your responses. It is with a heavy heart that I read your advice to slow down and even stop doing what I have been doing. Words to ponder, for sure, and I have also re-read "Drop the Work Ethic for Your Recovery".

Admittedly, I am one for whom these recommendations are hard to hear. From my perspective, I have slowed down. A month ago, I was at the physio clinic every second day where I used the stationary bike for 30 minutes at a time (dropping the seat height after 20 minutes), not for endurance, but for range of motion. Then I used the leg press to push 70 lbs with 2 legs and 30 lbs with my operated leg X 30 reps each. Upon returning home, I would continue with the crunches and the lunges (followed by the ice therapy machine). This in keeping with exercises that my PT introduced and the advice of my surgeon to exercise hard one day and rest the next.

I dropped the bike and the leg press because I was feeling a lot of pain around my knee cap that just didn't seem to be abating. What few exercises remain still seem like so little effort to try to regain function. And that's what is fueling my despair.

I am accustomed to "working up a sweat" whether hiking, biking, playing pickleball. This business of barely moving is "playing with my head". For me, 7 months post-op is an age - it's high time I got back at it. To boot, it's summer here - time for seasonal activities, like kayaking, which wouldn't stress my knee joint at all, except that I have to be able to get in and out of my boat!

It also doesn't help to view all of those YouTube videos of patients who exhibit extraordinary recoveries after so little time has passed since their surgeries. And there are also the surgeons themselves who stress the importance of bending and straightening to regain range. It's so disheartening for me.

Jamie - I do have access to a stationary bike at the physio clinic (gyms here are still closed). Pools, however, remain closed and are not expected to open for weeks (outdoor pool not at all this summer). And, yes, the ROM in my left knee (replaced in March 2017) was last measured at -2/110, while the best ROM measurement in my newer right knee (replaced in October 2020) is -5/110. The pain that I still feel around my right knee cap is the distinguishing factor. What is the cause of that pain? Why can't I even go down the stairs with some fluidity?

I remember agreeing to the surgery in October thinking that I would be healed and ready for all the activities that our short summer allows. Instead, I'm sidelined and loathing the prospect of watching others enjoy their bikes and their boots and their boats . . . . this is so hard for me.

 

[sistersinhim]

I am accustomed to "working up a sweat" whether hiking, biking, playing pickleball. This business of barely moving is "playing with my head". For me, 7 months post-op is an age - it's high time I got back at it.

A knee replacement is not like some of the sport's injuries that a person works through the pain, it's a traumatic surgical injury and your knee has to heal from the damage that comes from the surgery. Overworking your knee like you are doing is keeping it inflamed and not allowing your soft tissues to heal. You are doing yourself more harm than good. Why not just try taking a month off and doing just your normal daily activities. That will give your knee a chance to heal more and relieve some of that inflammation.

 

[Roy Gardiner]

this is so hard for me

I am an underachiever in this world (yes this is your recovery thread; this post is about you, bear with me). I was involved in IT consulting in the 1970s when it really was the Wild West and many people of my acquaintance at that time have done well, a good few becoming filthy rich. I didn't. I was too lazy. And this has been true of everything I've undertaken, and I strive against it.

Knee recovery, I was a superstar. Because hard work is (nearly always) counter productive, whilst watching telly is a carefully considered proactively designed heuristically programmed dynamically structured recovery programme.

99.9% of the time your approach to life is vastly superior. Not this time.

A month ago, I was at the physio clinic every second day where I used the stationary bike for 30 minutes at a time (dropping the seat height after 20 minutes), not for endurance, but for range of motion

I've posted you the guidelines on the bike. You're doing far too much, far too few times. 2 mins spinning until the knee is warmed up is all you need, and you can do it loads.

Then I used the leg press to push 70 lbs with 2 legs and 30 lbs with my operated leg X 30 reps each. Upon returning home, I would continue with the crunches and the lunges (followed by the ice therapy machine). This in keeping with exercises that my PT introduced and the advice of my surgeon to exercise hard one day and rest the next.

So, if I'm interpreting your reply appropriately, Celle, I should not even be doing quad-strengthening exercises for 10 minutes every second day?

Your knee is injured not unfit. These exercises can do no good, in the BoneSmart view. I doubt 30lb is a strain to your muscles, but it's hurting the soft tissue. So it's neither training, where you press on until failure, nor recovery, which is strain-free.

The BoneSmart view is that you shouldn't try to train until the soft tissue is recovered enough to take it; you can recover strength later - and as you know, rebuilding strength one previously had is vastly easier than going to a genuinely new level.

This business of barely moving is "playing with my head"

We're not explaining it well if this is how it's come across.

You can move as much as you like. What you must avoid doing is stressing the soft tissue around your knee because that just damages it.

To be advised to just rest is a jail sentence for me. I have to move.

Once again, no-one is saying 'just rest'. The BoneSmart view is that if you move enough, or against enough resistance, to be painful then you are not helping your recovery.

I have been diligent in exercising and moving my knee. What else can I do to speed the healing process up?

Nothing. Healing is automatic, at the body's pace. You can't do anything to speed up healing a broken bone, for example. But you can slow it down easily. When I fell off my bike and broke my left collar bone, the docs did nothing (they don't unless you break the skin). 'Keep it in this sling and don't move it' they said. 'OK' I said. I am right handed, so instead of the bike I followed my alternative hobby of table tennis. Yes, you've guessed it. 5 weeks later no healing at all; table tennis was too much movement, even with the arm in a sling.

Why not get a static bike at home? You can ride it all the time, gently (see the posted guidelines).

Walking is good, so long as it doesn't hurt

Swimming

In fact, pretty much anything that doesn't hurt or lead to pain and/or swelling over the next 24 hours.

 

[Jockette]

Thank you all for your responses. It is with a heavy heart that I read your advice to slow down and even stop doing what I have been doing. Words to ponder, for sure, and I have also re-read "Drop the Work Ethic for Your Recovery".

Admittedly, I am one for whom these recommendations are hard to hear.

I’m so sorry that you are struggling so much with this concept.

Your knee still needs time to heal. Slowing down so that can happen is not forever. Try not to look at it as doing nothing, or slowing down, look at it as giving your knee the best opportunity in which to heal. Giving it the time it needs will give you back the activities you want, later.

It also doesn't help to view all of those YouTube videos of patients who exhibit extraordinary recoveries after so little time has passed since their surgeries. And there are also the surgeons themselves who stress the importance of bending and straightening to regain range. It's so disheartening for me.

Stop watching those videos, they are not helping you. Not every knee heals the same way, even two knees on the same person, even done on the same day.

Not all surgeons recommend an aggressive rehab like you are doing and even if they do, we really have to listen to our particular body, and take care of it in a way that is best for it. Too many surgeons and PT have a one size fits all rehab, and we are individuals, not one size fits all.

At basically halfway through this year long recovery (on average) you will improve if you stop upsetting your knee by subjecting it to all the exercises you currently are.

 

[sistersinhim]

My surgeon never stressed PT, only healing. He never measured my ROM just wanted to see what I could do. I never took one day of formal PT. I did my daily activities and increased them as my knee allowed with minimum pain and swelling. I've had 12 knee surgeries with no PT and I am doing just fine, able to do whatever I want to do. It didn't happen overnight, but it did happen without the awful pain and swelling of aggressive exercising. Through the years I've had 5 different OSs, starting from 1983. None of these surgeons prescribed aggressive PT. So, your surgeon has a different attitude than the 5 of mine did. That goes to show you that not all believe in rough PT. Please know that we are only trying to help you.

 

[Spex10]

Very, very good advice here. I speak as one who did all the exercises and stretches and forced bends and ended up having a MUA. It wasn't nearly as bad as I'd feared. After that I followed the Bonesmart way and all went well. Second knee op I sacked the PT straightaway and did the ice, elevate and just keep walking about. Guess what? I did really well. I was so pleased. So was my surgeon. He said he wouldn't bother with PT either.
Top tip re stairs: up to heaven (unoperated leg first) and down to hell (operated leg first)
Good luck - and just chill!

 

[Sisterpat]

The moderators/advisors are on target. Watching those videos is counterproductive! You don’t know anything about the circumstances of those people. Who knows if they’re even real?
I had a friend who was trying to lose weight and it drove her crazy to have to say “I CANNOT eat this, I CANNOT eat that..” because it seemed so restrictive. Someone suggested to her to spin it into the positive and say “I CAN not eat this” thus giving her total control. Why not try that when an activity you’d like to do would be counterproductive? Instead of saying “I CANNOT kayak today“, try “ I CAN not kayak today”! A subtle difference but can make a world of difference putting you in control.

 

[Jockette]

Instead of saying “I CANNOT kayak today“, try “ I CAN not kayak today”!

and add, but I WILL kayak after I heal and recover.

As long as we don’t continually over stress our new knee, recovery is temporary, though for almost all of us, it takes longer than we’d like.

You can do this!

Hang out here with us.

Bonesmart has a wealth of advice, information and support.
We will offer helpful suggestions,

Cheer your accomplishments

And send hugs when you are feeling down.

Best wishes!

 

[Jamie]

Given the exercises you say you were doing a month ago, I'm proud of the reductions you've made. Some people who are really "into" working out and exercise do feel a loss and frustration when their recovery slows and they need to take things easy when it seems they should be getting back to normal life again.

I hope you can accept this concept at some point and practice it for at least a month or two. After all this time, it may very well take that long to see any lessening of the pain in your patella area. One of the comments above was excellent about "you can move your knee as much as you like. What you must avoid doing is stressing the soft tissue around your knee because that just damages it." That's key to where you are right now. You need motion to keep things loose and flexible at the ROM you have achieved. But you shouldn't be "stressing" your soft tissue by trying to exercise or do any strength training. There is plenty of time for that once you get the inflammation under control. Hang in there. We're here to talk any time to help you get through this challenge. You'll find your balance if you listen to your body. It will tell you (pain) if you've pushed too hard for the activity you were attempting.

Doing stairs (especially down) is one of the last things people are able to do with little discomfort, so don't despair. It will come. It just may take a whole lot longer than you wanted or expected.

 

[SkiBikeHikeDude]

Hi Minstrel, I just read your thread. I'm so sorry you are struggling with pain and ROM issues. I totally get the need to move and that lying around is a jail sentence. My surgeon and PT basically put me on bed rest somewhere around 4 or 5 weeks post op as my surgeon said my knee clearly needed rest and that I was doing too much. This crushed my soul as I felt I was hardly doing anything and I was dying to do more. I stopped biking on a trainer, gave up walking around the block (I had only recently been allowed to do this), and even cut down my ADLs. My surgeon suggested I go back to a walker to take stress off my knee, but as I had moved on from that after just a few days I couldn't go that far, and I couldn't even make myself go back to the cane. But I did mostly lay around icing and elevating. My sports watch told me I cut my steps down to around 600 a day. This was not good for my mental health, but luckily I was taking an online course that included lots of interaction with the other learners, so between that and work I had people to communicate with and things to keep me busy. But I hated sitting around. Until I realized it was working. After very little progress in over a month, my knee started to feel better and my ROM started to improve. I feel like I am finally healing. I am now riding a bike trainer for up to 30 minutes at 80-95 rpms (very low resistance) without pain, and just ride outside again with no pain yesterday. I finally did a short walk the other day and walked normally and felt great.

Sorry for the long story but I wanted to share both that I feel your pain and also that doing nothing for a while probably sped up my recovery. I'm far from healed, but I'm only 9 weeks. I am finally able to see myself biking hard in a month or two, and I'm hopeful I will be able to paddle a kayak or paddle board for a backcountry lake camping trip in three weeks. I may not be able to go, but finally I have hope that I can do it as I am really healing. I finally see myself returning to an active life with less pain than before surgery.

Best of luck to you. My surgeon is a rock climber, skier, mountain biker, etc, and he keeps telling me to go slow to go fast, to take it easy to let the knee heal so I can get back to what i love sooner than if I push too hard before it has healed.

I don't know what is best for you you, but maybe go slow to go fast will work for you too.

 

[FCBayern]

My surgeon is a rock climber, skier, mountain biker, etc, and he keeps telling me to go slow to go fast, to take it easy to let the knee heal so I can get back to what i love sooner than if I push too hard before it has healed.

This is really REALLY good advice, but not what an active person wants to hear. We see over and over that this recovery is about healing not rehab. The harder members push early the longer and more painful their recovery is. Some set themselves back weeks. Letting your body rest and heal truly is the fastest way recovery.

 

[Minstrel]

First of all, thank you all for your feedback. After my submission last weekend, I did return to the forum, read your responses, and contemplated long and hard what to do with your recommendations.

Roy, your frank response was what I needed to hear and . . . I got quite a chuckle reading your description of how watching TV is therapeutic.

Sistersinhim, your comment regarding how I should not be treating my knee as a sports injury was enlightening. As a self-described "jock" who has overcome several sports injuries over the years, I have been guilty of applying the same approach to my knee replacement recovery. Having watched a live video of the procedure done on my knee, I could see the trauma I was subjected to. Thing is, I never truly understood, never really internalized, the necessity to allow my body's ability to heal itself to take precedence.

Jamie, I could learn from your patience. This being my second knee replacement recovery, you might wonder why I have such difficulties accepting the Bonesmart concept (again!). With my first recovery, I had as trying a time adopting the approach and it did prove itself in the end. I thought this time, things would be different, better . . . especially faster. If ever there was a case of not being able to compare one recovery to the next in the same patient, mine is it!

SkiBikeHikeDude, yours was a submission that brought tears to my eyes when I read it; I think you could be my kindred spirit. When you said that it "crushed your soul" to be told to rest and that the absence of steps was not good for your mental health, it resonated with me to my very core. I read your thread and it sounds that, like me, you thrive on activity that makes your heart pound. Denying that is devastating to your spirit. You get my perspective; your moniker is evidence of that. Sincere thanks for your response; "Go slow to go fast" is my new mantra.

So, during this past week I took everything to heart and I succumbed, or as Spex10 said, I "just chilled". No specific exercising; no walking; just ADLs. I also got a prescription for an anti-inflammatory and now apply Diclofenac 10% in PLO get twice daily to both knees.

Can't say whether it's the anti-inflammatory or the absence of joint specific exercises, or both, but I honestly feel less pain descending stairs. This is somewhat of a "litmus test" since descending stairs pain-free (and fluidly) has become a measure of healing for me. I think my husband might also add that my mood has lifted this past week, too.

Where I live, in Alberta, Canada, we are anticipating the re-opening of public facilities in the next week or so as pandemic restrictions are lifted. I was ecstatic to learn that it means that our outdoor pool will likely be open in a matter of days. Now that I have received my second vaccination, I can look forward to swimming again, pretty much fully protected, so that prospect has done wonders for my frame of mind, too.

In addition to all of the contemplation undertaken regarding my current knee recovery, I uncovered some history regarding my first knee recovery. At 3 months post-op, my measurements were -6/96; at 6 months, -2/100; at 9 months 0/104; at 4 years -2/110 (extension within the range of error for any measurement taken any given day), These stats, together with "Go slow to go fast" are also posted at strategic places around my home - a reminder that everything will be alright in the end - and if it's not . . . it's not the end!

 

[ihavetwins]

@Minstrel

I know it must be difficult to feel great about a workout when you’re not lying on the floor in a pool of sweat, heart pounding and euphoric that you just gave it your all.

With two TKRs I’ve had to completely rethink what it means to be a disciplined athlete. Now, it is actually more of a test of discipline for me to NOT overdo it and I have come to view this as my goal. The best part is the reward of having my knee feel better after I’ve backed off.

The amazing sweaty workouts will come again and it will be fun to rebuild my strength through hiking and biking but my biggest challenge now is taking it easy. That is my daily test.

Wish me luck!!

 

[Jamie]

@Minstrel.....thanks so much for coming back and posting your very thoughtful response to those trying to help you. The fact that you're feeling better makes my day. The "go slow to go fast" mantra you've adopted should serve you well as you go forward from here with your recovery. You're gonna make it. This is just a temporary change and it will be worth it in the end when you can resume your active lifestyle. It will come!!