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TKR Nanners adventure to the other side

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Nanners,

I think I have mentioned this a few times but I never remember to whom!:heehee: So if you are one of those that I have, just ignore me and go on! My leg was put in an immobilizer brace so that I couldn't do bending! The day before I had my little "accident" that got me into the brace in the first place, my ROM was at 82 I think. I would have to look back but it was the low 80's or high 70's. Anyway, no heel slides no anything that would help with bending or extension for almost 5 weeks. Dr. Maale just wanted it to heal. I will tell you what he says about ROM and maybe that will help. Once the tissue settles down, the ROM will come. He isn't a believer in adhesion's because he takes care of only the worst cases though, and so if a person has problems with that he works on that in surgery to make sure that will not be a problem. At the end of five weeks my ROM was already 90 and I hadn't been able to bend the leg. It was easy to do also because I didn't even realize that I had pulled it up when I was talking to Katie and Chris ran and got the tape measure! I am up to 130 now, but they don't pressure me, and Dr. Maale said he feels like sometimes MUA's give people false hope because of the very reason Jo talked about.:umm:

Please remember and for the normal person, MUA's might be fine. When you have to depend on a specialist, they don't want to open you up again unless it is absolutely necessary! He said it just takes time. I do understand there are exceptions to every rule though.:)
 
Nanners said:
I can tell you when I try to put my leg on a chair to stretch it, it hurts. I can only do it for about 30 seconds. And as you say to us, if it hurts don't do it. Yesterday I was trying to stretch a few times thru out the day, and lastnite by bedtime, I was more swollen and achey.
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Gail,

During most PT and stretching there is some discomfort. It is pretty impossible to do the stretching and exercises with no pain. So when you say "hurts", you need to use the pain scale to determine how much. You should not be crying or screaming, but squirming and hating it and feeling discomfort and some hurting are OK. In the beginning when I did the stretches on the chair, I was in alot of discomfort and could not tolerate it for very long, so you just take your time and do a little each day. It is not a linear progression but over time it will improve. The stretches do stretch your tissues around the knee as well as the surrounding muscles in your legs. I know you are around 6 weeks out and if you had not been doing any stretching during this time, your tissues may protest a little more, than if you had started early on as they have had a chance to get set in their ways. Stretching and exercise increase blood flow to the knee, which is a very good thing and very necessary to heal and dissolve scar tissue, so a certain amount of swelling and achy is normal after exercise or stretching. This is why the PTs ice you after every session and why I ice every time I come home from exercise. A gross amount of swelling and pain is not good, but usually the stretching exercises do not produce that if not done to excess. Hope this helps you with what you are experiencing.
 
Nanners,

Please remember that your body is going through a heck of a lot besides just dealing with the knee! I can tell you when I went through that 3 weeks before I knew anything, i got tired my ROM decreased and it was not comfortable to extend my legs without a pillow or something propping and elevating. The body was fighting way too many battles, Your extension issues may be like mine were. Take it a day at a time.
Hugs, Sonja
 
Nanners said:
I am currently at 6 1/2 wks post surgery. OS is giving me 3 weeks of PT to see if I can improve enough to avoid the MUA. What has been your experience as to the best time to get the MUA? My OS said the best time for it to be done is between 8 to 12 weeks.
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Nanners,

This is somewhat controversial. We do not have a solid answer for this one. However, I will tell you that performing a MUA can be effective even later in the healing process. Take a look at this study: broken link removed: https://jbjs.org/article.aspx?articleid=27904

I will quote an important finding for you:
"There was no significant difference in the mean improvement in flexion when patients who had manipulation within twelve weeks postoperatively were compared with those who had manipulation more than twelve weeks postoperatively."

Personally, I think this it is appropriate how your OS is managing you by watching over the next 3 weeks to see your progression. If your motion improves, then continued observation is very reasonable. I would emphasize obtaining your extension as much as possible.

I do believe in the development of "adhesions," as I have seen them develop rather aggressively in several patients. This, however, is rather rare. My personal MUA rate is probably somewhere around 1%, which is consistent with most OS. I think that the general philosophy of letting the "angry" tissues heal, and stretch them slowly will work in the vast majority of patients.

I hope this helps.

Orthodoc
 
Hi Nanners!
How are you doing today?
HAPPY ANNIVERSARY! What a beautiful love story!
My extension stinks, too. I had PT today and it measured 7. It could be because I usually go home and stretch & ice before PT, but today I just couldn't get away from work, and had to go right from there. I was stiff when i got there. He said that my hamstrings were tight and worked on them. I'm home and just finished icing. My bend was only 114 today. Oh well, moving forward, right?
Take care my friend!
 
Orthodoc thank you so much for that info and article. My feelings are if the PT shows even some improvement, I am going to push for even more PT first. In the article it stated that pain was a big issue after MUA, and thats been a big problem for me since I was on opiods prior to surgery. I have been thru hades with bad case of gastritis from the pain meds, not wanting to go thru that again.

ElanorG it is quite uncomfortable. I did some mild stretching this morning, and let me tell you no matter how much icing and elevating I have done today, I am quite swollen and stiff now and hurting. Maybe having someone in PT, be able to massage it correctly, will help some.

Nyland, I would give anything for a 114 right now! Haha....

And lastly my buddy Sonja, you are right! I need to take my time with this, as I don't need to stir anymore problems up. I am just barely feeling human again, and do not want to go back there if I don't have to. Hugs!
 
I'm 5 weeks ahead of you. I was where you are. It will come. Ice, Ice, ice, and gently stretch. Baby steps and we'll get there, I promise!
 
Happy belated Anniversary! I am so glad to hear that your tummy is a little better. Praying that your tummy will continue to get better and that your knee will begin to bend and straighten like you want it to.
:angel:
 
Well it seems the adjustment to my Prilosec has done the trick, I am feeling much better of late. I still have to watch the diet a little, but slowly but surely I feel I am making progress. I have decided I am going to really work hard with PT, as I do not want a MUA. And will avoid it all costs, as it will just make more pain, which will make me take more pain meds, and that just means more gastritis. Thanks for all the support you have given, it means more than you know! Hugs!
 
Well Gail, it looks like you got a handle on it now, good for you!:thumb: That's great that your tummy is feeling better too! Slow and easy wins the race!

Stay well and stay positive my friend!:friends:
 
Everyday I have been doing little short walks and I mean short, and a "few" different stretching exercises from the sheet the PT gave me from rehab, taking it very slowly and easily. But no matter how much I ice and elevate, my knee blows up and gets so stiff and swollen. And then of course hurts.

I know this is expected to happen, but how do you get the swelling to go back down? No matter how long or how often I ice and elevate this is the same reaction.
 
Nanners,

Here are some suggestions for you to play with. Everybody's body is different so you have will have to play around and find what works for you.

1) Are you elevating your leg during the night? If not, that can help alot. See if you can keep it elevated all night.
2) When you elevate are you getting it the right height?
3) Wearing TEDs or compression stockings to above the knee can help. And wear them at night.
4) I do my exercise in the morning as I tend to be stiffer and sorer in the afternoon, so find the best time of day for you.
5) Putting your leg out on the chair is the hardest stretch for extension as gravity is working on it. If that is too hard, do the stretch in a standing position using a wall or counter. I stretch my leg when I brush my teeth and do the dishes. I play games with myself, "I will hold the stretch while I wash 2 dishes...I will hold the stretch while I wash 3 dishes" etc.
6) Put ice packs both on front and back of knee and elevate for 20 minutes. Then get up and doe a few stretches (but do not expect alot since your knee will be cold), then lie back down and ice and elevate for another 20 minutes. See if that helps keep the swelling down.
7) Do a day where you take no walks, other than what you need in house, and just stretch. Monitor if the stretching alone makes it swell and stiffen. Then do a day with a short walk but no exercise, etc. Ice and elevate immediately after you do either the walk or the stretching. This is just to see if you can identify what is aggravating it the most.

YOu don't say how much you are doing around the house in terms of stairs, laundry, cooking, etc. but all of that can also affect your swelling and stiffness.

I hope these suggestions may help you find doing your PT more comfortable. Remember, this is a process and you are getting to know your body in a very detailed way and it takes time and practice. So don't get discouraged but just keep playing with it. Keep us posted!
 
Thanks for the suggestions ElanorG. But I cannot elevate all night, in fact, I do sleep with a pillow between my knee's and never have too much swelling in the mornings, just a bit of stiffness. I have tried putting something over the knee, but can't stand anything too tight on the knee. I pull it off within 5 min. I am not doing any chores or anything around the house. As I stated above I only do light stretches and minimal walking. I am seeing the PT today, so hopefully he will have some suggestions that will help me. Thanks again.
 
Well I have some good news!! I went to PT yesterday, and had a great guy! When I went in my extension was -25 and my bend was 80. He had me lying on my stomach, and he put a heated weighted pad on the back of my knee and then let it just relax till my foot finally rested on the table. He also did some bending and loosening of the knee. Anyways, when I left my extension was -12 and my bend was 93. I was so pleased, and it gave me lots of hope. I won't lie I am a bit sore today, but its a bit of a good sore. He wants me to stop and stretch every little bit, and to get on my bike and rock the pedals till I can get it around. I am going back in on Friday and will be a part of TKR PT class. I am going to work real hard, and have decided I do not want a MUA and am not going to have one! By the way I asked him to show me with my good leg, what differing degree's were. I think I would be ecstatic with a 115! Hugs!
 
Thanks all! I am quite pleased with myself. And no worries ElanorG, I am doing those stretches. Already been on the bike for 5 min this morning and will do more later. Never realized how much the bike helps both extension and bend. I am going to avoid that MUA, as to me its only going to be more pain, requiring more pain meds, which is just going to lead to more gastritis. So gonna keep fighting! Hugs!
 
Gail,

Yes I credit all my biking that I did before the surgery as well as the fact that they put me on the bike my first week post-op. My knee had a lot of "muscle memory" after the surgery and just remembered how to bend so the flexion came very naturally. But the bike is just fantastic for that. Good going!
 
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