Bilateral TKR Nensi_New_Nees
- Thread starter nensi
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United States
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nensi
senior
@Celle
My OS encouraged me to do sitting heel slides using a dish towel, even having a helper to nudge my heel backwards bit by bit to achieve 90 degrees. My ROM before surgery was only 60-70 and he said that he had a lot id difficulties with shortened ligaments and that it could even be a limiting factor to achieve 90 post-op, citing a tendency for the ligaments to reattach in the old fashion. Does this make sense to you? Comments?
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My OS encouraged me to do sitting heel slides using a dish towel, even having a helper to nudge my heel backwards bit by bit to achieve 90 degrees. My ROM before surgery was only 60-70 and he said that he had a lot id difficulties with shortened ligaments and that it could even be a limiting factor to achieve 90 post-op, citing a tendency for the ligaments to reattach in the old fashion. Does this make sense to you? Comments?
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Nancy, I don't think it's a good idea to have anyone help you with heel slides. They just might force your knee too much. Similarly, we don't advise using anything to pull your knee back.
Do the sitting heel slides by yourself, and you can gently nudge your foot back by using your other foot, but never cause your knee any pain. Sitting heel slides are easier to do that the ones lying down in bed.
You will get the best results by using your own muscles.
Heel slides and how to do them properly
As early as you are in recovery, swelling is the most likely thing to be preventing your knees from bending, so work on reducing that, with lots of rest ice and elevating.
Range of Motion (ROM), both bending (flexion) and straightening (extension) can continue to improve for a year, or even much longer, after a knee replacement, so don't be misled by any worries about a window of opportunity.
Myth busting: the "window of opportunity" in TKR
Do the sitting heel slides by yourself, and you can gently nudge your foot back by using your other foot, but never cause your knee any pain. Sitting heel slides are easier to do that the ones lying down in bed.
You will get the best results by using your own muscles.
Heel slides and how to do them properly
If your ligaments had shrunk, it could take a bit longer than usual for them to lengthen again. They will need to be stretched slowly. However, I don't think they will reattach in the old fashion. If your surgeon moved them, he will have sutured them in place.
As early as you are in recovery, swelling is the most likely thing to be preventing your knees from bending, so work on reducing that, with lots of rest ice and elevating.
Range of Motion (ROM), both bending (flexion) and straightening (extension) can continue to improve for a year, or even much longer, after a knee replacement, so don't be misled by any worries about a window of opportunity.
Myth busting: the "window of opportunity" in TKR
OP
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nensi
senior
@sistersinhim, I am quite comfortable but really have not cut back so much. The first few days I probably had 2 Tramadol instead of 1, along with the 4x1000mg paracetamol.
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Josephine
NURSE DIRECTOR EMERITA
Oh you silly billy! Learn from your mistakes!
MY comments? DON'T! It seems like thus far you have escaped my interrogation but I can share a bit of it with you here (though you were given these in your recovery article compilation but clearly you need to read them again)
Heel slides and how to do them properly
BoneSmart philosophy for sensible post op therapy
I saw a photograph earlier showing that you had HUGE swelling in both legs. This and only this is what is responsible for your low ROM. If you exercise it like this, even ever such a little, it will prevent that swelling going down and releasing your ROM. So far you are only 10 days out so mind my words ....
It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
knit2tog
senior
Healing purrs are some of the best kind of purrs. Cute nurse! 
Shoot, so many of us were on the heavy stuff for a month or so. It's wonderful that Tramadol is keeping your pain down enough. I'd must rather take that, too, instead of the heavy narcotics.
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nensi
senior
@Jennszoo, nothing doing wuss! I am being coddled by my kids - they are 18, 20 and 21 and have pretty much arranged 18 hr per day care between them. I have not done a single household ADL (except for snapping beans or peeling potatoes while icing and elevating). Night and day compared to your "zoo". I remember those days ! Never had any trouble sleeping !
Also even though there's a lot of talk out there about how intense bilats are, I think the psychological drain is much higher for a staged approach like yours - hats off !
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Also even though there's a lot of talk out there about how intense bilats are, I think the psychological drain is much higher for a staged approach like yours - hats off !
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OP
OP
nensi
senior
@sistersinhim, thanks for the reinforcement - I've convinced myself to medicate at this level with an alarm. It's good enough for awhile.
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Sent from my iPhone using BoneSmart Forum
OP
OP
nensi
senior
@Josephine, not sure which picture you were referring to regarding huge swelling in my legs. I have pretty beefy thighs from my Italian ancestry (and big Sunday get togethers where food may never be lacking...) and have what I consider to be moderate swelling judging from your three example photographs. Please see a before and 11 day after comparison, the last taken today this AM. Do you call this swelling huge ?
Mind you, I rolled up my sundress for the picture and took my TEDS off - otherwise they are my next best friends to my ice cuffs. Thank you for your comments - of course you are right -- just takes time to sink in.
![[Bonesmart.org] Nensi_New_Nees](https://bonesmart.org/forum/attachments/upload_2017-7-11_17-16-19-png.58288/ "[Bonesmart.org] Nensi_New_Nees")
Mind you, I rolled up my sundress for the picture and took my TEDS off - otherwise they are my next best friends to my ice cuffs. Thank you for your comments - of course you are right -- just takes time to sink in.
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OP
OP
nensi
senior
Hey I forgot to mention - look how skinny my ankles are, that is simply amazing ! There was always so much fluid draining from my knees into my lower legs that I had cankles - calves which melded with my ankles. Also the fact that I had extension of 12 or so also gave a weird optical illusion that I had no ankle.As far as the rest, my flexion now is pretty dismal. The PT has been increasing my swelling, so I am going to take it easy for a few days, hopefully the rest of the week and do a few heel slides, but now, now it's afternoon nap time here in Belgium.
I think your photos look really good for 11 days out!
SusieShoes
Former BoneSmart staff member
Your legs do look great for just 11 days post-surgery! If the PT is increasing your swelling... well, that's telling you something. Your knees are saying they don't like it. Your instinct to take it easy for a few days is good. In fact, you should just plain take it easy for a few weeks, or months. I think there's a place for PT, just less PT than the PT people want you to do!
knit2tog
senior
Your legs are looking great. I hope you get a great nap in.
Jennszoo
post-grad
Look at those sexy, straight legs! I keep admiring how not-crooked my legs are now. It's crazy what "normal" used to look like.
OP
OP
nensi
senior
Hahaha, you guys ! Had a great nap, gently snorting myself awake. Woke up to the delicious smells of dinner. Had a walk outside half way around the block. That took me 26 minutes. Too far and too long. "Stupid is as stupid does."
In bed now, elevating and icing.
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In bed now, elevating and icing.
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SusieShoes
Former BoneSmart staff member
Slow down, you wild and eager woman. Halfway around a block is also halfway around a block back (unless you got a ride back somehow). Walk a little. Walk a little more the next day, if that feels right. If your knees protest, give them a day of rest and healing, then try the shorter walk again.
I love walking, and feel walking has been really good for my new knees. It's a great natural exercise, and what the knee joint is constructed--muscles, tendons, and the whole package--to do. Remember your muscles were moved around in surgery, and you haven't been using them correctly for a long time, most likely. Also, after a week or two of lounging around doing not much walking at all, those muscles are a little out of shape. So break them in slowly and work up to what you really want them to do. Me... I want to walk for miles. Currently I'm doing about a mile and change at a time. Not much, right? But when I started right after surgery, I could only walk to the bathroom!
I love walking, and feel walking has been really good for my new knees. It's a great natural exercise, and what the knee joint is constructed--muscles, tendons, and the whole package--to do. Remember your muscles were moved around in surgery, and you haven't been using them correctly for a long time, most likely. Also, after a week or two of lounging around doing not much walking at all, those muscles are a little out of shape. So break them in slowly and work up to what you really want them to do. Me... I want to walk for miles. Currently I'm doing about a mile and change at a time. Not much, right? But when I started right after surgery, I could only walk to the bathroom!
Oh no, Nancy! I know you know better than that! Don't do anything else for the rest of the day but rest, ice and elevate! You know the routine! I pray you won't suffer for it tonight!
