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TKR Nine weeks out and still limited ROM

Gilina said:
Last night, I accidentally bent the leg way too far back and besides the incredible pain, it has stiffened up since and become hot and tender again.
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I think almost all of us have done something like that. Just ice and elevate the heck out of it and be sure to take your pain meds. It should settle down.
 
Hi @Gilina - just dropping in to give you the following information:) - This is a snapshot of where you are in the medically acknowledged healing phases.

The following is a link to an article which provides the science regarding the healing process beneath and around the implant and the approximate timeframes for our bodies healing phases and processes.

Healing Phases & Nutrition

Nutrition plays a huge part in surgical recovery, in fact it is one of the 'forgotten topics' of recovery..

This second link is to other nutritional articles which you may find interesting, including one relating to bone health.

Nutritional advice for pre op and recovery

This third link refers to my ongoing research..

nutritional-snippets-did-you-know

Feel free to tag me if you have any questions regarding nutrition.

However, I would appreciate if you (or any other member) do not request advice regards supplements as I would be breaking the Common Law Act (under which I am governed) to prescribe outside of my practice, especially via the Internet.
 
Thanks, Poppet. I have observed that nutrition is a missing topic from all medical education/information, so your information is great.

So, first out-patient PT yesterday. Note that before I went, I was doing everything I needed to do for personal care and some household chores. While the knee was stiff, it had cooled off considerably and I had "recovered" from the huge set-back caused by my in-hospital PT experience. Still stiff and painful (drugs not helping), but I had been walking away from my walker and getting up out of chairs just fine.

I told PT person about how PT last week had set me way, way back. Told her we "wouldn't be doing any of that" (meaning pushing, bouncing type stuff). She looked surprised. She made a thinly disguised comment about MUA. She told me that even though I had "missed" some days of PT, we were going to "catch up" by doing more reps. She also repeated the "3 weeks to get back ROM or else" myth to me.

Went through some exercises--she would say "two more" I would say "no, that's enough." Etc.

Today, I am stiff and sore and in more pain (with even less ROM) and depending on my walker again and can't get up from some chairs. Seems like another giant leap backwards, and I don't think being less able to function should be the outcome of PT. I am contemplating bailing on PT and doing it myself. BTW, using a bending ruler and my protractor, I had estimated my ROM yesterday at 60 (in hospital before PT it was 75) and she measured 58. Afraid I'm not that hung up on what that that number is right now, though it seems to matter to everyone else. I believe that when I can start going for walks again, the rest will follow.

Upshot--PT may work for some people. It does not seem to be helping me at this point--quite the opposite. Sigh.

Gilina
 
I have been fortunate with my PTs. 3 of the 4 I've worked with over the past several years have been excellent - and I do have a discussion with each of them before I begin my initial sessions about what I expect & want from them. I have found the hospital based PTs to be more aggressive than the VNA PTs. And I don't put up with any of their dire predictions - last year on my 1st post-op day I was threatened with a MUA. I politely told her to get off my carousel - and in fact it took me 10 months to achieve my max flexion after knee #1. For knee #2 I have a very different kind of home based PT. she makes sure I know how to do the exercises, sets up what I should be doing when she's not there, and then spends her time working on the soft tissue with massage & some myofascial release techniques. Big difference for me - my knee is way less swollen than a year ago (and I know every knee is different) and I'm moving so much better. I do all my exercises spread thru the day - I got discharged with a long list of exercises to work thru, but I don't do them all at once & I don't do them all as I need to be stronger for some of them. I think I'm going to skip outpatient PT completely and just do it on my own.

Recovery is a series of ups & downs, but your "downs" after PT seem to be real deep. Is there a different PT in the agency you've seen working with patients & liked? You could always ask for a different PT. And I also performed my own personal MUA last year - went down too deep into a wall squat and that cost me a couple of days on ice, elevation & pain meds. So don't worry about that! I'm hoping you get PT straightened out - its adding too much stress into an already stressful recovery!
 
Gilina said:
She told me that even though I had "missed" some days of PT, we were going to "catch up" by doing more reps.
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The last thing you should do.

Went through some exercises--she would say "two more" I would say "no, that's enough." Etc.
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:thumb:
Don't worry about the ROM yet. Lots of us start out slow.
 
If that's your option for a PT, then you may be best to work on your own.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 
@Gilina
I agree that the type of PT you are having is doing you no good at all. In fact, it's probably slowing down your progress. You'd be much better off doing your own exercises, at home.
We can help you with suggestions, if you decide to do that.
Heel slides and how to do them
Home physio (PT) and activity progress: suggestions

As you realise, that corny old myth about having to achieve ROM within a certain time is just nonsense. It has no foundation at all in fact.
Myth busting: the "window of opportunity" in TKR

Remember these, from the BoneSmart mantras?
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

Give your knee a rest, spoil it with lots or rest, ice and elevation, and see what happens.
 
Well, I got very sick after PT again, though I don't think PT was the direct cause exactly--maybe a stomach bug or food I am bothered by. A really interesting thing happened though. I was so sick--almost passed out 3 times--that my sister noted that my lips had turned white and bluish, and I was very, very cold (and I'm normally always warm, even my hands). I figured that all my blood had rushed to my torso to do whatever as I was shivering under a pile of blankets.

But, you know what I noticed? My knee wasn't tender, it wasn't hot, and it bent just fine, without feeling restricted, to at least 90 degrees. And I was too sick to get ice packs. On Monday, as I stopped being cold and started to warm up, I noticed that my knee was getting more and more stiff again--and hot and tender, too. I can't help but think that once it stops being swollen, inside and out, my ROM will be just fine.

dtmbf--massage sounds wonderful, esp. since I am having muscle spasms and some sciatica issues after regular PT. I doubt that that service is available here though.

kneeper--I had already decided "catching up" was not going to happen, even before I got sick again. My mother and sister both noticed that drastic backward effect of PT and agree it's time to say "no" and proceed on my own. Let's face it--the exercises are not rocket science and I have done PT before--in fact got back nearly 100% ROM in a wrist they told me I never would get even 50% downward ROM after a break. And, if what I noticed this weekend is a sign, over time, as swelling recedes, I should be just fine--esp. if I don't keep making my knee mad by making it swell more.

Celle--I love all the resources available here. They have proven very helpful. Thanks for the links.

Thanks to you all. I feel I have the support and tools to get on with recovery at my own pace. I am walking away from my walker quite frequently already. Still have to deal with the control-freak PA when I get my stitches out tomorrow, assuming I feel good enough by then for the two hour round trip drive there and back.

Gilina
 
Forgot one thing. I am not on any pain meds now. Oxy and Vicodin both were ineffective, did nothing for my pain. And, I'm pretty sure they were part of what was making me sick. So, yet another reason to be extra nice to my knee.

Gilina
 
The best parts of my PT has been the massage aspects for relaxing tight areas. You're right, the exercises are basic, and you'll regain ROM when the swelling goes down. Gentle periodic movement will be enough.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 
Well, told my doc I won't be participating in "aggressive" (AKA from my viewpoint "assaultive") PT. They weren't happy. But the most interesting revelation was that they expect 90 % ROM at 2 weeks post-op!!! Does that seem, well, overly optimistic?

From what I have read in other people's threads, 90% at 2 weeks seems, well, ridiculous. Esp. since my leg muscles at the back of my leg keep spasming and the sciatica continues to act up after exercising. Lifting my leg, walking, etc. are all going very fine--it's just the bending that causes so much pain and after working on it, the whole leg tightens up and spasms.

Which leads to this question: Is there any way, on this forum, to post a separate question/thread in order to garner as many responses as possible to a single question? Sort of survey like. The question would be something on the order of: What did your surgeon state to you were his/her expectations for X ROM at X weeks.

Thanks,

Gilina
 
@Gilina my home PT was for 2.5 weeks. She indicated her goal before releasing patients from home therapy was a ROM of 90 (note: not 90%). I asked her if that was a personal goal or a goal of her agency and she said it was a personal goal. I wasn't there; I'm sure she was disappointed, but oh well. My ROM starting outpatient PT was 85, Monday, 5 weeks post-op, it was 95. It's been a very slow process for me.
 
Oh forgot to add, the OS wasn't worried when I saw him at a month post-op, but instead of saying he wanted to see me at 12 weeks, he wants to see me at eight weeks, and mentioned the possibility of a manipulation. I was too nervous at the time to ask what he wanted the almighty ROM to be.
 
tigz--Thanks and interesting information. My take is that the PT's or OS's goals are their own, not mine. Plus, patients aren't toys on an assembly line--rigid expectations that everyone should meet are silly. I am quite happy with my progress--not happy with the pain from the spasms, etc., but I am functioning very well for two weeks out--even showered standing up, doing laundry, dishes, picking up, walking around the house without walker or cane most of the time, etc. I'm not concerned about my ROM right now since it took over a year and a half of personal PT to get my wrist flexion to the point where I was happy. And the wrist wasn't operated on and had no ROM at all when the cast came off.

I need comparison data for the OS with the expectations/actual results others have experienced.
 
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tigz said:
Oh forgot to add, the OS wasn't worried when I saw him at a month post-op, but instead of saying he wanted to see me at 12 weeks, he wants to see me at eight weeks, and mentioned the possibility of a manipulation. I was too nervous at the time to ask what he wanted the almighty ROM to be.
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I feel like the threat of manipulation is kind of like their Boogey man--at least for the PTs--since the "time" when manipulation is considered necessary seems to vary quite a bit based on posts I have read here. It's still your body, your choice, IMO.

Gilina
 
PolarBear60 said:
The best parts of my PT has been the massage aspects for relaxing tight areas. You're right, the exercises are basic, and you'll regain ROM when the swelling goes down. Gentle periodic movement will be enough.
Click to expand...

I could definitely go for a massage. I feel like that would help a lot!
 
If I didn't have to go back to work at 12 weeks post-op, I'd probably be more adamant about holding off on a manipulation. Yeah it's seven weeks from now, but I keep thinking about where I am at the moment.
 
Gilina said:
tigz--Thanks and interesting information. My take is that the PT's or OS's goals are their own, not mine. Plus, patients aren't toys on an assembly line--rigid expectations that everyone should meet are silly. I am quite happy with my progress--not happy with the pain from the spasms, etc., but I am functioning very well for two weeks out--even showered standing up, doing laundry, dishes, picking up, walking around the house without walker or cane most of the time, etc. I'm not concerned about my ROM right now since it took over a year and a half of personal PT to get my wrist flexion to the point where I was happy. And the wrist wasn't operated on and had no ROM at all when the cast came off.

I need comparison data for the OS with the expectations/actual results others have experienced.
Click to expand...

You're doing great! Just don't over do it!

But even the comparison data isn't necessarily accurate, because like you say we're human bodies with inherent differences....not an assembly line of widgets!
 
The massage is easy, but easier if someone is standing at your feet and working upward. You can do a few things to help yourself. The massage consisted of pressing fingers and pressing lightly and pushing upward. If you're doing it yourself, you would be pulling upwards ragging fingers over the tight areas. It should not hurt, but you should be able to feel the pressure.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 
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