Become an Insider

TKR Nine weeks out and still limited ROM

tigz said:
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!
Click to expand...

The data isn't for me, per se--it's to provide alternative examples of expectations and results from around the US and the world to maybe broaden the viewpoint of my OS.

I can't find the posts now, but I remember one where the post-op person was told that a ROM of 60 at 2 weeks was good and not to worry. I just think the expectation of 90 at 2 weeks is excessive.

Gilina
 
I hear you on both counts. That's why I appreciated what my physical therapist did for me.
 
Gilina said:
The data isn't for me, per se--it's to provide alternative examples of expectations and results from around the US and the world to maybe broaden the viewpoint of my OS.
Click to expand...
Don't waste your time! You won't broaden his viewpoint, which is a product of what he was taught during his training and of his experience in his own practice.
Different surgeons have different perspectives and there is no one right way.

My surgeon has never asked for my ROM to be measured. He just eyeballs the knee. He likes it to be at 90 degrees by 6 weeks (he can tell by looking and, after all, what does it matter if the ROM is not exactly 90? 89 or 91 - it's immaterial.)
He has a very low rate of performing MUAs and his patients do well.

I've had 3 knee replacements. I needed PT after the first one, because I had left it too long and had lost muscle tone and developed tendon and ligament deformities.
I had minimal PT after my revision to TKR - just 3 or 4 visits, at 2-weekly intervals.
I had no PT at all for my latest TKR.

ROM has never been a problem with any of my TKRs. Once the swelling has gone down, the knees can bend.

Don't allow yourself to be pressure or threatened into having a MUA. It's not a quick fix for ROM that's developing slowly. It's a cure for genuine adhesions (not the normal scar tissue that forms) and is rarely necessary.
 
Actually this surgeon seems to be open to new information and has asked for some of my research into topics like bone cement rxns and metal allergies. So, I have hope.

I am trying to figure out how to contact one of the forum advisors about changing my thread title--I don't have the little option to do that mentioned in the help section. How do I contact one of the forum advisors?
 
Use the @ in front of their name with no spaces, like this @Jamie or whoever you want to flag. This sends the person a notification.


Sent from my iPhone using BoneSmart Forum
 
Yes. Just let them know what you want the title to be and tag their forum name using the @ symbol.
 
@pumpkin

I don't seem to have access to the "change thread title" option on my thread. Can you help?
 
In some respects, I feel I am doing great. I am walking around the house without a walker or cane most of the day. Doing chores, personal care, etc.

But, attempting to increase ROM is a continuing problem. Even gentle heel slides make my leg very stiff and tight within a few hours, so I feel like I am going backward instead of forward. And I do the heel slides carefully, since I am not on any pain meds.

The additional problem--and much more painful problem--is that my large leg muscles go into spasms every time I challenge my knee to do more. My muscles relaxers only help a little and I am doing heating pad and massage as much as I can. (This is probably related to a back problem (I have a herniated disk) and is not new--in 2013 my "good" left leg was spasming very painfully for many months before they figured out I needed muscle relaxers. It still will spasm if I bend that knee too far back, though the ROM in that leg has increased slightly in the last year or so (hovers around 90). I have learned to live with it.)

Has anyone experienced a similar problem? While the knee hurts, the muscles spasms are much, much more painful and are driving me nuts.

Gilina
 
Gilina said:
We share the same surgery date! I had my stitches out a few days ago, but the OS is not happy with my lack of ROM. They expected me to be at 90 by two weeks, and I am nowhere near that. My PT experience was not good, so now I am working on my own, but after every session, my knee is tighter and hotter and more stiff. Spend a Lot of time icing. I feel like I am going backwards as far as ROM is concerned. I am walking around without a walker or cane in the house, doing chores, etc., and napping a lot during the day. Finally back in bed at night, though sleeping on my back is getting annoying. Can't wait to be able to sleep on my side again.

From posts here, that tight band feeling is normal and will take some time to go away. There is tons of good info on this site. I keep rereading certain articles now that the drug fog is over. I'll be curious to hear about your experience with PT. From the postings here, PT experiences range from wonderful to horrible.

Good luck.

Gilina
Click to expand...
I've copied the above post from MamaDi's thread, so we don't hijack her recovery.

Expecting a ROM of 90 by 2 weeks is just plain ridiculous. Don't worry about it and don't aim for it. And don't be pushed into having a MUA, because you are trying to fulfill unrealistic expectations.

You can't make your knee bend further until it's ready to bend, no matter how much you work at it. In fact working madly to make it bend is more likely to slow down your progress than help it. Doing too much right now will make your wounded, healing tissues angry and inflamed, which is obviously not a good thing.

At the moment, it's most likely to be swelling that is preventing the ROM. Spend lots more time resting, icing and elevating (toes above your nose) and less time exercising.

I hope you are still taking pain relief medication? If the muscle spasms continue, ask your primary care physician for something to control them.
 
Thanks, @Celle.

Celle said:
You can't make your knee bend further until it's ready to bend, no matter how much you work at it. In fact working madly to make it bend is more likely to slow down your progress than help it.
Click to expand...

That's exactly what I think has been happening. After PT, I had less ROM and needed my walker again. It is disappointing to feel that I am doing so well in every way except "bendiness" of my leg and to have the focus by the docs to only be on ROM.

I am doing the exercises (the ones that don't bother my back) very gently. I still get stiff, but I think minute progress is happening. Fingers crossed.

They can threaten MUA if they want, but without my consent that won't happen anyway. I was glad to find on this site some studies about MUA to add to my file.

Gilina
 
@Gilina
You're correct. They can't do a MUA without your consent. It's your knee and you alone have the say on what will happen to it.
As long as you're making progress, even if it is slow, you don't need a MUA.

Even if you should need a MUA later, there's no harm in deferring it now.

Let them worry about the ROM, if that's their " thing". Try not to get hooked up on their concerns.
 
I'm 3 months. My rom goes from 118-110 my extension 5-3. I'm still stiff as I've had 2 sets of pt. it's a roller Coster. Don't over do it.

Xxx best reguards.


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015
 
Well, I had been doing my exercises very carefully, sleeping well in my bed (finally) and on Monday felt like I was making good progress (albeit incremental) with less pain, etc. Then, I bent my knee too far back accidentally--ouch. 3 steps forward, two steps back is how I feel. Plus, a new weird pain along my shin bone--feels like my leg is in a clamp and it is making it almost impossible to sleep. There was also a tender spot on the side on my shin/leg--worried about a blot clot for a bit.

Is it normal to have weird pains below one's knee? The shin pain doesn't let up, but I suspect some of the other pains have to do with things "waking up" but, wow, some of the pains are sharp though very short-lived. Sometimes all my toes tingle and my foot feels floppy for awhile, too.

Not making as much progress with ROM as I had hoped, but at least I haven't had any major setbacks like formal PT caused. I think I have reached some sort of plateau and the poor sleep and lack of progress is getting to me. Plus boredom--even when I was in pain before surgery, I was more active than I have been lately. But, I can walk almost normally (need a little more bend still) without canes or anything. At three weeks and 2 days out, maybe that's the most I can expect. Only taking small doses of "tylenol" and a muscle relaxer for the ongoing sciatica issue. My incision is healing well and probably won't look too bad.

Anyone know when can I switch to a heating pad instead of ice? I ask because it seems like heat would help make my leg more bendy, but maybe also increase swelling?

Thanks,
Gilina
 
@Josephine or Jamie will probably want to quiz you more on the shin pain--there are particular symptoms for a blood clot. But in general it is possible to have shin pain after tkr-- (I did) --they did hammer on your leg after all.
We should get a smiley with a little carpenter--tkr is a kind of carpentry, really. :wink:

As far as heat, I used a heating pad on the thigh muscles which were very sore, but not on the knee itself.

Are you taking pain meds regularly? For me a lot of the pain was in the form of stiffness.
 
From what you've described, I don't think your lower leg pain is anything serious. However, I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!
[Bonesmart.org] Nine weeks out and still limited ROM
) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you detail it like this
At physio or PT
First description - 5 reps x 2 sets
Second description - 10 reps x 2 sets

At home
First description - 5 reps x 2 sets 3 session a day
Second description - 10 reps x 2 sets 3 sessions a day
 
1. Pain levels change all the time. Right now, a 4 or 5. The level was less yesterday, but I must have tweaked something while asleep last night as my knee was much more stiff when I woke up this morning than when I went to be last night. Forms of pain: All of the above except throbbing. Sharp, very short-lived pains at various spots on my leg below the knee, plus the shin pain comes and goes. When it is ongoing, I can't sleep, but Aspercreme seems to help. Of course, the thigh above my knee is very stiff but no longer painful to touch.

2. Right now just taking tylenol, 325, one or two every 4 hours or so. Couldn't stomach (literally) the other pain meds. Can't take anything that is orange or red coated (food dye issue). And a muscle relaxer, since the exercises seem to cause episodes of muscle spasms (back/sciatica issue which is normally not an issue).

3-4. Icing whenever sitting down, or using my foam triangle thing to elevate my leg (2x a day for 1 to 1.5 hour--I tend to fall asleep when I lie down). Heating pad on my backside/hip and/or calf when having muscle spasms.

5. Don't know what my ROM is--it is still less than 90 degrees, but also changes from day to day. Is that weird? Extension--I haven't had 0 degrees extension for a couple of decades, so I suspect getting there will take awhile. Doc wanted 90 degree ROM at two weeks.

6. Been walking without support for over a week, showering, doing dishes, some cooking, picking up the house a bit, laundry. No shopping yet.

7. Doing PT at home only after twice being set back drastically by the "professionals" (who couldn't even figure out how to modify certain exercises to protect my back--sheesh) who caused 1/3 of my leg to go numb and somehow wrecked my ability to lift my leg (not a problem immediately after surgery and not since I recovered from the too aggressive treatment). Concentrating on bend since I have strong quads, etc. Heel slides 3x a day 5 reps. Ankle pumps anytime I am sitting. Plus extra bending when walking around, and using a rocking chair to push the bend a little. Some days the bend shows improvement--and then like today, I seem to have gone backward overnight. I push to the line between discomfort and pain, but it still results in more stiffness afterwards some days--and almost always causes the muscle spasms to start up. My outward swelling is almost gone, but I can tell there is still plenty going on inside. In a nutshell, I don't seem to be making much progress over the long haul as far as bend/ROM, but in every other way, I'm think I'm doing fine. I was very ill about 9 days of my first two weeks at home, so that probably set me back a bit.

Does that help? Thanks,

Gilina
 
You must log in or register to reply here.
Active Antimicrobial Hydrogel

Staff online

Members online

Total: 1,920 (members: 2, guests: 1,918)

Latest posts

Back
Top Bottom