TKR Nine weeks out and still limited ROM

[Josephine]

If the lack of ROM is due to swelling and not adhesions, then wouldn't the MUA just make the knee swell more and be more painful and make it less bendy afterwards?

Exactly! You have hit the nail on the head!

... my knee/leg was very hot except, strangely, when I was really sick, then it cooled and got more bendy all on its own. Then it got stiff and hot again.

Celle's explanation here was spot on too. But plus, when you were sick you were resting more and unable to do any exercises so the swelling went down and lo and behold, the flexion showed itself. Then when you were up and about, your leg swelled again and the gain disappeared. Which absolutely proves my opinion that your problem is not adhesions but simply swelling and pain.

My 2-3 PT experiences (the bouncing and pushing, etc.) made the pain and stiffness and muscle spasms much worse. So, those two things make me wonder if maybe it really is adhesions. Do they not have a way to tell for sure? Or does it not matter and MUA would be their solution either way?

No, you said it yourself "the bouncing and pushing made the pain and stiffness and muscle spasms much worse". It also caused more swelling and all these three things are what is blocking your ROM. No adhesions. I'll stake my frilly cap on it!

And when I go for walks, I feel a "pulling" across my knee as I bend it that is not really painful.

Read this "Tight band" feeling across the front of my knee

BTW, I do feel it getting more loose/less tight and more bendy as time goes by. It is just very slow

Depends what you mean by 'slow'. In general, this improvement in flexion IS very slow, especially when the patient is being subjected to too much and/or too aggressive exercising. You should read my recoveries (link in my signature) as I proved this twice by doing no exercising at all! Otherwise, you have identified your situation in a nutshell! You're not even 10 weeks out yet so still in the very early days of your recovery. I'll bet that if you go more easy on your knee, ice and elevate it, you will find that in another 6-8 weeks, your ROM will improve tremendously. And remember this - your surgeon and your PT appear to be in a hurry to get good results. Ignore them and don't you be in a hurry. Time is your best friend here and time is what is going to get you where YOU want to be!

Read these again
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Pescara]

I am 7 weeks out and also have had a hard time with pain meds. My OS did a mouth swab and did a genetic test. I was surprised when I got the results. A long list of things I am sensitive to. Norco 7.5 is good for me but gives me headaches so I also take 1 Fiorcet for migrains. I was in the hospital for 4 days due to medication problems. I did home PT 3 times a week for 2 weeks and also a visiting nurse every day for 3 weeks 100% paid by insurance. I am now a member of the "over due it club". I have learned all kinds of great information here. You are doing great. Keep up the good work.

 

[Gilina]

I wonder if the fact that you were dehydrated caused your body to take some fluid from your swollen knee, which then was able to bend more easily? Then, when you were rehydrated, your knee swelled again. If that was so, then it seems to me that the cause of your difficulty with ROM is swelling, not adhesions.

Thanks! That is pretty much what I thought at the time, only I put it more in terms of "my body sent all its healing mojo to my gut because that took precedence for awhile." But it was quite amazing. When I got sick, I was freezing cold (as happens when your blood goes to your torso instead of your extremities) and my knee stopped hurting. I could suddenly bend it and put my foot flat on the floor with no pain (and up until then, just bending it more than a little hurt a lot) and the knee cooled. 36 hours later (when I still was doing nothing--too weak) as I warmed up and started throwing off blankets, I could feel my knee "fill-up" again.AS the hours passed, it got more stiff and warm and painful, and I could no longer put my foot flat on the floor. It was quite amazing. It happened a second time when I was sick again, but not to the same extent.

The PA rolled his eyes when I told him. But, it made it obvious to me that the body's healing processes--the swelling as part of that--was what was blocking my bendiness. Makes sense to me!

 

[Pescara]

I am hot then cold. Living in Florida it's hard not to run the a/c. I had to get a different FD since the PA and doctor treated me like that. Everyone heals differently. Take your time rest and elevate and ice. Nap when you can. Keep your chin up. It will get better. You are doing fantastic!

 

[Gilina]

Then when you were up and about, your leg swelled again and the gain disappeared.

Actually, the knee got stiff and swollen again before I was able to be up and around (see post above). I didn't do much for 4 days I was so sick and weak. But as I mentioned above, the second day, I could actually feel the knee "filling up" and getting more stiff as I was sitting, doing nothing. The change started when I started to warm back up. Seemed like a completely physiological event to me. I just wished I hadn't been so out of it that I didn't have my sister take a photo of my foot flat on the floor for proof!

@Josephine I have read your recoveries. I was amazed when I discovered they still like to do the aggressive therapy here in the US--well, at least in some places. Your method in the UK makes so much more sense. And the guilt trips they try to lay on patients here! Ugh. I had two PTs tell me "you have to get all your ROM back in 3 weeks or you are sunk." Well, I knew that wasn't true. And the PA "We like to have a ROM of 90 at 2 weeks!" I must such a disappointment to them (like I care--not!) Yikes, I just clicked a button and got tons of smileys!

Anyway, I think I won't be saying yes to MUA for now. Unless someone tells me I am totally crazy and should go for it.

Thanks, again.

 

[Gilina]

A long list of things I am sensitive to.

Yep. Me, too. I also didn't think the ones I had after the hospital worked very well. Another example of how everyone responds differently to drugs, to surgery, to healing, and of course, rate of ROM improvement. One of the issues in the US with insurance companies and corporate dictated medicine is the desire to make everyone fit some "model" or expectation. The whole "meet your benchmarks" issue. Well, I have always marched to a different drummer.

I am hot then cold.

I am usually warm, hands and all. This kind of cold is what happens when you get really, really sick (when you are cold inside, I guess I would say) and is not related to air or room temperature at all. If that was the case, I'd freeze all winter when I keep the house at 66 degrees, but I am perfectly comfortable.

This is a great forum to learn more, to accept the variations in healing, and to get support and understanding. If I hadn't found this place--well, I think I would be in terrible shape, wondering if I was somehow failing, and not confident at all about my decisions. Keep reading and asking questions. Information and help--and support and validation-- can be found here. Hang in there.

Gilina

 

[Gilina]

Thought I would share, though I don't know how to get this info out to a larger group. I haven't used YouTube much over the years (slow Internet connection) but I found this earlier today and so wish I had found it 3 months ago. Best description and demonstration of the widely accepted post TKR exercises I have seen (though my sample size is minuscule) and it can be found on YouTube. Search for Knee Replacement post op exercises by peacehealth.



And also, I want to thank @Josephine, @bob-uk, and @PolarBear60 for adding to the discussion of MUA and post-op stiffness and continuing ROM issues. I hope Jean and Josephine are correct and I won't need an MUA and I can get back to my regularly scheduled life. Fingers crossed.

Gilina

 

[Josephine]

I added the YT link for you, Gilina. There's not instructions because all you have to do is copy the link from the YT address bar and paste it in your post.

I agree it's an excellently made video but don't agree with most of these exercises and particularly not the 10 reps 3 times day bit. Nor the 'you can do these from day one' voice over at the beginning. I would also suggest that almost no-one with a TKR would be able to do the patellar mobilization, it would be far too painful!

As most of you know, I'm a proponent of NO exercising. I think it's over emphasised and over vaunted and of no value to anyone but the PTs!

 

[PolarBear60]

Grin. And I support at least a little PT designed to work on specific areas of concern at the appropriate time. When the focus remains on helping the patient meet specific goals, I believe it can be useful.

However, if this is not the case, the mantra of "first, do no harm" applies, and BoneSmart philosophy is the way to go.

Might be a cultural difference? Since I've been on this site, I've gained a healthy respect for the BoneSmart philosophy.


Jean

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

 

[Gilina]

I added the YT link for you, Gilina. There's not instructions because all you have to do is copy the link from the YT address bar and paste it in your post.

I tried that and then it disappeared, so I thought I hadn't done it correctly.

As most of you know, I'm a proponent of NO exercising. I think it's over emphasised and over vaunted and of no value to anyone but the PTs!

I agree that your method makes a lot more sense and will hopefully be adopted here in the US. In the US however, it seems to be normal for people to get rather aggressive post-op PT. (I did and it pretty much wrecked me--so I refused to continue that way.) If I hadn't found this forum, I would have felt pressured to do that form of PT believing it is the only way to go.

And I support at least a little PT designed to work on specific areas of concern at the appropriate time. When the focus remains on helping the patient meet specific goals, I believe it can be useful.

For those who do not want forced PT, this video was an alternative and was clear and well-demonstrated, I thought. The sheet of exercises I had (which the PT person said were the ones they do), well, the way it showed some of the exercises made them much harder to do--esp., the heel slides. The "skateboard" method seems much better to me, and much more possible to accomplish. (I've seen it on this site as well.) I had a bad time with heel slides for some reason, and if this method accomplishes the same goal, then it is good to have the alternative. In fact, I think each patient needs to figure out which exercises benefit them. For example, I did not need to do leg lifts because I had no problem lifting my legs, and doing it their way (flat on my back) just caused back problems.

As for the start right after surgery and the 10 reps--I guess I never paid attention to that part (and failed to really notice it in the video) because that would be too soon and I always do only as many reps as is comfortable and then stop, not bothering to count reps at all. I was interested in the alternative ways to do some of the exercises (when one does get to that point). I don't think the way we are shown to do them is necessarily the best way. PTs seem to have a set regimen and deviation from it brings on the eye rolls (in my experience).

I do agree that the patellar exercise would probably hurt right after surgery. Didn't think of that (and with the incision and stitches right over it--no way that could be done right away). I (at 10 weeks out) did try it yesterday and my patella does move on my surgical leg. (But, on my other leg, it doesn't budge.)

Thanks for the feedback. Tomorrow I have an OS appointment with still no real gain in my ROM. Wonder what will be discussed!

Gilina

 

[PolarBear60]

Just to clarify, I'm not advocating forced PT. As for different exercises that accomplish the same end result, those are very valuable in achieving recovery goals. Always listen to your knee.


Jean

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

 

[kneeper]

They had me do knee cap "mobilization" but not for several weeks and it didn't hurt.

 

[Josephine]

Glad to hear that because it was something I never did! As a matter of fact, my surgeon's instructions to his patients are NO exercising for the first three weeks, not even heel slides! Only rest, elevate, ice and pain meds! I don't make this stuff up myself you know! It's all based upon his regime!

 

[Celle]

They had me do knee cap "mobilization" but not for several weeks and it didn't hurt.

I've never done it and my kneecaps move just fine. I think that, as your knees recover, your kneecaps naturally become mobile.

Like Josephine's, my surgeon recommends no PT for the first 4 weeks after surgery, except for walking around the house a bit. His patients all do well. He's trained in New Zealand, so this philosophy isn't just confined to the UK.

 

[Gilina]

I'm not advocating forced PT.

No, fear. I didn't think you meant that.

As a matter of fact, my surgeon's instructions to his patients are NO exercising for the first three weeks, not even heel slides!

Wish they had that attitude here! They start (quite aggressive) PT while we are still in the hospital here and expect you to go to outpatient PT that day after you get home from the hospital. I maintain, they did a lot of damage to me and slowed my recovery quite a bit. But, none of the medical types here even seem to know about the "other" way to do recovery.

Like Josephine's, my surgeon recommends no PT for the first 4 weeks after surgery, except for walking around the house a bit. His patients all do well. He's trained in New Zealand, so this philosophy isn't just confined to the UK.

Those UK and Aussie docs need to write and get published papers on this subject! Of course, my OS is known for very good outcomes here--so, I guess they like to stick with what they think works.

Going to the OS today for what I suspect will be the big MUA conversation. I wouldn't be totally surprised if I do have adhesions, but I want to be sure before doing anything drastic. And, I tried to cut down on the muscle relaxers--big mistake--as I have a muscle spasming all the way down my surgical leg and will have to drive for about 3 hours later today, which is painful with muscle spasms. It also means my leg is even less bendy than it has been on some other days lately. Still on that roller coaster, I guess.

Gilina

 

[PolarBear60]

I think we're seeing a whole spectrum for PT here in the States. My in hospital PT was very mild. I arranged my home health PT, and my doctor prescribed outpatient PT , but I have a strong sense he didn't care if I went or not. In fact, halfway through, he said I could quit if I wanted. I was finding them beneficial for targeted areas, so I kept going.

As the U.S. moves to the UK model of health care, we'll probably see more of this.


Jean

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

 

[dtmbf]

I'm in Josephine's camp on the issue of PT. I had 2 knees done, 1 year apart. The 1st knee I was swollen beyond belief, yet hunkered down & did all the exercises PT threw at me. The bend was very slow to come - and I was miserable. And swollen even at 6 months. And that knee has what I believe to be soft tissue damage & doesn't "feel" right (altho it works just fine).

My second knee I saw the light - I did no real exercises for the 1st 4 weeks. Oh I moved around, put my foot flat on the floor & did the gentle bend routine, walked up & down the stairs, and did do quad sets as my quad was visibly wasted. But no heel slides, no leg raises, no short arcs - nothing. My PT did all soft tissue work when she came as every muscle & tendon was tight as a drum. The swelling was manageable and my flexion was over 120 by week 4.

My OS is kinda wishy washy on PT, "let your knee tell you what you can do", "don't take meds before PT as it will mask them pushing you too hard", "this is a long recovery & it will take up to a year". So I followed the care plan of Great Britain & Australia & I am one happy camper.

 

[Slainte]

Sounds like today will be a long day for you. Those muscle spasms are a beast. Hang on for this part of the roller coaster ride, and let us know what the OS says.

 

[Nana moon 27]

Good luck @Gilina

I will be very interested to see what your OS says tomorrow. I am also in slow recovery. ROM now 70/20, was stuck at 45/0. Wish I still had the 0!! I'm also under threat of MUA but trying to do whatever I can to avoid it.

Please take care
Love Nana moon 27 xxx

 

[Gilina]

Nana moon 27 Slainte dtmbf PolarBear60

I admit, I've been mentally hiding out since I saw my OS a week ago, trying to make a decision on what I will do. I asked him if by scar tissue he meant adhesions. He said yes. And, I remember exactly when the feeling in my leg/knee changed around week 4--after I had been very ill and dehydrated--when it suddenly felt like something was blocking my bend beyond a certain point. So, that I might/probably have adhesions made sense.

The other part of that discussion was about staying overnight in the hospital after the MUA. He said, the reason for that was so I could get PT in the afternoon after the MUA and the next morning. I said, those PT people are never touching me again because they had messed my up bad. Oh--well in that case, I could go home the same day. Great. I was ready to sign on.

Then he looked at my ROM. My surgical leg actually goes straighter than my other leg. As for bend--he said I had gained 30 degrees since my last appointment a month before! (Would that happen if I have adhesions?) Still not quite 90, but...it was after that previous appointment that I stopped trying to make my knee bend doing heel slides and just started going for short walks a couple times a day and living my life. @Josephine -- That certainly makes the case, once again, for no "forced" PT.

And after I stopped pushing my knee (even though I was trying to be very careful, I still made it mad over and over--stiff and swollen), my knee also cooled off suddenly and most of the pain was gone, too. I haven't taken pain killers for over a month now, and my knee only hurts a bit now and then. I do still take the muscle relaxers as the muscle spasms still flare up now and then.

So, will I gain more ROM in the next few weeks? And, if I do, does that mean I can skip the MUA.? I've been back and forth every day. My OS did say that the fact that I am functional is good, but that doing the MUA would improve the outcome of the surgery and improve the quality of my life. In my particular situation, that would be good since my non-surgical leg developed bending issues a couple years ago so I had ended up relying on the more painful, but more bendy leg, that now has a new knee.

Can you tell I keep changing my mind about doing the MUA. I'm going to hunt around this site to see how people felt after having an MUA, but I think I will ultimately (but soon) decide to go forward--assuming I can find someone to drive me there and back. Thoughts? Opinions? Comparable experiences?

I must say though, it is wonderful to be able to do things that before surgery caused me so much misery, as in pretty much everything one does in the course of normal life--errands, grocery shopping, cooking. In that sense, my life so much easier than it has been for over 20 years. It is quite amazing.

Gilina