TKR Not having enough ROM

[Mercifulmar]

Hi everyone, i am very grateful for this site bc everyone is so real. I had my surgery jan 22. So today i am 5 weeks out and so down in the dumps, i guess i had no idea it was going to take this long to heal. I just want to walk normal, sorry to be a baby. I am still going to PT ,2x a week and feel like i was doing better in the beginning. Anyway, thanks for listening....

 

[Layla]

Here are our Recovery Guidelines to get started on and I will type more in a post below.

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Layla]

Welcome to BoneSmart and recovery! Thanks for joining us, we're glad you're here.
Please identify which knee was replaced so were able to add that information to your signature.

I suggest you read the article on Post Op Blues in the Recovery Guidelines above. It is very common, especially at the stage of recovery you're currently in and it's only temporary.
Realize that at five weeks post op, you're still in the very early stages of healing in a recovery that lasts a full year for many and even longer for some.

Since you feel like you were doing better earlier on, I wonder if the PT you're engaging in is too aggressive for the stage of healing you're currently in? Please tell us a little about a typical PT session and what it involves and whether you're in pain afterward, or the next day, which you don't want to be. If you are, whatever you're doing is likely to much for your body to handle at this point.

By "walking normal" I am assuming you mean with out a limp and if so -
Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe. It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Here is a visual -

We are here to listen, advise and support always so stop by whenever you're in need and we'll be available.
I wish you lots of comfort and a good week!
@Mercifulmar

 

[Sdfoxy1]

Mine was January 25th. I feel the same way. I tell myself husband it felt better last week. That’s probably bc we’re moving more and it’s making it more sensitive. I even feel like it is not progressing any. Then I notice I was able to get my leg over the tub easier. Or someone says boy you hopped up out of that chair pretty easy. So we are progressing little by little and aren’t really taking that into consideration. I always seem to go on what I can do at PT. To be honest there are a couple of exercises that hurt and I do not know any to do. I asked can’t I get pain free stepping up on the little step before going to the higher one and it’s always you won’t get better if you don‘t move on. I think they are going to move me to the 8 inch step tomorrow and the five inch is still quite painful. I am going to have to refuse doing something for the first one and it’s making me uncomfortable. But we are paying them. Correct? I hope you recover well and will be watching your journey

 

[Sdfoxy1]

PS. I also thought at this point I would be home free. lol.

 

[mendogal]

@Sdfoxy1 addresses a really important point!
Some PTs are old-fashioned and believe "no pain no gain."

That's a myth and interferes with our healing. If something you do in PT hurts in the moment, say STOP and mean it. If something you do, at home or in PT, hurts that night or causes you to need to do less the next day, don't do it again.

Pain and swelling is a new knee's only way to tell you it can't handle what's being asked. Because swelling reduces our range of motion, any momentary gain in flexion or extension achieved by aggressive PT will evaporate that evening.

For me, on my first TKA, before I knew about BoneSmart, I had to limit my (overly aggressive) PT to once a week. Twice a week was too much pain and fatigue!

With my second TKA, I went to PT a couple of times initially and once or twice again at 6 weeks - mainly to find out my ROM measurements - and then did my own rehab at home. I found that doing all the exercises in a 50 minute PT session was counter productive, but when I did them at home, not even counting reps, just comfortably and spaced out throughout the day, it was never overdoing it.

 

[Mercifulmar]

Hi Layla, just wanted to respond to your post, today was my first post in the tka recovery page. I had my right knee done. I go to therapy 2x week. I think my first week i did squats onto a chair bc my quads weren't firing. I also did the bike for 7 min and many quad muscles. Last week my Pt fellow had me sit on a table and i raised my leg and he bent my leg under the table, it was pretty painful. After working a while hour on my quads and stretching that knee, i went from 106 to 108. I was pretty sore after that, i am being obsessive about my knee and i have to stop. I had knee surgery when i was 16 and now i was bone on bone so for very many years i protected that knee and have to undue all my crazy fears and thoughts. I also was unprepared for the surgery, my doctor said i would take a month to heal!?!?!? So thank you for the tips on walking. Also bc my quads were weak, my knee will sometimes jerk while walking. Anyway, i appreciate your help and having someone to talk to. Xoxo

 

[Jockette]

@Mercifulmar Hi and Welcome!

I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

How can I find my threads and posts?

There are a couple of ways you can find categories of threads on the forum. You are able to use links in the main forum toolbars at the top of the screen to quickly access certain types of threads: your own threads, threads with your posts in them, and watched threads. You can also use links...

bonesmart.org

Best wishes on your continuing recovery!

 

[Jockette]

Last week my Pt fellow had me sit on a table and i raised my leg and he bent my leg under the table, it was pretty painful.

I’m sorry your PT did this to you, he really should‘t have done that, it won’t help you at all. Please don’t let anyone do that to you again. If they don’t listen to you consider looking for another office with a more updated approach to this rehab.

I also was unprepared for the surgery, my doctor said i would take a month to heal!?!?!?

Wow! I’m so sorry you were told that. This recovery actually takes an average of a year for complete recovery. You’ll feel better way before that, but healing can take that long to complete.

Hang out here with us. If you read other recovery threads you’ll find a similar theme to all of them. It’s always nice to share experiences with others going through the same thing we are.

 

[Layla]

Hi again,
Thanks for responding!
I am so sorry you had that experience with your PT, causing you pain.
Please refrain from engaging in movement that causes discomfort or pain, or allowing the PT to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases.

I do understand the desire to get through recovery and back to life, but you’ll read here, over and over, that no one heals any faster by engaging in more aggressive therapy, in fact it’s often the opposite and can cause you to be sidelined stalling your recovery and I know you don’t want that!

It is sad that you struggled with the bone on bone pain for so long, thankfully now you’re on the road to recovery. You’re really not being a baby about this as many feel blue post op. I know that isn’t much comfort, but you’re not alone here. You will get through this and we’ll support and encourage you for as long as you’ll have us.

Something that helped me in my recovery was to choose a day of the week, then on that same day, each week, I’d reflect back and realize the progress I was making. It was something to look forward to, because there will be progress.

I am sorry you need to reset your expectations given what your surgeon said. When you’re feeling down reflect on all you’ll soon be doing without the pain, holding that brighter future as your focus.
Looking forward to future updates!
Hugs and Best Wishes!
@Mercifulmar

 

[Naomi60]

Hello @Mercifulmar,

My surgery was January 18 so we are on the same time frame. I too have been feeling somewhat down. I have a really bad day about every three days or so where my pain is way more than day before. Yesterday I could barely function. I ask myself what did I do the day before that was different or too much. The only thing I could come up with is that I took a shower and shaved my legs lol! Maybe I twisted my leg. I don’t know but boy is it hard to stay positive when you’re in pain. I took an extra pain pill and went to bed. Today I woke up feeling awesome. I am beginning to accept that there is no normal. Every day is different.

Since this is my second go around, I know it takes months, not weeks, to heal. But there are milestones along the way and that’s what we have to focus on. Last time, I traveled to Cuba at 5 months post op. I danced the night away at my daughter’s wedding at 9 months post op. But it wasn’t until a year had gone by that I felt truly healed. This go around, I am hosting a baby shower this weekend, although I am paying people to do the heavy lifting, and my first grandchild will be born at the end of May. So, I definitely have some things to look forward to.

i think we have to find a way to settle into our new reality. We chose this for a reason and this healing time is temporary. Keep your eye on the prize!

 

[mendogal]

I am frankly astonished that a PT would have someone under 8 weeks post op doing squats. They are strengthening exercises absolutely contraindicated so soon after surgery when muscles and tendons aren't healed and can be damaged.
Based on that, then add in the painful manipulation, and I say find another place to receive PT.

A bit late now, but one of the few exercises my ortho team wanted me to do right away were quad sets. They are intended to activate your quads, plus the up and down movement of the knee in response provides gentle range of motion. To further promote activation I gently touched different areas of my quads with fingertips to encourage activation in all segments.

 

[selketine]

I'm almost 2 weeks ahead of you and, if it makes you feel any better, I'm still needing the walker and trying to move to a cane. I cannot tell you how sick I am of this walker!

I don't know why a doctor would say it takes a month to heal - my surgeon also had mentioned to me that nurses in that office who had TKR had come back to work after 2-4 weeks which astounds me. Who are these super humans?? I also have good days and bad ones - something that felt great yesterday won't work today. Seems like all the pieces in the leg are just waking up and starting to engage - and of course we're trying to do more and more - so it makes sense. Today I actually crossed my leg to put on a sock - without thinking (surgical leg over the other leg) - and I'm like COOL!

I agree with others that the PT doesn't need to be pushing you to the point of pain. I've overdone it at PT and was sore later but that's different (cause it wasn't painful at the time).

 

[Mercifulmar]

Hi, i just have some questions that i am sure you have Heard before. At my 6 wk check up, the doctor said, of is that all you have? I said, yes, PT said i am at 108, but that is with the strap pulling my leg. He said, of that's ok, you can do almost anything with 108. So immediately after my appt, i go to PT, and at the end of our hour, he says, oh Kim will be contacting you. I said, huh? He said the doctor wants you to have this brace, it's called dyna splint and hopefully may get me ten more degrees. So when she checked me without pulling on it, i was only 92. What i am wondering is, why isn't my leg moving, is it scar tissue? I am concerned i will never get the rom but i need to be positive and see what this does. So i wear it 3x a day for 30-45 min and next week start 1 hr 3x a day. Are you familiar at all with this? Thank you

 

[Layla]

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting.
Please post any updates, questions or concerns about your recovery here.


I am not familiar with this, but possibly others may stop by that are.
All I can offer in regard to ROM is while your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Patience required, it does take time.you are not even two months into a year long recovery, on average. I will leave a couple of accounts from other members in this regard.


JusticeRiders post -
“I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked”

 

[Layla]

One more update from member VolLady -

“I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!”

 

[Mercifulmar]

Thank you so much, i wish i would calm down, i go in spurts. Thanks for your help, i could cry, it's so consoling

 

[Jtmav]

So I am 6 weeks out and had PT yesterday. My PT is not so fixated on numbers, I was at 102 yesterday and she was fine with that. She told me she’s not concerned that by 3-4 months out I will be where I should be. In my case I only had 115 before surgery and so that’s the goal. I was a pretty consistent cyclist before the surgery so I was in ok shape but this knocked me back more than I was prepared for. I was able to ride the stationary bike for 25 mins today and stretched a good amount afterwards. Baby steps but Ive learned from the wise people here that patience is the key, you will get better. Good luck.

 

[Jockette]

In a recovery that takes an average of a year, 6 weeks is way too early to worry about your ROM. The number will vary, from day to day, and even hour to hour. That’s because sometimes an activity will increase swelling, which will affect ROM. This is perfectly normal and par for the course.

My ROM continued to increase all through my second year, proving there is no
Window of Opportunity

 

[mendogal]

My surgeon and his PAs never once checked or inquired about my range of motion. They wanted to see me move and tell them what I could do in life.

So my focus was on noting and celebrating small milestones.