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TKR Now what have I gone and done?<

@BadKneesTO, I saw that @Jockette tagged me to respond to your post. Josephine provides you her advice. Your OS has provided theirs. Don’t know if you have started PT or not, but assuming you have, I’m sure you have their input also. Now it’s time for you to decide what is best for you. In my particular case, I didn’t start PT until 3 weeks post op. I also had very direct discussions with both my OS and PT about my expectations from PT: no pain, no pushing, focus on reducing swelling and promoting healing. Both were on board with my goals and approach.

The key to moving forward is to determine what you believe will work for you. But it’s also important to be cognizant of what is working and what isn’t and to make changes when things aren’t quite what you feel you need.
 
Thank-you Josephine, Jockette and NavyGunns. I must confess to being more than a little overwhelmed with just about everything else right now. Why should I have expected advice re: PT/exercise/etc. to have been the exception? :heehee:

I suppose I’d been hoping for a single “magic bullet”, and that all I would need to do was follow directions diligently and all would be well. But then why should this time be any different???

It seems that perhaps it’s a bit more like choosing a diet plan. There are all sorts to choose from, and each has its strong proponents and detractors. All the user needs do is select the plan that fits them best, and follow it sensibly, and “roll with the punches.”

Well I’m all set now: PT today and OS tomorrow, following up on progress, all in the light of whatever it was that happened to the knee last night that has me all iced up and drugged up today and virtually unable to flex. An excellent opportunity to re-open any discussions re: approach and philosophy.

I know it’s a long road, and that there will be humps and bumps and hills and valleys and detours along the way. I keep telling myself this, and maybe one day I will actually believe it!

Cheers, all. Thanks again!
 
We often refer to this recovery as a rollercoaster, just as you described.

Swelling prevents your leg from bending. Trying to force a bend, or allowing a therapist to bend it further than you can yourself, will produce more swelling, further preventing the bend everyone wants you to have.

I was shocked by how many opinions there are about this recovery from absolutely everyone, especially surgeons and therapists. I also found that not all therapists are therapeutic.

We each have to find our own approach in this recovery. Sometimes take a little of one advice/approach and take a little of a different approach until you have an approach that you are happy with. Since there are so many opinions, we get to choose the one we want.

I didn’t know that in the beginning and blindly did what I was told and ended up with set backs. Some PT sessions took me 2-3 days to recover from. I felt that was counterproductive, so I googled stopping therapy and found Bonesmart, and Bonesmart’s approach made the most sense to me, for my situation.
 
@BadKneesTO, here is a great analogy to think about when you begin to wonder why your knee won’t bend when swollen and what to say to your OS and PT when they insist that you need to push things even though you are so swollen.

Have you ever tried to bend a fully charged firehose? Well I have (used to be a volunteer firefighter). You can’t. It’s impossible. The internal pressure (ie swelling) against the hose will not allow it to bend. Once that pressure (swelling) is eased down to a lower level, the hose can begin to bend more and more until you get to a point where there is no pressure and you can fold / roll it up. Your knee is like that hose. Since it is a very boney and rigid structure, the majority of the swelling occurs internal to the knee itself. What you see outside the knee is just part of the swelling that’s affecting the outer tissues. It’s the internal swelling that is preventing you from bending your knee. Until that swelling goes down, you won’t have much success getting it to bend and will just add further trauma to an already injured knee.
 
Thanks all. I have read your advice and replies to my questions. Much of what you have to say, while it appears to make sense, is diametrically opposed to what my OS has in mind for me. I am left in the middle, and have some choices to make, and make them I have, at least for now. Whether or not they may be the "BoneSmart way", wish me luck.

Cheers and thanks for the advice.

BadKneesTO
 
Keep us posted on how you go - whatever the choice.


Sent from my iPad using Tapatalk
 
Thanks for your concerns Josephine. Yes, I read that the previous times you shared it.

While it is true I am indeed concerned about the consequences of declining the PT my OS has prescribed, I have gone to a fair amount of effort to seek out this particular surgeon and his expertise. I am therefore inclined to follow his directions.

At the end of the day, I will likely decline any PT "assistance" that gets to be too aggressive, but I think a fair amount of leeway will factor into my decisions.

With thanks,
BadKnees TO
 
Yes, PT can involve a bit of negotiation. I found once they realized I wasn't being resistant, just trying to find the right balance of exercise etc. we could work out something that worked for my situation.
 
This is week 2 PO and I have had 4 in home PT sessions. So far I'm in pain afterwards and if this continues this coming week and I'm going to stop her from coming 3 times a week. After reading these post I'm not as worried about saying NO.
 
@julie1968, it would be great if you would be sure to post this information in your own thread also so that it doesn’t get lost in someone else’s recovery.
 
@BadKneesTO : I understand about how you feel about doing what your surgeon and your physiotherapist want and/or expect. My surgeon really wants my extension to be better than it was pre-op. I almost get there, then it's major pain and swelling. Ain't happening soon.

I have had a discussion with my physiotherapist about how much I will do. I let him know he cannot torture me, although we do talk about it being torture. I work through discomfort, but not past pain. It hurts, I stop. This has worked the best for me so far. My recovery has been spang in the middle of the bell curve. Not super fast, not taking forever, although it sometimes feels like that.

Not sure what is going to happen when I see the surgeon again in April. Yes, he might have been able to move my leg in all sorts of directions while I was under anesthetic, but there's all kind so tissues etc. that have not been moved or stretched in years.

Best wishes.
 
One Month update.

Hello all. I'm still here and still progressing.

Surgery was 4 weeks ago, yesterday. So hard to believe: it feels like just yesterday, yet it seems like forever ago. Pain now managed almost entirely with Acetaminophen/Paracetamol. Just need a little hydromorphone to help put the bugs inside the knee to sleep when I want to go to bed at night. (Feels exactly like my restless leg syndrome in this knee pre-op. I do hope it takes a holiday at some point!) OS was very pleased with X-rays at 3 weeks, unchanged since surgery. Apparently he removed more old scar tissue and adhesions than actual bone. My knee today is actually smaller around than it was pre-op!

Exercises are all about range of motion and flexibility. Some moderate PT "assistance" with flexion - does it hurt? Yes a bit. Is it intolerable? No, but it gets close sometimes.:shocked: Do I know about it next day? Yes, about half the time. Icing? Yes, before and after. Heat? Yes, to relax the hamstring tendons before stretching. Range of motion? Measured by PT at the end of the last PT session as +4 degrees to +120 degrees. (my good leg is -5 to +134, my goal is 0 - +130. Time will tell. I am pleased with this progress.

Walking - one crutch outside the house and on stairs, no crutches inside. No pain with walking, but lots of work to do on all the supporting structures and muscles - walking around the block, here I come.

So I am feeling pretty good, except for the impatience. It has frankly gone much better so far than I had expected. It did take me aback when the OS said last week that I could expect full recovery (though we did not discuss a definition for that) to take two years!

So that is the challenge just now - Being torn about so many things: Hanging on to the positive feelings and feeling I've come miles while at the same time knowing I'm only just about 4% of the way there; it's spring gardening time and I'm itching to get into the garden, but mustn't overdo it! Hurry up, but not to much! And hang onto the good feelings, because the dark days are just a setback away.

And of course I wouldn't be a fraction of the way there without the ongoing support of my sweet wife. And yes, in a few years it will be her turn.

I hope you are all progressing as you want to and hope to, or at the very least, as well as you are able.

Cheers,
BadKneesTO
 
@BadKneesTO WOW! That's fantastic progress on range of motion. I'm 7 weeks out and at 102 and +8 respectively. Don't let the PT push you too hard, you're doing great already.
 
Thanks @FCBayern And then we have days like yesterday - a walk around the block (1 crutch) yesterday afternoon (about 500m) felt good, so I carried on and did it a second time. Won't be doing that again any time soon! By evening I was so swollen I could barely bend the knee.

I know we are supposed to take it slow and easy, but it's frustrating when the first indication you've overdone things is after you've done it!

Ah well. Lesson learned. It may be a case of "three steps forward and two steps back", but so long as there are more steps forward than backward at the end of the day (or week, or month!), progress is still being made. I guess that's where the patience part comes in.....
 
BadKneesTO said:
And then we have days like yesterday - a walk around the block (1 crutch) yesterday afternoon (about 500m) felt good, so I carried on and did it a second time. Won't be doing that again any time soon! By evening I was so swollen I could barely bend the knee.
I know we are supposed to take it slow and easy, but it's frustrating when the first indication you've overdone things is after you've done it!
Click to expand...
Ah, you've joined the ODIC (Over-Did It Club). We've all been there. It's so easy to do when you start to feel a bit better and think that you could/should be doing more.

It's a matter of balance, of finding the right spot between '"just enough" and "too much" exercise.
The only way you can do that is by trial and error.

As long as your knee recovers after a day or two of additional rest, ice and elevation, no harm has been done.
 
BadKneesTO said:
I know we are supposed to take it slow and easy, but it's frustrating when the first indication you've overdone things is after you've done it!
Click to expand...
Too true!
 
BadKneesTO said:
I know we are supposed to take it slow and easy, but it's frustrating when the first indication you've overdone things is after you've done it!
Click to expand...
I found that to be a real pain in the knee, too! I learned the hard way like just about everybody else has. What I finally ended up doing was to add just a little bit activity and then stop and see how I felt that night and the next day. If I was OK, then I'd add a little bit more. But I did give a day of normal activity between those added activities to give my knee time to recoup. Even in a gym we are advise to always take a day in between our workouts. Why shouldn't our injured knees be the same way?
 
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