TKR October 6, 2016 2½ weeks post op'

[Roy Gardiner]

Check the mantras, PT should not hurt.

I understand mantras. I also think you have to listen to your body and mine is screaming for walking to get the pulse rate up.

Fair enough; it's bending the knee beyond the point of pain that's bad.

And if you walk and get more pain or swelling the next day, back off. If not, walk a bit more.

To get your pulse up, maybe try a static bike.

 

[sheliac]

My husband was the same way. But after going to preop class, he watched a YouTube video (the real thing, not animation) of the surgery . He only made it 1/2 way thru the video but it changed his attitude for good. I sent him the links to the scientific journal articles regarding negative impact of aggressive PT on TKR outcomes, too. Now, he's the one who reminds me to slow down. He also went to first OP PT with me (where I presented the Bonesmart philosophy and my boundaries related to PT). I think having him there, as support for the science behind going slowly and easily was helpful. I tend to be a "pleaser" and setting the boundaries before we started helped, too. Maybe have your husband watch a surgery video and explain the science behind "less pain, more gain".


Shelia
RTKR - 8/23/16
LTKR - 10/11/16

 

[FlaGranny]

My PT discharged me yesterday after 5 visits. I am functional. She told me I am doing better than all her other knee patients. Guess what? I do none of her exercises when she is not here.

 

[Josephine]

I had two Tylenol before bed. Nothing till..well this am before exercise.

Never EVER take pain meds before exercise or PT. Worst thing you can possibly do. Pain is important - it tells you when you are doing too much so do not mask it. Pain meds AFTER PT!

but I am having trouble knitting with my knee up and head down!

There's no need to do that! Sit up while you're elevating and do things you want to do. Like these examples

I'm a hiker and want to be ready for when the ice hits. That will be soon.

Forget the hiking! It will still be there when you are better but that's not right now. I KNOW you're impatient and ready to be getting going but you can't - yet. You're not even three weeks out and have at least another 12-14 weeks before you can even think about that!

I think that aches are worse at night and worse of all when one can't sleep. The immune response works overtime so it's a balancing act of not upsetting it while maintaining some mental sanity.

It's nothing to do with the immune system but TKR pain is always worse are night, that's why you need to be regular with your pain meds and make sure you take a night time dose - 3-4am if needs be. Set the alarm so you don't miss it.

Next week I am in outpatient PT and have not met the provider. If it's a PT Nazi I am out of there.

Good for you!

Today some PT assisted.. On my own to 107 and with assist 114

Sorry to be on your back again, but NO assisting! Those extra 7 degrees you got 'with assistance' are irrelevant. What you achieve on your own is all that counts. Besides which, 107 is pretty darned good for 3½weeks!

I am a wimp with pain and asked him to stop.

Actually, far from being a wimp, you are showing remarkable assertiveness and strength of character! I admire you.

PT says no lateral motion much yet so no raking leaves.

Indeed - I agree with her 100%. Not that you should even be considering anything in the garden until about 8 weeks out.

My husband is confused. He has always done as the professionals have dictated. To him my skipping PT is a no no. if the dr says you must do it you must

LOL! That's really funny. If only he could spend a day in my chair, it would soon change his mind!
In the meantime, it seems that Sir Lancelot Spratt is alive and well!

 

[greatlakes]

I've found that the oft stated point here, that you can't bend a hose swollen with water, is a good graphic for people to understand. Then I follow that up with another repeated phrase from here, that the bend and extension are there, they are built into this new knee replacement, and is just waiting for the healing in the soft tissues in order to be able to function. What do you think, I then ask, heals a sliced open soft tissue, muscle or tendon? Vigorous exercise, or rest, elevation, and ice.

 

[Josephine]

@greatlakes I like that!

 

[little red canoe]

Climbed three stairs with repaired knee first. No Pain!

I know I should have caned the PT yesterday with an aggressive stretch.. Now I have mild swelling ( from no swelling at all) and heat.

But I had to try the stairs.

Hiking has to happen here. Even if its a five minute hike with camera and cane. New England leaves beckon. We live on a dirt road no sidewalks.

Josephine, respectfully I am not built for no exercising. I am goal oriented to kneel again in a canoe for long trips.. ( which until 2014 I could do fine) and hike. It gives me a target. If it weren't snow on the ground I would want to canoe today.

But Josephine I am no longer going to slavishly follow the 3 x a day 15 reps two sets dogma either.

My TKR was the result of traumatic arthritis. The other joints are fine. The scar from the TKR is barely noticeable but the flaying of the meniscus in 1971 left two long scars that are ugly..

 

[newlybionic]

Work on increasing your heart rate by doing upper body exercises for now. Give your knee some time to heal and then you will be ready to get start getting ready to do all the things you want to do again.

 

[FlaGranny]

Greatlakes, I like the hose analogy, and this morning something else popped into my mind: Swelling is nature's splint. That knee is swollen to prevent too much motion. Silly to try working against it.

 

[greatlakes]

It's actually Josephine's analogy! It's repeated a lot on this forum.

 

[Josephine]

Hiking has to happen here. Even if its a five minute hike with camera and cane. New England leaves beckon. respectfully I am not built for no exercising.

But this isn't about you, it's about your knee! A whole other issue. I'm not saying never hike again, I'm saying just not NOW. You have to give your knee another 4 weeks at least. You can't start doing these things at only 2½ weeks out.

My TKR was the result of traumatic arthritis.

ALL arthritis is traumatic. That's why it's invariably referred to as "wear and tear".

 

[little red canoe]

As my arthritis was a result of the surgeon removing the cartilage in 1971 as a result of a very bad ski accident: it in the USA is termed traumatic arthritis. It was not the result of wear and tear.

Its funny you mention it because now I have 3 PTs assuming my other knee must be bad too.. And its not.. I can get right down into telemark position with the unaffected knee

 

[referee54]

Josephine, respectfully I am not built for no exercising. I am goal oriented to kneel again in a canoe for long trips.. ( which until 2014 I could do fine) and hike

I would say that the vast majority of us here on the forum are very goal-oriented. I umpired (and still do) HS and college baseball and I cycle 120-160 miles a week., I wanted desperately to get my active lifestyle back.

I did find, though, after my BTKR, that by me setting goals , I would become more frustrated. I found that my two surgical knees were going to recovery at their own pace, regardless. I also found that the harder I worked, the slower my progress---and my PT's had to reign reign at times.

I look back and I think about trying to rush recovery---and there was nothing that I could do to speed it up. Recovery from a TKR can take upwards to a year to be 100%---and I gained ROM well after my one-year anniversary---in tiny increments.

I hope you reach your targets---but be please understand that the surgical knee is the one that truly has the schedule for recovering.

 

[KarriB]

You're getting lots of great advice here. Unfortunately, exercising wounded muscles, tissues and bone is counterproductive to healing. I'm afraid you may get your hike in, but will suffer from it later. Like Tim I found there was nothing I could DO to hurry my recovery, but lots I could DO to hinder it. TKR rehab takes a different set of goals; giving your body the rest it requires to heal from a traumatic surgery, the ice and elevation to lessen the swelling in the soft tissue and the patience your mind needs to wrap your head around what you've just done.

I wanted to work on stamina after my second surgery in a month, so my OT and PT suggest the arm cycle. While it gave me a bit of a workout, the only thing that helped my body regain stamina was time. With time I was able to resume my lap swimming (20 laps a day), biking (5 miles a day) and teaching first grade. Good things come to those who wait.

 

[little red canoe]

The exercises I am doing are focusing on lengthening the hamstring and gastrocnemius. Waiting for that to happen naturally isnt going to be productive. Now that I have worked the stretches for about ten days the pain is much less.

I have quad sets
bridges
foot on wall heel on ground lean forward..
heel slides seated and laying down
hip abduction lying on side and standing
going up and down mini stair ( golds Gym stepper) reps of just 7 one set twice a day
quad stretches on real stairs ( now can go up two with bad knee with good foot planted on stair 0)
Going up two stairs ( real) with advancing the bad knee. twice a day
Getting up out of a chair with toes at the same place.. not one leg advanced. Still need some support on this one..using less and less support
Hamstring stretches with leg on stool
Prone lower leg raises ( they really feel good.. never thought about sleeping on stomach)
Straight leg raises.. Can do alot when lying down without pain.. About 5 is enough at a time when sitting
Stepping up a step side to side..
I had to step laterally a big distance yesterday and was glad the operative leg ( which was planted) was happy. This was NOT a planned event!

I walked around Best Buy yesterday but demurred to the scooter in the grocery store.

Today knee almost same as other knee and I cooked dinner forgetting about it.. That is a good sign

I do not do the exercises all at one time.. I do a couple then rest or do something else then a few an hour later..ice in am , afternoon and evening.

Forgot... if it hurts I mentally put that in the "Not Yet" file.

 

[Josephine]

in the USA is termed traumatic arthritis. It was not the result of wear and tear.

Same difference. The knee doesn't know the difference!

I have quad sets
bridges
foot on wall heel on ground lean forward..
heel slides seated and laying down
hip abduction lying on side and standing
going up and down mini stair (golds Gym stepper) reps of just 7 one set twice a day
Going up two stairs (real) with advancing the bad knee. twice a day
Prone lower leg raises (they really feel good.. never thought about sleeping on stomach)
Straight leg raises.. Can do a lot when lying down without pain.. About 5 is enough at a time when sitting
Stepping up a step side to side..

I'd say without any hesitation that all of these are contributing to your night pain. That and the fact that you arfe doing all this when you are only 3 weeks out from surgery.
You should read this BoneSmart philosophy for sensible post op therapy

 

[little red canoe]

No knee pain for two days now. No meds either. My night pain was quad and gastrocnemius. Muscle.
I feel more normal.. Appetite and bm have come back..

Those exercises I think have alleviated pain.. I gave my dilaudid to the Police Dept
This all started 46 years ago when my knee was opened to remove cartilage. Back then they took everything
Surgery this time was also to remove three huge cysts. It's called traumatic as it's the direct result of previous surgery and isolated. If you wish to quibble that is fine. I was told in 1971 that by 1981 I would have arthritis at the op site at the age of 35

 

[Josephine]

I'm not quibbling - just stating a simple fact

 

[little red canoe]

It's not my terminology. My surgeons. I think it's not worth a kerfuffle with him
Walked 3000 feet today. Not using a cane. I use two hiking poles as my husband noted my gait with the cane tends to lurch and with two sticks I can walk slowly deliberately with equal arm swing and knee raise and no limp
He watched my gait. No pain but the feeling of all the hardware moving around is unsettling
Feel blah. I've been taking the Tylenol as prescribed and again can't go. Went to the store for prunes and Pepsi.
I'm sensitive to meds and usually the lowest dose works well so thinking of discontinuing Tylenol

 

[newlybionic]

Tylenol won't affect your ability to have a BM. I think you feeling blah may more likely being your body telling you to rest a little today. It needs a small vacation.