TKR ONE YEAR AFTER TKR

RED HOWARD

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I had a TKR on JUNE 25, 2019, I had twenty sessions of PT and was doing well making good progress. I had to stop the PT and have been trying to do the exercise on my own for the past seven months. flexion and extension are causing a great deal of issues. It is hard to walk up and down stairs, my right heel is drawn up, probably because of tight tendons or scar tissue. Has anyone else experienced this issue. I sure do not want to go under anesthesia for knee manipulation. Hopefully I can do free leg hanging exercises with weight attached to my knee for better extension. Any good advice will help.
 

Pumpkin

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@RED HOWARD
Welcome to BoneSmart, glad you joined us! :welome:
flexion and extension are causing a great deal of issues.
Here is some information about flexion/extension including some gentle activities you can do to increase both.
A sustained gentle stretch can help with flexion, a stretch to discomfort, no pain = gain.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

For your drawn up heel, suggest you achilles tendon has shortened, is there a reason this has happened?
Are you doing gentle heel cord stretching?

These degrees of flexion are required for the following activities:
- 65° to walk,
- 70° to lift an object from the floor,
- 85° for stair climbing,
- 95° for comfortable sitting and standing
- 105° for tying shoelaces.
 
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RED HOWARD

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Thanks for info. I noticed you posted no pain =gain. I have been allowing for some pain, maybe a 3 on a scale of 1 to 10, is this recommended ? Also as I mentioned leg hanging gravity exercise w/ weight. I will start doing gentle heel stretches again probably 3 to 4 sets of ten heel slides with a little extra force at the end of each set. Not familiar with heel cord stretching but will look into it.

Thanks: Red Howard
 

Starsfan22

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IMO the weighted leg hanging is a medieval torture punishment. My PT talked me into tying 2 or 3 times before I refused to do them. You want extension, walk with a longer stride, a purposefull walk not just around the house.
 

Pumpkin

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Roy Gardiner

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Hopefully I can do free leg hanging exercises with weight attached to my knee for better extension
Very much not recommended by BoneSmart.

Stretching

The Bible is Bob Anderson, Stretching, ISBN 0-7207-1351-X

Right at the beginning he states that stretches should be held for 10-30sec only. As long as you don’t break this rule and never go to the point of pain, you can stretch as often as you like.

But Anderson emphasises that holding a stretch for many minutes is not the way to do it. My personal view is that the popular exercise of laying prone on a bed with one's leg hanging off the end, being borne down by its own weight, is is much too aggressive – too much weight and held much too long. The body reacts against and resists long periods of stretching.

I am for this one exercise – extension stretches - once again disagreeing with the general BoneSmart view that one shouldn’t let anyone else touch one’s knee, for fear of ‘overdoing it’. I think (and have found personally) that having someone gently helping is very useful.

ROM, Extension and Quad exercises http://bonesmart.org/forum/threads/rom-and-extension-stretches.13159
 
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PegGar16

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My OS had me focus on the straight leg lifts and the recumbent bike (gradually moving the seat forward).
 
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RED HOWARD

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Recumbent bike and gradually moving forward with straight leg lifts are great. also I will check out the Bob Anderson book. thanks for this information. yes free hanging leg with weights attached can get painful, setting a person back as well as very little results. i will try these different approaches. slow and steady and pain free, or with very little pain.
 
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RED HOWARD

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Also loved the ROM and extension exercise videos. I will certainly try these. Thanks for info. Love this Bone Smart forum
 

Roy Gardiner

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Recumbent bike
Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough (forward enough on a recumbent) so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
 
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RED HOWARD

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Thanks Roy, I belong to a gym, Planet Fitness and find with my post TKR, one year later that it is more difficult to pretty much do standing exercises or even lying dumbell bench press. I like to workout and gain functional training for everyday use. Slow and steady stretching is the way to go. As you posted in a forum 30 sec. stretch max is what the body responds to as apposed to torturous 10 to 12 min. leg gravity stretch w/weights. It is pretty tough to walk up stairs especially if there are no rails. I have not measured my knee flexion or extension but do know that box squats using your own body weight will build muscle in the legs. Are both quads and hamstrings involved in this move ? It is pretty much like the one shown in your pictures where as you advance little by little. I like this method and will definitely try the skateboard method. As pumpkin mentioned in her forum, I need to keep swelling down and will use ice. Also if no swelling present would you recommend using or alternating with a heating pad. Thanks again.
 

Roy Gardiner

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box squats using your own body weight will build muscle in the legs
True, but don't go too deep. Imagine the shear forces on the knee - you don't want to stress the glue that holds the implant in.
 

doodlebug60

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Red Howard; hi and welcome. one thing that helped me a lot with Rom was to sit on a porch swing and put my foot on a table and swing back and forth. It would naturally bend the knee and worked great for me. you can move the table in and out to increase or decrease the bend according to your discomfort level. discomfort is good; pain is not. hope you have a great recovery; Doodlebug
 
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RED HOWARD

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Thanks, doodlebug60, I will add this to other routines I am doing for ROM. For strengthening the legs I do body weight box squats and straight leg raises engaging the quad muscle through the whole lift.
 
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RED HOWARD

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My knee has limited ROM after one year of TKR. Twenty sessions of PT until insurance ran out. Frustrated. Wondering if I can still take a slow and steady approach in gaining ROM in extension and flexion. Pain in trying to gain ROM, but pain is not too overwhelming. Is it normal to experience some pain while trying to gain ROM ?
 

Jaycey

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@RED HOWARD you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.

Yes, it is normal to have stiffness one year out. Especially since (as you indicated in your thread earlier) you pushed to gain ROM early in your recovery. No - you should not push to the level of discomfort when working on ROM.
Wondering if I can still take a slow and steady approach in gaining ROM in extension and flexion.
Absolutely! There is no time frame for gaining ROM. Take the advice in the articles below. Ice and elevate - that will get rid of the stiffness and allow more mobility in that knee.

Knee Recovery: The Guidelines
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 

Jockette

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I had a very difficult first year and my ROM wasn’t great. But, I had much improvement in my second year, as I continued to heal and my whole leg continued to relax. I didn’t “work on” improving my ROM, I just went about my life. I even noticed more bend in my third year. I hope the same happens for you.
 

roboknee

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@RED HOWARD I sat in an office chair with wheels just high enough so my feet were fully planted on the ground then gently rolled back and forth with my foot stationary until I could feel the stretch going a little further each session. it worked great for me.
 

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