TKR Pam’s TKR PO journey

[jeffjob]

You are really doing well and Love your positive outlook. Your pain sounds very typical, bad at first and then at about 7 - 10 days really gets lower.

Your bathroom issue day one in the hospital reminded me that I would up in recovery with a "surprise" catheter (I also had a spinal)! At first I was a bit upset as we were told in our pre-op training that we would not have one. But my OS likes them. As the day went on and I was drinking my usual large amount of water, I realized how great it was to have one. I could drink all I wanted and not worry about it, LOL!

I actually asked for one on my second TNR six weeks later.

Keep doing what you are doing and be well.

 

[Jockette]

9/16. PT this morning. 98/5. I have to start “hanging” my leg more so the weight of my knee straightens it more. Started exercises with resistance bands, walked up and down one step and started pulling my leg further back with a strap while doing heel slides.

At less than 3 weeks post op these are not good exercises for you. Your ROM is great already, no need to do all this forcing.

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[LindaO]

It sounds like you want to jump some steps in the healing process but maybe slow down just a bit and allow swelling to decrease. Congratulations on the movement you have and hope you have continued success!!

 

[Shewolf38]

Thank you for the guidance! I’m going to talk to my PT about this at my next appointment

 

[Shewolf38]

9/17. My knee feels a lot more “loose” since the kneecap massage at PT yesterday. That’s really the only spot that’s still tight. I’m in pain this morning though. I see that a reply to my post yesterday says that I shouldn’t be using bands yet. I understand why. I feel like I’ve taken a step backwards because I may need a pain pill today. At this time I’m icing and elevating.

 

[Jockette]

You are going to be tight for a while.

I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”

 

[kneeper]

It doesn't take much to aggravate a baby knee. You're not going backwards, your knee just told you to back off and ice and elevate to give it a break--which you're doing.

 

[Shewolf38]

9/19. Exactly 3 weeks PO. I’m healing great and I am sleeping much better. I have PT today. I’m always exhausted afterwards so I know that I’ll be taking a nap sometime today. My kneecap has been feeling very tight but this morning when I got out of bed I noticed that my kneecap isn’t as tight. Now it’s the bone directly below my kneecap that’s very tender to the touch and I feel pain while walking. The top of my foot on the surgery side is starting to bruise on top. I’m going to keep an eye on the bruise to be sure nothing else is going on. I have been very careful so I know that I didn’t do anything to cause bruising.

 

[Shewolf38]

9/19. Woke up this morning with minimal stiffness in my kneecap! Went to PT and he really worked me out. Thigh massage, kneecap massage and scar massage ( that hurt). Stretches included sitting in a chair and doing deep ankle slides, getting up and sitting in the chair with no hands while holding 8 pounds, the leg press machine, and standing on one foot (my new knee), using a band around my ankles and side stepping across the room and back, and throwing a ball into a mini trampoline and catching it when it bounced back. All new stuff. My flex is at zero. He didn’t tell me my bend, but said that since my flex is at zero we are going to focus on getting my bend better. I’m exhausted, and elevating and icing my knee.

 

[judgar]

Everyone is different. I was told not to do leg press at all. You never know what is right and what is wrong. I get so confused on what excersises to do

 

[sistersinhim]

getting up and sitting in the chair with no hands while holding 8 pounds, the leg press machine, and standing on one foot (my new knee), using a band around my ankles and side stepping across the room and back,

Oh my goodness, these exercises are way too much for a 3 week old knee. You shouldn't even be getting up without you hands with NO weights now, much less 8 pounds. Bands are also a no no. The leg press is really a hazard on a new knee. You are doing weight training. Your knee is not out of shape, it's extremely injured and traumatized from major surgery. Weights should not be used until your knee is at least 4 months old. Please just do gentle movements with no weights or bands or you're setting yourself up for potential long-lasting problems.

 

[Jockette]

That is totally inappropriate “rehab” for a new knee. I would either stop going all together or find another facility with a better approach.

 

[Jamie]

@Shewolf38 ... it certainly sounds like your therapist overdid things with you today. You'll know for sure in the next 24 hours. If you are at all sore or swollen, you really will need to put your foot down (the one on your GOOD leg! ) with your therapist so that you are only doing more gentle exercises with no weights and no bands. Your knee is still healing and all that activity risks setting your recovery back every time you do it, get sore and then have to recover from the therapy.

You are doing very well and I think that must give your therapist the feeling he can be aggressive with you.
Please let us know how you're feeling later today and tomorrow. Frankly, I'll be surprised if you're not hurting some from this last round of exercise.

Just a point of information for you. When a person is recovering from a knee replacement, you don't "work" to get increased bend. It's there already in your joint. The only reason you don't have your full ROM right now is that you have some internal (and maybe some external) swelling in that new knee. It doesn't take much fluid to restrict your bend. Once your knee has completely healed and settled, you'll have your bend. If you do exercises that work it hard, you'll just cause inflammation and swelling and delay the process. At this point, all you really need are gentle bends and stretches to keep the joint moving plus rest and ice and possibly some medication to reduce the inflammation and swelling. Strength and balance training can come later once the healing is completed. That would be at the 2-3 month mark at the earliest.

 

[Celle]

The others have already said it. The exercises you did are far too much for such a new knee. It needs gentle treatment at first, so it can heal, and exercises like you did shouldn't be started until at least 3 months post-op.
PT should never hurt. If it does hurt, that's your knee telling you that you're asking too much of it.
Myth busting: no pain, no gain

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.
​

Let your knee take its time increasing its flexion (bending).
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.

My flex is at zero. He didn’t tell me my bend, but said that since my flex is at zero we are going to focus on getting my bend better.

By the way, ROM consists of both flexion, which is bending, and extension, which is straightening.
So it's your extension that is at zero.

 

[Shewolf38]

9/20 PT kicked my butt yesterday. I’m 3 weeks PO and I started using the leg press machine and standing on one foot (knee replacement side) while throwing a ball at a mini trampoline and catching it, as well as holding a 8 pound ball while standing up and sitting down in a chair without using assistance. When I left pt, my leg was literally shaking. Pain all night and swelling this morning. I’m sipping coffee with my leg elevated and iced. I think that it’s going to be a slow moving day today!

 

[Jockette]

When I left pt, my leg was literally shaking. Pain all night and swelling this morning.

Several of us have told you these exercises are very bad for you. You need to stop doing them. It is way too early, if indeed they are ever appropriate. You are going to be in a bad way if you continue to listen to this particular PT person.

 

[Shewolf38]

9/20. I went on a few errands earlier and now I’m having pain on the inside of my knee. I guess I’m done for the day. Meds, icing and elevating the rest of the afternoon. I’m going to let the pt know that his exercises are too much for me.

 

[Jamie]

GOOD! It's obvious from the pain you're having that you're nowhere near ready for anything like this. Please don't let the therapist guilt you into these exercises by saying things like, "You'll not get your full ROM if you don't." or "You only have a short time to work on getting ROM." or (my favorite) "Do you want your leg to freeze up at this ROM forever?" These are actually things some therapists tell their clients to scare them into doing too much. You're the one who knows your body. Stick to your guns. Just gentle exercises and no weights or resistance or balancing on your new knee. It's too soon.

 

[mannbub]

@Shewolf38 You should definitely listen to Jamie. The exercises your PT is making you do
are damaging your new knee rather than benefiting you. I have been silently following the forums advice and it helps with keeping the swelling and pain down.

 

[Jockette]

And don’t touch that 8 pound weight. That’s the weight my bowling ball is and I can’t imagine getting up from a chair holding it, even in the whole first year of my recovery.