TKR Physio left me disheartened

[kneesrus]

Here is a common problem during recovery, your thigh is weak and is having difficulty lifting your leg while lying down. You have this big incision, all types of parts and your bones have been cut, drilled and hammered.
The body will always protect itself, so it is trying to figure out what in the world did you do.
The concern I would have, is your quads are shutting down because of disuse. At 4 weeks post op, you should be able to perform a straight leg raise.
So, here is a trick. Bend your good knee up, have someone lift your leg, keeping it straight, to the height of the other knee. As your mate lowers your leg, try to control the decent with your thigh muscles. Now, your mate does not let go of your leg on the way down. When laying down, your thigh muscles pick the leg up and control the pace bringing it down. Because the body wants to protect itself, the thigh muscle start to kick in to control the leg going down.
Your mate will start feeling the leg get lighter as the muscles start to kick in to control. You soon will be able to lift your leg without help.
Give this a try, it is the most lease painful to engage your thigh. Just start with 4 sets of 5 or 7.
You have to start engaging your quads.
Good luck
David

 

[Lizzie Pearson]

Good idea, David. I can actually do the straight leg raises now, but they're not easy, so perhaps if I try your method as well it will help. I'm in complete agreement about the muscles. I was told seven years ago that I needed a new knee, and eighteen months ago had a new hip on the other side, so by the time this op happened I was stumbling round like a drunken duck. I realise I need to re-train my muscles and effectively learn to walk again, but I've decided there's no point in getting too stressed over it as if I keep working gently at it there will come a day when it all clicks into place. I don't expect miracles...though it would be nice to have the occasional one!

 

[kneeper]

That sounds like a pretty good routine to me. Gradually you'll find you can do more. I know I was sitting with very little improvement in bend for about 2 weeks, I did my exercises-but not to major pain and I also iced and elevated a lot and lo and behold two weeks later I had gone up about 10 degrees. I want to say that was between around week 4 and 6. Gradual and steady seems to be the way for some of us, particularly if we've had muscle and other issues pre surgery.

 

[Josephine]

I went to my first physio last Friday, three weeks after the op! I was told in no uncertain terms that my knee bend was rubbish and that if it didn't improve the surgeon might have me back in, anaesthetise me and force it to bend!

but I am dreading going to physio again this week in case I get another dressing down for not doing enough!

I suggest - should you ever meet up with him again - that you tell him "in no uncertain terms" that you'll do it your way, thank you very much. And ignore his bullying tactics. I hate bullies.

A phone call to a private physio I went to after the hip proved interesting...he laughed and said they are just trying to scare me into doing the exercises and getting it moving, because if it's still stiff at three months it will take longer to improve.

Quite so but whey they feel they need to or even have the right to do this is beyond me.

Less than a week later, this is where I am: I can do eight straight leg raises, going up to around eight inches. I can do ten heel lifts with a rolled pillow under my knee. They both hurt to do.

Never ever do an exercise that hurts. Only ever do it to the point of discomfort and no more.

I oil my scar regularly

Massage post THR

I elevate it..,despite the advice from the hospital booklet not to support my leg on a pillow!

Then the hospital's booklet isn't written very well. If you look in here, you will see illustrations of the right and wrong ways to elevate Pain and swelling control: elevation is the key.

why is the pain so bad down the back of my knee?

The most common cause is because you're under-medicating your pain.

Then I found that I was forgetting the next dose, and for the last week I've only been on two doses a day...afternoon and before sleep. However, I woke this morning and it was very stiff and painful, even after a walk, so I took a couple of Paracetemol, went back to bed with a nice pack and elevated it, which worked. It may be better if I take meds morning and evening?

You're only 4 weeks, much too early to be reducing pain meds. I was taking the full amount of Tramadol and paracetamol for 4 months! Even if you drop to Tramadol 50mg and 2 paracetamol 3 times a day, don't do less than that. This early in the game you need it.

During the operation my surgeon also gave me a new kneecap, because apparently the original one was 'shot'! Does anyone know if this influences the speed of recovery/bending of knee at all?

It doesn't. It's a minor event compared to the rest of the procedure.

 

[Lizzie Pearson]

Thank you! More very useful advice! Am well prepared for the physio now!

Exercises went very well tonight...strength coming back into thigh muscles and although it was still uncomfortable, it really wasn't too bad. Interesting re the meds, especially the bit about the pain behind my knee, so I'll monitor that carefully. I'm going to check out the bit about massaging the wound, but I've been using Bio-Oil, which I've always found brilliant. I waited until the wound was dry and since then I've been gently massaging a few drops in a few times a day. It seems to be working well and the scar already looks great.

Going back to the physios, I'm normally a very strong person, but at the time it really upset me and I think it's very wrong to do something that is really taking advantage of someone who is in a very vulnerable place...and after major, brutal surgery we are vulnerable at first! I'm going on Friday but it may well be for the last time!

 

[wolf woman]

@Lizzie Pearson

Hello Lizzie!

I haven't any advice to add to the above experts, as I have not been around here long myself. However, I wanted to say Welcome Aboard!, and hope that you get as much out of this forum as I have thus far.

It's a journey, that's for certain, and you will be just fine!

Mary

 

[Lizzie Pearson]

Thanks, Mary! And yes, I believe I will! So glad I found this forum! I will probably now all bore you to death with daily updates!

 

[Jamie]

It is common to have swelling behind the knee and that can cause pain. Be sure you ice both the front and back of your knee when you're resting....in addition to taking those pain meds on a set schedule for a while longer.

 

[Ollie]

Welcome @Lizzie Pearson!! You are well on your way to being your own best advocate!! Keep up the ice and elevation; it will do so much for your recovery!! And as others have already told you, be gentle with yourself and don't let anyone tell you that it has to hurt to get better. It doesn't!!




Ollie. LTKR June 10, 2014

 

[dtmbf]

I have no advice to give that hasn't already been given. It took me at least 2 weeks before I could do an unassisted straight leg raise and it wasn't easy. I was grunting & groaning also, but from the effort & not from any real pain. My quad just didn't want to wake up too fast! I think you're doing brilliantly - ignore the PT bullies. I was actually threatened with a MUA my 1st post op day by PT. I just laughed in her face & told her it was a bit early to pull out the threats. This forum is a fabulous resource - I used the collective wisdom for both my BTHR & my TKR and have never been led astray!

 

[kneesrus]

Lizzie, it is very common to be emotional following this surgery, it does bring tears for no reason at all. Don't feel you are losing your inner strength. I have treated cases that the patient was going to show the world they were a cut above. They would have a day, in clinic, breaking down in tears, not because of pain.
Take one bite of the elephant at a time, but keep eating.
Best of luck,
David

 

[dovemck]

Hi Lizzie - just found your thread. I'm 6 weeks post op (Aug 30) and have limited flexion. I'm trying to find other threads of people in the same boat to help bolster my flagging attitude. I'm so very happy for those lucky ones that wake up with 90+ flexion and are able to do a few rotations on the bike - I'm not one and maybe I've been reading too many of those and subconsciously trying to compare myself to them. Like you, I had many years (okay, decades) with poor gait, pain and silly ways to deal with it all. I shouldn't expect everything to just happen magically, but I can wish! Now I'm going to go work on a few leg raises which are pretty poor and a bit painful - burning painful. See if I can keep up with your reps and sets. Cheers mate.

 

[Lizzie Pearson]

Hi all! Thanks for being so supportive!

Dovemck: I was mulling this over last night and am definitely going to challenge the physio this week regarding their starting points for all their nonsensical expectations. The one I saw last week was not even considering the state I was in before the op when every movement of the knee was excruciating, and had been for a long time. Like you, this all started decades ago. I vividly remember going away with some girlfriends for a couple of days in the early 90s, and explaining that to join them on a planned walk would be sheer misery for me because of my knee, and that I would be fine left behind with a book. They thoughtfully arranged a shorter trek just for me so I wouldn't feel left out...like the physio they just didn't get it! The few weeks before the op were the worst...as soon as I had a date I just went into meltdown! It was like I gave myself permission to stop struggling on, resulting in the fact that eventually I could only walk a few yards without a stick, and those few yards were incredibly painful. The only way I could shop was by clinging onto a shopping trolley! None of this has been taken into account. It took years to get my muscles into this state, and they won't improve overnight!

What are the thoughts over using crutches? One or two at this stage? (Nearly four weeks post-op)

 

[jeano]

A walker (Zimmer frame to you Brits) with front wheels gets my vote. I am terrified of crutches since I am a klutz. I used a walker without wheels for my first knee, and found it very difficult to use without limping. I did much better with a cane, which I could use properly, but had to have the walker for safety, especially outside, for about a week. . This time, with the wheelie walker, I was able to walk with a confident heel-toe gait immediately.

For whatever reason, my balance was good enough and my head clear enough that I stopped using the walker after a couple of days, and now only use the cane outside.

Your new knee might still be uncomfortable and your ROM might not be ideal, but it has been perfectly able to hold you up since before you left the hospital, so crutches, which are designed to reduce or eliminate weight bearing, seem like the lest desirable and most inconvenient option to me.

 

[Celle]

Use two crutches until you can walk properly, with a balanced gait. Using one crutch can tend to make you walk unevenly.

I know that many people in the USA are discharged from hospital with a walker. I think that the use of crutches is more common in the UK.

Certainly, in New Zealand (where I live, and where we tend to follow UK protocols) crutches are used. I only had a walker for the first 2 days in hospital.

Perhaps it's another cultural difference between the US and the UK?

 

[jeano]

Likely so. My first OS says crutches combined with people over 40 just means more business for him.

 

[dovemck]

I used a frame in the hospital and first couple of days at rehab - mostly because I was having low blood pressure problems. I use two crutches out, one crutch when I first get out of bed or when I've been sitting for awhile and often go lurching around the house without any crutches, but I'm not sure that's a good idea, I don't want to get into bad habits. I feel when I use two crutches I'm getting a good stretch up and down the front of the knee and it feels good/right.

 

[Lizzie Pearson]

That's interesting re the way different countries approach it!

In my case, since I also had a left hip replacement eighteen months ago which, although no major problems, not 100% ok because of the ongoing right knee problems!, coupled with the fact that I want to avoid strain on my back (small scoliosis, several damaged discs), I feel more comfortable on two crutches, especially outside the house. I am generally using one, sometimes none, in the house, and although I weight-bear perfectly well I feel that I am walking in a more regular, balanced way with them at the moment. I have no intention of using them for ever, but am sure I will know when the time is right to graduate to a stick and then nothing. Lots of advice says not to withdraw aids too early because you risk a limp, but equally a lot of people seem to avoid making that final move to independant walking and so end up using a stick for life.

One thing that has struck me is that most people on this site appear to be in their 50s and 60s, yet many people a decade or two older at least have hip and knee replacements. In my opinion I just can't see how most elderly people will be able and/or willing to focus on a recovery programme...or am I being a bit harsh?

 

[jeano]

My uncle got a knee done when he was in his late 80s! This has been discussed elsewhere on the forum, but there seems to be general agreement that many very old people have excellent recoveries, possibly for the very reason that they AREN'T quite as focused on working hard. They are better at resting and being patient with gradual improvement and healing. One of my PTs told me he is always happy to work with patients in their 90s because they heal slowly and get excellent ROM.

 

[Lizzie Pearson]

That's very interesting...and actually makes sense. I suppose many older people are, as you say, more patient, but also haven't got the kind of exercise background that many younger people have. My friend had a new hip well into his seventies and now, several years later is still working, including up and down ladders!