TKR Post surgery - Finally!

[EalingGran]

She thinks it's my muscles not wanting me to go further, not scar tissue, as that would feel like a hard stop, in her experience. No

I think from what I have heard and read that it is the hard stop which is characteristic of scar tissue/ arthrofibrosis and your PT knows what she is talking about. I would trust her opinion more than a surgeon who is telling you to push past pain.
Pain can increase inflammation and be counterproductive.
I was never ever pushed to pain by my pilates teacher, whom I used instead of a PT. I recovered really well without any painful exercises or pushing my knee.

 

[BarabooProud]

Now that I think about it, how can he determine if it's scar tissue without truly evaluating me? He just asked me to bend my knee back while sitting and that is all. I had an hour drive to get there, so I'm sure I had swelling, as a result. I'm thinking he looked at the PT notes, but must not have looked at them all because I thought I was at 109 the last time I was there and he said 104. Why, oh why, do I not think of these things until I'm home and not during my appointment. Oh well. He did say that if I make some progress things would be fine and he was saying he thought I would make progress. Maybe I'm overreacting.

 

[Layla]

Maybe I'm overreacting.

You can push your consistency, but I wouldn't advise pushing your pain limits. Trust your body's natural healing timeline. This is a marathon, not a sprint and you're in the very early weeks of healing in the entire scheme of things. Protect your progress and your peace. You're doing just fine.
Happy Wednesday!

 

[BarabooProud]

Thanks! And something I've realized is that the degree of flexion all depends on which way they measure you. I get a different number from each different PT I see! There are 3 different PT's that I end up seeing and they each measure me a different way.

 

[Jockette]

The measuring tool they use is not an exact science, they just place it next to you, and most likely, not always in the exact same place. It always amazes me how much our recovery is rated on a number that is derived from such a tool.

Way too much is made of the ROM number. It is only one way to show recovery improvement.

 

[benne68]

I get a different number from each different PT I see! There are 3 different PT's that I end up seeing and they each measure me a different way.

Exactly! My surgeon considers the goniometer "absolutely useless" since the exact result can't be replicated (even by the same therapist)! He never measured either knee; instead, he asked me to move different ways -- for example, swing my leg in and out while sitting on the exam table or step up on a low stool -- and watched my movements.

The best strategy is focus on your function -- what can you do that you couldn't do a month ago -- and what are you still aiming for. That's a more important goal than some arbitrary number!

 

[EalingGran]

My surgeon never measured my knee except by eyeball and asking about function.
I think there is way too much emphasis on ROM in some places and it makes people necessarily worried.

 

[BarabooProud]

I agree. Function over numbers is the way to go!

 

[Jockette]

My surgeon was always very focused on the ROM number. He would push my knee as far as he could, “to achieve the highest number” which was very painful for me and always produced extreme anxiety as my next appointment was approaching. It took me until my 7 month appointment for me to refuse to get on the table and give him easy access to my leg. Since then I will never allow that again.

 

[Layla]

Function over numbers is the way to go!

Yes, I have to chuckle at the thought of contemplating whether we should attempt to "do this, or do that" based on computing degrees. As long as you feel yourself getting your life back, albeit slowly, you're good!!
Have a great Thursday and weekend BarabooProud!

 

[sistersinhim]

There are 3 different PT's that I end up seeing and they each measure me a different way.

Oh yes, this is why measuring ROM, (bend and extension) is not that important. It's what your knee can do.

I was blessed to have a surgeon who never pushed PT. He gave me a prescription for it, which I threw away and never went. My OS never even asked about PT when I went back for my 3 checkups! Of course, he knew I was a single lady who had to take care of myself and trusted that I would not be just lying around all the time.

Because of birth defects, I had to have 12 knee surgeries, so I've had lots of knee recovery experience. I knew from that experience that I did not need formal PT after my TKR, and neither do many others if they do their own daily activities and do not just sit around all day. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart.org was even thought of. My surgeries started in the early 80s, and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then, I had already had 6 knee surgeries and rehabbed the Bonesmart way! I believe that gentle, non-painful movements lead to a quicker recovery for most people. Of course, that is just my experience. You have to do what feels right for you!

 

[InkedMarie]

My surgeon never measured my knee except by eyeball and asking about function.
I think there is way too much emphasis on ROM in some places and it makes people necessarily worried.

The same with my surgeon. I was rarely measured in PT. Therapist didn’t care much and neither did I. It’s just a number.

I’m seven years out from the first and five years with the second. That is crazy, doesn’t seem that long. Anyway, I still hate stairs. I can kneel for a very short time on my right knee but not the left. I can’t squat. I’m okay with this. It’s only an issue at work at times but I’ve learned to work around.

Marie

 

[BarabooProud]

I asked my surgeon about the muscle guarding I have going on and if he had suggestions to help that. This was his answer:

"This is unfortunately a no pain no gain scenario. You have to push through that discomfort to get the bend. Otherwise the scar will tighten at the degree you are at now, which is not where you want to be long term, though you do sound like you are making great progress.

Your pain is going to flare as you get more motion, which isn't a sign things have gone wrong. It is a necessary evil at this part of the recovery and the motion gains will be worth the discomfort. So hang in there and keep pushing through it, and know that you aren't injuring yourself. "

I don't really know what to think...

 

[EalingGran]

This is unfortunately a no pain no gain scenario. You have to push through that discomfort to get the bend. Otherwise the scar will tighten at the degree you are at now

This really isn't true. I was never pushed beyond pain and I have great ROM ( 150 degrees).
I would exercise daily with a pilates bases approach but always stop at the point of any pain. Movement is important ( motion is lotion) though. I walked plenty from early on and used a rocking stool in the evening when watching TV.
You definitely can get great results without any painful pushing on the joint.

 

[Jockette]

I also disagree with the no pain, no gain theory. We have too many members who did not go this route and had great outcomes, for it to be true.

Reread these articles from the Bonesmart guidelines:
There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR

Here’s what one of our former staff members said:

It is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers.

 

[BarabooProud]

This is unfortunately a no pain no gain scenario. You have to push through that discomfort to get the bend. Otherwise the scar will tighten at the degree you are at now

This really isn't true. I was never pushed beyond pain and I have great ROM ( 150 degrees).
I would exercise daily with a pilates bases approach but always stop at the point of any pain. Movement is important ( motion is lotion) though. I walked plenty from early on and used a rocking stool in the evening when watching TV.
You definitely can get great results without any painful pushing on the joint.

@EalingGran, did you have pretty good ROM right after surgery?

 

[BarabooProud]

We have too many members who did not go this route and had great outcomes, for it to be true.

@Jockette do you have members who did not get good results from the Bonesmart way? Just curious.

 

[EalingGran]

you have pretty good ROM right after surgery?

I honestly can't remember because no one ever asked me about it or bothered me.
I only really heard about ROM at about 10- 12 weeks when I joined BoneSmart- because I was worried about continuing medial pain ( which turned out to be a ligament issue- overstretched MCL).
By that stage I think I was about 120 degrees and it gradually increased over the first year to 140 degrees and I then got maybe an extra 10 degrees to 150 in my second year. I was borderline hypermobile before my surgery and could sit fully back in child's pose/ sit with my knees fully bent under my buttocks.
I also had a very mobile PKR implant fitted ( Oxford fixed lateral). It is so mobile that they had to stop using mobile bearings because it had a very high ( over 10%) dislocation rate- so ROM was never really an issue.
However, if I try to think back I do remember not being able to bend much in the first few weeks. Even tiny squats were painful- so I stopped when it hurt. The same for heel slides. I have a medical background and I have always been taught to respect pain as an important signal from the body and not to go beyond that. I had private pilates sessions instead of PT and that was/ is my teacher's philosophy as well.

 

[Layla]

do you have members who did not get good results from the Bonesmart way

I am sure, Jockette, will respond also, but I'd like to expound on this a bit. It's a fair question.
In my time here, I've seen the great majority have significant improvements in following the BoneSmart protocol. Healing journeys are individual for sure. Some experience slower progress due to additional health conditions, age, medications, the state they were in as they approached joint replacement, or how their body responds. Wins and challenges are both reported here because both are reality. When those who aren't satisfied with a slower more relaxed recovery, where "no pain, no gain" is discouraged, they're free to go at their own pace, follow their OS's or PT's recovery protocol and hopefully share their progress with all. We all learn from one another and our goal is to support, respect and encourage individual choice as we walk along side each other as a community.
We appreciate you sharing your progress here, it means a lot and we're thankful for you, BarabooProud!

 

[Jockette]

do you have members who did not get good results from the Bonesmart way? Just curious.

Yes, we have members who didn’t get good results from the Bonesmart method, as well as those who didn’t get good results following a painful rehab. It’s not always the rehab method that guarantees the result, though it can be a factor. There are many reasons one might not get good results.

You are still very early in this year long recovery, so it’s way too early to judge how good a recovery you will have.

Remember what is written in the Bonesmart recovery guidelines:

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.