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TKR PT Mentioned the JAS

Roy Gardiner

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Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough 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. (If you can't make a rotation, set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain)
  • Gently turn/rock 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
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

Rockgirl4

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@TKR_Bill My surgeon had a similar response in that he didn't think PT was necessary for much except managing soft tissue pain, help with gait/walking/ditching the walker, etc. He didn't like that they had me doing 3-4 different bending episodes in a day.

I would never tell you to disobey your Dr., but i'll give you my surgeon's version-----At PT for example, they had me use the bike for 6 minutes to warm up, then use a step to help with bending (it wasn't a lunge, but my leg was up on the step and I was leaning in to bend more 20 times, with a 10 second hold), then 1 other exercise I can't remember right now, but it was to help with bending. Lastly, I was to use my stationary bike at home again later in the day---again for 6 minutes.

At my 5 wk visit, my surgeon said STOP STOP STOP the repetitive bending episodes!!!! All it does is inflame and anger the knee over and over again. All he asks of his patients is 5 minutes a day on the bike and NO MORE---and do not break up the time. I could just rock forwards/backwards until I got all the way around, but even after I could go all the way around, I was to do only ONE period of 5 minutes each day still until the swelling was under control. My PT wasn't sold on the idea, but she honored his wishes and couldn't help but agree weeks later when I made progress. This made a huge difference.

Granted, my surgeon also had me start taking Arthrotec (an anti-inflammatory known to help joint stiffness). It was my miracle drug and also gave me overnight pain relief the likes I didn't know was possible without narcotics. I had tried most NSAIDS on the market over the years, but the Arthrotec was a game changer for me. I agree the combination of the Arthrotec AND only one short episode of bending a day was the solution.

My only other suggestions are ones I need to still be doing at 5.5 months---keep up the icing and elevation. I stopped elevating around 4 months and regretted it. :banghead:I am a very active person and upon returning to some normal exercise/activity, I found I still need a good 30-40 minute period each day to elevate. My entire lower leg likes to swell still, and this helps immensely. I also have to ice EVERY SINGLE DAY still, at least once. Granted, I'm doing everything normally, just less of it (like standing in one place or shopping) and less exercise than I want and am used to. :( The swelling/stiffness that night and the next day just aren't worth it though.

I do get very frustrated at the amount of swelling I still have, but knowing my body, I'm just not surprised. :shrug:I also have a tentative diagnosis of "undifferentiated inflammatory arthritis" by a Rheumatologist. For the last 6 yrs, she and my knee surgeons have always thought this was responsible for my knees wearing out so quickly, even with no injuries to blame things on. She thinks I have Psoriatic Arthritis, but the lab tests can't confirm anything yet. This, plus my weird "severe inflammatory response" to the TKR (severe swelling and 15-16 fracture blisters) make them both suspect I always have a low-level inflammatory response occurring in my joints all the time, making it MUCH harder to knock down any inflammation/trauma from major surgery. Just my luck, I guess:bored:.
 
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TKR_Bill

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@Roy Gardiner I appreciate the bike tips. I’m progressing very slowly, but I can tell the progress. Haven’t made it around yet, but I’ll take my 200 or so degrees. Soon .....
 
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TKR_Bill

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My surgeon had a similar response in that he didn't think PT was necessary for much except managing soft tissue pain
@Rockgirl4 this was very true for me, especially at my first PT visit. My pain level was a strong 8 with meds when I went in and I was on the verge of tears. (Or already there, being a manly man that was hard on my ego, but I was really hurting and I’m kind of a cryer anyway) Through PT magic (ice, TENS, cupping with a “sink plunger” and massage) they brought me down to a 5. Of course then they started bending ....:oyvey:
Granted, my surgeon also had me start taking Arthrotec (an anti-inflammatory known to help joint stiffness).
I have not tried that. Being an NSAID though I probably can’t take it. But sometime I wonder if the stomach risks would be worth getting swelling to go down.
keep up the icing and elevation
Seems to be my full-time job .... :ice:
 
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TKR_Bill

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Hi Folks ... this may seem minor, but I thought it was a win.:loveshwr: I was able to move my patella in all directions without resistance ... even heard a little "click" when going side to side ... perhaps the swelling IS starting to subside. (8 longggggha weeks .....)
 

Jockette

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I’m glad you were happy with the ability to move your patella, it doesn’t take much to thrill us in this recovery!

However, it’s really not necessary to do that. It’s better to leave it alone and let it continue to heal.

And yes, I know the PTs make a big deal about mobilizing our patella, but it seems that mostly only happens in the US.

To be honest, I always found it really creepy to touch my patella area, and I only did when putting body lotion on my leg (after my incision had healed). My patella seems to move around way too much for my peace of mind! :yikes:
 
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TKR_Bill

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My most recent update. I had a visit with my OS Tuesday of this week. He is not happy with my progress! Still at 70ish° of flexion and 10ish° of extension. I am just barely getting the swelling under control, so I haven’t pushed real hard. Just ADL’s and sometimes too much of those. Of course he wanted to do an MUA right off the bat. But I told him I’ve read that that doesn’t work out so well most of the time. I mentioned that it would take me back to ground zero. His response was a rather nonchalant, “No it won’t.” He then cautioned me about what would take place if I didn’t get the scar tissues broke up and the sooner, the better. He then proceeded to tell me that he would give me three more weeks to push myself at which time he wanted to see me again and would encourage me again to have the MUA if I haven't met satisfactory flexion. (I think it's at least 90°) If I didn’t have the MUA then, I would have to wait six months or so and then have orthoscopic surgery to relieve the scar tissue.

Of course that scared me somewhat. I want so much to follow the bone smart principles, but my brain waffles between assumed ”given medicine techniques” and the experience of folks here in this forum.

I hope that through my venting someone here will help talk me off the cliff. I can’t say that I haven’t considered the MUA because I want to move beyond where I am. But the more I read on the procedure, the more scared that Murphy’s Laws would ultimately be applied to my case and I’d be worse off. Maybe even permanently.

Help me Obi-Bone-Kenobi.
 

Jockette

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I hope that through my venting someone here will help talk me off the cliff.
I’m going to ask @Jamie to come talk to you.
I had a visit with my OS Tuesday of this week. He is not happy with my progress! Still at 70ish° of flexion and 10ish° of extension. I am just barely getting the swelling under control, so I haven’t pushed real hard. Just ADL’s and sometimes too much of those. Of course he wanted to do an MUA right off the bat.
MUAs help people who have true adhesions. But you still have a lot of swelling and that is more likely the reason for the low ROM.

You are still pretty early in this 52 week (on average) recovery.
 

sistersinhim

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If I didn’t have the MUA then, I would have to wait six months or so and then have orthoscopic surgery to relieve the scar tissue.
This is so untrue. A MUA can be done at anytime. Don't let him scare you. I notice you are in the states. Take notice that doctors in the US want to do MUAs much more often than those in other countries. Those patients in other countries recover just fine without the extra cost, the pain and swelling, and the setbacks that people having the MUAs do.

Sometimes MUAs do help, but in someone who's knee is still swollen and healing, it's way too early to do them. As the swelling goes down your ROM will naturally improve. Oh, and by the way, you don't have to go back to your OS just so he can measure you and then try and talk you into doing something more that likely you don't need to do. You yourself can tell if you are improving without measuring. Many of us never measured our ROM. What we measured was our function. That's the important thing, not numbers!
 

Pumpkln

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TKR_Bill,
Seek out a lymphatic massage specialist, they may be able to help with your swelling.

Here are the ROM numbers of two of our members whose ROM progress was very slow.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
1 month
- 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees
 

Jamie

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I can certainly understand your confusion as to what the best approach will be for your knee. I do appreciate that your surgeon got you off that therapy that was obviously not helping you one bit.

You say your surgeon wants to see you in 3 weeks to see how you're doing and then talk about an MUA. That's fair. Since you stopped with the painful therapy around the end of October, that will give you a full month to see how things go. But.....and this is HUGE.....don't allow yourself to fall into the trap that you must "work" on improvement. If you see an improvement, don't rush to do more. Doing your ADL's and bike rotations (at zero resistance) several times a day should be it during these next few weeks. And continue with as much icing and elevation as you can stand. If you're swelling during the night, you need to ice while you're sleeping. I do know that it's not always comfortable to do that and, believe me you wouldn't be the first BoneSmartie to have an iced knee that's covered by warm blankets! Do what you have to do to stay comfortable. The idea is to give your knee its best chance possible to reduce the swelling.

With all you have going on in your body (thanks, by the way for the detailed description), you likely have pretty consistent inflammation even without adding a recovering knee to the mix. It makes sense then that things might go a little slower for you. Expect that and own it! It's your body and that's how it works.

Your goal should not be any number, but rather some improvement at the end of these next three weeks. If by then you are still around the 70 degree bend and 10 extension, then it is possible that an MUA would help you. Your doctor is right that it won't set you back to the beginning. It can cause some temporary pain after the procedure for a few days, but if you really do have scar tissue in your knee that's impeding your progress, then it either has to be broken up or cut away to get improvement. Your surgeon sounds as though he is a rational man and I don't think he's trying to rush you into something you don't need.

Give this your best effort and see where you are in a couple of weeks. Of course we'll want progress reports along the way, but I hope that you've gained some movement and swelling has reduced in the next couple of weeks. Watch yourself so that you are not pushing too hard, even if you're feeling better. Your body right now has a low threshold for pain and reacts easily with the swelling.

The idea of getting to a massage therapist is also an excellent one. I'm going to tag one of our staff members who is very knowledgeable in this area so she can elaborate on this treatment and what it might be able to do for you. @CricketHip
 
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TKR_Bill

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Hi folks, I'm so grateful for each of your responses. One thing I really like about this forum is how kind and sincere each respondent is. You truly are doing a great work here.

I apologize for my delayed response. I've had a few bad days back to back, and on the bad days I shut down completely. My pain levels have been out of control, probably set off by me doing too much and poor med management. I have no rational explanation, but at times I get into a sort of funk regarding my pain meds. I’ve been taking pain meds for so long, that I just get tired of taking them and want a break from them. (Chronic back and neck pain for better than 18 years before the total knee replacement.) But of course that catches up with me very quickly. And then I’m in over my head with pain. Hopefully I can learn from the stupid things that I do.
You are still pretty early in this 52 week (on average) recovery.
Thanks @Jockette for connecting me with @Jamie and reminding me of the length of my journey. I must admit that I wanted to be done already and to be back to normal life. Your kind reminder helped me put it in perspective. It’s a long journey.
Sometimes MUAs do help, but in someone who's knee is still swollen and healing, it's way too early to do them. As the swelling goes down your ROM will naturally improve.
@sistersinhim, thanks for what I receive as a better perspective on the MUA and the reminder that I am in the driver’s seat of my health and healing. Right now, my knee tells me how it really feels. I’m gonna try to listen more better.
Here are the ROM numbers of two of our members whose ROM progress was very slow.
@Pumpkln!! Thank you, thank you, thank you! The two examples of members ROM progress was very helpful for me! It’s early in my progress but in time I will get there. I’m also very interested in the ‘lymphatic massage’. I’ve not heard of it.

@Jamie I appreciate your great advice. It‘s very reasonable and better yet, doable. Three weeks has turned into five weeks due to the doctor’s schedule. So that gives me even more time to get the swelling and inflammation under control.
With all you have going on in your body (thanks, by the way for the detailed description), you likely have pretty consistent inflammation even without adding a recovering knee to the mix. It makes sense then that things might go a little slower for you. Expect that and own it! It's your body and that's how it works.
I‘m working hard at excepting and owning my body’s reaction to all this. To be truthful, it’s a hard pill to swallow. But swallow i must.
Of course we'll want progress reports along the way
I’ll do my best to keep you all updated as the weeks progress. I so truly appreciate the warmth I’ve felt in this community.
The idea of getting to a massage therapist is also an excellent one.
Two votes for massage. I am highly interested in the idea of massage therapy. I’ll look forward to hearing from @CricketHip and do some research on my own.

Thanks ya’ll!
 

CricketHip

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@TKR_Bill
You have had a time of it, haven’t you? I’d like to take some time this morning to read through your thread before replying.
I’m so appreciative of your tagging me as I missed Jamie’s earlier.
 

CricketHip

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Okay, Oh my goodness, I can understand why you are feeling confused and worried.
In regards to MLD (Manual Lymphatic Drainage) I can't recommend this strongly enough.
You can find somebody who does this type of modality in 2 ways.
Either a Lymphatic Drainage Massage Therapist or possibly through a PT office that offers it.

Massage Therapists, such as myself, take a certifying course and the one that seems more readily recognized is the Vodder Method. This is a very gentle, yet effective therapy and will help move fluid and inflammation away from your knee and leg, which in return will help your range of motion and pain.
I would be happy to help you in your search, just look for MLD therapists and PM me their info and I can most likely tell you if you are on the right path.
It also could be nice if you could ask your current PT people to advise, maybe they have someone on staff or knowledge of someone elsewhere that they can recommend. I hesitate to have you ask them, simply because they seem to be less concerned about the swelling and frankly, that is causing a good bit of your issues. For instance, I have several PT offices referring to me when they don't have someone on staff, so it is possible that they know of someone. It's up to you as to how comfortable you feel in asking them.

For the time being I will leave you an easy exercise that you can do yourself! It's very effective in helping to "prime" your lymphatic system and will help your body move some of the edema.
It's a great thing to do at night, when in bed and ready to sleep.. lets your body heal while sleeping, but it may cause you to get up a few times and head to the bathroom. :heehee:
I would suggest doing this 3 times daily and focus on your breathing.
Many of your lymph nodes and lymph powerhouses are in the abdominal area.
Good luck and please let me know if you need help finding an MLD therapist.
*****************
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Take deep breaths.. deep, as in breathing in to a count of 5, or 3 or 4, whatever is best for you. hold it for another count of 5 then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up.
Do this whenever you feel up to it during the day or night. The more supine that you could get in the recliner or bed, the more effective this can be.. you have lymph nodes seated there in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will, and it will help get things moving.
The reason this can help is because our lymphatic system doesn't use our cardiovascular system to help lymph fluids move.. no assistance from the heart pumping. Our breathing and our physical (muscular) movements keep it flowing.
****
 

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