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Question and implications about a comment in a Recovery Thread

Discussion in 'Knee Replacement Pre-Op Area' started by robert johnson, Jan 14, 2019.

  1. robert johnson

    robert johnson member
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    In Scouseman's Recovery Thread (My TKR Journey) on Page 2 Josephine was commenting on the answers Scouseman gave to her questions. Since it was so early in a very long thread, I didn't want to quote it there and interrupt the thread, so I was wondering if someone would tell me what Josephine meant by this answer:

    Scouseman: Leg raises 4 x 10 repetitions 4 times a day
    Josephine: a tip: once you can do a straight leg raise, you don't have to do them any more!

    What does that mean? Would someone please elaborate on this. I suppose I could take that literally, but it would be very helpful to me if I knew what the implication was by that comment, since in my recovery I'm likely to be inclined to follow the basic six Post Op HEP exercises, one of which is:

    Straight Leg Raises: Repeat 10 times
    Hold 3 seconds
    Complete 2 sets
    Perform 2 times a Day

    The other five Post-Op initial Home Exercise Program (HEP) exercises are:

    Quad set (2 sec) - towel under knee: 15x; 1 set; 2x day
    Seated Long Arc Quad - 1 sec (with assist): 15x; 2 sets; 2x day
    Ankle Pumps (Hold 0 seconds): 10x; 1 set; 10x day
    Heel slides - 3 sec (with assist): 15x; 1 set; 2x day
    Heel Prop: 1x (Hold 5 minutes); 1 set; 2x day
    These 6 exercises are given to the patient on leaving the hospital (I got them at my Pre-Hab) and my assumption up to this point has been that they were intended to be done at home right away. As a matter of fact, I've been doing the leg raises already as a way to "be ready" for them.

    Is this way too much to even be thinking of doing when I get home. Should I instead do some subtle (gentle) subset of them? Not at all? If not at all at first, ease into them as tolerable?

    Thanks in advance for any help on this.
     
    Last edited: Jan 14, 2019
  2. Jamie

    Jamie ADMINISTRATOR Administrator

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    This means just what it says....after a TKR once you can engage your quad muscles and raise your leg, you no longer need to do this exercise. It's your choice whether or not you do it.
     
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  3. robert johnson

    robert johnson member
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    Wow, that's very interesting. I thought that's what she meant (hey, she meant what she said!) but just wanted to make sure I wasn't missing something.

    OK, I get it. Thank you. That's fantastic.
     
  4. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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  5. robert johnson

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    Thanks for the link @Roy Gardiner , and I'm totally on board with the whole idea. I think the list of exercises (above) are exactly the kind that I can control how much or how little I want to explore in the early days to see how far and how easy or hard things move. I thought Josephine's tip was pretty ingenious, and I absolutely get the meaning of it.

    I tend to push the boundaries, on the one hand, but if it hurts I'm not going to do it. I'm going to be paying much closer attention to how it's healing. Same goes for the bike. I'm going to start very early but "back and forth" until I can comfortably go around in the forward direction, and zero resistance at first.

    I think I knew a lot of this intuitively last time, but what I didn't know was the part about PTs getting you to questionable stuff early on while still on pain meds. I figured it out eventually, but having had 2 operations within 3 months, that meant it took a total of over 5 months before I realized that some of what I was doing didn't make sense. If it hurt immediately after stopping pain meds, that meant I'd been doing stuff that would have hurt from the beginning. I'm certainly not going to do that again this time. When all was said and done, I feel very lucky that my left leg is functioning as good as it is.
     
  6. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    Great that your eyes are opened. Now to open them a wee bit more, consider not starting things like pedaling "vey early." This is a very traumatic surgery, as you well know. The more rest these tissues get early on, the more they can mend without interference. As long as whatever you do doesn't increase pain and swelling, you'll be fine.

    I started off Day One with pain controlled by Tylenol (to my great surprise). I've babied myself now for four weeks. The pay-off is very little pain and very little swelling, and swelling impairs healing. I am off my feet most of the time (still!), but I already walk normally, drive the car, and go up and down stairs pretty well.

    What was the reason for your spacer exchange in 2010?
     
  7. robert johnson

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    Rather than retell the whole story, you can read as much as you like from the thread back in Nov 2010 where I described it:

    https://bonesmart.org/forum/threads/creaking-at-6-months-post-tkr.8476/

    I don't believe my profile is "protected" so you should be able to read it. Let me know if you can't.

    As a side issue, I got some good advice from Josephine and Jamie about "velcro" noises that were bothering me at 6 months post-op. They were absolutely correct in that they eventually went away. Once recently while doing a sort of "lunge" movement I heard two loud pops that sort of startled me. I thought for sure something was going to be painful after that. But not only was there no pain associated with the pop, now when I get up from a very low seat, I no longer hear the velcro noises that I've always heard. When I told my PT about it, he said I obliterated some strands of scar tissue in the way, and that can be a desirable thing to happen.

    I believe he's correct, because after that happened, I have literally no more velcro sounds and no negative feeling at all getting up from a low chair, proving again that improvements can still happen years after surgery.
     
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  8. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I like this!
     
  9. Susan1234

    Susan1234 new member

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    I don't understand the rationale for not doing straight leg raises once you are able to do them. Don't they help strengthen the quadriceps muscles? My PT says to do them for that reason. MY ROM 11 weeks after surgery is good but my strength and balance remain terrible. What's the best way to improve them?
     
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  10. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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  11. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    Once muscles activate after surgery, then the activities of daily living will result in muscles resuming strength and function.

    That said, as I've aged, I have taken up strengthening exercises with light weights. I find this reduces pain and increases a sense of well-being. The straight leg raises have served me well over the years for reducing or eliminating knee pain.

    Right now, 7 weeks post op, I have added a light ankle weight. I find if I lock my knee before the leg raise, it protects the knee from pain, as Roy is right, one should not do anything that hurts. I also do leg raises on my stomach and while laying on my right side and left side in order to strengthen all thigh muscles, as that seems to be quite beneficial.
     
  12. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Adding weights works for Mary, because she's had a lot of experience. She's had a previous knee replacement and she knows her own body.

    As a general rule, it isn't advisable to use weights on a leg that has a new knee. Using weights can even do harm, if used too soon, or inappropriately.
     
  13. Susan1234

    Susan1234 new member

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    The straight leg raises don't hurt my operated leg. They do hurt my unoperated leg. Is it better not to do them on the unoperated side? I just want to get stronger and be able to walk outside without a cane, which causes excruciating pain in my thumb. I do walk 15 minutes a day inside in the halls of my apartment building without a cane. Any other suggestions for improving strength and balance?
     
  14. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Time and patience. Complete recovery is going to take a full year, no matter what you do to try and speed it up.
     
  15. kneeper

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    I continued to do some straight leg raises but not many at a time and not with weights. The more important thing for the first several weeks is to let the tissues heal rather than re-aggravating them.
    The recovery is all about gradually increasing activity/exercise as the healing process continues--you don't exercise your way into tissue healing.
     
  16. Celle

    Celle FORUM ADVISOR Forum Advisor

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