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[TKR] Range of Motion decreasing<

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Justine-S

Justine-S

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Thanks for all your answers and encouragement.

Ok, so I was doing the elevating wrong - not high enough.
I do not understand the use of pain medication though. Yes, my knee is stiff in that I cannot bend it properly but it is not at all painful. When I say high pain tolerance I don't mean I'm sitting here, gritting my teeth, thinking I can handle this. I mean I feel absolutely no pain whatsoever. In the hospital, they gave me Tramadol on the second day when I had a pain surge and it nearly knocked me out. I stopped taking painkillers because I wasn't in any pain and I don't really get why I would want to put such strong drugs in my system because my knee is stiff? Sorry if this sounds a bit blunt, but I have overdosed before and have had problems with addiction. I will not take drugs if I do not need them.

The swelling is mainly at the back and came after the last physio session. The front looks like the slight picture. And it is not painful either, just annoying because it was not there before!

Re the extension - measuring like above sitting on the floor I get 0. I will try and get someone to take a pic of flexion but I don't think I'll be seeing anyone before the weekend.

Yesterday I tried my own test, sitting on a piece of furniture and marking on the floor where I could bend my knee back to comfortably without any pain. Today I did it again and I have an increase of 5 centimetres which seems like a lot for overnight. Skipped physio and stayed in bed all today, so going to do the same today. I still find the lack of flexion incredibly frustrating though. I have always healed really quickly and never had issues with pain. So I don't understand why everything else seems fine - no pain, extension ok, walking unaided - and yet the flexion is bad. I did not have full ROM before, lost it after my second op in 2013. Lost my ACL around the same time (it was hanging on a thread anyway) and since then have never been able to sit back on my haunches or kneel fully on the left knee so I don't know if that has anything to do with it. But I could certainly do a lot more than I can now! I'm just worried it's never going to come back and have a huge dilemma about succumbing to physio, where I know they think what they're doing will help as they're getting results with other people.
 

traceys

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@Justine-S
Yup. That sounds right. Internal swelling drops and suddenly things progress faster. I lived it last month. It’s crazy trying to figure this recovery out.

I too barely took any pain meds. Just no pain as others experience it- just real tightness. I get where you are coming from on your history with meds and kudos to you for being aware. You may find by elevating and icing and resting these few weeks instead of pt you will be fine.

Keep us posted!
 

Roy Gardiner

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I did not have full ROM before, lost it after my second op in 2013.
:idea::idea:
so I don't know if that has anything to do with it
It does. Your body has adjusted to the restricted ROM and will need time to adjust back again to the new possible range. Gentle stretching exercises will do it, over time.
 

SusieShoes

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Yes, my knee is stiff in that I cannot bend it properly but it is not at all painful.
I also have high pain tolerance, and often don't feel pain when other people would. For the most part it's a good thing. If you're not feeling pain, you don't need pain-killers. You're the envy of a lot of TKR patients! Pain is one of the main reasons people seek support and advice.

So I don't understand why everything else seems fine - no pain, extension ok, walking unaided - and yet the flexion is bad. I did not have full ROM before, lost it after my second op in 2013.
As Roy said above, you've answered your own question: your flexion is less responsive because of so many years of being compromised. I had both my knees done at the same time: the left had been flexing abut half as it should for a year by then, whereas the right was painful but still bent normally. After surgery my right knee regained flexion and extension faster than my left. My left knee was months behind. Your knee needs time to stretch the muscles and tendons that shortened from the years of less flexion. That will happen!

I'm just worried it's never going to come back and have a huge dilemma about succumbing to physio, where I know they think what they're doing will help as they're getting results with other people.
Those other people don't have your knee. It's tempting for therapists to generalize -- if something works for most people, it should work for every person -- even though they know better. They should figure out what gets the best results for YOU. Maybe you can help your therapist help you by pointing out what's working, and declining to do what isn't. [I did this. My therapist and I had an adversarial but ultimately productive relationship.]

Yesterday I tried my own test, sitting on a piece of furniture and marking on the floor where I could bend my knee back to comfortably without any pain. Today I did it again and I have an increase of 5 centimetres which seems like a lot for overnight.
Members often talk about "the bathroom tile" method of measuring flexion. If your bathroom is tiled in a way that allows you to use the tiles as increments while you're on the toilet, that's an option similar to what you're doing. It's perfectly valid, though not something sure to impress your therapist. But yes, we can notice our own improvement, and it counts. :ok:
 

sistersinhim

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I will not take drugs if I do not need them.
I agree with you. You seem to be doing just fine without them. Stiffness is considered a type of pain, but it doesn't hurt. It's just aggravating. As your internal swelling goes down and your muscles and tendons begin to stretch out, that stiffness with diminish. Stiffness was the last complaint that I had.
 

Josephine

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Yes, my knee is stiff in that I cannot bend it properly but it is not at all painful. I mean I feel absolutely no pain whatsoever.
I still say that stiffness is a form of pain and should be treated accordingly.
measuring like above sitting on the floor I get 0
Excellent!
I will try and get someone to take a pic of flexion but I don't think I'll be seeing anyone before the weekend.
No rush. Whenever you get to it.
 

Celle

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Members often talk about "the bathroom tile" method of measuring flexion. If your bathroom is tiled in a way that allows you to use the tiles as increments while you're on the toilet, that's an option similar to what you're doing. It's perfectly valid, though not something sure to impress your therapist. But yes, we can notice our own improvement, and it counts. :ok:
After my last TKR, I didn't go to PT, so I never had my ROM measured. My surgeon doesn't measure, either. He just looks at the knee and says "Show me what you can do". He says that what you can do is more important than the numbers.

i did use the bathroom tile method of measuring flexion progress, though.
 

maryo52

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Bathroom tile method of measuring ROM!!! Love it.
 

traceys

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@maryo52
Been doing it since the day I came home from hospital. Have moved 14.5” from that day to now. I thought I was the only one doing it!!
:snork:
 
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gbcforever

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The worst thing is all the 70 and 80 year olds at the centre are fine with the same treatment, all great ROM and I just don't understand why my body won't work.
I know exactly what you meant. The day after surgery at the hospital, I was at physiotherapy and was told to do the straight leg lift. I couldn't, no matter how hard I tried. Physiotherapist raised it for me and asked me to hold it up. I teared continuously and couldn't stop crying because of the pain. I was the youngest and the only one crying... I wondered too what was wrong with me.

I struggled through all the excruciating pain in the following weeks to get my ROM to 'agreeable' measurements ... Yet I wondered if this is the only way to achieve the same goal. That was how I ended up in this forum. I am still reading past recovery posts and learning.

Here's wishing both of us a smoother and kinder-to-our knees recovery. :)
 

sistersinhim

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Been doing it since the day I came home from hospital. Have moved 14.5” from that day to now. I thought I was the only one doing it!!
I started doing this shortly after my surgery. My foot would slide easily and it was so much fun when it went a little farther back. Some people use a skateboard while sitting to increase the bend gently. There are lots of ways to work on the bend that we can be in total control of.
 
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Justine-S

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well, five days off physio and exercises and a complete turn around. After three days I went for a gentle swim. I find it really hard to just do nothing. After I came out of the water I felt a kind of release inside the knee and now the ROM is much greater. I think I'm still behind what it's supposed to be right now but it's definitely a huge improvement. I will see the physio tomorrow and see what he says. Hoping he will not be offended and take it on board for other people in the future.
 

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I'm glad the time off PT has helped your knee.

It really doesn't matter if your physio is offended. That's his problem, not yours.
It's your knee and you have the right to say what happens to it.
Saying no to therapy - am I allowed to?

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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.
 

kneeper

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On the stiffness/pain issue. Most of my pain was in the form of what I describe as achy stiffness. Lo and behold pain med, whether the narcotics or later plain tylenol, helped it. I found I could bend a bit better with some meds on board.

You don't have to do "nothing"--you just have to give your knee a chance to heal and stop re-aggravating it. Easy does it will do the trick.
 

pdx

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Hmmm. Wonder if you had a Baker's cyst behind your knee. When mine released, wow! Instant improvement. In any case, hope you continue to feel better. I think swimming is the best exercise ever!
 

Josephine

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well, five days off physio and exercises and a complete turn around
You were lucky. Usually it can take upwards of 5 weeks to see an improvement! Don't be tempted to get right back into the exercises because I can promise you it will come straight back and probably worse!
I think I'm still behind what it's supposed to be right now
There's no such thing, m'dear! It's more like this ...
wiggly line.png
 

traceys

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@Josephine bravo!!! Very accurate depiction of this recovery. I just keep thinking of BuzzLightyear “to infinity and beyond!” Because it’s never really over. Lol
 

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