TKR Reader's Left TKR Spacer Exchange

[Jamie]

Goodness, please don't be embarrassed! Forums can be quite mysterious until you use them a bit. Navigating how they work and the rules each site establishes can be confusing. I'm sorry if you felt embarrassed in any way and I'm glad you're feeling better now.

Over the many years BoneSmart has been in existence, we've figured out things like our "one recovery thread" rule that make things work better here. People sometimes don't understand why we have so many rules (many forums don't and they are basically a free-for-all). We run BoneSmart a little differently than most forums because part of our goal is to keep the overall forum as a great information resource that people can come to and read older threads to easily follow other members' journeys. This requires some organization to the posting by members, which we try to accomplish without making anyone feel like their content is being too heavily managed.

You have pain when walking because you are still healing. If that pain is causing you to limp in any way, please go back to using a walking aid for a while. Allowing yourself to limp works against your recovery while use of a walker, crutches or a cane (whichever allows you to walk without a limp) helps your body adapt and adjust to the new implant. Your body becomes out of alignment when you have a bad joint. The surgery instantly puts things back to right, but then all the soft tissues (muscles, ligaments and tendons) must readjust themselves to the new, correct alignment. This takes time.

The knee compartment is very compact, so your walking pain indicates you do have some swelling internally that you cannot see. It doesn't take much fluid in that tight knee space to cause pain. Pain behind the knee is very common as well. Be sure you are icing that area a well as the front of your knee regularly. I used to sleep with ice packs as I was recovering and that really helped me with my pain levels. Just be sure to keep a towel between the ice source and your skin to avoid skin damage.

 

[Reader525]

@Jamie, thank you again for explaining everything. I am someone who likes to understand the "whys" of things, so hearing there is swelling inside the knee makes sense to me. I also have some swelling around the knee which I can see. It's definitely feels full, for lack of a better word.
I find unless I walk like a snail, even with the support of my cane or a walker, I limp. And for some reason, my PT and the doctor are pushing me to give up the support of a walking aid. I was told to lose the walker the first week and switch to a cane. I have some days I'm better than others, but by the end of the day, I'm pretty darned sore.
I get confused by all the different things they tell me and then see on here. I'm trying to be proactive, but then I overdo, and then when I try to rest, I get worried I'm not strengthening my muscles to support my new knee! Arrrgghh!
PT tells me the back of my knee hurts because my quads are weak and I hyperextend my leg, straightening it too much. This is so frustrating to me, I don't think that's why the back of my knee hurts. I think it's what you said.
My husband says it isn't even a full 6 weeks yet, that will be next Wednesday, and to stop pushing so hard. This is an all consuming recovery, isn't it.

 

[Jamie]

Don't worry about strengthening at this early stage. There is plenty of time for that later once you've healed. Your body only has so much energy it can devote to this recovery process and it needs to put that energy into repairing itself - not fighting inflammation from swelling and pain. Right now the important thing is to allow yourself the time your body is telling you it needs to heal. You have good ROM. All that's needed right now since you still have some pain and swelling is to do walking around your house for 5 or 10 minutes every hour or two along with some gentle bends and stretches to keep the joint mobile. Your goal right now should be to be able to walk with an aid with no limping and no pain. Once you reach that milestone, you can start working on strength, longer walks, and add additional exercises gradually if you like. An exercise bike is a also a good exercise as long as you don't overdo it and use no resistance for now.

 

[Reader525]

Thank you!!!! I'm going to do what you said, I'll let you know how it goes. Thank you, @Jamie , you are a fantastic help. What you're doing for all of us on bonesmart.org is helping so many people.

 

[Jamie]

I appreciate your kind words. All of us here at BoneSmart know what it means to have people to talk with who completely understand how you feel and what you're going through because we've all been there, done that, and have the t-shirt! Knowing that we help our members means the world to us.

 

[Reader525]

@Jamie, I have a question. I did a lot of things around the house today and was slowed down by the aching pain in my knee. I have a friend who said she used one crutch instead of a cane for stability and as a walking aid. I decided to try it and it was pretty darn good! I'm worrying because when I looked up knee pain after TKR, everything kept saying at 6 weeks you won't need a cane or any aid anymore and that the pain is disappearing.
This is NOT the case for me. I am also worrying that if I walk into PT tomorrow with a crutch to aid me, I will get a big talk about how I need to walk on my own. My ROM is perfect, exemplary, really, so why are they making me feel so awful about my walk? It hurts, and I don't want to feel the pain, so I limp to avoid it. Is it alright to tell them to back off?

 

[beesknee]

The PTs work for you.

I am wondering what they have you do in PT? My PT mostly involves trying to increase ROM with bending stretches and you already have a better ROM then I did at 12 years old!. Very little strength exercises for me so far.

I think you are perfect candidate for Bonesmart way. ADLs at home and heal up!

 

[Jamie]

Beesknee is absolutely correct. YOU are in charge of your recovery and you know your body better than anyone.

I'm so glad you decided to give the crutch a try and it worked for you. Don't feel one ounce of guilt for using it as long as you need it. It won't be required forever, but it really is needed if it keeps you from pain and limping.

Also, try and stay away from researching on the internet to find "normal" time frames for the various stages of recovery. You and your body are unique and it will take as long as it takes. The trick is to find a good balance between exercise/activity and rest/ice/elevation each day. You want to do as much as possible to keep your joint mobile, but not so much as to cause you pain or swelling either that day or the day following. If your therapist cannot understand that and tries to belittle you when you explain what is working for you, please feel free to find a different therapist. Or take a break completely from therapy for a couple of weeks and work on your own.

So the answer to your question is that you most certainly may tell the therapist that you'd like them to back off.

 

[Reader525]

@beesknee, @Jamie, thank you! Every time I go to PT, my therapist has me do leg raises with ankle weights that I could do all day, then it's the leg press and then it's the therabands and standing leg kicks. None of this causes me any probles. They ALWAYS measure my straightening, which is perfectly flat, or 0 degrees, and bent knee, which range from 140-145. But then comes the walking which hurts. I am asked to walk in front of the mirror so we can see how I limp and to self correct. The problem is I do not like pain at all, and I will not do something 100% if it hurts, I will hold back and be tentative. It may be that I'm a big baby, but I don't think I will ever change that about myself. Discomfort is one thing, but a pain is not something I can be a hero about.
I thinkI will take me crutch tomorrow and grit my teeth and say it works for me. I'll try not to look online about the pain,I know everyone is different.

 

[Jamie]

Just be sure that when you're walking with the crutch that you practice the correct gait. That is something to have your therapist check for you and help you see what that proper gait feels like with a crutch. You want your heels to strike first, then you roll toward the ball of your foot and push off for the next step with the ball of your foot and toes. It's a fluid motion that you may have to practice for a while by doing it very slowly to get it right. But when you do learn how to do this and can practice it on your own each day with the crutch, you'll be on your way toward getting stronger and able to leave the crutch behind. If your therapist cannot do this kind of gait analysis for you, find one who can. It's that important. We also have the OneStep app available for our members at 15% off the monthly subscription rate, if you'd like to try that. We've received great feedback from our members about how it helped them normalize their gait again after surgery. It's the only app we've seen that provides a medical grade gait analysis each time you take a short walk. That way you can easily see how you're getting along. It can be used with an in-person therapist, if that's what you prefer.

I am curious, though. You say the therapist has you walk in front of a mirror without an aid so you can self correct your gait. Do these corrections work to relieve or lessen your pain? Can you ever walk without pain - either with or without a walking aid?

 

[Reader525]

@Jamie, I have not been able to walk without pain at all, either with aid or without. Again I stress that I'm very sensitive to pain, and maybe the aching and gnawing sensation wouldn't bother someone else, but they bother me. When I am in front of the mirror, I can see my leg not moving correctly, as in limping, but there is no way I can walk "normally". When I took the crutch out of the closet and tried it today, I called to my husband and said, "Look!", and walked to him. He said wow, you're almost walking completely normally and he encouraged me to use it until the pain goes away. My friend who used it successfully herself told me the PTs are against using one crutch, so be ready. I can't imagine why! I'm going to look at the OneStep App.

 

[Jamie]

The PT may be against one crutch because it can put your body off balance. Do you have a walker? Given the fact that you still have pain when using the crutch, you probably should be using a walker. It offers the best and most balanced support for you. That will enable you to walk more normally.

As a frame of reference, I never used crutches and only took a cane along as a "guard" against people when I was out (once I could walk without a limp). Instead, I used my walker around the house for 5-6 weeks, practicing my gait and working toward a good, long stride. It worked for both my knees.

Do you have pain when standing if you put weight on your operated leg? Is there any time that you are not in pain with your leg?

 

[Reader525]

@Jamie, I have no pain when I'm standing, if I balance solely on my surgical leg, I feel a twingey ache, but it's not terrible. If I attempt to do bent knee hip raises, it hurts the knee. Sitting in my recliner, with pillows on the foot rest, I can forget all about it, except for the intermittent aching which I attribute to healing pains. My most problematic pain is with walking.
I can do better if I walk so slowly it's almost laughable. I feel like the cane would be better used to hit the PT with.

 

[sistersinhim]

I am also worrying that if I walk into PT tomorrow with a crutch to aid me, I will get a big talk about how I need to walk on my own. My ROM is perfect, exemplary, really, so why are they making me feel so awful about my walk? It hurts, and I don't want to feel the pain, so I limp to avoid it. Is it alright to tell them to back off?

It sounds like you are doing great and don't even need to be going to PT. If they are making you feel bad about your walking and you know why you are limping, then you don't need them. Your husband and mirror will tell you what you need to hear without being put down.

Every time I go to PT, my therapist has me do leg raises with ankle weights that I could do all day, then it's the leg press and then it's the therabands and standing leg kicks.

No wonder you are hurting. Weights and bands are greatly frowned upon at your early stage of recovery. The general rule is to not use them until your 3-4 month of healing. Using them now is keeping your knee angry and inflamed. That's why you are having pain when walking.

You can do all you need to do to rehab your knee at home. Your ROM is beyond amazing so all you need to be doing is working on your gait. You don't need a therapist to tell you how to do that.

I agree with Jamie that you need to be using a walking aid until that pain goes away. That's all it is...an aid, something to help you get through this year-long healing.

 

[Reader525]

@sistersinhim...Thank you so much, I think it's hard for the physical therapists to understand anything beyond their protocol for building strength. It's their job and they get paid to put me through the paces, and if I walk in there with a walking aid and sore from working so hard there and at home, I might add, they have to do something! I know my quads need strengthening, and I know I tend to push myself, so hearing your sensible words give me perspective.
I honestly am so frustrated because I DO know what a correct gait is, and would naturally do it if it didn't hurt. Why are they so determined to make me walk as if I hadn't had my bones sawed and hammered last month? It's crazy to me.

 

[sistersinhim]

I completely agree with you. If they aren't helping, why go? I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I am not a lazy person! I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do. Strength training can wait until you are healed more. Doing it now just slows down that healing.

 

[kneeper]

I was still using a cane at 8 weeks--mostly for extra stability. Could I have walked without it? If I absolutely had to but it would have been more fatiguing on the knee and that sets you up for possible trips etc.
I agree with @sistersinhim that weights are too much at this stage. You have time to build strength. You can do a lot of strength building even with more gentle exercise and walking.

 

[Reader525]

@kneeper @Jamie , I went to PT yesterday and with all my dreaded about using one crutch, I was told, hooray for you! You found something thatvhelps you better than a cane. They said "it's your knee, do what's best for you, nobody else", how about that! We didn't do the one leg leg press because that hurt, we didn't do anything that hurt. I don't feel any pain or discomfort when I do leg raises with 1 1/2 lb. Weights. But I do NOT want to increase the weight until 12 weeks, because by then I think the pain will be less.

I am still trying to understand why the back of my knee hurts. I see the PA tomorrow for my checkup, and I will try to get a clear answer. I keep imaging the TKR and I can see the sawing of the tibia and fibula, the pushing of the tissues and the hammering of the patella. But where does the back of the leg come into play? I am someone who needs that kind of answer and I hope he can answer me.

Incidentally, I noticed today that if I walk ridiculously slowly, my gait isn't bad, it's just not something I can conceivably do in the real world. But I can at home, and that's where I'll practice my walk.

 

[Jamie]

There are a number of bursae around the knee (blue areas):

They can get inflamed and cause pain, so it's possible that's what's bothering you.

You say that it doesn't bother you to use the weights for exercises, but if you're still having pain, try doing your exercises for a week or two without the extra weight. Many times things can feel just fine when you're doing it, but the pain and inflammation comes in the 24-48 hours later. If your pain lessens when you don't use weights for this time, you'll know your knee is not quite ready for that level of exercise just yet. Weights are not needed in the early stages of recovery because you're healing, not strengthening.

I can appreciate that you don't want to be in anyone's way when you are walking out in public and you go slow. But, please remember that you are recovering from major surgery. You'll have the crutch with you to indicate this and you can give yourself permission to walk any way you want. It's not important that you're not at a normal pace yet. People get it and no one thinks twice about it actually.

I'm glad your therapist is working with you on a different approach.

 

[Reader525]

I just came home from seeing the PA at my surgeon's office, and I actually bumped into the surgeon in the hallway too. I had X-rays done and was told my knee looks perfect. My recovery is ahead of schedule and the only thing I have to be conscious of is my tendency to overdo. I was told not to do my PT everyday, which I had been doing and that may be why I'm a bit sore and have some swelling. The bursa behind my knee, which I can now visualize, thanks to @Jamie sending me the illustration, is where my swelling is. I need to slow the hell down.
I was told I could rub some vitamin E oil on the scar as opposed to any of the so-called scar creams. Does anyone have a better solution, or is that a good idea.
I feel encouraged, and I go back in 6 weeks for my final appointment with the surgeon himself.