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TKR Rich13hvr recovery

Rich13hvr

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Good afternoon

This is a great site and It's been really informative reading some of the articles and others' experiences.

I had my total knee replacement on 5th January, so it's still early days form me. The procedure appeared to go we'll and I hit all of PT expectations and was able to head home after 4 days.

However after a couple of days my quadricep became very painful, stopping me from bending my leg sufficiently to complete my bending exercises properly and it has got tighter over the next couple of days. This "dead leg" probably came about because of the tourniquet during the op.

I've still tried to do extension exercises and weight bearing, but my knee is now swollen as well. I think I may have pushed myself too hard.

I am concerned about missing a few days exercises because of the emphasis place upon these, but I can hardly bend my leg at all present. The treatment for a dead leg is initially full rest and RICE....the opposite of what I'm attempting to do.

I know this is not a major issue and I'm sure others would have been through the same situation. It would be great to find how how they dealt with it
 

Roy Gardiner

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:welome: to BoneSmart

There isn't anything to deal with, IMO. Just relax, do gentle mobility movements or stretches, that's it. Time is the healer.


Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access these pages on the website

The Recovery articles:

There are also some cautionary articles here


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

sistersinhim

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I am concerned about missing a few days exercises because of the emphasis place upon these, but I can hardly bend my leg at all present. The treatment for a dead leg is initially full rest and RICE....the opposite of what I'm attempting to do.
Welcome to Bonesmart! Missing a few days of exercise is actually very good for your knee. All it needs in these early days is your ADL, (activities of daily living). These are exercises in themselves. What is hindering your ROM is your swelling. Getting that swelling down by elevating and icing will help to bring that swelling down. When that comes down, the ROM will improve. But, this doesn't happen overnight. It takes time. The average total healing time for a TKR is a year. Your knee is a newborn infant and needs to be treated with TLC, just like you would a real baby. You can add gentle heel slides to your ADL to help loosen your knee up a bit. But, don't go to pain. That just causes more inflammation and swelling, defeating their purpose. Listen and obey your knee and you'll be fine.

Which knee did you have replaced? I will add that, along with your surgical date, to your signature.
 

sistersinhim

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Will remember when I'm washing dishes and picking up about the house. Useful all towards being active, healing and restoration!
Yes, maam. All those types of things are exercise. Even brushing your teeth and taking a bath. All that type of stuff are using your knee. That's all I did to rehab my knee. Never once went to PT after all 11 knee surgeries. I learned early on that all I had to do was to use my knee as God created it to be used and it'd come right back to where I needed it to be!
 
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Rich13hvr

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Thanks. It's nice to read a bit of realism.

I phoned the PT today explaining my concerns. All I received back is "it's essential that you keep pushing your exercises"....wich was very deflating.

It was my left knee.
 

Jockette

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Just because your PT believes that doesn’t mean you have to agree. There are some PTs and surgeons that agree with the Bonesmart approach to recovery. Others do not. This means there isn’t “only one right way” to do this recovery.

Use common sense. Give your knee mobility. But let it heal before you stress it further with exercises. The best “exercises” are “natural ones” like walking around the house, sitting down in a chair, getting up after a while, going up some steps, on your way to another area, etc. We call these ADLs/Activities of Daily Living. There is no need for a long list of reps of exercises that are too painful for you to do.


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
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Rich13hvr

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Why is there an obsession about trying get back this ROM so quickly, which creates pressure and stress on the patient.......which surely can't be good
 

Jockette

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That is the 60 million dollar question! I’d like to know that, also. All I do know is that we have members who have used only their ADLs as their rehab, and came out fine. Here’s my favorite:


This is what @TortiTabby experienced:
Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. :happydance:
 

Jockette

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My ROM continued to improve after my one year anniversary and after my second year anniversary.

I am almost 3 years post op (in March) My recovery has been a bit slower than most. But when I look at what I can do well now, that I couldn’t even towards the end of my first year, I get mad to think that we are pressured to recover Right Away! It doesn’t always happen that way. It truly does take time, and the amount of time varies for all of us.

Just get on with your life, as you are able. Get back to doing the things you want to do. Take things carefully and slowly the first few months. Try something, if it causes pain and swelling, back off for a bit, and a week or 2 (or 3) try it again. Always be mindful of your knee’s reaction to activity.

I love to quote Josephine, our Nurse Director, who said, “Allow your knee the privilege of sorting itself out.” It will, if you don’t push it to do more than it’s able, at each stage.
 

InkedMarie

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Call some other PT offices and ask what they do for physical therapy. I did phone “interviews” and found a therapist who agrees with the Bonesmart way.
 
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Yes, the main thing that is keeping me going to my PT is the extension stuffs she is doing that seems to need a second person to help me. Though I'm about to explore more of what I can do on my own per that! There are links here I've noted. Seeing my surgeon today...
Will remember when I'm washing dishes and picking up about the house. Useful all towards being active, healing and restoration!
Yes, maam. All those types of things are exercise. Even brushing your teeth and taking a bath. All that type of stuff are using your knee. That's all I did to rehab my knee. Never once went to PT after all 11 knee surgeries. I learned early on that all I had to do was to use my knee as God created it to be used and it'd come right back to where I needed it to be!
 
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Murphsouth

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You're early on in the recovery process but after you get over the rough part (stitches, etc.), follow the PT religiously to get your range of motion back. That's critical before strengthening your leg.
 

sistersinhim

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Why is there an obsession about trying get back this ROM so quickly, which creates pressure and stress on the patient.......which surely can't be good
I don't know, but it does more harm than good. Stress actually slows down healing. The calmer we can stay, the better our overall health is.

It has been proven over and over again that, for the majority of people, a gentle PT appointment causes fewer problems with less inflammation, leading to less pain and swelling and better ROM. We all need to just take the time our body needs to heal itself and stop worrying about it.

Or you can take people like me who just let their ADL be their PT and had a successful recovery without the stress of formal PT.
 
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Rich13hvr

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Why is there an obsession about trying get back this ROM so quickly, which creates pressure and stress on the patient.......which surely can't be good
I don't know, but it does more harm than good. Stress actually slows down healing. The calmer we can stay, the better our overall health is.

It has been proven over and over again that, for the majority of people, a gentle PT appointment causes fewer problems with less inflammation, leading to less pain and swelling and better ROM. We all need to just take the time our body needs to heal itself and stop worrying about it.

Or you can take people like me who just let their ADL be their PT and had a successful recovery without the stress of formal PT.
How comes you were confident enough to go down this route, when all of the "people in the know" adviced you otherwise. And what was their response when you told them your plans?
 
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Rich13hvr

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10 days after my op.
I still have a lot of swelling around my knee, despite upping my elevation and compression and icing. Even the static exercises are painful.
And my bruised thigh will not allow me flex my knee more than about 20%.
 

Rockgirl4

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@Rich13hvr It all depends on who you're calling "the people in the know!" :) My TKR surgeon was of the Bonesmart philosophy, and I know 2 PTs who are more Bonesmart-ish than most. It just took me awhile to come across them. :)

I was confident enough to NOT let my PT rush my range of motion because I had been there and tried that with a previous massive knee surgery in 2015. I ended up with Arthrofibrosis 3 yrs before my TKR because I was forced to do aggressive PT for weeks by my surgeon and PT staff (from not knowing any better) following that big procedure. I followed every instruction, documented my CPM usage, documented my exercises in an Excel spreadsheet, etc. I was the poster-child of recovery, just like after all of my other knee and ankle surgeries.:wow: Unfortunately, the only thing I got from all of that bending and PT was a scar tissue removal surgery and an MUA 8 days after that. Then there was even more forced bending (and screaming, crying, begging!!) for 2 weeks. There was so much forcing of my knee in those 2 weeks that the stitches ruptured. :hissy::censored::no-fin:

Fast forward to meeting my new surgeon--the one doing my TKR. He flat out said NO ONE was to force my knee to bend or straighten, and my previous nightmare recovery was a perfect example of hot, inflamed tissues sticking together, actually creating adhesions because of doing too much and bending way too much. When he got inside my knee for the TKR, he spent 40 minutes just cutting out MORE scar tissue from that awful rehab described above----then he did the TKR. He did not want more scar tissue being created after the TKR because it can push/pull (?) on the new implant.

I sought him out and actually valued his opinion because he's a knee/hip reconstruction and revision specialist who has seen it ALL. He made sure my new PT did it the Bonesmart way, so as to prevent another scarring/adhesion nightmare. He said there needs to be an entire overhaul of PT protocols following TKR because they are outdated. Too many PTs are sticking to the 20-yr old protocol of "no pain, no gain" yet modern research is proving "less is often and usually better."

So for me, a prior bad experience helped me find a different surgeon who would listen to MY knee and MY body. I'm a super athletic person who has never been a lazy patient in her life....but I rebound swell horribly if I do too much after knee surgery. It's not an excuse, just a sad fact. I've proven it time and again over 11 knee surgeries in 20 yrs, some major and some minor. Thus I prefer to work with a surgeon and PT who will work WITH me rather than with a set of "one size fits all" instructions. I've been called me a liar and lazy by 2-3 PTs in the last 20 yrs....recovery is hard enough without that baggage added in. Especially when I know the truth.:xmark:

---Lisa
 
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sistersinhim

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How comes you were confident enough to go down this route, when all of the "people in the know" adviced you otherwise. And what was their response when you told them your plans?
The up-to-date OSs and PTs are 'in the know' that the gentler way is the better way. I have had 11 knee surgeries and never took PT. I didn't discuss this with my surgeons, just didn't go. They were always happy with my outcomes. When home PT called, I refused home PT after all my surgeries. I recovered using common sense. The only problem I had was after my first kneecap remover. The in-hospital PT forced my knee to bend causing bleeding. My OS was furious and had to drain my knee of all the blood. No PT has touched me since then and that was back in 1991.

Many people enjoy their gentle exercises with PT and have good results with them. I do fine without.
 

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