TKR Right TKR 6/5

[snowleopard]

I honestly don't know how accurate it is. He looked at my knee after it had been working out on the CPM machine, and went from there. Maybe he needed to record progress, maybe it's accurate. Just don't know.

I also have a habit of using a strap or my other leg to help my surgical leg get into bed, get onto the CPM, and sometimes to start a PT motion. If I don't, I get a strong yanking sensation above my kneecap that feels more like a jolt than a smooth muscle engagement. Whereas when I use the strap, I can make it move more smoothly, and still engage that muscle, but the movement goes further up the muscle instead of just that kneecap yank.

Every time he sees me do that, he says, "I want you to stop doing that." But it feels like the right thing to do. I don't know if that's natural caution speaking, or just inherent lack of discipline and laziness. Therein lies the quandary.

Also, some of these seem extreme. He wanted me to stand in front of the washing machine, rest my hands on it, and do the `snow-angel' side kicks. Okay for the surgical side, but then he wanted me to do it with the other leg. So my surgical leg would be supporting my not-inconsiderable weight while my sound leg is cavorting up in the air? I told him it felt like my leg would buckle if I tried that, and he agreed I shouldn't do that. Same with the standing marches. I can't see how my surgical leg is ready to support all of my weight, and dynamic weight at that, when it's just re-learning to walk.

 

[PolarBear60]

Tell him, conversationally, "I want to stop using this strap too. Please tell me, specifically, what exercises we're doing that will help me get to that point." Keep that conversation going. I will tell you that at 9.5 weeks out, for me, that pain is finally down to a three on the pain scale. My PT and I are working on getting it gone. Let him know what he's asking is too much at this point in your recovery and ask him to help you target some basics to work on to keep you moving in a positive direction.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[Celle]

Also, some of these seem extreme. He wanted me to stand in front of the washing machine, rest my hands on it, and do the `snow-angel' side kicks. Okay for the surgical side, but then he wanted me to do it with the other leg. So my surgical leg would be supporting my not-inconsiderable weight while my sound leg is cavorting up in the air? I told him it felt like my leg would buckle if I tried that, and he agreed I shouldn't do that. Same with the standing marches. I can't see how my surgical leg is ready to support all of my weight, and dynamic weight at that, when it's just re-learning to walk.

I agree with your feelings. These exercises aren't necessary yet.

 

[Celle]

I am three weeks out from my RTKR today, and am feeling a lot better. I'm still extremely lazy, would say that I spend the majority of my time in/on my bed. Yesterday I took a shower, made a trip down and up the stairs for provisions, tidied up a (very small) bit, was up to prep meals for myself, did some (not all) of my PT exercises, refreshed my ice in my cryo-cuff, was up hosting a friend who came over for about an hour, and the rest of the time I was pretty much in bed.

The exercises the PT has me doing is a set of bed exercises:

• ankle flaps
• butt squeezes
• extension stretches
• heel slides
• "snow angels", moving leg out to side without lifting off the bed to engage hip flexors
• leg lifts
• passive leg roll stretches.

OK for those, although i'd skip the snow angels.

He's also got a protocol for walking with the walker, and I've come quite a ways with that. Instead of my hunching over and throwing foot out and pointing it off to the side, the foot is tracking forward and it's a more balanced walk. I walk around the house a bit, revert to a chair when I'm tired, shuffle to the bathroom, etc. I've tried a few jaunts without it, but it's pretty pathetic, again, so I quit.
Next are some seated exercises:

• hinge kicks
• seated slides
• march in chair
• rocking chair stretches
• seated slides (bend leg back and plant it, then slide myself forward and stretch)

Not necessary yet. No kicking or marching.
Next set is theraband exercises:

• Hamstring curls
• long arc quads
• ankle pumps against resistance

Not necessary yet.
Then the standing ones:

• Marching in place
• more snow angels
• mini-squats
• toe raises

No. It's much too soon for these.
I'm supposed to aim for 10 each of the rep ones, and a count of ten for the resistance ones (too soon for any resistance exercises). He encourages me to get through all of these at least once a day, and then start the list over at the beginning if I want to.

I've put my comments in red, in your post that I copied, above.
All you really need to be doing at this stage is Heel slides and how to do them
and some walking around the house.

My surgeon has a protocol whereby you don't have any formal PT for the first 4 weeks after surgery. His patients all do very well and he has a very low incidence of doing MUAs.

I'd say that your PT's schedule is a case of "too much, too soon". Your knee needs to time to heal before you start any strength training.

 

[KarriB]

That's a lot of exercises.
What type of job will you be going back to?

 

[snowleopard]

And the winnah is . . . . ding-ding-ding: sore and swollen! Awakened tired and groping for a pillow to elevate on before I woke all the way up. Even my back muscles are sore from forcing the leg lift. I realized why it was easier to do the leg-lifts in the hospital: I had a trapeze and I could isolate the muscles more easily with that.

Celle, I think I love your surgeon.

There's almost a "we must make the naughty patient comply" mentality in PT. I read an article yesterday about how to force a passive stretch without taking too much of the PT's time and energy. Setting up these systems ("Be sure to unplug the hydraulics once it's arranged so that no one accidentally steps on the button." Wonder how they figured that out?) and describing the patient's tolerance for pain as a limiting factor. The comments sections were full of the same kind of questions asked here on the forum all the time, with patients offering advice and encouragement to one another, really groping in the dark with some of it. Heartbreaking. I remember a PT trying to force the bend in my knee after I got out of the cast last year, and laying there with a towel over my face crying. And guess what? Didn't do a lick of good. If only someone had listened then and x-rayed my knee. I told them something was wrong with it.

Karri, I do desk work in an individual office, so I can ice and elevate (and will if it's easy, won't if it's a struggle and I get busy and distracted--I know me). Computer, phone. Some walking around a good sized office building, but I will limit that as much as possible. Our schedules are somewhat flexible. Some days blocked--everyone must be there--and some days we select on our own choice, just have to be there on the blocked days and hit our total quota for the year. Our new year starts July 1, and I usually like to start getting days in early so that I can work a four-day week when possible in the winter. (Our winters here are cold and icy and long and dark, so it's nice to have things be a little easier then, and also less intense.) I don't have to be back until mid-August, but each day I work in the summer before that represents a four-day work week, so I was planning on working three-day weeks in July and half of August.

When I get cleared for swimming, there's a pool a mile or so from work that is compatible with my hours. I look forward to getting in the water.

So. Today I do the mild bed exercises, some walking, maybe a trip downstairs if I feel better later. It's R&R day (rest and recuperation) today, but this time guilt-free. Maybe some upper body/ab work.

 

[KarriB]

Before my TKR I thought I would have no trouble going back to work and onky asked for 2 months, my dr. suggested 3 months. Well, after complications I ended up going back to teaching part time, 3 months after my TKR. My stamina wouldn't allow me to go back full time, so 6 weeks of just mornings helped to build my stamina. There are some here who have gone back to desk jobs after a few weeks, but still elevate and ice throughout the day.

 

[jbrooklyn]

There's almost a "we must make the naughty patient comply" mentality in PT.

Snow Leopard, I totally agree. Effective p/t is hit or miss. I went for some useless p/t to see if it would help with arthritis, and I got whoever was free, and some were gentle, some were bossy, some tried to get me doing stuff that was way too painful, and then scoffed when I said it was beyond me. I started learning to set my own limits--pushing myself appropriately, but definitely came up against the 'naughty patient' attitude. Ugh! It seems like first few weeks after tkr, it's all about healing, so less is more.

Kudos @PolarBear60 for this excellent way to respond to over-ambitious p/t:

"I want to stop using this strap too. Please tell me, specifically, what exercises we're doing that will help me get to that point."

Good luck with your continued healing.

 

[Celle]

It seems like first few weeks after tkr, it's all about healing, so less is more.

That's correct! Your leg has suffered some serious surgical trauma. It's wounded, not lazy.
It needs gentle treatment and time to heal. It doesn't need "boot camp".

 

[kneeper]

Just chiming in to say I agree with Celle's recommendation on the exercises. You are just too early for some of these and some you probably don't need. On the leg lift situation--my pt told me that height is not important, just getting your leg off the bed.

 

[snowleopard]

Well this has been pretty persuasive. Kind of a lost day. Napped on and off all day, leg is still swollen. Have gone from being pretty close to straight, if not there, to having about a ten degree bend in the leg. Also when I tried to walk on it about ten minutes ago, it came too close to buckling. And this is without even completing all of those exercises listed for me. Back to icing and elevating.

Thank you very much for the feedback on this.

 

[snowleopard]

I have unvented an unvention!

unvention: noun, meaning something useful that someone already probably thought of--maybe everyone even thought of this already--and isn't exactly rocket science. But still, it's a something.

unvent: verb, meaning to think up and make an unvention.

This is for those of you who:

• are tired of elevating your knee with a pillow and then having it slide off to the side, esp in the night,
• are looking yearningly at knee pillows on Amazon and wishing you'd bought one before surgery,
• are getting a little stir crazy, but still on meds with a short attention span, and so need a project that can be completed in one minute or less using three simple ingredients that you already have on hand.

Here it is in two or three or four simple steps:

1. I took two pillows--it took a little experimenting here to find the best ones for the job. I settled on my oldest, squishiest, most broken-down pillows for this job.
2. I worked them down side-by-side the long way into a pillow cover with a zipper on it. (Caution: do not attempt this step while being supervised by a bored cat.) A simple pillow case would probably also do the trick, but I wanted a one-and-done project, thus the zipper. The two side-by-side pillows make a channel in the center the long way.
3. I then zipped the cover.
4. I placed it under my leg, and said, "Ahhhhhh . . . . ' I didn't realize that I was using muscles to hold my leg on the elevating pillow until I felt what it felt like to have it cradled and supported. Bliss on a budget.

Hope someone else finds this useful.

 

[Josephine]

I'm upstairs, kitchen is downstairs (hillside house, so backdoor is at ground level upstairs, front door is at ground level downstairs), and I'm not ready for the stairs.

You couldn't do stairs at two weeks? After my first knee I did stairs at 9 days and after the second, after 4 days - and I was 'home alone'! The only caution is to do them slowly and carefully.

yesterday my PT told me that the time could come when he would have to sit on my leg to get the extension, and force the flexion. It's not going to happen. There's almost a "we must make the naughty patient comply" mentality in PT.

Couldn't have put it better myself. And if anyone ever tried to do anything like that to me, they'd get the other foot straight up their jacksie! And I'm not kidding!

He said that the critical thing here is to get the muscles firing again, to remember to do their job.

I have absolutely no idea where these people get these crazy ideas from! It always sounds like they think the muscles have been switched off or something which is so far from the truth. The only thing 'wrong' with your muscles is that they have just been subjected to the trauma of surgery and just need time and lots of TLC to recover which they will do in time.

On the days where I do less, I'm not as racked out. But I still see gains

I was astonished to see your list of exercises at only 3 weeks out. It's like the PT thinks the 'naughty patient' is the muscles which must be beaten into submission before they switch off completely like a out of charge battery! I have never subscribed to this bizarre notion and proved it with both my knees by doing absolutely no exercising at all ! It's true! The links to my recovery threads are in my signature - I do recommened you take a look.

I'm also facing the possibility (but not necessity) of going back to work next week. Wondering about the wisdom of that, or whether I'd be wiser to wait another week or two and focus more on my recovery

Back to work at 4 weeks? Good grief! I've always recommended return to work at 12 weeks and even then using a Phased return to work. This might seem excessive but don't forget the Energy Drain and that overall healing really does take that long! I know long periods of sickness absence is now moving out of favour with modern management but 4 weeks is just plain ridiculous! Do pitch for as much as you can get. It's always better to ask for more then then, if things get better more quickly, be able to ring up and say you can come back earlier than you thought than the other way around, don't you think?

 

[kneeper]

When you try a leg lift, are you doing a quad set first, then lifting?

Re: returning to work. Remember that desk work is also difficult even if you *think* you'll be elevating a lot.
Not to mention the energy drain. If you absolutely have to go back to work before 8 weeks, definitely try for very limited hours at first. There is no way I could have done even partial days at 4 weeks. Even people who have gone back at 8 weeks say it's tough. I had the luxury of 12 weeks off and I was still pooped out at the end of the day.

 

[KarriB]

I went back at 12 weeks to half days. Three days a week I went to PT in the afternoons. I was exhausted and often came home to ice and elevate while napping. Everyone is different, but be prepared as everything takes longer.

 

[Raffs]

Thank you so much for the pillow tip! My surgery is tomorrow so I'm preparing and nesting today. I found two very old pillows which, quite frankly, should have been thrown away a long time ago but they are perfect for this. I've put them into an ordinary pillow case and it has worked a treat. Looking forward to trying it out on the operated leg when I get home. Thanks again.

 

[snowleopard]

Raffs, you're welcome. Thanks for posting; I'm happy to hear that you found this tip, and I hope you find it helpful after your homecoming. I awakened this morning with my leg still cradled and resting in the groove. Best to you in your surgery and recovery.

Your cat's gorgeous, btw. The cat that lives here is a tortoiseshell too, but a little darker. Same big, intelligent green eyes though.

Josephine, I was in agreement with the PT's recommendation to wait on the stairs. My energy level was very low initially, and my staircase has steep stairs without much depth. The railing doesn't go all the way to the top, and at the bottom, the wall supporting the railing stops three steps from the bottom, and the steps fan out in a twist. I've fallen on those steps in better days, so am very cautious. I went down Saturday when I was not feeling very well, and before I went down, an image flashed through my brain of my prepping for a spelunking expedition: helmet, goggles, rope, haversack, crampons.

The weekend was pretty much lost to icing, elevating, and napping. No further exercises. PT is scheduled to come today, and I think I'm going to tell him no exercises, just get me driving the car again. I'm reconsidering my intentions for going back to work this week. I think I'll need longer.

 

[snowleopard]

PT was scheduled to come out today, and I told him I thought not, that I needed another recovery day. I was in still in a fair amount of discomfort this morning, napped part of the day awake, and finally feel that I have my extension back, but my flexion doesn't look like it's back where it was. However, I can walk better today (buckled a few times over the weekend, first time for that).

I did some balletic kinds of stretches and moves just now, feel like my posture is improving, was able to straighten my leg out and flip it up behind me (while balanced on the walker). That feels more like what my body wants to do than the calisthenics. That tight knee-band feels a tiny bit looser.

I have a court date coming up later this week that will take several hours (divorce stuff). Asked my lawyer if I will be able to elevate, and she said yes. It will be my first time driving since the surgery as well. I made arrangements to meet her at her office and get transportation over to the courthouse, as it has the typical public-building park-far-away arrangement. Like the surgery, not looking forward to it, but looking forward to having it behind me. Another hurdle.

Weight is peeling off. I gained 10 pounds while in the hospital (fluid weight, I'm sure, in response to all the stuff being pumped into me, and the trauma of surgery). Came home and got on the scale and saw a number higher than I've ever seen--not happy-making. That dropped off, and my weight has continued to drop. I'm down about 25 pounds since that high. I'm concerned that some of that might be loss of muscle, but it doesn't feel that way. I'm eating better, and eating less, and under much less stress. I think that some of the weight I was carrying around was not fat but rather fluids in response to the inflammation from the arthritic knee. I haven't seen any written confirmation to support that idea, but it's just a hunch. Anyway, I'll be thrilled if this keeps ups. New knee, divorce behind me, and weight loss: that sounds like a prescription for a better life.

 

[snowleopard]

Arrrggghhh! Two steps forward, one splat back.

PT came out, told him my energy level was very low and my ROM wasn't back, so better not to work on exercises. He was good with that. Went outside on crutch to try to work on driving, and I caught my heel on the edge of the deck. Instead of using the force of my swing to move my leg forward, it all went to flexing the knee quite forcefully.

Thankfully, he was right there and caught me and I did not go down, but it hurt like bloody blue blazes! Sat for awhile to let the pain and nausea and dizziness pass, and went back inside and thus endeth the driving session. He asked if I had been driving and caught my heel on something, twanged my knee like that, how would that effect my driving, and I said I would not able to safely drive or even stop the car. I'm not ready to be behind the wheel. Called work, told them that I needed longer to recuperate, not cleared for driving yet. No problem.

It means I have to find transportation to the dentist's office tomorrow, and to the courthouse on Thursday. And that I'm not a superhero, and I am not ready to do the things I felt I needed to do. Ventrantventrant. And my leg hurts still. Came in, took a pain pill, slapped on the ice, and went into this shivering-shakes state for a little while (had a weird taste in my mouth, too. What's that about?) and then went to sleep for the rest of the afternoon. Let is still sore, in these come-and-go twinges that get my full attention. Mercifully brief.

So went my day.

 

[PolarBear60]

Ggrrrr. How frustrating. It will get better.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005