TKR ROM issues

[skiforever]

Knee TKA June 8. Rough recovery.

 

[Jockette]

@skiforever Welcome to Bonesmart! Please tell us a bit more about your situation so we can help you with your concerns. Hopefully, our recovery guidelines will help you. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

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Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[benne68]

Welcome @skiforever Glad you found us!

Recovering from knee replacement is indeed a rough journey. We've all been through it, and are here to help! Let us know what questions or concerns.you have ... or feel free just to vent about the experience.

 

[skiforever]

By "Rough Recovery" I mean that this, my second knee, is not at all like my first, which went very easily. I have more pain and far less ROM.

I found the article at Forums > REFERENCE LIBRARY > Library > LIBRARY General Topics > Exercises, therapy, walking aids >
BoneSmart philosophy for sensible post op therapy
to be interesting because I am finding I am getting worse (more pain and less ROM) with outpatient PT and the many requested exercises (lots on the not good list).

I am considering stopping PT, but I had reached a plateau in trying to recover on my own, so the decision is not easy.

Timeline: Home PT first 2 weeks, no PT but continuing home PT exercises next 2 weeks, outpatient PT with extensive home exercises the latest 2 weeks.

 

[LD of Michigan]

Welcome to Bonesmart! I too have had two TKR's the second one easier in a way, yet odd pain down my left leg tibia or that smaller out bone is called was a remains a problem on deep compression (like cylcing, and certain positioning). I like my PT as in a way it pushed me farther than I would have gone in some ways and I could see measured results. Yet I over did it at times, but could never blame that on my PT.

 

[mendogal]

By "Rough Recovery" I mean that this, my second knee, is not at all like my first, which went very easily. I have more pain and far less ROM.

I found the article at Forums > REFERENCE LIBRARY > Library > LIBRARY General Topics > Exercises, therapy, walking aids >
BoneSmart philosophy for sensible post op therapy
to be interesting because I am finding I am getting worse (more pain and less ROM) with outpatient PT and the many requested exercises (lots on the not good list).

I am considering stopping PT, but I had reached a plateau in trying to recover on my own, so the decision is not easy.

Timeline: Home PT first 2 weeks, no PT but continuing home PT exercises next 2 weeks, outpatient PT with extensive home exercises the latest 2 weeks.

Many of us find that our PT regimen is way too severe to be productive. It's not a binary all-or-nothing!
You can see your PT less often and/or ask them to back off ...
AND you can decide what is *your* best simple at home regimen, completely omitting what actually hurts and - what I find helped - instead of doing all my chosen exercises at once, I do a few minutes at a time throughout the day.

 

[Tentcamper]

@skiforever I find the right PT is invaluable. My ROM is 60 (yikes!) and PT is the only thing helping me gain more motion. I felt I needed some guidance given how little bend I have. BUT I've told them to back off when I felt the exercise was hurting rather than helping. It's a tough balance.

 

[Jockette]

I am finding I am getting worse (more pain and less ROM) with outpatient PT and the many requested exercises (lots on the not good list).

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

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.

 

[Layla]

outpatient PT with extensive home exercises the latest 2 weeks.

Wondering what this means exactly. Only asking because I am wondering if you're doing too many exercises, and reps, too often and it is unnecessary? Possibly some of the exercises are not really beneficial which you may hear through the personal experience of some of the members here.

Please refrain from engaging in movement that causes discomfort or pain. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time. At less than seven weeks post op, you're very early into a recovery process that can last a full year for many and even longer for some.
Best wishes as you continue healing!

 

[skiforever]

At 6 weeks out I have decided to stop the PT exercises (listed in later post) except for maybe a couple of them from the original Home PT that I thought had value and can actually be completed in a day. I will accept massage and a few things from outpatient PT, but no more trying for better numbers.
My daily activity list would be different than most, dog walking, hiking, biking, kayaking, paddle-boarding, and swimming with fins, plus sometimes carrying the equipment to the car and to the water and back. These things all require leg movement and are far more fun than sitting or laying around doing PT exercises.

 

[Layla]

Great news!
We often remind members that engaging in the activities of daily living is therapy in itself. With all of the physical activity you engage in, which by the way is amazing, I can't imagine why you'd need PT.
Enjoy the rest of Summer...something tells me you will!
@skiforever

 

[mendogal]

@skiforever ...just want to say... You totally rock!

 

[skiforever]

This is the list of the "extensive" home PT Exercises

Stationary Upright Bike as directed
Supine Heel Slide With Strap 20 reps 3+x/day
Seated Heel Slide 20 reps 3+x/day
Quad Set In Long Sitting With Towel 10 sets 3x/day
Straight Leg Raise (SLR) 3 sets of 10-15 reps 3-4x/week
Clamshells 3 sets of 15+ reps 3-4x/week
Prone Quad Stretch With Strap 2-3 sets 2-3x/day
Seated Hamstring Stretch (Left) hold 20-30 sec 2-3 sets 3+x/day
Seated Figure 4 Stretch hold 30 sec 2-3 sets 2-3x/day
Prone Knee Extension Stretch With Towel hold 1.5 min 3 sets 2-3x/day
Supine Butterfly hold 30 sec 2-3 sets 2x/day
Single Leg Balance hold 10-30 sec 3 sets 2-3x/day
TKE With Ball At Wall hold 10 sec 10 sets 1+x/day

 

[Layla]

I don't understand the need for any of those exercises at this point since you seem more active than the average person. I can see maybe the exercise bike for fitness, if you enjoy it, and single leg balance, only because balance can be an issue as we age, but the rest of them don't really seem necessary at this point especially given the reps and number of times per day suggestion. I'd kick em to the curb. Just My Opinion.
@skiforever

 

[mendogal]

@skiforever ... Writing as a retired RN and longtime martial artist who normally nowadays does weight training and tai chi....
This list is too much and counterproductive! My specific thoughts:
-Rule of thumb on strengthening exercises is to have a full day off to allow muscle to remodel.
-There is no scientific physiological basis for "three sets of any number repetitions" with brief rests in between... I am not going into a detailed explanation of different types of muscle fibers... suffice it to say you will get just as much benefit from doing a single set of any number of repetitions until the target muscle is feeling fatigued. Take the next day off.
-I agree with the Bonesmart philosophy against using straps or towels to overstretch healing soft tissue. Stay within your range of motion initially, then simply stretch ever so slightly - not to pain, just to a feeling of slight tension - and deep breathe into that light stretch. Repeated a few times daily it will make a difference.
-Clamshells rock for ensuring functional glutes; whether the goal is good gait, reducing falls, or resuming athletic activities, doing one slow set until the glutes are trembling a couple of times a week can be part of a forever regimen.

 

[EalingGran]

Seems like a lot of very boring repetion and early for using straps. Agree clams are good for glutes though.
Have a look at my pilates teachers free YouTube glutes videos ( Google Katja pilates). Definitely more varied and not damaging.

 

[sistersinhim]

Some people have a problem with doing clamshells at your early stage in recovery. Be very careful with them and check out your knee's reaction. Remember, going slow with everything is much better than going gung-ho. The tortoise won the race!

 

[mendogal]

Some people have a problem with doing clamshells at your early stage in recovery. Be very careful with them and check out your knee's reaction. Remember, going slow with everything is much better than going gung-ho. The tortoise won the race!

I agree; I was doing them after about three and a half months out from my first TKA and haven't resumed doing them yet.

 

[Layla]

We often discourage Clamshells early on because apparently they can be hard on the IT Band. I never did them because I was cautioned to avoid them, so I really can't speak to it personally.

 

[skiforever]

What a fun day. No PT exercises, but I walked to the lake on the trail and back on the road (1.7 miles), went paddle-boarding into a head wind (good balance and leg torque work), rode my electric bike a couple times to check wind/water conditions, and went kayaking into a strong headwind (upper body work). I noticed that putting on hiking shoes is the figure 4 exercise, biking outside requires the same flexion as the stationary bike, and paddle-boarding works everything in the leg.