TKR ROM issues

[amber777]

How do you direct a comment at someone? I see these @ thingies but do not know how to use it.

Just type the @ and then the persons name that you want it directed too like @skiforever

 

[Jaycey]

Tagging other members and answering tags

 

[Jockette]

The PT focus is to stretch these tight muscles and the tight hip joint to make them relax and enable movement.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more.

I want to be able to walk and bike; that means 0 to 115 degrees, so I have to improve ROM. I would love to experience some of your advanced bodywork. I have now tried chiropractic, massage therapy, physical therapy, and nothing (my own exercises under my control). It seems nothing has worked the best.

Your ROM will improve but it takes time.

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]

I just want a slower pace, one that does not kill ROM progress. I want to be able to walk and bike; that means 0 to 115 degrees, so I have to improve ROM.

See if reading current member, JusticeRider’s, post at ten months post op makes an impression. I find it inspirational and her expectations realistic. Our bodies will not heal from the controlled trauma of joint replacement any faster by working harder. As you’ve discovered, it’s stolen time / days from you as you’ve had to recuperate from over activity.

Justice Rider at 10 months post op said -
“I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked.”

 

[skiforever]

PT certainly does not facilitate taking one's time healing. A lack of ROM before surgery will certainly cause a slower recovery. My second knee had little more than 110 before surgery, so that is going to take quite a while to improve.

PT for 3 months was unable to get my first knee ROM to 0 degrees or to 120, but I stopped doing anything and noticed that at a year it was straight and bending well.

I think the scar tissue issue that surgeons, PA's, and PT's worry about is mostly for not being able to bend as much as 90 degrees, fortunately not my current problem.

 

[benne68]

PT for 3 months was unable to get my first knee ROM to 0 degrees or to 120, but I stopped doing anything and noticed that at a year it was straight and bending well.

Many of us have experienced this -- in fact, lots of members have reported that their range of motion continued to improve well into their second year. It's certainly been the case for me.

Stand your ground with PT! You're not a novice at TKR recovery!

 

[skiforever]

Stand your ground with PT! You're not a novice at TKR recovery!

Since every knee is different I am fairly ignorant about this one causing "rough recovery". My physical therapist defines pain as something above level 1 or 2. I rarely have that and have been backing off at the slightest bit of pain, thinking I have over done it if I feel anything.

My PT encourages me to do more movement every day and work through very low level pain. "Work through" means, for example, raise the seat on the stationary bike a bit and continue to pedal. The knee settles down and starts to feel good within minutes. The claim is that this will not hurt me.

 

[trinket]

Here are my modified (=manageable) home PT Exercises to be done 3x/day or until the target range of motion for the day is met.

Bending
* Seated Heel Slide 20 reps
* Stationary Upright Bike

Straightening
* Prone Knee Extension Stretch on bed hold 1.5 min
* Bridging hold as long as possible

I know some people will disagree, but I found GENTLE heel slides to be most beneficial in improving my flexion. I did mine lying down, left leg bent with foot tilted up and used a yoga strap to gently pull my heel towards my butt. I had my foot on a plastic bag to allow it to slide easily. I did them only until I could feel a little pull, but my ROM of motion improved a bit with each slide. I needed the yoga strap to assist my knee because my leg was't strong enough to slide under my own strength.

I wasn't able bridge, I found that it hurt my knee, but the prone knee extension also helped me, although I don't think I ever held it for 1.5 minutes.

Good luck. You're very active for six weeks. Very impressive.

 

[mendogal]

This is re working through pain at level 1 or 2 - IF that's on a 0 - 10 scale, I agree. I characterize that as " mild discomfort" not pain.

Of course we are all different both in perceiving and in describing pain! Personally 3/10 is like "ok, mild pain, back off what I am doing; I don't need meds and can easily distract myself." 4/10 is "hmmm rest and ice *now* plus distract" and 5/10 is where I start to consider extra meds.

So yes for me 1 or 2 out of 10 is something I may try to relax into. Especially when walking. I find walking within my current tolerance to be remarkably therapeutic.

 

[skiforever]

@mendogal
Thanks! Yes, it is 1-2 out of 10. I like the idea of doing more things. There is probably no substitute for real activity rather than sitting or laying around trying to rest or worse, trying to bend and straighten, so I hope this opens up the chance to hike, bike, swim and dive, unlike my highly restricted past world.

 

[skiforever]

@trinket
My wish list for activities is much longer than my can do list.

The date of your latest surgery is in the future: Left TKR November 6, 2023

 

[mendogal]

@mendogal
Thanks! Yes, it is 1-2 out of 10. I like the idea of doing more things. There is probably no substitute for real activity rather than sitting or laying around trying to rest or worse, trying to bend and straighten, so I hope this opens up the chance to hike, bike, swim and dive, unlike my highly restricted past world.

LOL My "real activity" at 6 weeks is... cooking dinner three or four days a week, sweeping one room, scooping cat litter, watering plants, a few minutes of weeding... and happy to be able to do them!!! My walking limit with a walking stick is under a half mile but am hoping to achieve a half mile sometime next week.
My very long term goals are to walk five miles (it's been over 20 years....) and resume tai chi and a form of very slow weight training I actually enjoy.

 

[skiforever]

Ureka! I went for a walk yesterday evening (down and up a hill with 160 feet vertical on a bike path) and found that my leg straightened out at bedtime. I could straighten it with and without an ankle weight on it. I could press it into the mattress in bed. The muscles decided to work correctly. Wow! Unbelievable!

@mendogal
Very cool that you are doing many things! I cooked dinner last night for the first time.
One of my goals is to hike 5 miles or more.
Incidentally I ditched the walking stick because it was causing me to have an uneven gait. These new knees easily support our weight and can be used like a regular one, but our minds interfere with that. I am working on an even gait, focusing really hard on it, and find a stick is distracting.

 

[Layla]

I am working on an even gait, focusing really hard on it, and find a stick is distracting.

Here’s a tip -
Try heel-toe walking.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Here is a visual -

 

[WFD]

Incidentally I ditched the walking stick because it was causing me to have an uneven gait.

I find that the assymmetry of one cane does this to me as well. Do you have access to two trekking poles? Old ski poles work well and you can often find them at yard sales etc. for cheap. Using two poles is symmetric and I find easier than one cane, when I'm able to walk that is.

 

[skiforever]

@Layla
The hard part is lifting the operated foot from behind with a natural bend in the knee. For me I also have to focus on getting it straight on heel strike.

 

[skiforever]

How easy to get discouraged. I have made no progress on range of motion for over a month.

 

[benne68]

I have made no progress on range of motion for over a month.

Please don't get discouraged! You aren't even two months into this year-long recovery.

I know it's easy to get frustrated -- especially when everyone is focusing on our ROM numbers. What helped me helped me get through those early months was shifting my focus to how I was functioning. Once a week or so, I would list of all the things -- even the little ones -- that I was able to do now that I hadn't been able to do the week before -- whether it was the distance I walked, the number of steps I climbed, making dinner, doing a load of laundry, or other activities of daily living.

I also had a list of the things I was looking forward to being able to do again in the future. As items moved from one list to the other, I saw real progress and it helped me stay positive. Why not give it a try?

You've been on this journey before, so you know you will reach your destination. Just give it time.

 

[WFD]

I have made no progress on range of motion for over a month.

Many people seem to have a month long plateau around this time in their recovery. They keep at it and start making progress again eventually.

 

[skiforever]

How do you get going in the morning? My leg is so stiff I am unable to walk for a couple hours.