TKR ROM issues

[skiforever]

@Jockette
If I understand what you are saying, they must have done more carpentry on me than anyone else to give me the tightest muscles my therapist had ever seen. I doubt it is just the carpentry that determines the tightness. My first knee did not have the tightness and was done by the same doctor. My husband also had 2 done without the tightness. I suspect it is neurological but cannot figure out the details.

 

[sistersinhim]

Internal swelling can also affect your extension. Have you tried to ice the back of your knee along with the front? Another thing I did was to stand on the edge of a step and slowly lower my heel to stretch the back of the knee. Be sure to hold on to the rails while doing this! My bend came in much faster than my extension did, but I didn't worry about it, just did little things that would cause the stretch. Like I said before, it takes time, but it does happen!

 

[skiforever]

It seems that working on ROM causes pain in my knee that lasts a long time. Today I am still hurting from working on ROM yesterday. My first TKR was not like that. I could work on ROM and when I stopped it stopped hurting. For my recent TKR I was so happy to have the pain stop at 2 months, but now I realize that was because I stopped working on ROM. How does one determine the right amount of ROM work? I think I prefer doing none of it. Then I can be pain free.

 

[sistersinhim]

There are quite a few of us that never worked on ROM at all. We did use our knee in our everyday life and the ROM just automatically came in. Even after 12 knee surgeries I never did any exercises, just did my daily activities as my knees would allow me to do without causing more inflammation, which causes pain and swelling. I am a firm believer that the natural PT is the best PT.

 

[JusticeRider]

I have needed to work on ROM daily because I had a quick to swell, slow to bend knee. I have gained steadily over the last 7 months or so. I never push until it hurts. Never. I push to where it feels tight, (before pain!) and that’s it. Pushing to pain, even a little, made my knee swell and that restricted my ROM. I think working on ROM can be helpful for some of us, as long as we don’t hurt those healing tissues. All in good time.

 

[mendogal]

@JusticeRider I agree. Too many PTs and patients think "doing ROM" means painful stretching (or flexing). That isn't ROM! ROM is moving easily, in any combination of active and/or passive movement within the current comfortable baseline to loosen things up and maybe even mobilize some of that swelling.

 

[skiforever]

If I work on ROM at all I have pain later, despite not experiencing pain at the time. The more intense the pain-free ROM work is the longer the pain that appears after the work lasts and the worse the pain is.

The message it is sending me is not to work on ROM. The world is not perfect, though. When I do not work on ROM I lose it. I had better ROM at 3 weeks than I have now at about 12 weeks.

Maybe the best answer is to do only a very tiny bit of ROM work each day. And not forget to do it!

 

[Jaycey]

When I do not work on ROM I lose it.

No, you don't lose ROM. It's there but swelling is limiting it. Try focusing on icing and elevation to get that swelling controlled. Then very gentle stretches.

 

[JusticeRider]

Maybe the best answer is to do only a very tiny bit of ROM work each day. And not forget to do it!

Yes, don’t overdo it! I agree with @Jaycey , make sure you keep icing and elevating and only do gentle ROM work that your knee won’t complain about later. Your knee will tell you when you find that sweet spot. My ROM routine for a very long time was just ADL’s throughout the day, walks, and 20 minutes on the stationary bike in the evening. The bike was for stretching purposes, not for exercise. No resistance and nice and slow. Then gradually lowering the seat as my flexion increased. As far as duration, I started at 2 min and worked up to 20 minutes over the course of a month. Yours might not need to progress that gradually. And maybe the bike isn’t what your knee responds to. Find what works for you. But that might be very little ROM work for a while. Happy healing!

 

[skiforever]

No, you don't lose ROM. It's there but swelling is limiting it.

ROM is what allows me to put on my socks and pants. Yep, it is gone.

 

[Layla]

Yep, it is gone.

Not really, it only seems that way.
While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. I understand it can be frustrating, but please give it more time.

 

[mendogal]

No, you don't lose ROM. It's there but swelling is limiting it.

ROM is what allows me to put on my socks and pants. Yep, it is gone.

As near as I can tell, you've been in the ODIC (overdo it club) it from the git-go, quickly advancing to hiking miles and miles and engaging in all kinds of athletics (to you, maybe normal activities, definitely beyond what would be prudent at 6 weeks to 3 months). I beg you, please just dial everything back, ice and elevate an hour at a time several times a day, and let your body heal.

 

[skiforever]

ice and elevate an hour at a time several times a day, and let your body heal.

I have found no help from icing or elevating at this stage of the healing. What does work to lower swelling is sleeping, so I do that 10 hours a night.

I am not in the over-did-it club. I am very sensitive to how my knee feels. I did get into that club by going to a physical therapist who was in the You Must Get ROM club. For a week I could do nothing. That put me in the Never Again club, no more PT.

 

[sistersinhim]

That put me in the Never Again club, no more PT.

Good for you! You are doing great and don't need them.

 

[skiforever]

you've been in the ODIC (overdo it club) it from the git-go, quickly advancing to hiking miles and miles

Walking does not seem to strain my knee. It is fine, even on irregular terrain. Most days I walk the dogs about 1.5 miles. I even did a hike that was over 3 miles up a canyon trail without any issue.

What really hurts is biking. I recently tried to ride 5 miles on flat ground on an electric bike and that irritated my knee. I limit the stationary bike to 5 minutes to prevent strain. Yet I read about people riding for 20-30 minutes every day and finding their knee is irritated but not blaming the biking.

 

[Layla]

Happy Three Month Anniversary!
Have a wonderful weekend.
@skiforever

 

[skiforever]

Thanks. I did some strenuous diving today gathering data on underwater species. The knee works ok but I lack strength and stamina, sigh. It was beautiful! It is so nice to be able to do these things.

 

[Scully2005]

I’ve got to say @skiforever I think you’re doing bloody amazing!!
If you turn your thinking around to all the things that you CAN do and focus less on the things that are more difficult I think you should be really really proud of yourself! A 3.5 mile canyon walk, diving, paddle boarding daily dog walks of in excess of 1 mile … I am so impressed! I am a glass half full person - my brother says I wear rose tinted glasses at times - but you know what? What you’re doing and achieving right now is nothing short of a miracle! Go Sister!

 

[skiforever]

If you turn your thinking around to all the things that you CAN do and focus less on the things that are more difficult I think you should be really really proud of yourself!

Thanks Scully2005. I stopped posting favorable things because of the response, but I am super happy being able to do things. Yesterday I walked along the ocean to the coffee shop and back, 3 miles RT. I did not have to keep sitting down on the way back as I had done earlier from being too tired. That was great progress!

I am working on leg strength by carrying 20 lbs in each hand up and down the stairs. Later I will increase the weight. The shore SCUBA diving required stepping up big steps in the underwater sand without being able to see the contours. My lack of strength was a serious limitation. Wearing 80 lbs of gear does not help (I am 125 lbs).

My 3 month doctor (PA) visit was ok. They think I am pretty close to straight and have 113 degrees flexion. There was no mention of an MUA and no advice to go through more PT. They said the remaining swelling at 3 months is usually gone by 6 months. All good news!

 

[skiforever]

Perhaps my thread could be renamed to

Building strength after TKR