ROM Realities

[lgobrien]

I am 2 weeks PO today! My ROM is 86. My at home PT comes twice a week and (for the last week) I have been doing my PT three times a day (20-25 minutes each session) with 15 reps. I am working myself so hard and it hurts SO bad that sometimes I feel I am going to pass out. I was so disappointed that my ROM did not increase this week at all.

MY PT said I'm doing well, but explained how important it is to get your ROM back in the first 6 weeks because the scar tissue grows stronger and stronger and you don't get much more ROM change after the 6 week mark.

After she left, I thought about everyone's posts here about keeping up with their medication. A week or so ago, I changed my pill regime to 1 Extra Strength Tylenol and 1 10/325 Hydrocodone every 5-6 hours. I didn't want to be on any more medication than that.

I always make sure that I do my PT routine about an hour after I take my meds, but wondered if I changed my meds to TWO 10/325 HYDROCODONE every 5-6 hours if I'd get more out of my workouts. So, starting this morning, that's what I'm doing. After two workouts already today and another one in a half hour or so, I think I'm already feeling a little more spring in my step.

Hopefully this little step-up in meds will sabatage my ROM plateau. I also think that because my last five years have been relatively EXERCISE FREE because of my knee pain, I am paying for that in my PT now. Many people who were not as sedentary as I was probably are able to achieve their ROM without having to do this higher med thing. Hope it works for me and I don't have to do this too long to get out and moving again.

Laurie

 

[northman22]

For two weeks you are doing fine! There are peaks and valleys with recovery. Everyone is different. I took two 10/325's for the first 6 weeks or so. My biggest problem was inflamation the first month or so. I finallly ended up on Daypro, an NSAID and slowly progressed. Just keep up the work and look at your progress from a weekly or longer standpoint, and count the little milestones as they come.

Just to let you know, and I doubt you are like me but I'm 3 months out and am still between 100 & 110 with both knees. I go to PT 3 times a week and my PT says I'm just one of those people that take time. She trys to keep me positive and insists that in time I'll get my ROM back. My OS won't do manipulations if your ROM get to 90 degeass either.

Just keep on keepin on & Good Luck!!!!!!

Steve

 

[lgobrien]

Because I'm only 54 years old, I really, really want to get my ROM up to 110-120. I've tended to be quite lazy these past years using my knee as an excuse and I'd really like to see if I can get in much better shape so I can enjoy grandkids when they start coming.

I have a new lease on life and another chance!

You said you go to PT three times a week, do you still do at home exercises too at 3 months out?

Laurie

 

[beachcomber]

Laurie--

Just think about what they did to your knee only 2 weeks ago.

Have you watched the video of a TKR? If not---- do it.(there is a link around here someplace) If you have---- go back and watch it again. Girl-- they sawed the ends of your leg bones off and replaced them with metal and plastic parts that were drilled, glued, and pounded into place and then sewed and/or stapled your leg back together! (and BTW--- having a PKR instead of TKR doesn't change that!)

Now--- tell me you still think you shouldn't be taking much pain medication only two weeks later! It is more than okay to be taking two 10/325s every 5-6 hours. I took them every 4 hours at 2 weeks. If you *under*medicate for pain you will not be as productive with your PT and rehab.

Also--- *more* is not necessarily better when it comes to your self-initiated PT sessions and reps. Be sure to follow your therapist's instructions. At 2 weeks I decided that if 2 times per day was good--- that 6 times per day would be three times better. It wasn't. Being a chronic overachiever only made it hurt more. I backed down to the recommended program and progressed much better.

Best of luck to you.... Remember, your knee didn't get to the point it needed to be replaced in a short time and it won't be "all better" in a short time either. You are looking at a good year of recovery. ROM is most critical in the early weeks but can continue to improve slowly over time as well. You should plan to keep working on your knee recovery for MONTHS because you can lose progress made if you stop.

Everyone heals at their own rate. Listen to your body. It will tell you when you are ready for less pain medication. Some of us "winters" made decisions to reduce/eliminate pain meds at a specific point--- but for many it was really a process where we would just one day realize "pill time" had passed hours ago and it was only beginning to ache hours later and gradually the time became longer or we could switch to only Tylenol.

Okay--- off my lecture podium.... I just hate to have you fall into the same pitfalls many of us "winters" suffered through. That's why some of us are sticking around here to try and share what we learned. Besides--- there's just some darned good company around here!

 

[Skeet]

I had my TKR on 12-17 and was on 10/325 for months. I took them round the clock for the first few weeks. Gradually, I tapered off to 1 every 4-6 hours, then lengthened the time between those. In April I had my doctor give me 5/500 so I could wean myself and do half of those (2/250). Take whatever drugs you need to be able to do the PT. It will be worth it long term. My ROM is now about 0-130 and I still have to work on it regularly - exercises and stationary bike riding, plus lots of walking. I didnt' exercise much before due to pain. Feels great to do things now.

You are doing fine so early on. Stay with the PT and plan on 12 months of work to maintain the ROM you get. It's not easy but it is worth it. Trust me!

God bless,
Skeet

 

[Rowdy66]

Laurie You Should Not Be Discouraged, You Had A Very, Very Serious Surgery Only Two Weeks Ago. Personally I Think You Are Pushing Yourself Too Hard. I Had Both Knees Totally Replaced Four Weeks Ago Today And I Decided Early On I Was Getting More Out Of My Pt When I Split My Exercises Into Three Parts. In The Morning I Do The First Third, Takes About Twenty To Twenty-five Minutes, Then Mid-day I Do The Second Third, Same Time. After Supper When My Hubby Is Doing His Exercises I Do The Bike Riding And The Rest Of My Exercises And End Up Doing The Stretches. It Was Just Too Much For Me To Do The Entire Set Two Or Three Times A Day And I Actually Felt Guilty About It. I Don't Know Why, Now I Am Just Happy I Can Do What I Do. I Do, However, Try To Do As Much As Possible Around The House As I Can. Yesterday Just Changing The Sheets On Our King-size Bed Made Me Feel Like I Had Accomplished A Lot. I Did It With Very Little Pain And All At One Time Where Before I Had To Break It Into Parts I Could Handle. My Range Of Motion Was 95 Last Week At Pt And Up To 110 This Week But More Important To Me Was That I Was Making Progress I Could See And Feel In My Life. I Think You Are Being Way To Hard On Yourself. We All Heal At Different Paces And You Will Do Just Fine So Long As You Keep Trying And Get Enough Rest. Sometimes I Think I See The Most Improvement On Days When I Rest More And Exercise Less, So Go Figure. Best Of Luck. Rowdy

 

[lgobrien]

Beachcomber wrote:

Girl-- they sawed the ends of your leg bones off and replaced them with metal and plastic parts that were drilled, glued, and pounded into place and then sewed and/or stapled your leg back together!

REALLY???? Maybe I should watch the clip... where can I find it?

I was getting the impression that my PT felt we had some "catching up" to do. I am only doing in the range of what she's asked me to do. PT 2-3 times a day (I chose 3 times a day) and reps of 10-15 (I do 15). So I wouldn't consider that I'm over doing it - am I?

I feel better that you guys think I am in the "running" for normal recovery.

WINTERS? Are you the ones that had your TKR during the winter? I chose this time of year because I tended to hibernate in the winter... We live on a beautiful lake in Northern Michigan and I figure as soon as the water gets warm enough I'll be able to do alot of exercises and walking in the water come July and August!

 

[beachcomber]

Laurie--

To see the knee replacement video I watched===
go to:

broken link removed: https://www.nlm.nih.gov/medlineplus/surgeryvideos.html

and scroll down to :

Total Knee Arthoplasty (St. Mary's Medical Center Duluth, MN, 10/18/2006)

I'll warn you---- it is very graphic but you will really see why your knee feels the way it does. You (and I) have PKRs which means they didn't open the whole knee-- only the medial compartment so you can focus on 1/2 of the knee instead of the whole thing... but you get the idea.

This is a long video..... it takes a long time to take a knee apart and put it back together with new parts!

Yes, I am a "winter" I had my PKR on Dec. 21st. I am a high school culinary arts teacher and I could not continue walking on that knee for an additional 6 months till summer vacation. I didn't choose the surgery timing--- it chose me with a sudden, acute breakdown. But the good news is that now the weather is good (well, not really here in Oregon, but soon, I hope) and I am healed enough to really get out and enjoy it.

 

[Josephine]

lg, the others have said it far better than I can because they speak with the voice of hard experience but they do know whereof they speak! Under medication yourself and overdoing the PT is a BAD combination and will likely get you nowhere fast! Nevertheless, you do seem to be doing remarkably well except I don't like the "hurts so bad I could pass out" bit.

My observation on your post is that you didn't mention icing and elevation which is just as important. Are you doing this? And especially immediately after PT? If not, you should do it as much as you can.

 

[lgobrien]

Josephine -
Yes, I ice IMMEDIATELY after each workout, sit in my recliner and usually fall asleep for at least an hour. I have been concerned that I am doing a lot of recliner time when I am not doing PT.

Maybe I should be trying to incorporate much more of my everyday tasks into my life that I have not taken back up yet, but it still hurts to be up and about for too long of a time. Although, I can really tell that it's getting stronger energy wise each day.

My most difficult exercises are the ones involved in pulling/bending my knee in. There are two or three exercises that can bring a tear to my eye if I push it just a little further than I think I can. I keep hearing the No Pain, No Gain and figure I won't gain ROM unless it really hurts...

Laurie

 

[gatiger]

lg, it has been awhile since I've posted here although I keep a check on the board from time to time. I had the TKR on 12/28/07, so I'm something over 6 months out. When I found this board at about 3 weeks, I was so desparate for help, answers, encouragement that I would have done pretty much anything. Thank God the people on here and Josephine held my hand and helped me crawl out of "The Pit". I am not a medical person but I know a little something about KR and ROM. Maybe your PT was trying to 'push' you, I don't know, maybe I am an exception, don't know that either, but I DO KNOW that at 6 months my ROM is still increasing and I am just back doing my 'normal' job with no PT. Please, please, run this by Josephine as she has never steered me wrong, BUT, there are tissues that must heal, swelling that must subside and those things take time along with meds, ice, elevation. My point in this ramble is that at 2 weeks, you are doing fine. DO NOT let your PT push you past your threhold of pain. Yes, it will hurt, but it should not make you want to pass out. My guy was way overly aggressive with me, so I know it can happen. This recovery takes TIME and WORK. You cannot make it with only one of those two. Do what you can, but please do not let those guys hurt you un-necessarily. God bless you and keep you and give you Peace.

 

[beachcomber]

The PT instructions I received were to stretch until a "good" stretch is felt in the joint--- NOT until it hurts so much you feel like you are going to pass out! Leave the more extreme pressure to the professionals. My PT would massage my knee, flexing it more and more as he massaged it. Once or twice he pushed it past the point of discomfort to surprise and pain, but I made good progress. My job was to flex/extend it to the point of "stretch" and hold it there for the number of minutes (1 for flex and 5-8 minutes for extension) in the instructions. I set the timer and try to relax and breathe my way through till the timer goes off. (the old Lamaze breathing). It usually hurt more when I relaxed my way out of the exercise.... I found that "yelping"--- "owie, owie, owie" made me feel a lot better! Then ice and elevate.

What are you using for icing? Did they send you home with a Polar Care unit? I ice the top and underside of my knees since I get a lot of swelling behind my knee too.

 

[lgobrien]

gatiger and beachcomber -

My PT has been very kind and gentle and always tells me to tell her when I've reached my limit with each stretch that she adds to my sessions when she's here. I am the one that's pushing myself past what I feel comfortable doing and boy am I paying for it today. My knee is throbbing today!

I did three very intensive workouts yesterday with lots of ice after each workout (I have a large gel pack that wraps all the way around my knee above and below - so I think I'm icing properly). I'm rethinking my strategy to flex/extend to the point of stretch and hold as you say instead of push (or pull) until I can't stand it anymore.

I hadn't thought about at what point am I damaging any new tissue that is trying to heal. Instead of three intense sessions, maybe I should do two sessions and start making a point of getting out of this recliner and doing some everyday "occupational therapy" - things I need to do everyday, like laundry, walking, even sitting at a desk, which I can't do yet for any length of time.

Thanks for your advice - you guys are so wonderful to share your experience...

Laurie

 

[Weezy]

Hi Laurie....I'm at six weeks today and thought I weigh in a bit on the energy issue since we're about the same age...I'm 52.

Don't worry about being so tired! That has been and still is the MOST difficult part for me. Even at 6 weeks I still get tired much too easily for what I want, but at 2 and 3 weeks about all I could do was PT and rest/sleep/ice. Daily life chores will occur naturally, and the few times I really pushed it, I regretted it with increased swelling and pain for a few days following.

One of the best pieces of advice and reality checks I got from all the great folks here is that RESTING IS PART OF HEALING and without proper rest, we won't heal as well. As a normally energetic person, this has been and still is really hard for me, but I still make sure that I have time every day to rest and nap, and I'm sleeping a solid 10-12 hours a night now.

As others have said, let your body tell you when to move ahead and when to rest...and if you're like many of us, you probably didn't sleep too well for the first week or more so your body is tired and worn out for a variety of real and valid reasons.

Weezy

 

[Doug]

I'm at 5 months post op. now. Although ROM is important, for me it just got old after the first couple of months post op. I have worked out since I was 13. It is as normal as brushing my teeth. Only doing ROM exercises just got depressing. Also, the number isn't magic. Gat and I lamented on this several months ago. If you get to a point where you feel happy with it, then that's the number you need. As your swelling goes down, your ROM will increase as you use your leg more.
My recommendation is to join a gym. At least on a temporary basis where you can enjoy a whole body workout.

 

[Josephine]

Josephine -
Yes, I ice IMMEDIATELY after each workout, sit in my recliner and usually fall asleep for at least an hour. I have been concerned that I am doing a lot of recliner time when I am not doing PT.

Maybe I should be trying to incorporate much more of my everyday tasks into my life that I have not taken back up yet, but it still hurts to be up and about for too long of a time. Although, I can really tell that it's getting stronger energy wise each day.

My most difficult exercises are the ones involved in pulling/bending my knee in. There are two or three exercises that can bring a tear to my eye if I push it just a little further than I think I can. I keep hearing the No Pain, No Gain and figure I won't gain ROM unless it really hurts...

Laurie

"No Pain, No Gain" might work well in general fitness exercising but in this situation doing it to extreme can be counter-productive as gatiger said. It's not the extreme flexing or pain that gets you moving forward, it's the repetition. Sometimes people fall into the trap of thinking if 'x' is good then 'xx' must be doubly so when the real facts are that 'x' more frequently is best!

I take it you are not yet sleeping well at night so do NOT push yourself to getting going in daily activities. You're still recovering from the surgery and the anaesthetic. They really knock the stuffing out of you so only do what you feel up to doing when you feel up to doing it. Maybe at 4 or even 6 weeks you can start thinking about the 'oughts' and 'shoulds'. Right now be kind to yourself and allow your body to regain strength by just focusing on the PT and the rest. Rest is SO important. You need to allow yourself sleep time during the day to recharge your batteries. Low batteries good healing does not make!

 

[lgobrien]

Thank you all for permission to heal slowly and properly. Because I was feeling so bad about not being able to make this trip with my sisters and cousins, I was feeling like I was behind. Before the surgery, I asked the doctor if he thought if I'd be able to make this trip at 3.5 weeks PO and he said I probably could if I took it easy, but I started stressing that I couldn't even sit up in a chair for any length of time, let alone, sit on an airplane for an hour...

My sister just found out that she was able to make accommodations with the airline for special seating for me so that I can extend my leg and a wheelchair will be available at the airports. I'm so excited that it looks like I can go. Our hotel is only a mile from my cousins house, so I will be able to get transported back and forth if necessary.

This is a surprise gathering for my cousin. She has inoperable cancer in her spine and is coming with her husband and three of their youngest kids (who are still at home). Other cousins are coming from different locations, so it is going to be a bittersweet weekend, but who knows how much time any of us have! God has given us this opportunity and luckily my sisters are going to look out for me so I can make this trip too.

So, I will "let up on the gas pedal" for awhile and get some smooth sailing on the road to recovery. I don't plan on going back to work until mid-July (or later if I want), but the doctor thought I'd be able to go back 2 weeks post op if I needed to because I had a desk job... Ya Right! If they didn't mind that I slept in a recliner at my desk, then I could go back to work!

Laurie (lgo)

 

[ship4]

Thank you all for permission to heal slowly and properly. Because I was feeling so bad about not being able to make this trip with my sisters and cousins, I was feeling like I was behind. Before the surgery, I asked the doctor if he thought if I'd be able to make this trip at 3.5 weeks PO and he said I probably could if I took it easy, but I started stressing that I couldn't even sit up in a chair for any length of time, let alone, sit on an airplane for an hour...

My sister just found out that she was able to make accommodations with the airline for special seating for me so that I can extend my leg and a wheelchair will be available at the airports. I'm so excited that it looks like I can go. Our hotel is only a mile from my cousins house, so I will be able to get transported back and forth if necessary.

This is a surprise gathering for my cousin. She has inoperable cancer in her spine and is coming with her husband and three of their youngest kids (who are still at home). Other cousins are coming from different locations, so it is going to be a bittersweet weekend, but who knows how much time any of us have! God has given us this opportunity and luckily my sisters are going to look out for me so I can make this trip too.

So, I will "let up on the gas pedal" for awhile and get some smooth sailing on the road to recovery. I don't plan on going back to work until mid-July (or later if I want), but the doctor thought I'd be able to go back 2 weeks post op if I needed to because I had a desk job... Ya Right! If they didn't mind that I slept in a recliner at my desk, then I could go back to work!

Laurie (lgo)

Laurie,
I am glad you have reached this mindset. Do what you can do comfortably, do not put yourself under pressure. Return to work when you are ready......
Enjoy the weekend visit with family and treasure the memories you will make during that time. You will do fine, people will be conscious that you will require rest and ice daily. Pace yourself in this recovery and enjoy yourself too!
Best,
Crystal

 

[dar]

I'm just at five weeks (today) and I hit your spot a couple of weeks ago. I had tried and tried so hard doing three times as much as they said. It didn't get me anywhere. I spent an entire week getting more and more frustrated. But what everyone is saying is right on. When I slowed back down and didn't push myself past the instructions given to me I saw the progress return. I did what they gave me to do, I did ice and I rested. Since that day I shifted my mind set I've seen pretty much steady improvement. A few degree's back now and then, but today they pushed me to 110. I'm getting there and so will you!

 

[edk]

I would suggest you add a NSAID to your pain killers. Tylonol and narcotics
help with pain but they don't really help with inflamation. And swelling will
restrict your ROM some. And they work much better to prevent inflamation than
reducing it. So if your stomach will tolerate perhaps a naproxen twice a day
along with the icing would help. (this assumes you are not doing heparin or
any of those things any more)