TKR Sher101 TKR Recovery 4/16/2
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Your ROM is great! Most OSs don't expect 90 degrees until 6 weeks. You have surpassed that at 4 weeks! You probably don't even need any more PT with all you are already doing. 5000 steps a day and your normal daily activities a day is PT!
101
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Well, I didn't fire my PT. I thought I could work with him. I told him I was swollen and painful after PT, so he just gave me a massage. That was last Tuesday. I also mentioned I was afraid of lunges at this stage, and he said, "Oh, that's way down the road." so I felt reassured.
Today I saw him and he was pushing on both flexion and extension, insisting I had to get to certain numbers. I was 122 flexion and -2 extension. He said he wants to push for 135 next time. My response was, "No way." So by the end of the session he said I should be at 125 and 0. I just shook my head the whole time. He asked me to do a bridge, which turned into 30 reps for reasons he never did explain. I did a few. he gave me an easier balance posture after I explained that between my si joint problems and my chronically enflamed ankle, I thought balance on the surgical leg was too much. He kept telling me things might hurt, but he would make it feel better with massage. I felt like a petulant child the whole time and nearly cried.
I also told him after PT or a walk, I had to ice. I said I love the ice for its pain relief properties. He told me I should not be icing for 45 minutes at a time because I was reducing blood flow to the knee needed for faster healing. He said I should do less of it--20 minutes max. So now I'm confused about icing.
I know I said I would quit, so don't feel like I have the right to vent. I guess I don't want to be tabled "the bad patient" in case I need him for something else. It almost impossible to find a sole practitioner who takes medicare, and he has been good up until now.
Anyway, thanks for the space to get my thoughts down. It's my own fault.
Today I saw him and he was pushing on both flexion and extension, insisting I had to get to certain numbers. I was 122 flexion and -2 extension. He said he wants to push for 135 next time. My response was, "No way." So by the end of the session he said I should be at 125 and 0. I just shook my head the whole time. He asked me to do a bridge, which turned into 30 reps for reasons he never did explain. I did a few. he gave me an easier balance posture after I explained that between my si joint problems and my chronically enflamed ankle, I thought balance on the surgical leg was too much. He kept telling me things might hurt, but he would make it feel better with massage. I felt like a petulant child the whole time and nearly cried.
I also told him after PT or a walk, I had to ice. I said I love the ice for its pain relief properties. He told me I should not be icing for 45 minutes at a time because I was reducing blood flow to the knee needed for faster healing. He said I should do less of it--20 minutes max. So now I'm confused about icing.
I know I said I would quit, so don't feel like I have the right to vent. I guess I don't want to be tabled "the bad patient" in case I need him for something else. It almost impossible to find a sole practitioner who takes medicare, and he has been good up until now.
Anyway, thanks for the space to get my thoughts down. It's my own fault.
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Hi there 101
Your PT sounds a little passive aggressive. You site concerns and he counters with a "don't worry" or "not now, but later" type responses, or a massage...like it's a treat for enduring pain after he's pushed you. Hopefully you're able to stand firm with him.
Why Does BoneSmart Recommend Icing for Longer Periods of Time Than Advised by My Physical Therapist?
Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.
Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.
Please read the following article also - BoneSmart philosophy for sensible post op therapy
Hopefully you enjoyed the long holiday weekend. Happy Tuesday!
@101
Your PT sounds a little passive aggressive. You site concerns and he counters with a "don't worry" or "not now, but later" type responses, or a massage...like it's a treat for enduring pain after he's pushed you. Hopefully you're able to stand firm with him.
Why Does BoneSmart Recommend Icing for Longer Periods of Time Than Advised by My Physical Therapist?
Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit.
Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.
Please read the following article also - BoneSmart philosophy for sensible post op therapy
Hopefully you enjoyed the long holiday weekend. Happy Tuesday!
@101
101
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Thank you to Layla for the icing information. I've read it before more than once, but could always do with a reminder.
I think my PT thinks he's being amusing, when I am now in no mood for his brand of humor. He's gone. My partner thinks I'm being ridiculous. He is having knee surgery in a few months, and he said he would take advantage of getting as much PT as possible. I, on the other hand, have had enough. He gave me for home exercise:
bridges 30 reps with 1 sec holds, 2xday
single leg raises 5xday, 5 reps, 5 sec hold
single leg stands
foot hanging off chair for leg extension, hyper extend, hold 5 sec, 3xday
piriformis stretch 5xdy (the only exercise I plan to do).
I think my PT thinks he's being amusing, when I am now in no mood for his brand of humor. He's gone. My partner thinks I'm being ridiculous. He is having knee surgery in a few months, and he said he would take advantage of getting as much PT as possible. I, on the other hand, have had enough. He gave me for home exercise:
bridges 30 reps with 1 sec holds, 2xday
single leg raises 5xday, 5 reps, 5 sec hold
single leg stands
foot hanging off chair for leg extension, hyper extend, hold 5 sec, 3xday
piriformis stretch 5xdy (the only exercise I plan to do).
and 
Way too early in recovery for all this!
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Good for you canceling! Bad PT is worse than no PT.
As one who loves resistance training on machines, and who understands the cellular healing process....
I feel strongly that it's too early for you to do targeted strength training; bridges aren't at all necessary for knee rehab; incremental increases in walking and daily living can be your main rehab (when I felt ready for semi-squats I resumed scooping the cat litter; when I felt ready to increase squatting, I resumed pruning the undersides of my woody perennials!).
Stretches like the piriformis stretch and seated heel slides, done within current comfort levels, are great.
The one exercise I found most helpful at all stages of recovery was "quad sets." That's extending the leg and then tightening the quads which effectively further extends the leg as the knee moves downward.
Immediately after surgery, this is good for circulation and range of motion, but most importantly it activates the quads post op. As they start waking up and firing more reliably, it helps tone them without stressing the joint.
But even these are certainly not necessary!
As one who loves resistance training on machines, and who understands the cellular healing process....
I feel strongly that it's too early for you to do targeted strength training; bridges aren't at all necessary for knee rehab; incremental increases in walking and daily living can be your main rehab (when I felt ready for semi-squats I resumed scooping the cat litter; when I felt ready to increase squatting, I resumed pruning the undersides of my woody perennials!).
Stretches like the piriformis stretch and seated heel slides, done within current comfort levels, are great.
The one exercise I found most helpful at all stages of recovery was "quad sets." That's extending the leg and then tightening the quads which effectively further extends the leg as the knee moves downward.
Immediately after surgery, this is good for circulation and range of motion, but most importantly it activates the quads post op. As they start waking up and firing more reliably, it helps tone them without stressing the joint.
But even these are certainly not necessary!
101
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I should mention re quad sets: you don't extend the leg anew each time you tighten. The exercise is done while the leg remains extended, which can be sitting upright, in a recliner, or lying down.
101
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Hello All,
I have to admit I'm feeling a bit rudderless without my PT. He, at least, gave me a bit of motivation, albeit negative. It was something to do, someplace to go, and his end massages were good. So I'm going to try another PT at a facility where I heard the focus is yoga and pilates. I can't get in for a month, however, so will have to be my own PT. Today I took myself out for a walk in my hilly neighborhood where the hills were manageable for 9/10 mile. Took me 26 minutes. I was so happy to see my bed and fell into it while my knee proceeded to make out with the ice machine's wrap--a fulfilling experience for both of us. I cannot believe how exhausted that little walk made me. Whoosh! @mendogal you mentioned somewhere you increased your walking by small increments, but I can't find the reference of how much and how often. Would you mind repeating it?
My mercurial moods during this experience continue to confound me. This morning I was weepy and lonely for no reason. And 2 hours later I was fine. I'm glad I have this forum to read and post to. It certainly helps.
I have to admit I'm feeling a bit rudderless without my PT. He, at least, gave me a bit of motivation, albeit negative. It was something to do, someplace to go, and his end massages were good. So I'm going to try another PT at a facility where I heard the focus is yoga and pilates. I can't get in for a month, however, so will have to be my own PT. Today I took myself out for a walk in my hilly neighborhood where the hills were manageable for 9/10 mile. Took me 26 minutes. I was so happy to see my bed and fell into it while my knee proceeded to make out with the ice machine's wrap--a fulfilling experience for both of us. I cannot believe how exhausted that little walk made me. Whoosh! @mendogal you mentioned somewhere you increased your walking by small increments, but I can't find the reference of how much and how often. Would you mind repeating it?
My mercurial moods during this experience continue to confound me. This morning I was weepy and lonely for no reason. And 2 hours later I was fine. I'm glad I have this forum to read and post to. It certainly helps.
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At 6 weeks, 1/2 mile
At 8 weeks, 3/4 mile BUT I soon realized I
needed extra ice, rest, and pain pills so I cut back to 1/2 mile and stayed there a few weeks
Then increased in small increments
At 12 weeks, back up to 3/4 mile
At 3 months, 1 mile most mornings, plus a short second walk in the evening
At week 15, 1.8 miles
At 16 weeks, 2.25 miles
At 5 months, 3.5 miles with one short sitting break before transitioning from flat Mission St to climbing Bernal Hill
So I can walk over 3 miles non stop; I recently did 4 miles and my hip wasn't happy so won't push past that.
At 8 weeks, 3/4 mile BUT I soon realized I
needed extra ice, rest, and pain pills so I cut back to 1/2 mile and stayed there a few weeks
Then increased in small increments
At 12 weeks, back up to 3/4 mile
At 3 months, 1 mile most mornings, plus a short second walk in the evening
At week 15, 1.8 miles
At 16 weeks, 2.25 miles
At 5 months, 3.5 miles with one short sitting break before transitioning from flat Mission St to climbing Bernal Hill
So I can walk over 3 miles non stop; I recently did 4 miles and my hip wasn't happy so won't push past that.
101
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@mendogal Thanks for the detailed progression example. I think I go out with a clear idea of how long I'm going for. So it's one day 7000 steps, then 2 days self soothing with ice. So I need to be more systematic about my approach. I have a meme playing in my head "Go hill walking," left from my time with the PT. Think I need to go back to the flats for a bit. I keep forgetting what a short time it's been since surgery.
BTW you and I are neighbors, sort of. I'm across the bay in Point Richmond and can see the city from my living room.
BTW you and I are neighbors, sort of. I'm across the bay in Point Richmond and can see the city from my living room.
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I'm actually two hours up 101, in Ukiah. Was just visiting SF friends.
Yep the flats are good for distance. The hills are good in smaller distances for glutes and endurance!
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I had a post op with my pa yesterday at 7 weeks. She told me I am doing 'fantastically', so much so she had to review my chart again. She thought by the way I walked and my ROM (eyeballed at 121+, -1) that I must be 3 to 4 months along. Quite a boost to me both physically and mentally as I lie around and continue to ice and only see the swelling that's still there and not the amount it's gone down (I'm a glass-half-empty kind of gal.) Doing very little PT with a new guy. The PA said normally they'd have me back at 3 to 4 months, but I'm already there, so make the appointment for one year. yay for me! sorry my post is a bit funky here. keyboard is acting up.
oh and could you change my title to Sher101 TKR Recovery 4/16/24?
oh and could you change my title to Sher101 TKR Recovery 4/16/24?
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That's an excellent report!!!! 
I would encourage you to note each small milestone here so that you can look back and see a cup that is slowly filling.
It will also help you, were you to overdo it, to figure out how much to temporarily cut back (trust me, in a week or a month or even in three months you will overdo it - it can't be helped as we continue to improve and are unsure of our current limits).
I would encourage you to note each small milestone here so that you can look back and see a cup that is slowly filling.
It will also help you, were you to overdo it, to figure out how much to temporarily cut back (trust me, in a week or a month or even in three months you will overdo it - it can't be helped as we continue to improve and are unsure of our current limits).
