Bilateral TKR Stiffness

[Celle]

My surgeon showed my husband and I how to get it. Put your leg as straight as you can and have a partner push down on your knee to help it get closer.

Doing that is likely to cause problems.

Instead, try a couple of the exercises in this article:
Extension: how to estimate it and ways to improve it

Walking is one of the best ways to improve extension, especially if you lengthen your stride a bit, because ti stretches the back of your leg.

 

[sistersinhim]

Put your leg as straight as you can and have a partner push down on your knee to help it get closer

This is a big no no. Having anyone force your knee either for a bend or extension can easily cause damage. Walking with a nice long stride, heal to toe, with an assistance device is an easy way to work on those long, tough muscles and tendons on the back of your knee.

 

[Yerdua]

Thank God for intuition. Even though my surgeon said to have my husband push down on my knee I felt it was too aggressive and never did it. All your suggestions are so much better and I am so sorry for posting what he said. He is a very highly regarded surgeon but I don't listen if my gut says otherwise . I am so glad you all corrected his advice and I feel better for not doing his. Will do what you all recommend .

 

[Jockette]

At not quite 2 weeks post op I was told to work on ROM because “they” wanted me st 95 for my 2 week check up.

My husband and I spent the weekend before my Monday appointment with me often sitting on a dining room chair while my husband moved my foot under the chair as far back until I couldn’t take it anymore.

Unfortunately my intuition did not kick in. My husband did not enjoy causing me so much pain but we were told this was what we should do.

By some miracle my therapist “was able” to push me to 95 at my next appointment which was the same afternoon as my appointment with the surgeon. The surgeon “was able” to push me to 97. I was so happy and relieved to hear those numbers.

It wasn’t until 2-3 weeks later that I found Bonesmart and learned not only did I not have to do that painful forcing, but that it was bad to do that! I’m amazed they got the numbers they did.

I do not understand how surgeons and PTs can rationalize that forcing either bend or straight is good for a newly replaced knee.

 

[Tired2007]

Your surgeon said 95 at week 2? Wow. My surgeon’s comment was he’s happy if people are pulling 95 at 6 weeks post op. I was at 88/90 2 weeks post op and he was more than pleased- said it was not the norm. And I can honestly say my PT has been fantastic. No one forces or does anything I can’t handle. I think it’s finding one who listens. They told me on day 1 of PT post-rehab stay the goal is 115 degrees. I’m 110/111 today and post-op 4 weeks tomorrow. Told them to not kick me out anytime soon because I’m not ready! Lol thankfully, my insurance has no PT limit.

 

[Jockette]

@Tired2007 I never heard my surgeon say 95 at 2 weeks, but my PT told me that’s what my surgeon wanted and I took that to mean he expected it.

I was so inexperienced at that point I believed everything they told me. Both PT and surgeon force bent my knee to measure at every appointment.

If I ever have to do this again I will not let anyone bend my knee for me and I will not go to PT next time, I’ve learned it truly is not necessary. All that extra pain inflicted on me was not necessary and I’m amazed they got the numbers they did, because I sure don’t have those high numbers now at 13 months post op. I was 114 on my own power at my one year check up and I’m not comfortable keeping my knee bent at even that number for long.

 

[Yerdua]

I am so sorry to hear about your experience. I also was told I had to reach 90 by 2 weeks. I had Bilateral knee replacement and the pain made it impossible for me to do it.

I was sent to rehab for 10 days after 3 days in the hospital. I left only having 51 ROM. At my 2 week check up my surgeon was adamant that if I didn't get to at least 90 he would have to do an MUA.

I went to out patient rehab for 3 days a week 90 minutes each time plus killed myself everyday with exercises. I got to 70 by 4 week check up so my surgeon gave me 3 months to see and come back. Thank God I have great PTs. They told me to rest more and stop overdoing it.

BoneSmart has been a lifesaver as their advice helped me more than I can express. I am now 8 weeks and 86 in right knee, 75 left. I believe between PT and BoneSmart I will reach my ROM but now understand my journey will be longer and not to kill myself everyday with exercises and to ice, elevate, and listen to my knees. I personally believe with the right PTs it is for people like me a must but I definitely have found the advice here in conjunction with pt will hopefully help me not need MUA.

I am so grateful to BoneSmart. My surgeon is rated as one of the top and for the surgery he proved that but I think for exercising and ROM, he should redo his thoughts. Too aggressive especially for people like me who just can't get the ROM on their schedule. Or maybe for everyone. Let us heal more first.

I am not anywhere near an expert but after going through this hell for me, I found the advice on BoneSmart and my out patient PT to be much better than his. In fact without BoneSmart I was depressed, in excruciating pain and miserable. I am now progressing very slowly but I am progressing without such depression and killing myself everyday with exercises. So much better advice here.

 

[sistersinhim]

I definitely have found the advice here in conjunction with pt will hopefully help me not need mua.

Only you can say if you have a mua. You are progressing and will continue to progress without a mua. Here's just one example of how the bend improves over time.

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

 

[SusieShoes]

Thank God I have great PT'S. They told me to rest more and stop overdoing it.

We're seeing more and more PTs giving this kind of good advice. I'm so glad you got one of them! Overdoing exercise can be, and usually is, the source of swelling and pain for people who have great difficulty with flexion. Some people can exercise a lot and still recover their ROM easily; that can be the case, and more power to them. But it is so harmful to push people for whom that is not the situation. Those people who swell more with exercise do much better by slowing down, exercising less, and letting the knee heal. The healing, not the exercise, is what makes for good ROM.

Physical therapists who recognize what is going on with their "slow" patients and who know to tell them to slow down, not work harder, are in the forefront of good post-TKR PT.

I personally believe with the right pt's it is for people like me a must but I definitely have found the advice here in conjunction with pt will hopefully help me not need mua.

I also think you will not need that MUA. You're doing well and your knee is bending more all the time.

 

[Yerdua]

Again great and inspiring advice. I feel for me my pt's are so good they make me physically and mentally feel better . For me and the difficult time I am having with rom they are really helping.
Question: last night my left knees only when trying to sleep were in tremendous pain. A different pain than I have had. Just in the knees and so bad kept waking me up crying . Walking stopped it. Why?

 

[Yerdua]

Meant both knees and lying d9wn
Plus sometimes now icing hurts instead of help. I am 8 weeks today
No pt yesterday but I did drive alot and errands.

 

[Josephine]

I only do quad presses
heel slides with rope
leg lifts
pulling legs back sitting on the table with the rope
leg pulls 5 minutes each 30 on each leg of others

These are all exercises I strenuously advise against. Read this BoneSmart philosophy for sensible post op therapy

My surgeon showed my husband and I how to get it. Put your leg as straight as you can and have a partner push down on your knee to help it get closer.

I agree with the others who have comment on this. Totally the wrong way to do it!

 

[SusieShoes]

Meant both knees and lying d9wn
Plus sometimes now icing hurts instead of help. I am 8 weeks today
No pt yesterday but I did drive alot and errands.

Are you still doing the exercises with ropes? I’m asking because I think you said something about your PT being gentle and less aggressive. Exercises that ask you to force your knee in any way (with ropes or straps, or even using your own arms or other leg) are still forcing the knee, and forcing the knee is what causes more swelling and pain. Can you refuse exercises using ropes and force? I think you should.

Driving keeps the knee bent while at the wheel and if you did a lot of it, that could have contributed to your swelling at night. Same with running errands. When our knees start feeling good again, right about where you are in recovery, it’s really tempting to do too much. One or two small errands a day are enough. To do several and spend lots of time on your feet... your knees will let you know if you did too much.

I’m betting your nighttime pain is directly related to your busy day!

Icing can be unpleasant as swelling goes down. Can you still do it for long enough? It’s especially helpful, still, right after you’ve been exercising, or have spent time on your feet.

 

[Yerdua]

I find the ropes help me stretch my tight muscles and I don't pull as much as I did before reading everyone's advice. My knees loosen up afterwards so I just don't do them everyday anymore, just 3 times a week.

I still ice and most of the time it feels great but makes me feel stiffer. I think maybe it is when I don't have much swelling is when it hurts. Will pay more attention to see if this is the cause.

My PT 's will do whatever I want as they really listen to how I am that day. Gor now I want to continue the ropes just not pulling intensely, just to get the stretch.

I agree my surgeon was wrong on pushing the knee down. My pt's do also and they won't do it.
What a shame that such a great surgeon really needs to re-evaluate PT. I will speak to him on my next appt.

 

[Roy Gardiner]

I agree my surgeon was wrong on pushing the knee down. My pt's do also and they won't do it

I'm in the minority here; it worked for me and can be done pain-free. Not by pressing down on the knee itself - gross! - but either side, see the pictures in my thread https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159

 

[Yerdua]

I like your way better!

 

[Yerdua]

I am 9 weeks out of BTKR Bilateral knee replacement surgery and after walking maybe an hour on and off they get so stiff. My ROM Range of motion is also poor. Right knee 87 Left knee 80. PT physical therapy since beginning 3 times a week , 90 minutes each time . Plus at home.
Nighttime is the worse . I am worried about having to get MUA Manipulation under anesthesia .
I know I have to be patient but so many others got the ROM on time. My insurance policy only gives 30 PT and I am at 21. Without it I won't get ROM .
I am frustrated , exhausted from lack of sleep and pain . I don't know what to do. I just cry so unlike me
Lack of sleep messes me up going on this long and so tired of the pain
Trying to keep motivated but losing it .

 

[Pumpkin]

@Yerdua
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

Without it I won't get ROM

Sounds like you are doing way to much PT and exercise to force ROM, causing stiffness and swelling that will block and impede ROM.
Suggest you stop all PT and exercise for a week or more and give your poor knee a chance to heal. As your knee heals, swelling will go down, stiffness will decrease, and your ROM can start to increase.

You have been pushing hard with PT and ROM since your surgery and it has gotten you nowhere, maybe it is time to try something else.

 

[Jockette]

9 weeeks is still very early in recovery. I couldn’t walk anywhere near an hour at that stage either.

I never had 90 minutes PT sessions, my knee would not have been able to handle it.

I know I have to be patient but so many others got the ROM on time.

There is no “on time”. Yes, you have to be patient. Every one is different and at 12 months or more we have our ROM back so it really doesn’t matter when we each “arrive”, so there is no rush.

I learned with my knee the less I did the better I was. It’s not exercise that gets our ROM back, it’s time:
Time to recover
Time for pain and swelling to settle
Time to heal.

Many Bonesmart members have not gone to PT or done home exercises and had good outcomes and had less pain and frustration along the way.