TKR Ten weeks later . . .<<'

[KarriB]

Cratchit, I think it's absolutely fine for you to work on strengthening your leg now. You are 5 months out, you gave your TKR plenty of time to recover and now it's safe to work on it. My PTs began working on strength training at 4 months. Like you my leg was in bad shape before TKR, then I had two months of nearly 0 activity and using an imbolizer really left my leg weak. But my PTs started me out slow and worked slowly. I was doing leg presses, using a weight machine and they had a cool computer game that built muscle strength. Good news, it really didn't hurt at all because they gradually built strength. But strength training before 3 months post op isn't good for a new knee, just remember to start slow and work up. If you're on a bike add resistance slowly, leg presses, start with a little weight and add to it.

 

[Cratchit]

Interesting to hear this @Cratchit. It makes sense. Not sense that a lazy person wants to hear though!!

Is this referring to me??

 

[Cratchit]

Thanks @KarriB I have been using resistance on the bike. I have been doing steps and stairs. I have gradually increased both. I walk a lot and have increased pace and stride and no longer use the stick. That`s my point. I have been doing these things - and seen improvement - but still I haven`t done enough to improve the power in my quads. And yes, it`s deeply disappointing for I am not lazy nor was my TKR a waste of time.

 

[Spex10]

Of course I didn't mean you @Cratchit!! I meant me!

 

[Cratchit]

@Spex10 phew, that`s ok then! Well it isn`t but it is iyswim!

 

[Celle]

I have been doing these things - and seen improvement - but still I haven`t done enough to improve the power in my quads. And yes, it`s deeply disappointing for I am not lazy nor was my TKR a waste of time.

Of course your TKR wan't a waste of time!
I think you're doing just fine! Do remember that complete recovery from a TKR takes a full year and you are only five months out. Where you are now is not where you will end up.

You're doing the strengthening exercises now, and that's good, but remember that you are still recovering from a major trauma. Your quads didn't weaken in a matter of weeks and they won't regain strength fast. They were probably getting weaker before your surgery and the surgery added to that. You have plenty of time to get back to full strength.

 

[Spex10]

Sounds like you've got a knowledgeable PT. Good luck with it all!

 

[KarriB]

@Cratchit , remember it took years for your knee to get the shape it was in before surgery and will take time to build the strength back that you need. You're five months into a year long recovery. I think each month will show progress in your knee.

 

[Josephine]

It wasn't targeting specific muscle groups. It is generally not enough to simply get on with living without doing specific exercises

I would beg to differ. I have seen more than enough members and patients IRL who have suffered grievously because of excessive exercising. This was one chap I came across - you should read his story to see how really bad bad can be. PT: the seriously grave consequences of doing too much of it

 

[little red canoe]

Looking at my leg before surgery. The operated one was less developed for musculature. Shamefully so. The gastrocnemius was not really there. The quad was flabby; during pre op physical the OS could see and test for that
Then I had a TKR
Now I can see both muscles on the affected leg developing( now I WANT to wear heels!). With ADL and equal distribution of the work load right and left as my right is now trustworthy.. The right still hasn't caught up with the left.
It took years for the right to get deconditioned. I am reconditioning the right with out injury to the newly used muscles.

Just as in gaining weight.. It happened over time. Loss will happen over time.

 

[Jamie]

@Cratchit ... with both of my knees, my surgeon advised that I wait 6 months before returning to my trainer to begin strength training. And it worked well for me to do just that. You are just about at that point and as long as you start exercising gradually and work up the intensity slowly, you should be okay. You will know how it's working by how you feel in the few days after a session. If there is increased pain or swelling, you know that the intensity is too great for you still and you need more healing time. Be sure you allow at least one day of "recovery" in between exercise sessions. Your muscles need this time to rebuild after any exercise. Have your exercise person also add in balance training, as it's just as important as any strength exercise.

 

[Cratchit]

Of course your TKR wan't a waste of time!

Celle, I said this in response to a poster who suggested that if I wasn`t exercising it wasn`t worth having a TKR. I think she misunderstood and thought I was just sitting around all day doing nothing, which of course I`m not. You're right, where I am now is not where I will end up!

@KarriB - thank you! Seven months to go before I see the full effects - if not before!

I would beg to differ. I have seen more than enough members and patients IRL who have suffered grievously because of excessive exercising. This was one chap I came across - you should read his story to see how really bad bad can be.

You are citing an extreme case and one which is probably the exception rather than the rule. The age profile of patients undergoing a TKR is changing with much younger patients undergoing surgery. There are several on this board who are a similar age to me - mid 50`s - and for us to return to an active life, we will generally need to undertake strengthening work as suggested above. Highlander and little red canoe have been a great encouragement to me in this respect and both seem to have good outcomes so far.

@little red canoe you are so right. I lost about 2 stones (28lb) prior to surgery and had noticed that my (L) leg looked a lot thinner than previously. I hadn`t really associated it with atrophy. Now I realise that it was. I attributed the loss of muscle tone to not having the work of keeping and riding a pony any more since he died two years previously. It took time to wither, it`ll take time to build up, as you say. I do appreciate your common sense and encouragement!

Be sure you allow at least one day of "recovery" in between exercise sessions. Your muscles need this time to rebuild after any exercise. Have your exercise person also add in balance training, as it's just as important as any strength exercise.

I am in 'recovery' today following yesterday`s exertions. This morning I was stiff and sore though ok once I`d got going. I did attempt to give the lawn a first cut but the rain has set in so I have retreated indoors with a cup of tea. Seems fair enough to me!

I won`t be seeing the physiotherapist again. Monday was simply an assessment prior to returning to work. HIs disapproval and obvious exasperation was as upsetting to me as the pronouncement of my lack of musculature. I had thought I was doing quite well so didn`t expect to be told otherwise. Disappointment hit hard. Steps and squats seem to feature largely in the exercises he has set but I have to offset the number of repetitions against the pain in my (R) knee and the tendency for that one to give way, especially on the stairs. On a positive note, he did say that my legs were more or less the same length, give or take 0.5cm.

And just to take my mind off my knee, the dental abscess I have had since May 13th (yes it was a Friday) last year has re-emerged since the tooth was closed back in January. So now tomorrow I have to have the adjacent tooth opened with dressings applied and ultimately more root canal work. How lucky am I?!

 

[little red canoe]

How lucky am I?!

You are due for fantastic luck.. You have certainly had your fill otherwise!
I am doing mini squats maybe six each time I stand at my kitchen counter. So far that is not bothering me..
Why do we ladies want to measure up to others expectations?
I think makeup is just the oddest thing..

 

[Celle]

There are several on this board who are a similar age to me - mid 50`s - and for us to return to an active life, we will generally need to undertake strengthening work as suggested above. Highlander and little red canoe have been a great encouragement to me in this respect and both seem to have good outcomes so far.

No one here is saying that you shouldn't do strengthening exercises. Even us "oldies" need them - you think most of us don't return to an active life? That smacks a bit of ageism.
What we do advise here concerning exercise is that you should not do too much, too soon.
Allow time for your wound to start healing well before starting an intensive exercise regime.
Wait until at least 3 months before starting strengthening exercises.

Several of us have already told you that we think your approach to strengthening exercises is sensible. You are approaching it the right way.

In my 5 years here on BoneSmart, I have read many posts from people who started their post-op exercises too strenuously and paid the price, with stiff, inflamed soft tissues that slowed down their progress. Throttling back their exercise regime to a less intensive level proved helpful to them.

Outside BoneSmart, as an occupational health nurse, Josephine has seen people who are back at work, in various stages of recovery from knee replacements. The case she gives is the worst example, but she has seen others with similar problems, although to a lesser degree.

 

[Mireille]

@Cratchit I understand how you feel. I'm 12 weeks out and still need much improvement in my ROM. I will tell you that I do feel better and am able to do a lot of things that I wasn't able to just a short 3 weeks ago. I'm not seeing a physio or going to the gym but I'm walking quite a lot more, going up the stairs and doing exercises at home to gain some strength in my muscles which are still lacking. I think that you do well by listening to your body and making adjustments as necessary.

Good luck at the dentist! I have a phobia and shudder just to think of going, lol.

Take care!

 

[Cratchit]

Several of us have already told you that we think your approach to strengthening exercises is sensible. You are approaching it the right way.

And that is exactly what I was agreeing with, no ageism at all. Josephine frequently encourages people to read her recovery threads in which she states she did no exercise; I am saying that it is generally necessary to do some exercise - which is basically what you and others are saying. But thank you for the endorsement!

@Mireille thank you so much! I know you understand and I appreciate that so much. Ah, the dentist! I have been such a frequent visitor over this last year that I no longer have to give my name when I ring or turn up, they know me! I`m probably on their Christmas card list!

 

[PolarBear60]

Psst. When you read Josephine's threads, you'll see she did plenty of movement -- just not formal exercise.

 

[Spex10]

Poor you @Cratchit! All the problems with your knee (s?) and a dental abscess too. You most certainly are due a hearty dose of good luck!

 

[Celle]

And that is exactly what I was agreeing with, no ageism at all. Josephine frequently encourages people to read her recovery threads in which she states she did no exercise; I am saying that it is generally necessary to do some exercise - which is basically what you and others are saying. But thank you for the endorsement!

If you read Josephine's recovery threads, you will have seen that, while she says she did no exercising, she was actually quite active. She did no formal exercises, but she came home to live alone and looked after herself. She had a little help from family for a few days, but even then she was going up and down stairs, getting herself snacks, physically taking care of herself. That wasn't doing exercises as such, but it sure was getting some exercise, the sort that you get through your activities of daily living.

I did something similar: I never went to PT, but just gradually increased my activity at home. When I was sitting in front of my laptop, I did a few heels slides (when I remembered). Later, I walked up and down the stairs in the mall, instead of taking the escalator. People must have wondered what this crazy woman was doing, going up and down the stairs 3 or 4 times! I incorporated exercise into my daily living, instead of having exercise sessions.

My legs are strong and reliable, with good ROM. They didn't let me down in Asia, where I swam in the China Sea at Ha Long Bay, snorkelled, and crawled through Viet Cong tunnels.

Unfortunately, we've seen a lot of people here on BoneSmart who have started exercises with a hiss and a roar, almost as if their poor, new knees are in boot camp, and they have paid the price, with increased pain, swelling and stiffness. We don't say do no exercise at all, but we do say listen to your knee and don't do too much, too soon.

 

[Josephine]

You are citing an extreme case and one which is probably the exception rather than the rule.

If you read my post again, you will see I said I have seen MANY patients, both on here and IRL, who have caused themselves unnecessary pain and delayed recovery. And you will note there are TWO cases in that article, not just one but tis true they are extreme cases. That doesn't mean it's not possible for anyone else to suffer the same outcome.

for us to return to an active life, we will generally need to undertake strengthening work as suggested above.

Indeed, but in due course - NOT in the first few weeks.

Josephine frequently encourages people to read her recovery threads in which she states she did no exercise; I am saying that it is generally necessary to do some exercise

And your opinion is based upon what experience and knowledge? Do you note that I have a background of almost 50 years experience and frequent attendance at numerous conferences intended for surgeons, not to mention discussion with scores of surgeons during the conference. I've yet to meet a surgeon who threw up his hands in horror at this as you have done! So I speak from a prodigious background of experience and knowledge. That might sound boastful but it's true. Make of it what you will. However, if you choose to ignore my advice, that's entirely your choice. Just don't keep telling me I don't know what I'm talking about because that's just not true!