In the spirit of sharing one of many paths to recovery, here is my 8 week update. The preamble about many paths to recovery is a good faith effort to let everyone know that I have not followed the general bonesmart approach to recovery in either of my recent TKR surgeries (January 5 and August 5, 2015). In general I have done the opposite of rest, lots of icing, no physical therapy or limited activity. My path may not be for everyone, but it is certainly one that others here have taken with success and it seems important to share the full range of experiences so that everyone who visits here can see that there are multiple paths to recovery.
So, here is what has happened since my five week follow-up:
Everyone thought I was doing well at the 5 week check-up and I decided to back off exercises and activity because I thought my recovery would just continue to improve. I did decide to start out-patient PT as a means to monitor how I was doing and to see if there was anything new to learn, but I did not plan to continue for more than a couple weeks. More on that below. I also stopped taking Norco at the end of week 6.
By the middle of week seven my extension was worse and there was little improvement in flexion and in fact the outpatient PT measured me at 108 and slip back from the 115 at the five week check-up. I continued to have a slight hesitation while walking and my knee was feeling stiff. So, I decided to return to a more active approach. I began a more intensive exercise program (2-3 sessions a day 1 to 1.5 hours each) including additional work riding my bike on the indoor trainer. For a few days there was not much progress, but the more I worked on extension the more it improved. Similarly, the more work I did on flexion and especially riding my bike, the less stiff my knee became and I felt some slight improvement in flexion.
This past weekend, there was work to be done on an ongoing deck project and I did everything my doc said I should not do: squatting, lunging, kneeling, and extended periods on my legs. I was tired by the end of the weekend and had to spend a few hours elevating to get the swelling manageable.
The following Monday morning I did my morning workout, including laying on my stomach and using a band to pull my knee forward to stretch everything that needs to stretch. Afterwards I was pretty stiff and felt some very sharp pains out the outside of my knee near the knee cap. Anyway, it was time to walk the dog after the workout and as I walked down the stairs I felt more of that same pain, but I as I took the first walking strides I could feel my knee was more flexible. When I went to PT later that day I was measured at 120 flexion. Now, I do not advocate doing what I did, but I think what happened is that the scar tissue or whatever was binding in my knee was loosened by the activity and that resulted in more flexion. It also resulted in a lot of swelling.
The next day, I did my usual routine and although I still have to work to keep extension near 0, flexion work was much easier and I felt as if I have retained the 120. So, I decided to go for my first outdoor bike ride on Wednesday and I had a nice easy fifteen mile ride. My seat is about 5mm above pre-surgery position and it takes concentration to keep my heel flat throughout the pedal stroke, but I am almost there. I spilled all of this at the 8 week follow-up appointment and I was encouraged not to over-do it again on the deck project and to keep up work on flexion and especially extension. Everyone was happy with progress, but I was duly reprimanded for going against the plan.
So, as I move on from week 8 my plan is to continue working on flexion and extension exercises, indoor cycling 2-3 times a day for 20 minutes, and one day a week riding outside until my pedal stroke improves. I also plan to continue physical therapy and here is why. The therapist spends about 20 or so minutes doing what is essentially deep tissue massage on my knee, quads, and soft tissue stuff. After that we work on flexion and extension manipulation: for extension she presses down on my knee and for flexion I lay on my stomach and she pushes my knee forward. Our agreement is that she does not go past a 6 on the discomfort scale. This is well within my tolerance. After each session, my knee has felt considerably better: less pain, more flexibility, and overall better mobility. So, I have decided to keep going until my extension is completely under control, meaning I can consistently keep it at 0 as opposed to getting it to 0 only to have it lag back several degrees. And, my knee just generally feels better after these PT sessions.
For my first TKR, an active approach to recovery worked well for me. That knee is now at 130 degrees and it feels as normal as an artificial prothesis can feel for me. I still have some numbness in that knee, but I assume it will go away. I can cycle as hard as I wish without any issues. And, for this second recovery when I have been active, my recovery has moved along well, but when I have just rested and did few if any exercises, then my knee became stiff and more uncomfortable. After periods of activity, I do get some swelling and there is some short term pain, but the tradeoff is that I am functional and doing the things in life that need to be done for me.
This active approach is certainly not for everyone just as the preferred bonesmart approach is not for everyone. There are many factors that can influence what path to recovery works best and I think it is useful and important to understand the full range of experiences that constitute recovery from a TKR. And, it is also useful to note that a sample of one is not the basis for recommending any single approach: we have to find our own paths and that is helped by sharing the full range of recovery experiences.
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