TKR recovery and an analogy to athletic training


Former BoneSmart staff member
Dec 21, 2007
Northern Part of the Buckeye State
United States United States
When we begin recovery, most of us cannot wait to push ourselves to show the world that we can not only beat the odds, but also regain our lives as fast as possible. We must add many PT's into this equation, as well---many feel the need to push us to the point of pain and beyond---and many of us have bought into the "NO PAIN, NO GAIN" mentality. "I will show the world", we think, "I will get back to being active faster than anybody else!"

Let us look at a TKR or a BTKR recovery and see how, in many ways, it is analogous to increasing athletic training. Consider somebody who is a recreational runner and wants to take part in either a half-marathon or a marathon. Many folks look at running a marathon or a half-marathon as a goal to reach at least once in their life. Should they up their miles from two or three a day to say, eight to ten a day? What might that increase do to their bodies?

Consider what would happen if a recreational runner jumped from, say two to three miles a day for four days a week to eight to ten miles a day for six days a week? We all know how the person would feel the next day, right? We would also think that tendonitis, muscle issues, and perhaps, in the long run, stress fractures may occur. The pain might be such that, psychologically, the athlete will stop training altogether. Common sense says that ramping up one's activities this drastically will have horribly serious negative effects.

Nobody in their right mind would up their training by either that many more miles, that many more weights, or that much more intensity, etc. It would have horrible consequences on the body. In actuality, if one want to increase their mileage in running or weights in lifting, they should do it in small increments---no more than 10%. I have thought about this as I approach a 150-mile two-day tour the first weekend in August---I am working to slowly up my miles on my bike so that I can acclimate my body to the rigors of riding that kind of mileage in two days.

Anybody who wishes to up their training intensity understands that it has to be done gradually and patiently and with a purpose.

Now, how is this analogous to a TKR or a BTKR recovery? It is very simple---look at what many of the post-surgical people are attempting to go through---upping intensity either through their own efforts or through the demands of a over-aggressive PT. Consider this: if prudence and wisdom dictate that, with healthy bodies, we limit our intensity increase to 10% for a certain period until our healthy body is acclimated to that exercise, why on earth would we subject a joint that is rather compact in nature (limited room to expand due to swelling) and that has undergone severe surgical trauma to anything but a very gentle and a very slow increase in exercise intensity? It doe not make sense, does it?

Yet many of us continue to try to do this, or we continue to allow PT's to push us into painful levels during PT sessions. We also push ourselves and wonder why our recovery is so slow and our knees are rebelling. We wonder why we are in pain, why we are stiff, and why we are not progressing. We are seriously overlooking the obvious, aren't we?

If we seriously think about it, when we are healthy and in training, we should be very careful when we up our training intensity----and that will allow us to successfully see positive results in our training and allow us to continue to pursue training and reduce our chances of causing over-use injuries, right?

The analogy should now be coming clear in your minds. Please think about what happens to a knee during TKR surgery, the slicing, the sawing, the pounding, the manhandling, the gluing and manipulating, the tightness of the quads and the hamstrings, and the muscular atrophy, etc. Your knee has experienced very intense surgical trauma---and you want to work your hardest to recover---or allow somebody to push you into serious levels of pain? Why would you do that to yourself, or allow somebody else to do that to yourself?

If you wouldn't drastically ramp up your athletic training intensity levels when you are healthy, why would you even think about doing it when your knee (or knees) have just underwent the "Armageddon" of knee surgeries? Yet many of us continue to push ourselves or allow our bodies to be contorted well beyond what is immediately and prudently possible and conceivable.

It is time to take a step back, folks, and consider what we would and should be doing if we were healthy and in training---we would take it slowly and build from there. Now that we are undergoing recovery and are dealing with an traumatized knee or knees, why would we not do the same---take it gently---take it to the point of discomfort and no more----until our knee is acclimated to it and says that it is "OK" to go a little bit further?

Common sense tell us that, as athletes, we take care of our bodies and take equal care to exercise in a manner that can challenge our body but does not bring it harm. Overuse injuries can cause our training to have to be shut down. Why wouldn't we be thinking the same---even being even more cautious---after having a surgical battle fought in our knee joint or joints?

Patience, people, patience. Successful training for a marathon is not done overnight or even in a month. Recovering from a TKR or a BTKR is not done in a month, two months, or even four----so why push it, why stress over it, and why allow somebody else to hurt you, when your body is pleading for gentility and rest?

Take a step back, think about it, and think of your recovery not only as a type of marathon training, but actually the marathon itself. Take your time, take it gently, and use common sense. If you wouldn't think about doing it when you were healthy, why would you think about doing it after what has been surgically done to your knee? Remember, it is not "NO PAIN, NO GAIN", but rather, NO PAIN, MORE GAIN."

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