TKR Trying too hard, or not hard enough

NormyG

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RTKR Aug 4 2020
Hello all. This forum has been awesome to bring my expectations for recovery into reality. Im nearly 8 weeks in, and the path is there, but very bumpy!

Armed with a list of exercises given out when I left the hospital, I diligently worked thru the basics 3 times a day. Basics included heel slides, and quad exercises in various formats.

Started formal PT at about 2 weeks post op. ROM initially improved quite fast. At about 4 weeks out, ROM was around 105/0, but that a forced PT position. Relaxed it was more like 70/5.

Around then, the IT band decided to become an issue and I found the snapping pain to be bad enough to stop heel slides and switched to using the exercise bike to work on ROM.
Walking was a bear since my gait was so bad I ended up with a sore hip. Even though the handouts the hospital hands out says to walk, it just wasn't working.

Fast forward another month and the IT band has settled down. Heel slides are doable. But ROM has not changed much. I still have moderate swelling.

If I try and flex the joint to the extreme, it feels like I'm compressing clay inside the joint. I still cant quite pedal the bike all the way around without lifting my hips. If I stick with it for about 10min, it gets a bit easier, but by no means painless. I will usually try it a couple if times a day. I have even skipped a day of ROM stuff to see it improves, but no real change. Trying too hard? Or should i stick with trying to push past the bike pain.
 
@NormyG
Welcome to BoneSmart, Glad you joined us! :welome:

I have even skipped a day of ROM stuff to see it improves, but no real change.
One day is not enough time for your swelling and inflammation to go down, allowing your ROM to reveal itself. You may be setting back your recovery by trying to do to much too soon for your still healing knee.
Think about spending more time time resting, icing, and elevation to allow your soft tissues to heal.
Give it a week and see what happens. Right now the walking you do around your house is enough.
You can also do theses gentle flexion, extension activities.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
Trying to hard?
Sure sounds like you are trying too hard to speed up your recovery.
Or should i stick with trying to push past the bike pain.
I suspect this pushing set back your recovery.

Good luck, and keep us posted on how you are doing.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access these pages on the website


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
@NormyG hello & welcome to Bonesmart. I am a day behind you. Had a RTKR August 5th. I have some similar issues as you. I've found you really need to be careful with PT. More is not always better. I overdid it at one of my sessions & paid for it for almost 5 days. So I took a 3 week break. I'm starting back next week but only 1 day per week. At least to start.
Everyone it seems heals at a different pace. I thought I would be further along by now, but I do have severe OA in my hips too so probably some unrealistic expectations on my part.
I look forward to comparing rehab with you! Hope you are feeling well this evening!
 
Hello @NormyG - and :welome:

I agree with Pumpkln's advice to cut back the amount of exercise you're doing.
And whatever exercises you do, now and in the future, make sure that they don't cause you pain. Discomfort is all right, but causing pain is going to set back your recovery.

Your knee has been through major surgery. It isn't lazy or unfit - it's wounded.
It needs gentle treatment and time to heal.

You might find this article helpful:
Knee recovery - Lose the Work Ethic!!
 
I too think you are pushing too hard, however you did not mention any pain meds. I use Oxycodone (5mg) to get a little more from my workout and maybe for sleep; plus Tylenol.

When I left the hospital they too said to do the exercises 3x/day but within the first week I cut that to twice. Then I noticed that if I am on my feet a lot, like maybe an hour or so, the pain spikes up. So, I try to stick with 2x/day, but if that seems too much then it once. Always elevate with ice afterwards; given up pretty much on the idea of a good night's sleep. However, my ROM did advance pretty quickly. Re the bike... I just started (recumbent bike) and had to make sure the bend was not too tight; use it to warm/losen up at this point.
 
Last edited by a moderator:
I still cant quite pedal the bike all the way around without lifting my hips. If I stick with it for about 10min, it gets a bit easier, but by no means painless. I will usually try it a couple if times a day.
Pretty good. This is the programme I devised that worked well for me
  • Set the bike to zero resistance
  • Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain, for a couple of minutes only.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
When you can pedal:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different


Here is a bit more chat and some pix and how 'healing' and 'training' are different
 
Update on bumpy road to recovery. 11 weeks now. Still with fighting moderate swelling. Still using pain meds. Advil and some Tramadol. Recumbent bike is doable, but not by any means without pain. Flex will get to 120 if pushed. So its there, just not easy due to swelling. Walking us getting a bit better. 25 min is a long walk. Trying to do shorter walks, multiple times instead.
Latest battle is with my foot turning reddish and swelling up during the active part of the day. The swelling in the knee seems to affect the ability of the blood returning from the foot. Elevate seems to help. Bucket of cold water/ warm water contrast therapy helps. Ive tried compression sock, but it didnt really work that well.
Anybody else have this problem?
 
Flex will get to 120 if pushed. So its there, just not easy due to swelling
Please stop pushing your knee. It's not necessary and it's probably contributing to the swelling. Your knee will bend much more easily once that swelling is gone.
 
I think your foot turning reddish is your knee telling you that it is being over worked, seriously at this early stage in your recovery a gentle walk several times a day is sufficient, I never pushed or worked my knee, my range of movement is great at 1 year, I'm now back to hiking in the mountains with no pain and a very firm and stable knee, and I put this down to have taken my recovery slowly and following the BoneSmart guidelines all your knee needs at this stage is time to heal xx
 
flex will get to 120 if pushed.
This doesn't count. It's what you can do on your own. As long as your knee is being pushed your swelling is going to stay and you won't get to 120 on your own. Pushing causes inflammation and swelling, lowing your bend.
 

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