TKR Two surgeries in 48 hours<

[SusieShoes]

It does sound like doing so much aggressive, strength-focused PT is what's causing your knee to swell. I refused to do weights and squats. My OS said not to do them but my PT still said I should try. I just said no. Don't be afraid to say no.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Laurenkate]

Yikes....some of these threads make my knees ache and this is certainly one of them. Between the hematoma and all the hard core exercises, I can't imagine why your knee isn't the size of a watermelon.

Everyone has to do what they think is best but based on my first experience, I decided to do things a bit differently this time. I liked my physical therapist, he never hurt me to the point of tears and I was released after almost 4 months. My leg was swollen from knee to ankle until almost a year had passed and it still swells when I've done too much or am really tired.

I don't know if that was because of the therapy - but this time I went 6 times and decided to just do stretches and live my life. My leg isn't nearly as swollen and i'm not in the constant pain as before. You might consider taking a break from formal therapy for a while just to see if it helps with pain and swelling. If it doesn't, you can always go back to it. Cheers and good luck!

 

[denisetoli]

1.Pain level is at 4

2. No prescriptions pain meds now. Take two 200mg Advil and 2 500mg Tylenol twice a day.

3. No pic to attach, but it is at picture one. Better when elevated and iced.

4. ROM 118, extension is 0 to -2

5. Three times a day for 45 minutes at a time.

6. Evening only and especially after physical therapy 2-4 hours.

7. Work is sitting 90% of the time - legal secretary; home general housework, as stated above.


Exercises done at PT

PT x2 week
Recumbent bike 10 minutes (full rotation)
Padded balance beam, forward and backwards x3
Lunges on bosu ball two minutes
Weighted squats x30 15lbs
Leg extensions weighted 20lb 2 minutes
Other leg extensions pull back - opposite from first leg extensions - 30lb
Side steps x30
Sled w 25lb weight pushing up and back x3

 

[Roy Gardiner]

Wow. IMO you should stop doing all those things unless and until your knee is 100% healed.

And being on the recumbent bike for more than 5-6 minutes seems to be unnecessary

Using the bike:

• 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

 

[denisetoli]

Taking this week off completely from physical therapy. Going to measure my knee/leg and then again on Sunday, so I can show them the difference in the swelling. They are working me harder than my knee can take, I am sure of it now. I am just so tired. It will be good to rest.

 

[Roy Gardiner]

It will be good to rest.

Please do this.

'hard work' is not helpful in recovery, and ALL those exercises you describe are training, not recovery. You do NOT need training!!

 

[Josephine]

1.Pain level is at 4

Okay

2. No prescriptions pain meds now. Take two 200mg Advil and 2 500mg Tylenol twice a day.

I suggest you take the Tylenol 4 times a day. Tylenol is only active in the system for 4-5 hours which means you are going about 7 hours with no pain medication. And as for the Advil, that is not a pain med and it's anti-inflammatory effect is not really adequate for your situation. Plus it has side effects which you can read about here
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

3. No pic to attach, but it is at picture one. Better when elevated and iced.

You mean it's hugely swollen?

4. ROM 118, extension is 0 to -2

That is excellent!

5. Three times a day for 45 minutes at a time.
6. Evening only and especially after physical therapy 2-4 hours.

I suggest you ice and elevate together.

7. Work is sitting 90% of the time - legal secretary; home general housework, as stated above.

Okay.

Exercises done at PT
PT x2 week
Recumbent bike 10 minutes (full rotation)
Padded balance beam, forward and backwards x3
Lunges on bosu ball two minutes
Weighted squats x30 15lbs
Leg extensions weighted 20lb 2 minutes
Other leg extensions pull back - opposite from first leg extensions - 30lb
Side steps x30
Sled w 25lb weight pushing up and back x3

All of these are very counterproductive to your well being. As Roy said, ALL those exercises you describe are training. You don't need them. So little wonder your knee is rebelling with gross swelling, pain and stiffness.

I see you have already decided to take a rest from them but you mention only taking off one week. That's not enough. It can take 6-8 weeks to see any improvement so try to be patient.

I would also add that when you are working, you need less PT anyway and certainly should never use any weights. Worst thing possible!

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[denisetoli]

Day three with no physical therapy and I can already feel the difference. Elevating and icing in the evening, sleeping with leg elevated most of the night. Knee still swells when I walk too much but is much quicker to recover (meaning does not stay swollen). Even my scar looks more compact (darker). Not as stiff in the morning now. I still move around at the office, in fact I make it a point to walk every 1 1/2 hours around the office on my floor. Walk takes about five minutes. I have often wondered why the therapist would measure range of motion after they would have me do all of the exercises and my knee was most swollen. Then they would try to massage and get my knee into the range they wanted. Why not start with that before stressing the knee? Just a thought. Today is a good day!

 

[Jockette]

I think some PTs think it’s better to move your knee with exercises to loosen it up and then measure. Mine did that. Mine would push me to a painful place to measure. In spite of that, sometimes I would walk out of the office with a better moving knee. Of course it didn’t last long. And mine would ice me first, not after exercises. They are all so different.

Next time I won’t go to PT and I will recover better and with less pain!

Walking is the best thing for your knee, but not to excess. 5 minutes about every hour and a half like you’re doing sounds great!

Slightly different situation, but similar point, at one of my Weight Watcher’s meetings they were talking about exercise. They said it didn’t have to be done all at once and suggested walking 5 minutes every hour. By the end of the day you had a nice amount of exercise and it would help you lose weight. Who knew!

 

[KarriB]

Just wondering how your break is still going and hoping you feel a difference.

 

[denisetoli]

Just wondering how your break is still going and hoping you feel a difference.

I can feel a difference most definitely. I am not saying that my knee does not swell still, because it does. However, the swelling subsides much more quickly than it had when I was overworking it at PT. I am moving more at work (walking) and taking walks in the evening but the difference is that I am not pushing it and taking my time. No more weights, squats, pushing the weighted sled, lunges on the bosu ball. I can't wait to see what week two brings in terms of recovery! Thanks for checking on me! I appreciate it!

 

[SusieShoes]

Yay! Your knee sounds much happier. I’m glad you can feel the difference.

 

[KarriB]

Good to hear! If you need or want to train later you can, but it’s just too early for a TKR. It took a while for me to start a walking regimen but I eventually realized that since what I wanted my knee to do was walk, then walking was probably the best thing to do for it.

 

[AnOptimist]

We share a surgery date (bilateral in my case and I must make a thread someday). I too work with both Physical Therapy (fortunately, had good therapists who didn't push to pain) and a personal trainer (who had bilateral TKA three years ago, so she knows what to avoid). I'm glad to see you are resting now. One thing I was told when Physical Therapy recently ended was no extension or flexion machines for a long time. I am content to work on form and easing back in as my body is comfortable. Slow and steady.

I hope that things continue to improve for you.

 

[denisetoli]

We share a surgery date (bilateral in my case and I must make a thread someday). I too work with both Physical Therapy (fortunately, had good therapists who didn't push to pain) and a personal trainer (who had bilateral TKA three years ago, so she knows what to avoid). I'm glad to see you are resting now. One thing I was told when Physical Therapy recently ended was no extension or flexion machines for a long time. I am content to work on form and easing back in as my body is comfortable. Slow and steady.

I hope that things continue to improve for you.

I would love to hear how you are recovering!!! I have seen such a huge improvement in just mobility and recovering from swelling since stopping PT! I am not saying that I won't go back, but this time armed with the evidence that my knee is much happier not being pushed at all. And with the evidence that the swelling is beginning to subside. To the left of my scar is where most of the swelling was taking place. It is not nearly has hard to the touch the little pouch right on my knee cap has gone down significantly! I am just walking enough at work and the if I feel like it, a leisurely walk in the evenings, if not puttering around the house is enough. Still doing heel slides and a few stairs here and there. I can't wait to see what the next months brings! I think my PT's will have to agree that this was the best choice for me! And even if they don't, I know it!

 

[denisetoli]

Just an update on my vacay from PT. I am still progressing. I am not waking up with my knee stiff and swollen nearly as much as I was (it was an everyday occurrence). I am back at the gym working on upper body, which makes me feel better. I am letting my knee, finally, dictate my pace. Onward and upward!!!!