MUA UPDATE - MUA determined today...ugh!

[Celle]

My PT does "joint mobilization" where she pushes above the knee at a 45 degree angle toward the hip - a steady pressure. She is adamant at me having no pain - she checks in throughout and wants a moderate push only with no weights. We do this for a couple of minutes and then bend - and alternate with other activities during the session. It is a bit uncomfortable but not painful.

We don't recommend letting your PT push on your knee, in any circumstances. There's no need to mobilize your joint. Extension comes when the tissues at the back of your knee have lengthened enough. There's no need to rush, either, as both flexion and extension can continue to improve for well over a year after a TKR. Often, extension takes longer to achieve than flexion.

I don't think pain or pushing by your pt is necessary.

I agree.

Now, my doc wants me to wear the brace that helps straighten your leg. I don't know the name of it, but have seen it online, apparently has some sort of dial on the side. This sounds nuts to me

Sounds nuts to me, too! I think the JAS splint is an expensive bit of unnecessary equipment.
What's your surgeon's rush? It's only 3 months since your surgery and we know that extension and flexion can both continue to improve for a year, or even longer, after a knee replacement.
Just continue to encourage your leg to straighten, by doing gentle exercises such as one or two of the ones suggested in this article:
Extension: how to estimate it and ways to improve it

Don't beat yourself up @RadioGal. I don't think it's too late for you to improve your extension.

How right she is!
You haven't done anything wrong and there is nothing wrong with your extension that time won't cure. Since your knee was bent for a long time, your muscles and tendon at the back of your leg will have shortened.
It takes time, patience, and gentle exercise, to help them to lengthen again. Your surgeon needs to make allowances for that.

 

[RadioGal]

Ironically I did inquire about the brace prescribed for @patsortho having no idea that I'd need one as well. I just looked up the JAS brace and oh my gosh, that thing looks terribly cumbersome. Oh what fun! I'll give it my best. Meanwhile, I'm continuing my new routine of resting my heel on a half bolster and letting gravity do what it does best. I think you're right @JJ65, I'm not in this alone and this is pretty painful for most everyone. Thanks all, I'll keep you apprised of my progress. I HAVE to make progress, my kids are counting on me to help out with my grandson and with their twins that are on the way!

 

[RadioGal]

Thanks @Celle that was some good stuff there! I'm going to have to take more control of my recovery.

 

[Polkadot]

If 10 minutes is too ouchy, give yourself permission to let up a bit in the middle. I do several exercises with a timed component, where I was instructed to do them until uncomfortable, let up for a few seconds to "recover," and then "assume the position" again. It has been amazing to me how long I can tolerate a stretching position when I have permission to let up whenever I need to. You'll see an increase in how much you can tolerate over time when you treat yourself gently like this.

 

[RadioGal]

@Polkadot I think that's a great idea!! My PT made me hold it the entire time, so I was sort of following his lead, however, my knee is darn stiff after that 10 minutes that moving it again invokes a just days after surgery kind of pain. There is no way, no how I want to go back to that. Thank you!

 

[Celle]

Just do the exercise until it starts to hurt, and then STOP. There's no need to hold anything for ten minutes.

 

[patsortho]

I started home pt today because I was sent to rehab . They got knee to finally bend but extention isn't happening:(

 

[RadioGal]

@patsortho I'm so sorry to hear about the lack of progress with extension. Is that brace not helping? If I remember right you're required to wear the JAS brace, is that right? I am asking because, guess what? They now want me to wear it as well. Yikes, it looks cumbersome and ridiculous. I can't imagine anyone having to wear this.

My PT is thinking we can get extension to a successful degree before the "brace lady" arrives, which is next Wednesday. I too am hoping for that, but they are really pushing on my knee something awful @ PT to make this happen. However, it seems to be working. I am getting extension, but I'm also getting more swelling and pain. I hope you find something that works for you. Please keep us all updated. I've been following your thread.

 

[RadioGal]

It's the little things...today I rode a bike! A real moving bike. Didn't go far, just around the neighborhood, but it felt great!!!!!

 

[patsortho]

What are they doing to help your extention

 

[RadioGal]

@patsortho Basically the therapist is sort of cupping my knee, above and below knee cap, and pushing it into the table. Or at least trying to. The very back of my knee has never touched that table, but it's come close. With each push I'm making progress, but I've also returned to post surgery pain. It's manageable, but just not what I expected 13 weeks after my TKR. My pain was greatly diminished before they started pushing on it, but I do have to say I like that it's getting straighter. I went from -20 to -6, however, everyday is like starting all over again as it's not holding -6, rather somewhere right around -10. Still, progress is progress. PT wants to see it @ -5. Me too.

I know it's sort of not advised here @ BS to have someone doing what they are doing to me. But I'm admittedly a bit torn since I'm kind of anxious to get some extension. My knee has been sort of frozen in a bent position since about a month after surgery and I cannot walk properly this way. So, I'm willing to see if it works.

Have you had anyone do something similar? I'm just curious because maybe a new course is required. What all have they tried with you?

 

[patsortho]

For me they did ultra sounds , stretches , pushing above knee . We have tried so many exercises. Little by little I'm progressing.

 

[Clipless]

Hi RadioGal, I'm glad to hear about your fun bike ride around the block!

My first TKR was slow to gain ROM. I allowed a physical therapist to press down on my knee exactly once and never again. After conferring with my OS, I purchased a pair of soft, padded 5 lb ankle weights from a sports store. I would sit on the bed or sofa with my leg outstretched and a rolled washcloth under my heel. Then I would gently place one weight just above and the other just below the knee joint, and relax in this position for maybe 15 seconds to start, several times daily. I gradually increased my time in the stretch until I was stretching through TV commercial breaks, etc. Eventually I added a stretch rope to gently pull on my forefoot. It took time to reach zero extension, but I got there! I repeated the same stretch a year later on my other knee after it was replaced. Both knees now hyperextend a few degrees, which is normal and physiologic.

 

[Polkadot]

Super job, riding your "real" bike! I'm a bit jealous.... Next, this?

 

[RadioGal]

@patsortho I'm glad to hear you're making some progress, albeit slowly for both us, progress is progress!

@Clipless Thank you! I do have those weights already. I'm going to start that today. Anything at this point, I'm desperately trying to avoid wearing that brace!

 

[Bikesouth]

I am still working on extension. Having the same problem, get to zero stretching & next day back to +2 or +3.

 

[RadioGal]

Well, here's my latest knee adventure, the "Knee Extension Dynasplint." I had the rep bring it to my PT session today so the therapist could see it and we could both assess whether or not it was necessary. I guess it was (my choice) because I decided to give it a try for @ least one month. I'm wearing it tonight for the first time as they say 6-8 hours a day is helpful if, that is, I can handle it. I'll see how the sleep goes. It's very cumbersome, but I am going to try to stay on my back with legs elevated on the lounge doctor. I'm guessing I'll go about 4 hours before I throw it to the ground in disgust Oh wait, maybe not throw...I had to "rent" it to the tune of $276. Insurance should reimburse.

Someone on @patsortho 's thread wrote these braces are essentially a waste of time and money. I definitely took that into consideration, but I'm sort of in need of trying new things to gain extension. If anyone would like to weigh in regarding this brace, or braces in general, I am definitely open to any and all comments. Meanwhile, wanted to share the pics just in case anyone else has been told they need this as well.

BTW, my extension was -12 today. Down to -6 with some PT, but likely bounced back to somewhere around -10, my best guess.

 

[Polkadot]

Wow...that's quite an expensive rental! I hope this helps you big time, @RadioGal! It sounds and looks mighty uncomfortable.

 

[SusieShoes]

I have no experience at all with braces of that kind, not even friends or relatives, so can only stand back and see how this works for you. Of course hoping for excellent results! It does look uncomfortable... but I've found that anything supposed to force extension (rolled towels under ankles, hammy stretches) are uncomfortable. Wishing your experience to be painless.

 

[Celle]

I hope the brace works for you, but I've said it before and I'm going to say it again -
There's no need to rush to get ROM (Range of Motion) because both flexion and extension can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's only just over 3 months since you had your TKR, so you're only just over a quarter of the way to full recovery.
Don't put yourself through lots of discomfort in an effort to gain extension. Give your knee enough time, and it will get there.