TKR Veronica's TKR Recovery

Knee flexion still at 85-90 range. Extension is -8-12 most times; not sure why it won't go straight or why I have to work on it everyday and don't keep the numbers. SIGH PT had me do a new exercise yesterday; the stair stepper for 5 minutes. I did not have any issues or feel any difference in my knee at all. By this eve ink my knee feels strange; stiffer and sort of pain I've never felt at top of knee, possibly kneecap.
I think it's time to stop having your knee measured and stop doing all those exercises. They obviously aren't doing your knee any good. What you're doing isn't working, so you have nothing to lose by trying something different.

Instead, try a complete break from all exercise, except for just doing the bare minimum around the house.
Instead, concentrate on trying to reduce swelling, by spending lots of time resting, icing and elevating.

Take a vacation from PT. Give yourself and your knee a break.

You do know, don't you, that you don't have to work hard to recover a knee?
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!
 
Not sure of the swelling; doesn't look swollen to me. Seeing surgeon on Friday first time since staple removal at 3 weeks post op. I understand the mantra and everything that's been said about the ROM. Not being able to straighten my leg more really alters my gait and seems to put other stress through the knee. Didn't want MUA, but very perplexed now that I really need it.

My PT consists of the following:
Recumbent bike 10 minutes, Squats on wall with ball 25, balance board 4 minutes, standing SLR 3 lb ankle weight 15 reps (all directions), standing hamstring curls 15 reps, sidesteps #25, heel slides 20, lying flat on back and moving TKR leg out and back 20 times while keeping leg on solid surface. Hamstring stretch. Added the stair step machine on Monday for 5 minutes. I do prop my heel on roll for extension and also let my legs hang off bed for extension. Using cane.
 
Sometimes I find that even though my knee may not look very swollen that it really has a small amount in the knee itself that hampers my flexion. It usually happens when I do too much. It seems like you are doing a lot of exercises that are very tough and I know old cause me problems. Doing squats, a stair stepper and the balancing caused my knee to swell. You might want to stop PT and let your knee have a break. It may actually help you much more than continuing it.
 
I did cancel today and will ice and elevate as I am doing 3 days a week. Thinking of going down to 2 days and really want to get back in the pool. Therapist took me out of pool after 2 weeks of it; saying that I needed to be doing floor exercises to build muscle.
 
Did you read the articles I gave you? You don't need to work at rehabbing your knee..
Why don't you stop all your PT and just take yourself to a pool? You don't need your therapist's permission.

Cutting back PT to twice a week won't help. You've probably got inflammation of your tissues, due to doing to much exercising. That will take at least a month to settle down.
 
Not sure of the swelling; doesn't look swollen to me.
Many times people misunderstand the swelling that can take place after a TKR and expect to see an enlarged leg or knee area. This isn't always the case. Swelling can be internal within the joint. The knee compartment is a very compact space and it doesn't take much inflammation and fluid to give you pain and reduced motion. You are exhibiting just this type of problem. Your ROM is there, but it is masked by internal swelling. This is the result of the very aggressive therapy you've been enduring. I know others have suggested it and I'll add my support to the idea of cutting way, way back on any therapy or even stopping it entirely and just work on getting back to daily activities instead.

Therapist took me out of pool after 2 weeks of it; saying that I needed to be doing floor exercises to build muscle.
It's also a good idea to use the pool as long as you don't overdo things there. It's easy to have that heppen because the water gives you extra support to move. Things feel really good and you may not have adverse reactions until hours or even a day or so later. The idea is to start slow, wait a couple of days and see how you are and then increase movement in the pool if you have no pain afterwards.

Your therapist is wrong to tell you this is the time to build muscle. I know it can feel awkward to go against someone who is a "professional." But you are the one who knows your body more than anyone else. While a few people may be able to tolerate this aggressive approach to therapy, most don't. The fact that you have pain and reduced ROM is evidence this approach is not working for you. You are 2 1/2 months out from a very, very major surgery. Your body is still healing and needs all the energy you can give devoted to that process. This is NOT the time for weights, stair steppers, lots of squats, or lots of ball balancing. Save these activities until you are at least 6 months out. Right now, you need to prepare for your return to work. And once you do that, the process of getting ready in the morning, driving to and from and being at work becomes your "therapy." You won't need more.
 
Thank you all for the reminders of the PT. strongly considering putting it on hold for a while or telling him I only want aquatic therapy. He has the only heated pool in a 30 mile radius. My husband's words today, "the surgeon said you are going to be running and jumping again". I told him that some do, but even when I can, I won't because that will shorten the life of the knee. He replied that is for old knees not the new ones. Very difficult for me right now as I don't have his emotional support. Prayers to stay positive and focused despite my circumstances are requested.
 
So often folks seem to go off track---remember that not all PT's are well trained---some have ideas of their own that might not be the mainstream thinking.

I am also not a medical professional, here is what I think about rehab. The first two or three weeks you need to rest, elevate and ice---if you want to walk around to the kitchen or bathroom, great. But, that is the time to address the swelling of the knee. If you try to work or sit through a restaurant meal or a movie, you knee will react with swelling and pain.

By three weeks, my swelling was down quite a bit and I began gentle exercises in the gym--heel slides, leg lifts. But, I never did anything 15 times. Since the inflammation is getting under control then, it is important now to stretch and exercise the soft tissue without inflamming the joint. Since your muscles are not strong at this time, more pressure is put on the joint itself to hold you upright. So, if you do too much, the joint itself gets sore and cranky. By the way, I never had a pt push on my leg to get more flex---that is just asinine in my opinion. It causes the knee to swell more---so no more rom no matter what.

Finally at 8 weeks, I was feeling pretty good and began to do gentle exercises. I might do six leg lifts. Then, 8, then 10. But I did not do 15 of anything until well past the 12 week mark.

So many things can push the rehab of the knee back a few steps---maybe you need to return to work , or you are bored and so decided to go out anyway, maybe you have kids in your house and you need to care for them. They do not totally derail the rehab, but they do make it longer. Also, it is unrealistic to try to do all of the above and exercise too.

Most of all, you look like a sensible person---what is your body telling you that it needs? Not what the PT needs or what the doctor wants or what you husband expects, but what do you think?
 
When my body says rest, I rest. I'm confused because I don't want to over do, but I don't want to be too complacent either, if that's possible. Looking back at around the 4 week mark I do remember being more mobile, less stiff that is, when I moved more often. Getting up every 30 minutes, making a couple of trips down the hall or something. I truly understand that every recovery is unique; trying to find my happy medium. I went to office today and started unpacking some items and putting them in place; as we changed locations since my surgery. Will be going back on the 2nd of May.
 
@vonjpo
My comments in bold
My PT consists of the following:
Recumbent bike 10 minutes - that's okay provided no resistance
Squats on wall with ball x25 - squats are the most injurious of exercises. I strongly suggest you stop these
balance board 4 minutes - a balance board is also stressful
standing SLR 3lb ankle weight x15 reps (all directions) - NEVER use weights. As for SLRs, once you can do them, you don't need to do them any more!
Hamstring stretch/standing hamstring curls x15 reps - only do hamstring stretches if you have a hamstring pain problem. Otherwise it's a jolly good way to get pain!
sidesteps x25 - what's the point of these? Nothing as far as I can see
heel slides x20 - heel slides are very easy to do badly and doing 20 in one intense session is badly!
Read this Heel slides and how to do them

lying flat on back and moving TKR leg out and back x20 while keeping leg on solid surface - another pointless exercise!
Added the stair step machine on Monday for 5 minutes - and another
prop heel on roll for extension/hang legs off bed for extension - this doesn't improve extension, it just makes the pain worse. The reason you have bad ROM is because of all these injurious exercises.
strongly considering putting it on hold for a while or telling him I only want aquatic therapy
I suggest you quit PT completely! You will find your ROM decreases for a while but then it will improve. Keep on like this and you risk your pain and poor ROM becoming chronic. I've crossed out the exercises that are doing you harm. I would also add to that aquatic therapy as it's far too easy to overdo it and be worse off than you are now.

Take a warning from this poor man's story and stop now while you still have a chance to improve.
PT: the seriously grave consequences of doing too much of it
 
My husband's words today, "the surgeon said you are going to be running and jumping again". I told him that some do, but even when I can, I won't because that will shorten the life of the knee. He replied that is for old knees not the new ones. Very difficult for me right now as I don't have his emotional support. Prayers to stay positive and focused despite my circumstances are requested.

Ahhhhh.....I understand where you are in all this! Things are so difficult when the ones who are supposed to be our champions in life don't quite "get it." Your husband's thoughts are quite common from people who have not had a knee replacement. It's one reason why BoneSmart is so important. We've all been right where you are and truly understand what you're feeling and going through. My advice is to smile sweetly at hubby dear and then do what you know is right. Use us for support. That's what we're here for. We'll be your family and cheering squad for a while. Tell us the good times when you have a positive experience and come here to vent if you have a not-so-good day and need a boost. Recovery is not a straight line even when it's really, really good. We all have steps forward ("Hey, I did the steps like a normal person!") or little setbacks ("I spent too long on my feet and I'm paying for it now.").

Be sure you are icing your knee as much as you can. Ice is great for both swelling and pain. Plus it almost always just feels good. I slept with two large gel ice packs on my knee (front and back) for 3 months. Also, if you're hurting, take something for it. It can be Tylenol or a prescription med, but don't let the pain keep on. It makes your knee even more irritated if it hurts for any length of time.

Hang in there. We're here for you. And please know you are in my prayers for the next few months as you work through your recovery.
 
I'll be waiting to hear what your doctor says - I go Friday and have similar flexion range.

I think your husband just feels he is encouraging you, my mostly very supportive husband does that too sometimes. I'm sure he's frustrated too and really wants it to go better for you!

We had surgery the same day and I think of you often and will keep you in my prayers.


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One exercise that I did for extension was to lie face-down on the bed, and I would use a heating pad on my hamstring muscles---I would then hang the leg over the edge of the bed and let gravity do its work. I would also use small ankle weights later to help this out---as is demonstrated in figure #3 in the library article.

By heating the hamstring, you are allowing it to become more flexible and enabling it to lengthen a bit, which will slowly help with your extension.

I would then ice my hamstrings afterward.
 
The exercises you were doing for extension are not wrong. You'll see they are part of the article that Jo provided for you. The problem is that you are overdoing all your exercises right now and it's causing the pain you're feeling. Jo's recommendation to stop all the exercising for awhile (except for some gentle bends and stretches and walking about the house throughout the day) should allow your body to calm down. Once the pain has lessened, if you still need to gain some extension, you can start the exercises back again. But you want to do them in a manner that is only mildly uncomfortable....not painful....ever.
 
@charmed-life the doc said MUA as I expected. Scheduled it for the 9th, but if I have gains over the next 2 weeks, I will not go through with it. As soon as the PA saw me she said I see you are still going slow. I guess because of the cane and my gait is not good yet either.
Some good news is that I made that trip to Houston and back and did pretty good. I drove, as it was me and my 14 year old. Stopped at Kohl's and then met up with a former pastor and friends and ate a late lunch at Chili's before heading home.
 
My doctor is putting it off a couple of weeks and telling me to keep up bending with gentle pressure frequently. I'm not sure which answer I was hoping for...

Glad you got in the trip. Helps to feel normal now and then!


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@vonjpo, how are you doing? Any improvement? I actually did go up in flexion to 92 degrees - from about 85 a week ago so encouraged by that. Still does not want to bend when walking but leg moves easier in other positions. I get that tight band feeling when walking and it won't bend.


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