TKR Very little knee bend

[smithyknee]

Hi, just looking for some advice really.
I am 7 weeks post TKR and progress is really slow. I know i have to be patient, but i believe I have been set back by the advice Ihave received from 2 different physios and would like to try going it alone. The first physio talked over me all the time, didnt really listen and sent me exercises on a portal to watch, some of which i believe were for much further down the line. I have suffered with extreme muscle spasms in my thigth which at times were more painful then my knee, made worse by the exercises, and I couldn't get him to listen to anything about that. The second physio listened, explained and was lovely! But told me to do one knee bend exercise 5 times every hour. Which I did.
My knee completely seized up, I could put no weight on it, had to use 2 crutches again. It has taken me 7 days to get back to where I was before..... I can now walk quite well with one crutch, not long distances, can't sit for long and have about a 70 degree bend. I know I have to increase this, but have lost my faith in the physioterapy department. I am increasing my walking distances each day and very slowly building up on bending exercises. Any thoughts/suggestions......

 

[Jaycey]

@smithyknee Welcome to BoneSmart!

Please give me the date of your surgery and which knee. I'll put the information in your signature for you.

But told me to do one knee bend exercise 5 times every hour.

This is total overkill! Your poor knee! You are not in training for anything. You are healing. Please stop all this and get this pain under control.

Are you icing and elevating? Ice for 45-60 minutes several times per day. This will help reduce the swelling that is limiting your bend. Once the swelling decreases, gentle stretches are all that is needed. Do not force the bend or let anyone else force that knee.

I'll leave your recovery guidelines here for you:

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
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.

 

[smithyknee]

I had a total right knee replacement on July 18th
Left knee June 2014.
Double knee artroscopy june 2013

 

[smithyknee]

Yes, I have been icing and elevating and am now concentrating more on walking, gently building up, with heel slides to stretch my knee. Seems like that's the way to go !

 

[Nivea]

I am one day ahead of you and would say you are doing too much with your knee. All patients are different, all knees are different. However, it seems as though there is a consensus, less is more. My OS does not believe in any PT, he said to just use it. All I did in the beginning is walk around the house. I progressed to walking outside & around the block. I slowly increased that and I knew if I walked a bit too much. Other than that, I did my usual routine in the house. I started out not doing much other than getting up and walking in the house several times per day and progressed to doing things such as laundry. I am walking fine, no pain. I stopped using the can at about 1 month. Let nature takes its course and you will feel better.

 

[Nivea]

I will add that my OS does not believe in worrying about the “numbers”. He saw what I could do, never measured or told me any sort of numbers. Don’t worry about a 70 degree bend. Ease up on what you are doing and your knee will respond.

 

[smithyknee]

Thank you! So much pressure is put on us by physios - "the exercises are brutal, but necessary" that I got a bit sucked in! I am now listening more too my body and not to them. I just desperately want to be able to walk easily again....

 

[Jaycey]

"the exercises are brutal, but necessary"

Rubbish - obviously this guy has never had TKR! Exercises should be slow and gentle. Activities of daily living (ADLs) and walking is all that is really needed.

As my colleague Jockette says:

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[sistersinhim]

I was blessed to have a surgeon who never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he was interested in was to see what my knee would do and never measured. He never even asked about PT! Of course, he knew I was a single lady who had to take care of myself and obviously trusted that I would not be just lying around all the time.

Because of birth defects, I had to have 12 knee surgeries, so I've had lots of knee recovery experience. I knew from that experience that I did not need formal PT after my TKR, and neither do many others if they do their own daily activities and do not just sit around all day and night. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[mendogal]

Yes, I have been icing and elevating and am now concentrating more on walking, gently building up, with heel slides to stretch my knee. Seems like that's the way to go !

Gentle heel slides are a great range of motion exercise (ROM). A little slow ROM, staying within your current comfort range, is a great way to relieve stiffness and keep things moving without stressing out healing tissues.

 

[smithyknee]

Thank you all for your comments. I am so glad I found this forum. Looking for advice/ info online can be very dispiriting with tales of people back to normal after 6 weeks when you are still suffering with swelling and pain. I now apprceciate we are all different and patience is key....
Last week I was in a great deal of pain, not sleeping, tearful and feeling a failure.
This week after resting I am more stiff than in pain, still not sleeping ( !), smiling and feel I am on the right path.

 

[Jockette]

Most of us have sleep issues for a while after this surgery. Here’s an article from the Recovery Guidelines:

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

 

[benne68]

tales of people back to normal after 6 weeks

While every knee is different and we all recover at different rates, a lot of those claims are puffery by people who don't want to admit they are struggling. (Or, who had surgery so long ago that they don't really remember.)

Yes, this is a recovery that takes patience! Something that helped me get through the frustration and post-op blues during the early months was documenting my "achievements."

Once a week or so, I would list of all the things -- even the little ones -- that I was able to do now that I hadn't been able to do the week before. I also had a list of the things I was looking forward to being able to do in the future. As items moved from one list to the other, I saw real progress and it helped me stay positive.

Why not give it a try?

 

[skiforever]

Last week I was in a great deal of pain, not sleeping, tearful and feeling a failure.

This is so familiar. Recovery is hard and has many ups and downs. Here is one way of looking at it:

 

[MichiganGal]

Hang in there - after I finished PT I was frustrated because the more I tried to do the home exercises that they gave me the more my knee hurt and would swell. I then put it all away and started following the advice here. I ice and elevate my knee at least 3 times a day, I go for gentle 5-10 minute walks a few times a day, gentle stretching swims twice a week and I have stopped beating myself up.
Give your body time to heal and listen to your body. It will let you know what to do and not to do.
The last time I saw my surgeon was for my 1 month follow up and he did not measure, he only looked at xrays, asked me to move my knee, walk for him and his "prescription" to me was to put some miles on the knee.
Also, I found that getting myself a really good tearjerker movie, popcorn and a nice cold beverage is great therapy to get it out of your system

 

[Susie-Q]

Sometimes I think these PTs (and even some OS) forget that we've had MAJOR reconstruction on our knee joints, involving drilling into bone, cutting into the skin, adding metal implants, etc. There's a lot of healing that needs to happen before we can poke, prod and stretch this baby joint beyond what it's ready for. With my first TKR, I didn't start PT until 3 weeks post-op. Why the rush nowadays?

This week after resting I am more stiff than in pain, still not sleeping ( !), smiling and feel I am on the right path.

Great news! Best wishes on your continued recovery! Keep us posted!

 

[smithyknee]

Hang in there - after I finished PT I was frustrated because the more I tried to do the home exercises that they gave me the more my knee hurt and would swell. I then put it all away and started following the advice here. I ice and elevate my knee at least 3 times a day, I go for gentle 5-10 minute walks a few times a day, gentle stretching swims twice a week and I have stopped beating myself up.
Give your body time to heal and listen to your body. It will let you know what to do and not to do.
The last time I saw my surgeon was for my 1 month follow up and he did not measure, he only looked at xrays, asked me to move my knee, walk for him and his "prescription" to me was to put some miles on the knee.
Also, I found that getting myself a really good tearjerker movie, popcorn and a nice cold beverage is great therapy to get it out of your system

Thanks! And I totally agree about the movie!!

 

[smithyknee]

tales of people back to normal after 6 weeks

While every knee is different and we all recover at different rates, a lot of those claims are puffery by people who don't want to admit they are struggling. (Or, who had surgery so long ago that they don't really remember.)

Yes, this is a recovery that takes patience! Something that helped me get through the frustration and post-op blues during the early months was documenting my "achievements."

Once a week or so, I would list of all the things -- even the little ones -- that I was able to do now that I hadn't been able to do the week before. I also had a list of the things I was looking forward to being able to do in the future. As items moved from one list to the other, I saw real progress and it helped me stay positive.

Why not give it a try?

Great idea! It is easy to miss little achievements amongst everything else......

 

[smithyknee]

Update.....
One week on after gentle walking everyday and increasing normal movement around the house my knee feels so much better. Did a bit much yesterday so I am feeling it today, but not in the same way. It is a bit sore and swollen, but not painful. I have increased knee bends and stretches, but gently, and things are inproving.
Still not sleeping and thigh muscle spasms are still bothering me, but I feel so much more positive....

 

[Mutti3]

Are you still Icing your knee? I used ice packs on “ problem area”. Especially before bedtime I spot ice those areas. With my previous replacement I had thigh spasms. Used ice packs and had successful outcome. Ice / cooling is a knee best friend!