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[TKR] Walking, skiing, bicycling

Discussion in 'Knee Replacement Recovery Area' started by DIYSteve, Jul 24, 2018.

  1. DIYSteve

    DIYSteve member
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    I am 2 weeks post-TKR surgery with patella button on my left knee. Pain has significantly subsided. Swelling has ostensibly mostly abated, but the knee is very stiff, thus I surmise there is still significant internal swelling. I slept 6 hours last night, a post-op record.

    I am suffering some anxiety re ROM. I am currently at est. 60-65 flexion and est. 12 extension. Flexion seems to be limited by a very tight quad, but of course there might be something else going on. Extension seems limited at the patella -- it feels that it would pop off if I forced an extension.

    I have been doing very gentle exercises (provided by PT on day of surgery), never pushing to pain.

    My first PT appointment is in 6 days. I saw my OS's PA yesterday, who said he'd like to see my extension at 90 by my first PT appointment. That seems impossible.

    Prior to my surgery, my PT advised that working on extension early is more important that flexion, which he said will take time, perhaps months. He warns that lack of full extension can have a ripple effect on hip, opposite leg and back. That makes sense to me. AFAICT, my PT will not force anything and eschews the dubious "no pain no gain" dogma.

    FWIW, I had limited ROM prior to surgery, est. 100 flexion, 5 extension. I was very active (hiking, skiing, XC skiing, ski touring, climbing, bicycling, mountaineering, ex-runner) and I have thick leg muscles and stout tendons and ligaments. I have never been very flexible. OS said he installed the next-to-largest size knee hardware (Stryker Triathlon #7). He also warned pre-op that, because I my legs are heavily muscled, the surgery would result in more tissue damage.

    Other than ROM anxiety, I am optimistic about my recovery.
     
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    Last edited: Jul 25, 2018
  2. lovetocookandsew

    lovetocookandsew supremo

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    Your surgeon, or his PA, or a PT, may "like" your ROM to be at 90, or any other random number, by a certain point, but your knee has it's own ideas and schedule. I'm a couple of weeks ahead of you, my knee is still stiff, and I have no clue what the ROM numbers are, nor am I worried about it. Your knee needs time to recover and as it recovers, it will begin to bend more. There is still a lot of swelling in your knee at this point, even if you can't see it on the outside, thus the stiff knee. Trying to force it to bend with all that fluid inside is not only painful, but counter productive. As the swelling goes away, it will bend more. I've been told the extension comes naturally, but takes longer to arrive, than the flex. And that it will come naturally as you walk over time. I opted out of PT this time and am very glad I did. I spend my time icing and elevating, and doing some of my normal activities a little at a time; as time goes on I am increasing my activity as my knee allows. If I were you, I'd skip the measurements for ROM that PTs, and others, are so stuck on, and just let your knee heal without feeling pressured to get to x number by x date.
     
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  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @DIYSteve - and :welome:to recovery.

    It's much too early to be worry8ing about your ROM.
    In spite of what your PT or your surgeon may say, there's no need to rush to get ROM (Range of Motion) because it 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

    ROM consists of two parts - flexion (bending) and extension (straightening). It's quite normal for extension to take longer to achieve than flexion, but it will come. There are large muscles and tendons at the back of your leg that have to stretch gradually. Trying to force them to stretch too quickly could cause damage.

    Here is the post-op reading we give to everyone:
    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
    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
    5. Here is a week-by-week guide for 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

    Please don't be overwhelmed by the list. The articles are not long and they and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

    We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish.

    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.
     
  4. HoneyB

    HoneyB senior

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    I'm one of the "odd" folks on the forum who has enjoyed (well, as much as one can "enjoy") PT with both of my TKRs. With that said, it's way too early for you to be concerned about your ROM, and even after you get to PT and do your best at what they ask of you, your knee will still decide when your ROM is going to improve. I stressed over ROM with knee #1. I changed PT groups with knee #2 to a PT group with a totally different approach than PT group #1. I've been less concerned about ROM with knee #2. Funny thing is, with two different PT approaches and two different attitudes by me, my knees have progressed at almost identical speeds. These knees progress when they're ready in spite of us. Good luck to you!
     
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  5. Spex10

    Spex10 post-grad

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    It's very early days yet. I've found just walking up and down helps me a lot. My lovely PT says it's the best exercise. No pressure from him to do other stuff either. He shows me some things I could try if I wanted to but that's it.
    My leg hadn't been straight for years but after the op I was amazed to feel the sheet behind my knee. Its beautifully straight now. I'd done a lot of work with my quads pre op.
    I find that if I use my stick my leg bends more than when I try without it. Odd. Maybe because I put weight on my stick which frees up the knee to bend? Don't know. Something to think about?
     
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  6. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Worth plenty. It says to me that you will need to stretch a lot if you want full flexibility, because your muscles and tendons and ligaments will be short, because of your bad knees. But there's no reason why you shouldn't obtain that full flexibility, and yes it will help to prevent those ripple effects.


    The stretching Bible is Bob Anderson, Stretching, ISBN 0-7207-1351-X

    Here’s more, with some pix https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/
     
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  7. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Much too early to panic. You're right that there is bound to be internal swelling even if you think the knee doesn't look bad. Slow and steady wins this race. Ice, elevate and go easy on the PT was the recipe that worked for me.
     
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  8. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    My experience was that flexion came easily as the swelling went down. I’d just rest with my legs/knees elevated every moment I was not on my feet, and ice regularly, and the swelling decreased. When the swelling decreased, my flexion got better. It was magical, almost. The only time I ever did exercises for flexion were at PT (which I did mostly just so I could get out of the house) and only the minimum needed, never at home. I had my PT guy work with me on gait and balance for the most part and was happy doing that.

    Extension took longer. Like you, I had a bad knee, my left, which had pre-op extension of 10, and it took a few months of a walking program and some gentle stretches to get Lefty to 0. Got there, though. There was no need for any pushing or painful exercises. My tendons and the hamstring muscle naturally stretched back to the needed length.

    It does help with the gait, to be sure, and therefore for the hip and lower back.

    Try not to obsess about ROM. Recovery is not a contest or a race against time. It’s a bit like War Games, the movie: “The only way to win [the ROM war] is not to play.” Our knees are the ones in command for this recovery; best to keep our inner alphas out of it.
     
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  9. DIYSteve

    DIYSteve member
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    Thanks for the valuable input. It has renewed my patience.
     
  10. DIYSteve

    DIYSteve member
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    90 flexion today, 5 weeks post-surgery. Extension is est. -4. Strength is very good.
     
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  11. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    That sounds great for a little over just a month! Good going!
     
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  12. DIYSteve

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    Mods, please change thread title to "post-TKR walking, skiing, bicycling, etc." Thank you

    8½ weeks post-op: I walked 6 miles (3 x 2 miles) for my birthday, walking 4 miles the prior day and subsequent day. Terrain was relatively flat, no steeper than est. 6% grade. I suffered no ill effects, other than some tired muscles. Next day stiffness/swelling was pretty much the same whether I had walked or sat on the sofa. FWIW, I drove our camper while my wife bicycled 100km+ each day for 10 days. Prior to this year, we have spent my birthday week in the mountains, mostly off trail. I hope we can resume our tradition next year.

    Extension is close to 0, flexion est. 110, not enough to bicycle, although I can make a complete backwards rotation on the PT bicycle. (PT bicycle has short cranks; my bicycles have longer, 175mm, cranks).

    I'm confident re skiing this season. Indeed, I think I could ski a mellow groomer today.
     
    Last edited: Sep 12, 2018
  13. SherrieT

    SherrieT senior

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    What a wonderful report. Keep us up to date on the skiing progress !
     
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  14. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    You are doing great! Thanks for letting us know how good it can be!
     
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  15. Coach_HL

    Coach_HL junior member

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    Steve, I ride shortened cranks 155mm currently hoping post op to ride regular. I enjoy your thread and you give me hope for many years of cycling.
     
  16. DIYSteve

    DIYSteve member
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    Great idea. Thanks for the note. 155cm cranks would be just right presently, but I have no use for them in the long term. (I recently built a new frame for my wife, and blew our bicycle component budget building it up. I will soon start building a new fast road bike frame for myself.)

    I raised my seat 1-1/2cm higher than normal, which allows me to (now) do full circles (bike on trainer) with 175mm cranks after I warm up a bit. My ROM is not quite there to ride. Flexion improvement is quite slow, but measurable weekly.

    I have done three 6-mile hikes on easy, albeit flat, trail in the past 10 days. I'm headed out this morning to play golf, planning to walk 9 holes but might try walking 18 holes. Whether I walk 1 mile or 6 miles, I seem to feel the same afterwards.

    I need to get my flexion a bit more to get off ski lifts. My pre-op flexion was restricted by bone spurs (later removed during TKR surgery) and getting off some ski lifts was very painful.
     
  17. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Can you raise it any further? It would help.
    First frame builder on here I reckon, very cool; steel, is it?
     
  18. DIYSteve

    DIYSteve member
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    Yeah, steel. I've been building frames since 1974, although it's always been a hobby for me. My partner has built professionally nearly all of his working life. I currently build 2 or 3 frames a year.
     
  19. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Wow, please check out here https://bonesmart.org/forum/threads/cycling-club-pix-of-our-bikes.12812/

    I love custom one-off machines, pls post a few!

    You may well not need this, but here's how I've found to use the bike for ROM exercises
    • Set the bike to zero resistance
    • Set the saddle high enough that a rotation is possible, 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
     
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  20. Coach_HL

    Coach_HL junior member

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    Roy, At what point in your recovery did you start using the bike to help with ROM as you describe above?
     

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