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TKR What can I try next?

Gardengirl21

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My TRKR was Feb 28th. I am in Ontario Canada. I’m concerned as I’m getting quite depressed. Covid messes up my PT with closures etc but I have exercised everyday regardless. Still have pain, stiffness & trouble sleeping. In physio presently, still not completely straight & ROM fluctuates due to a lot of swelling. I’m not sure what to expect at this point. I’m a gardener that can’t put in more than 1/2 he in the gardener or I’m a sore swollen mess for days.
 

sistersinhim

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@Gardengirl21, welcome to Bonesmart! :flwrysmile: You are not quite halfway through a normally one-year recovery. Having pain on an unhealed knee is an indication that you are doing too much during the day. When your knee swells, it can't bend or straighten as easily. That's why you are seeing your ROM fluctuate. It's not PT that improves ROM, it's time. I will leave you your very own recovery articles. Even though it has been going on 6 months, your knee is not healed inside yet.

The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​
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

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.
 
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Gardengirl21

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Thank you for your reply. I am experiencing considerable pain & swelling. I have a rigorous list of exercises from my pt therapist that I am to complete 2 - 3 times daily plus walking & time on a stationary bike. I have been feeling very uncomfortable with my therapist's attitude, as well as the money I can Hardly afford to keep paying. I have made the decision to work on my recovery more gently. I have read through your articles & will follow your exercises suggested & take rest days. I have been feeling that I was sinking into a depression due to the constant pain but felt I had to keep pushing.

Thank you!
 

Celle

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Hello @Gardengirl21 - and :welome:

Complete recovery from a knee replacement takes a full year, no matter how much you wish it could be faster. There's good and bad in that. The good is that you still have more than 6 months for your nee to improve. The bad is that you may have to decrease your activity for a while longer.

I think the root of your problem is that you are trying to do too much, too soon, and your knee is swelling because of that.

In spite of what you've probably been told, 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

In any case, as sistersinhim said, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase.

My suggestion is that you stop going to PT, stop doing formal exercises, and just let your normal activities of daily living be your exercise.

it's really too soon to be expecting to do gardening, so reduce the time you spend doing that.
Instead, spend more time icing and elevating your knee, to try and reduce its swelling.

All the pain and swelling you've been experiencing are a message from your knee, that you're asking it to do more than it is ready for. Listen to your knee. It knows what it's doing.
 

sistersinhim

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Many of us never took formal PT or did exercises. I am one of them. I had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.
 
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Gardengirl21

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Thank you for your replies. What you are saying makes a lot of sense. I have been doing exercises everyday since a week following surgery. Still so much pain & swelling. Cancelled my PT appt this Thursday & I am taking your advice re:continued care. I will be gentle with this poor old knee. It started as a bad injury 3 years ago & has been a very painful journey which I’m hoping will settle down soon. Do you still recommend walking a few blocks on a sidewalk?

Many thanks for the support. I will continue to follow threads.

Patti
 

Celle

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I would start with walking just one block. If you experience swelling and/or pain after doing that, just walk around the house for a few days. If you find your knee doesn't swell or give you pain, at the time or later, stick to just one block for a couple of days and they try doing one-and-a-half blocks. Same thing: Pain and/or swelling = go back to just one block. If no pain or swelling, stick at that distance for a few more days and then gradually increase the distance.

Slow and steady progress should be your aim - not trying to reach someone else's artificial deadline. Keep your knee calm and happy and it will heal itself and continue to increase ROM.
 

Roy Gardiner

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I have a rigorous list of exercises from my pt therapist that I am to complete 2 - 3 times daily plus walking & time on a stationary bike.
As everyone is saying, it's far too much.

Imagine working like that to recover a broken leg or a sprained muscle; you can't, and walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Read full details here https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
 

sistersinhim

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Excellent advice from Celle and Roy. Slow and easy wins this recovery!
 

DBN

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I had my right knee replaced on Feb 13... have experienced all kinds of inflammation and stiffness... Finally went to a physical medicine orthopedic dr this week... Via sonogram they can clearly see that my Fascia )covering of muscles and tendons) is ‘stuck’ to my knee in all of the surrounding soft tissue... the fascia is tight as well, causing the stiffness...I had 10 shots of lidocaine and saline in various places in leg. They did the shots while using sonogram to view where issues are... It was also recommended to do fascial release massage... Have done some deep tissue massage through the past months, but started a more dedicated massage therapy this week.. Up until now everyone has been hesitant to push and prod too much... Will have to wait and see for the outcome... Dr and massage therapist see it won’t be a overnight fix...For now feeling some release of tightness and reduction of inflammation... Whatever works to make me more comfortable!
 
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Gardengirl21

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Wow. That’s a lot for you. Hope you get some relief. I’ve been in pt for so long. Here in Canada, they don’t seem to suggest anything else but forcing the bend etc. I’m taking this forums advice & going a little gentler on the knee & letting it heal. Already noting a change in the inflammation & stiffness. Hopefully it continues to loosen up
 

Roy Gardiner

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Here in Canada, they don’t seem to suggest anything else but forcing the bend
It makes no sense, IMO. Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Read full details here https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
I’m taking this forums advice & going a little gentler on the knee & letting it heal
Which, again IMO, is the reasonable approach.
 

kneeper

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It sounds like you may have been doing too much. My PT said it was ok to alternate exercises. So on the days when you garden you don't also need to do the PT exercises. Also at a certain point when you can do daily activities, you are taking the knee "through its paces" naturally.

Let us know how it goes with taking it a bit easier.
 
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Gardengirl21

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Thank you for the support! I am trying to listen to my knee. By backing off on the heavy exercises I am having moments where it is definitely feeling less stiff. Odd as it sounds I know now when I just need to do some stretching. I’m doing pretty well going up stairs but struggling going down steps if they are spaced a little further apart

Thank you! Really appreciate the encouragement. Actually slept through the entire night for the first time since surgery.
 

Jaycey

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Actually slept through the entire night for the first time since surgery.
:yes!: Well done! Sounds like you are on track in this recovery. Are you icing and elevating regularly as well? Ice for 45-60 minutes several times per day. It will ease the stiffness.
 

Jockette

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Going downstairs usually takes longer to accomplish comfortably than going up.
 

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Gardengirl21

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Morning share: I am sticking with my plan to be more gentle with my knee. So far, so good. When I do exercise for mobility it is certainly not as vigorous. I have an old skateboard that I use to loosen my knee, it seems to really help to hold onto a surface & exercise my operated knee. As well, in the last week I have started muscle release therapy, on my self. I had this therapy regularly when I was working actively in the landscape business, I honestly feel it kept me on my feet as long as I lasted. I have done some extensive research as well. So I'm comfortable with finding my own points that need release. It's really quite interesting, after a short while my legs already seem to be responding & letting me know the areas that need some attention. So far, I think it is definitely beneficial.
 

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