TKR When to transition from walker to cane?

[Morgaine]

Forget the numbers. As others have said, ROM will happen. With my RTKR, at 11 days post op, my flex was 28. I had just stood up the day before (took 10 days before I could even stand). Now my flex is between 101 and 105 on that knee, compared to my pre-surgery flex, I am thrilled with it.
If your sadistic brute of an alleged therapist tries to hurt you again, I suggest a rolling pin or iron skillet up side his head (just kidding ). Although that might get the message across.

 

[harplayer]

Just checking...
How do you know when to transition from a walker to a cane? Day 12 here...RTKR, using walker largely for balance (no death grip, able to bear weight on repaired leg/knee comfortably). Have caught myself taking a few steps without walker in the kitchen
Just curious....

 

[tashia]

harplayer, I found its very important not to rush from walker to cane. I did with my first knee and paid for it, it really swelled and soo sore. The second time I waited until I saw the OS at six weeks. It worked much better. I also know everyone is different. I wanted till I was using the walker just for balance. I wasn't putting much weight on it at all. Remember you have had major surgrey and your body needs rest, elevation, ice, and pain medicane as needed. Please take a easy and keep us informed on how you are doing. We care. Tashia

 

[harplayer]

Thanks Tashia! I will take your advice!

 

[tashia]

I dropped by to see how you are doing. Please don't ever let the PT do that to you again. They are to help, not to hurt and make the knee swell. Please remember you know what is good for you and if you would feel better with a different PT, tell your doctor so. This is hard enough without someone hurting you. Please keep us informed so we can help you and surport you. Take a easy and rest so you can get that knee doing what its surpose to do, not swell. Take care. Tashia

 

[ChibiGirl]

Hang in there! I am not there yet...I will come to this side on Tuesday. I have been reading a lot of posts and getting great information. Thanks...

 

[Morgaine]

I agree with Tashia, don't be in a hurry to move off the walker. With my RTKR, I kept a death grip on my walker for about three months. I doubt anyone could have pried it away from me. Then I went to using a quad cane. But at night, I still used the walker to make my bathroom trips (even the night before my LTKR). But then, I had problems with my other knee, so I was insecure with my balance. My thought was better to use the walker than risk a fall.
Everyone progresses at a different rate. Just relax, don't rush, when you feel comfortable you will reach for that cane.

 

[Ms.fixit]

I'd say move when you feel comfortable. For me, I moved to a cane after six days, but if you feel safer with the walker and you are getting around okay, don't sweat it.

 

[Chickie]

This feeling you are having is just so unnecessary! I went for PT evaluation 5 days after surgery and the pain I experienced was unbelievable. There is no need for anything past discomfort. Get rid of this PT. I was lucky enough to get with one that believed in working very gently with my knee, she did push me to pain at one point and after that I had a talk with her. Things improved so well, at not even 4 weeks post-op, I was released by PT with extension as perfect and ROM of 130. I am convinced that PT should not start until week three or four, it is not going to set you back, in fact, you will be surprised how much better you will do. Just follow the mantra, rest, take your pain meds, ice and elevate. I don't know why we, in the USA are so hung up on being the best and fastest. It just doesn't make sense and you need to be gentle with yourself. It is not uncommon to feel depression after surgery, you have been through a lot of trauma, it is after all, major surgery. I do believe with the anesthesia, drugs, trauma and the stress of an out of control PT, can add to that. You will not set yourself back, don't worry about it. This is a wonderful site and everyone is so helpful, you are doing the right thing by being here. Good Luck

 

[harplayer]

Well, I have survived another painful PT session. I am still negotiating with my PT re: painful ROM activities. I am doing better in some areas..good leg extension...walking comfortablely with the walker...much less day-to-day pain...and reduced swelling...until PT happens...then the swelling and pain come back big time!

My stride has lengthened...and I'm developing some strength...so my PT did begin my transition to a cane today. The cane is certainly more work for my legs and my core...right now I am practicing walking a straight path from the dining room, through the family room and into the far reaches of the kitchen...wow...sore/tired. Any suggestions from my Bonesmart friends as I attempt this transition will be so appreciated!

With all the improvements...my PT is still fixated on my ROM and bend angle...I am so tired of arguing with him...

Thanks,
Harplayer

 

[Jamie]

Harplayer.....I'm not thinking too many good thoughts about your therapist!!! It is obvious from the pain you describe that this person is pushing you to hard. It sounds like you are doing much better on your own, quite frankly!

You are barely over two weeks out from your surgery. Do NOT allow ANY therapy that hurts beyound mild discomfort. It will set you back in your recovery (as you notice) because you'll get swelling and pain afterwards. If necessary, ask for a different therapist, change to a new practice, or request they print out your exercises and you do them at home on your own for a while.

It's excellent that your stride is improving on your walker. There is no rush to get to the cane!!! So stop until YOU are ready and strong enough to make that transition. Using a walker is not going to hurt you. For example, I chose to use my walker for 4-5 weeks around the house because it enabled me to work on my stride better than a cane or crutches. I only used the cane when I went out places. There is nothing wrong with that. About week 5, I was able to walk short distances in the house with no aid and did that until I no longer needed the walker or anything.

It's all about what works for YOU and what is most comfortable for YOU. There is no one right way to do recovery. And the only wrong way is to do what seems to be happening with this therapist....pushing you to do things you are not ready for.

 

[harplayer]

Thank You Jamie! I will dial things back...as I don't have to get into it with my PT again until Wednesday! My surgery will be just 3 weeks ago tomorrow...so this is all overwhelming!

 

[Jamie]

I know, hon......this can be a rough recovery. But you're doing just fine!!! The important things to remember are to keep pain managed, keep swelling down (ice, ice, ice) and don't be in a hurry. Your body is in charge of this whole recovery process...not you and definitely NOT your therapist!!!

 

[gazelle7777]

I know, hon......this can be a rough recovery. But you're doing just fine!!! The important things to remember are to keep pain managed, keep swelling down (ice, ice, ice) and don't be in a hurry. Your body is in charge of this whole recovery process...not you and definitely NOT your therapist!!!

Your advise is so good Jamie! Harplayer you are doing so good! I am so proud and happy for you! We both need to remember:

YOUR BODY IS IN CHARGE.

This is going to be my new mantra!

 

[referee54]

The important things to remember are to keep pain managed, keep swelling down (ice, ice, ice) and don't be in a hurry.

:iagree:

I would rather take things a little too slowly than a little too quickly---it is easier to move slowly forward than to move too quickly and then regress and fight unnecessary battles.

Remember, your PT works for you---not the other way around!

 

[referee54]

YOUR BODY IS IN CHARGE.

Yes---we want to control the schedule---we are the control freaks, so to speak. In reality, the knee (or knees) are in charge and we recover on their schedule, not ours.

Patience is the key---the more "scheduling" that you do, the more frustrated you get. The knee or knees will let you know when it is time to move forward.

 

[Josephine]

​

One thread for your recovery please?​

 

[Josephine]

He indicated the the fluid around my knee was "thick and viscis" and it was his goal to move this thick fluid out of my knee...up into my thigh...so it can be "reabsorbed" and subsequently "thinned" as it was recirculated within my body.he said it needed to be "encouraged to head toward my heart".

What a load of ignorant, ridiculous, unmitigated tosh! I've never heard such rubbish in all my life!

What if I am making things worse? The messages I get from my PT are related to me "needing to do my part"..."try harder"..."force it a bit...you know it's gonna hurt".

As for this, it just confirms that this chap is making it all up as he goes along! Nothing he said goes along with good and sensible recovery. Gee wiz - I'd toss him out of my house in seconds!

Well, I have survived another painful PT session. I am still negotiating with my PT re: painful ROM activities.

Don't negotiate with him - FIRE HIM. He's a danger to you with his made up notions. Remember you are paying him for his services. He is not in charge of this, YOU are. Please, please, fire him and get someone who is more professional and compassionate.

Above all, you need to read these articles. They are crucial to your understanding of how to manage your recovery. Please read and absorb ...

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

My OS does still use CPM machines and I use it daily.... I was able to achieve 70 degrees of flex for the first time yesterday...anyone have insights re: how this translates to long term progress?

Almost none. The key is the P in the name - continuous passive motion. This means your muscles do no work at all and yet your muscles are largely responsible for getting that ROM. Therefore, the only good and lasting ROM you get is that which you've achieved with your own leg! But people do say they like using them so no harm done - and that's about the best I can say for CPMs - they may not do you much good but they won't do you any harm either! If nothing else, at least it keeps you off your feet and resting for an hour or two!

 

[Celle]

Well, I have survived another painful PT session. I am still negotiating with my PT re: painful ROM activities. I am doing better in some areas..good leg extension...walking comfortablely with the walker...much less day-to-day pain...and reduced swelling...until PT happens...then the swelling and pain come back big time!

. . . (I deleted a paragraph)


With all the improvements...my PT is still fixated on my ROM and bend angle...I am so tired of arguing with him...



Thanks,

Harplayer

Dear Harplayer,

Listen to what you are saying!

It is so obvious that this PT is the wrong one for you. He is doing you more harm than good. Stop "negotiating" and tell him. It's time to be very outspoken with him. If he won't listen, find another PT or else don't have one at all. It's perfectly possible to have an excellent recovery without PT - people in the UK do it and I have done it with only 4 PT sessions in total.

Remember these things:

• It is your body and you must not allow anyone to do anything to it without your consent - anything else is an assault.
• What he is doing is not helping. It is making things worse, because it causes more pain and swelling.
• Your knee can't bend while it is swollen, so this emphasis on ROM is completely inappropriate at this stage.
• He works for you; you don't work for him.
• Even if your PT gives you a lecture and threatens that you will retard your recovery, his other ideas are so wrong. You don't have to listen to him and you certainly don't have to believe him.
• He can't force you to go to PT. If you choose to stay home instead, he won't come to your house and physically drag you there.

Best wishes.

 

[Dulcimer Diva]

When to transition from walker to cane? When it feels natural to do so. I know that sounds evasive but it's true. Your knee will let you know how much weight it can bear and how well it can bend while walking. Your quads will let you know when they are strong enough to support your weight. And your sense of balance will tell you when it's comfortable not having to steady yourself with two hands. (If you must use stairs, though, a cane is usually better for that. You might want to put a folding cane in your walker pouch for just that purpose and steady your walker several stair treads ahead of you or pass it to someone else who'll have it ready at the landing. And a good physio will show you how to use a folded walker as your "cane" or "crutch" on stairs if you still feel shaky using a cane). There will come a time when you feel unduly restrained by the walker--that's when to transition. Just because you've inadvertently taken some unsupported steps doesn't mean it's time to ditch assistive devices. You can equally inadvertently injure yourself when walking unaided too soon. Get a pouch for the walker, even a cloth sling seat to use when you get tired when out & about and want to sit. A pouch frees up your hands to fully help you balance.