TKR Which exercises to continue pre MUA?

[Focuspositively]

I’m 10 weeks post op RTKR and scheduled for my LTKR in 2 weeks. While under anesthesia, my surgeon is planning to manipulate my right knee because I’m only at 85 ROM. The assumption is there’s scar tissue preventing progress. I’m wondering how much exercise I should continue for the next two weeks? I go to a physio clinic twice a week (Mon and Wed for 1.75 hours) where I do exercises such as lunges, wall slides, biking (which I find excruciating), use tens machines and get measured by the PT. Then I go to an aerobic swim class twice a week for an hour Tuesdays and Thursdays. I have also had appointments to see either an osteopath or message therapist (every 2 or 3 weeks) and have made an appointment tomorrow with a new PT for additional support. I also have my routine of stretches to do at home (3-4 times a day) plus two 15 minute walks a day, plus some biking if I can. I ice and elevate after the sessions. All this to help get the swelling down and make progress with flexing my knee. Now that I found out that I’m having a MUA on my right knee I’m wondering how much exercise I should be doing?

 

[sistersinhim]

Welcome to Bonesmart, @Focuspositively. Please tell us the dates of both of your surgeries. Knowing those dates will help us to better advise you and for other members to relate to you better.

About the MUA. It sounds like your knee is inflamed and probably swollen. You have definitely been overworking it. We have found that fewer exercises means better healing. Having a swollen knee restricts being able to bend better. There is nowhere for that fluid to go! I suggest you do nothing extra, no PT or exercises for these next two weeks and I bet your bend will improve, and you won't have to have the MUA.

 

[Jockette]

I agree, you are way overworking your new knee, no wonder your ROM is not improving. This is not a recovery where the more you do, the better you heal.

Healing takes time, and overworking the surgical knee hinders that healing.

I agree with @sistersinhim, stop doing all that rehab for the next 2 weeks, and give your knee some time to relax, and I bet you’ll see improvement.

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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.​

​

If you want to use something to help heal the incision, ​

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.​

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​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[benne68]

All this to help get the swelling down and make progress with flexing my knee.

Oh my! All this forcing of the knee is the cause of the swelling and the reason you can't flex your knee!

I echo the others: Stop the exercises for the next two weeks and ice and elevate your knee instead. I'll bet your flexion improves enough that you won't want/need an MUA.

 

[Focuspositively]

Thank you for your advice. I’ve been reading some of your articles which led me to seek your help. My first LTKR was August 27, 2024 and my RTKR is scheduled November 21, 2024. The Surgeon will do a MUA on my right knee at that time also to break up the scar tissue to help with the bending of my knee. I did see a new PT this morning before I received your messages. He also told me that I’m doing too much and advised me to cancel my PT appointments with my current clinic (under the government of Ontario hospital bundle care program) and cut back on my water aerobics classes too. He wants to see me next Friday. He did an assessment on me. I measured at about 70 ROM at first then 88 at the end of the appointment. He says he’ll do mostly hand manipulation to me during my appointments and review the exercises I’m currently doing and make recommendations on which to drop or replace. He wants to see me next Friday to prepare me for my next surgery and continue after my surgery once (or twice) a week. I canceled all my appointments with my other PT and at his recommendation was planning on resting and only do the exercises at home (twice a day) that he will recommend by email, plus water aerobics on Wednesday then see him next Friday. Do you think that’s still too much exercising for me? Yes, my knee is swollen and my message therapist noticed yesterday that there’s a little heat radiating from it. I noticed a little heat from it this morning before physio too.

 

[Jockette]

I canceled all my appointments with my other PT and at his recommendation was planning on resting and only do the exercises at home (twice a day) that he will recommend by email, plus water aerobics on Wednesday then see him next Friday. Do you think that’s still too much exercising for me?

I do think the above is still too much, after all you’ve been doing. It’s only 2 weeks until your next surgery. It won’t hurt to stop the formal rehab for that time period, and you will probably see that it will help. Don’t look at stopping your current routine as “doing nothing” look at it as giving your knee the best opportunity in which to heal. Remember, every movement you do, going about your daily activities, is mobility for your knee, and it’s what I like to call “natural PT.”

I’m glad to read that your new therapist agreed that you’re doing too much. There are many different opinions among all the PTs, so I understand it’s hard to know which one we should listen to. We should listen to the one who does indeed help us heal, and move on from the ones who end up causing us difficulty with our healing. Hopefully this next knee will do better, under the guidance of a different therapist.

 

[sistersinhim]

Do you think that’s still too much exercising for me?

Most definitely, especially the water aerobics. Water adds resistance, which is like using weights. That is not helpful at all for a swollen, inflamed knee, like yours. Many of us took NO formal PT or did any exercises at all. I am one of those, and I recovered just fine. Overworking a TKR just slows down its recovery, not speed it up. Please stop everything but your around-the-house daily activities, and increase your icing, resting and elevating before your next surgery, and you'll see an improvement in your bend. Having a MUA will only increase your swelling, inflammation, and pain in your TKR, thus causing a setback in its recovery. It will be rough recovering from two inflamed and painful knees.

 

[Focuspositively]

Okay. This is completely opposite from what my PT clinic was telling me but I’ve been doing plenty of exercises and having plenty of swelling. Thank you for being clear about how to prep for this next surgery. I’ve been resting, icing and elevating most of today, except for light housework and my two walks.
What about my two 17 minute daily walks? Should I cut that out too?
Also, at my first assessment appointment yesterday, my new PT mostly did manual massage on my scar, calf and knee muscles. Should I still cancel my next appointment with him this Friday? or would his massage help the inflammation? I would decline any exercises on my right knee if I went. He could also work on my left before the left knee is replaced? The appointment is 30 minutes long. What do you think?
I’m hoping I’ll be able to manage the stairs at home after the Surgeon works on both of my two knees .

 

[mendogal]

Walking is really good for our new knees as well as our overall health. We all heal at different rates, and we walk at different speeds, so generalizing is hard.

I had a good recovery and my once daily outdoor walk at 9 - 10 weeks was a bit over 1/2 mile, which took a good 15 minutes at the slow pace I could muster so soon after surgery.
I tried to increase the distance and my knee let me know that afternoon, so I kept it at 1/2 mile daily for a couple of weeks. So yes, you might consider one solid 15 minute walk or maybe 2 ten minute walks, icing and elevating and hydrating after.

If the new PT's massage was gentle and felt good, it certainly won't harm you! It may really help mobilize excess fluids contributing to swelling and promote relaxation of tight muscles.

 

[Jockette]

So yes, you might consider one solid 15 minute walk or maybe 2 ten minute walks, icing and elevating and hydrating after.

If the new PT's massage was gentle and felt good, it certainly won't harm you! It may really help mobilize excess fluids contributing to swelling and promote relaxation of tight muscles.

I agree.

 

[EalingGran]

Most definitely, especially the water aerobics. Water adds resistance, which is like using weights. That is not helpful at all for a swollen, inflamed knee, like yours

Absolutely agree with @sistersinhim on this. Water adds so much resistance.
I am 2 years out from my PKR and have overall had a great recovery with almost full ROM. I did some exercises in water at about 3 months whilst my daughter was swimming and my knee was really sore afterwards. I also recently tried an aquarobics class when we were on holiday and the hotel offered them free.
I noticed that my knee which has been totally pain free for ages just felt slightly tight and uncomfortable afterwards. Personally I am still avoiding exercises in water. I can walk miles and do pilates classes but I think you just can't judge in water what is too much.

 

[Focuspositively]

Wow! I’m blown away by this!

My Surgeon agreed that I could start back to aerobic swim at my 2 week post op visit but I didn’t because after seeing the Dr, his nurse took my bandage off to remove the staples and she noticed a small opening in the wound with fresh blood. I had been to PT that morning and feel that it opened then. She recommended that I stop physiotherapy for a week or two until my wound healed shut. When I called the PT clinic, they said that that would be the worst thing to do because I’d lose the progress in ROM that I had gained. So, I called the nurse back and told her and she said that if they agreed not to push me too hard, I could return in a week.

So, I ended up missing only one appointment but the wound seeped a bit after my return to PT again. I returned to the Surgeon’s office to get it checked out and the new nurse who changed my bandage said not to worry about the seepage unless the whole bandage was red (mine only had two small spots). She also said to stop PT for a week to let it heal. It was so hard to hear conflicting advice between the nurses and PT. I ended up returning to PT instead of stopping. My wound healed nevertheless.

But the fear of losing my achieved ROM influenced me to increase my exercises. Then the slow progress at increased ROM because my knee was swollen scared me. So I’ve been pushing my knee through pain and it’s been so hard.

Thanks to your advice, I’m now happy with the resting, icing and elevating only (no exercises) and already feeling less swollen after 1 day. I had asked the Surgeon for a medication to help with the swelling since the one 400 mg Advil daily didn’t seem to be enough. He prescribed 100 mg Celecoxib twice a day. In addition to the Advil, I’ve only been taking 2 - 500 mg Tylenol to help with pain pre PT sessions and the occasional Tylenol to help if I’ve had pain because I’ve overdone it.

Since I was scared about losing my ROM, and the slow progress, I increased the support by either seeing a message therapist or an osteopath to help with the swelling. Then when my insurance coverage ran out for the year, I made an appointment with a new PT with the intention that he help me with the swelling by doing deep tissue message.

After receiving your advice, I canceled all my appointments at the PT clinic, and my new PT has agreed to support me gently this Friday (no exercises) and I will only do the two short 10 min walks daily, light housekeeping and ice, elevate and rest!

 

[mendogal]

There truly is a lot of contradictory advice and approaches to our post op rehab. It's confusing!!!!

And the truth is, there's no "one size fits all" method. Our individual bodies, capabilities, and priorities come into play along with the providers we encounter, the insurance we have, our community resources...

What is unavoidable is the cellular metabolism in response to physical trauma and the physiology of stages of healing. There's definitely individual differences, but overall there's no shortcuts to healing - only optimizing it through things like rest, nutrition, mental attitude, and appropriate activity level - and not interfering with it by adding undue physical demands.

Our new knees only have two ways to give us feedback: pain and increased swelling. They deserve our respectful attention. I think you're doing that now and am very optimistic for your continued improvement.

 

[sistersinhim]

After receiving your advice, I canceled all my appointments at the PT clinic, and my new PT has agreed to support me gently this Friday (no exercises) and I will only do the two short 10 min walks daily, light housekeeping and ice, elevate and rest!

I think you will see success with this new routine! I'm so glad that you are already feeling less swelling. That's a sure sign that your knee is happier!

 

[Jockette]

When I called the PT clinic, they said that that would be the worst thing to do because I’d lose the progress in ROM that I had gained.

Your ROM return is not dependent on continuing exercises, it is dependent on healing and the swelling reducing. Too many exercises, before you are healed enough to do them, will increase or maintain swelling, preventing improvement.

The only way you “lose” ROM is when you have increased swelling. ROM will naturally fluctuate depending on activity that either increases the swelling (over activity) or decreases the swelling (rest and elevation and gentle movements.)

When your surgeon installed your new knee, he made sure that the implants bent appropriately. It’s a done deal. Now, it’s the swelling that controls the ROM number.

 

[Layla]

Hi and Happy Sunday!
I want to share the posts from two separate members in relation to ROM -

JusticeRiders thoughts -
"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

And here is a post from VolLady -

"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[Layla]

I canceled all my appointments at the PT clinic, and my new PT has agreed to support me gently this Friday (no exercises) and I will only do the two short 10 min walks daily, light housekeeping and ice, elevate and rest!

Yes! Good for you.
Please let us know how it goes. Best Wishes for a great week!

 

[Layla]

Best Wishes for your Right TKR tomorrow!
Please update us when you're feeling up to it. We will look forward to hearing from you!
Hope it's soon.
@Focuspositively

 

[Focuspositively]

Thx! I’m excited to have my LTKR and the MUA done on my right knee tomorrow. I hope I get an increase to my ROM on my right knee and my left knee heals better than my right did. I appreciate your message!. @Layla