TKR Worried about ROM, swelling, and general lack of progress

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My doctor and physical therapist keep saying that we have a narrow window of a few weeks to get the rom back or the scar tissue sets in and an mau is necessary to break the scar tissue up.
The "window of opportunity" is a myth that should have died long ago. It's possible to continue to improve ROM (Range of Motion) for a year, or even longer, after surgery.
Myth busting: the "window of opportunity" in TKR
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!

Scar tissue is a normal part of healing - it's what holds your wound together. What they're talking about is adhesions, which do not automatically set in. They aren't just waiting to pounce, and only a few people develop them.
Scar tissue and adhesions - what's the difference?
MUA (Manipulation under Anaesthetic) and Adhesions

Don't believe the "no pain, no gain" theory either. It is inappropriate for recovery from a knee replacement.
Myth busting: no pain, no gain

Please will you help us by putting your surgery type and date in your Signature? It makes it much easier for us to see how far along you are. Here's how to do it:
How to create a signature
Thank you, and best wishes.
 
My doctor and physical therapist keep saying that we have a narrow window of a few weeks to get the rom back or the scar tissue sets in and an mau is necessary to break the scar tissue up
This is rubbish, pure and simple.

Edit: Celle and I posted at the same time -- she's put in all the info you need!
 
My doctor and physical therapist keep saying that we have a narrow window of a few weeks to get the rom back or the scar tissue sets in
Not true at all ROM can be gain upward to a year post-surgery---and beyond.

Adhesions--(which I did have) happen only to a few people---it has nothing to do with a "Window of opportunity." It is simply genetic predisposition. I did not have any MUA's---I took care of them myself.

I would NOT apply heat to the knee joint--heat causes the body to send fluids to the warmed-up area. You do not want more fluid in the knee capsule. Later on, you can use a heating pad on the quads and the hamstrings---in effect, "Warming them up" and making them more elastic.
 
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I moused over my name (top left corner) a number of times but can't get that window to come up to create a signature. I'm sure a signature will be helpful when I can figure it out. Anyway, I had a total left knee replacement on the 25th of February of the year 2015.
 
I'm puzzled as to why a handful of physicians and therapists continue to scare people to death by mentioning manipulation under anesthesia so soon after surgery. I hasten to say that I am NOT a medical professional, but I did a TON of research before I had my surgery and I'm a pretty intelligent woman. I don't see where MUAs are necessary for most and the super-smart professionals who run this forum say the same. I tried to copy and paste the link below but I'm on my phone instead of my laptop so I may have mucked it up! Hopefully someone else will come along and do this right. In any case, before agreeing to an MUA, I would do some research on my own.

http://bonesmart.org/forum/threads/myth-busting-the-window-of-opportunity-in-tkr.6895/
 
I think you've been given some of the recovery articles several times over! I hope you've read them by now.
I've lost some ROM since leaving the hospital. I could go past 90 sitting on the side of the bed and placing weight on the leg before leaving the hospital. Now I can only get to about 80.
This is perfectly normal. To start with you've been topped up with lots of pain meds and still have the residue of the anaesthetic, spinal and blocks to keep things sweet. And you're relaxed in the care of the hospital staff. When you get hope, the meds are all wearing off and you're anxious so everything tightens up. Don't fret, things will settle down.
my therapist said I needed to emphasize the movements that focus on ROM even if it hurts. I've read all the stuff on here about that kind of statement.
As others have said - pure rubbish and positively the very worst thing you can do.
two week follow up with the doctor Thursday and I'm not making progress.
You'll not make any progress in two weeks. Good grief, you've just had mega-major surgery - your body feels like it's been run over by a mack truck! Let it settle down and recover!
I'm afraid if I take it that easy my leg will only stiffen more.
It may well at first but it doesn't mean anything in the long haul. Think of it this way: your ROM is all there, every bit of it, all cooped up and just waiting to let go! A bit like a seed in the garden. You plant it, water it a bit and then leave it alone and eventually, the flower springs forth! So your ROM will blossom forth if it's given a chance and not held back by making the leg/knee swell and be painful. I'll tell you more about this later ...
So the knee feels ok as far as pain is concerned this morning but is very tight in the front just below the knee cap. I don't recall seeing any discussion on this site about scar tissue.
Yes of course it will feel like that because that's where the surgeon cut through the tissues to put in your new knee. That all has to heal and it will react by swelling, being painful/sore and sometimes hot. All normal. It's nothing to do with scar tissue or adhesions which actually aren't that common. But some PTs do keep wittering on about it and applying massages and exercises in order to beat this mythical, imaginary dragon! Don't be fooled by them.
My doctor and physical therapist keep saying that we have a narrow window of a few weeks to get the rom back or the scar tissue sets in
Well you've read what everyone else has to say about that - nonsense!

So how do I know about this 'secret' in TKR recovery? Because I had a new knee about 10 weeks ago and I did absolutely NO exercises at all. I just rest my knee, iced it and took pain meds regularly at the start and later as required. By week three I had a ROM of 115 and in week four it was 120. Extension was good as well. I'm now in week 9 and it's 125! I'm telling you this to show how wrong these myths are and how they actually cause more harm than good. Revolutionary talk, I'll admit but we have to speak up about it sometime!
 
So how do I know about this 'secret' in TKR recovery? Because I had a new knee about 10 weeks ago and I did absolutely NO exercises at all. I just rest my knee, iced it and took pain meds regularly at the start and later as required. By week three I had a ROM of 115 and in week four it was 120. Extension was good as well. I'm now in week 9 and it's 125! I'm telling you this to show how wrong these myths are and how they actually cause more harm than good. Revolutionary talk, I'll admit but we have to speak up about it sometime!
I'm speaking up, too!

3 years ago, I had a revision from a PKR to a TKR. I had minimal PT. I was shown a few exercises in hospital, and at home I just did a few heel slides. My surgeon believes in not allowing any formal PT for at least a month after surgery.
I went to out-patient PT a grand total of 3 times - at about 5, 7 and 9 weeks post-op. At each session, the PT showed me a few more exercises , but she never hurt me. Usually, I forgot to do the exercises. I only had my ROM measured once, at 9 weeks, and it was over 90. Since then, it has improved under its own steam, and is now about 130.

Almost 6 months ago, I had a TKR on my other knee. Apart from the usual session in hospital (which concentrated more on how to get out of bed, walk and manage stairs than on exercise) I have had no PT at all. Once again, I only did a few heel slides - when I remembered - and I concentrated on walking with a proper gait. I haven't had my ROM measured, but it is almost as good as the first knee.

At follow-up appointments, my surgeon never measures my ROM. He just says "Show me what you can do." I show him how I can raise my leg straight, and how far I can bend it. After addressing any concerns I may have, he says "Great! See you next time!"
 
I think you've been given some of the recovery articles several times over! I hope you've read them by now.
I was lurking on this site for several weeks before surgery and had already read most of those articles and just now read the others that have been suggested. It's completely different reading the articles now that I've had the surgery. The personal first hand accounts with specific information are very valuable to me. I've been fearful I might mess this up and cause myself prolonged suffering but I have to say that everyone on this site has helped me greatly.
The knee has felt a little better all day and I made it through two easy exercise sessions. I'm going to physical therapy in the morning. I'm going to have to come to an understanding with my therapist. There won't be anymore fighting through the pain!
 
I'm going to have to come to an understanding with my therapist. There won't be anymore fighting through the pain!
Good!

Remember that it's your knee and you have the absolute right to say what happens to it. Also, the therapist works for you, not the other way around.
 
As far as movement or exercises, what worked for me early on was moving the knee a little throughout the day. That includes walking to the bathroom, to the kitchen for meals. I tried to move the knee through its range (whatever that was) and then try for just a bit more, but not to the point of intense pain. I only did actual "exercises" a couple of times a day and then only a few repetitions. You can increase when you get further along in the healing.
 
@kneeper - that's pretty much what I've been doing. After my two weeks of in-home PT right after leaving the hospital, it took 3 weeks for me to find a local PT in my insurance plan, so I did what I could at home. I did some light cooking, practiced on the stairs, did a few of the stretches the PT gave me, and my boyfriend took me on short trips to the supermarket and shopping. I elevated, iced, and rested as per the instructions I found here. When I finally did find a facility two weeks ago, the therapist was pleasantly surprised at my ROM. Even though my knee is still pretty stiff and occasionally swollen, you guys here taught me what to do and what not to do. I feel so fortunate to have found this group!
 
I tried to move the knee through its range (whatever that was) and then try for just a bit more, but not to the point of intense pain
This is what I'm starting to work on as well.
my knee is still pretty stiff and occasionally swollen,
Do you find that it starts getting stiff as soon as you get up and are walking around? Does the pressure just kind of keep building until you lay back down and ice it?
 
Do you find that it starts getting stiff as soon as you get up and are walking around? Does the pressure just kind of keep building until you lay back down and ice it?
I would wake up and the knees would feel pretty good---then, throughout the day, gravity would take its toll. This would go on for quite some time.

When I would go back to teaching at eight weeks, it was still the same---some days I would wake up thinking that this was the big day---that I would return home with a nice set of loose knees---no such luck.

It took me quite a while before gravity stopped working on the knees.
 
This is what I'm starting to work on as well.

Do you find that it starts getting stiff as soon as you get up and are walking around? Does the pressure just kind of keep building until you lay back down and ice it?

Just the opposite most of the time. It appears that inactivity makes my knee very unhappy. When it keeps me up at night, I sometimes just get up and move my leg around rather than take another pain pill unless I'm very uncomfortable. In the mornings, I usually wake up in a little pain and the knee is stiff and swollen. I take my pills (Celebrex, Percocet, HBP med, and a baby aspirin) and as I move around the apartment, the swelling subsides. Having said that, though, my knee also objects to TOO MUCH activity. When the weather is nice, my boyfriend encourages me to get some fresh air by taking me to the supermarket or some other store where I can walk around using the shopping cart to hang on to. I'm usually fine for an hour or so but if I'm on my feet longer than that, my knee is swollen, stiff and painful by the time I get home. I usually take a pain pill when I get home, ice it for about 20 minutes and then I'm fine. Incidentally, I've never felt the need to ice my knee for hours. 15-20 minutes generally brings the swelling down and makes the knee less stiff.
 
PT went well this morning. I explained to the therapist about the pain caused by pushing too hard. He said we need to take things a little slower. During the exercises when I couldn't do all the reps or sets of certain movements he he was much quicker to go along with my limitations.
some days I would wake up thinking that this was the big day
At first I woke up every day hoping for a big improvement but now I see that I have to take note of and celebrate the small incremental changes.
I usually wake up in a little pain and the knee is stiff and swollen
Mine is also stiff and swollen each morning even though I ice it throughout the night. I have a tough time finding a comfortable position while sleeping. I have been able to minimize the use of pain pills but I don't hesitate to take it if I need it.
Tomorrow is my two week follow up with the surgeon. The biggest thing I'm concerned with is I want my driving privileges back.
 
Same here with sleeping. :-( Sigh. I'd been sleeping on the couch for the past 6 weeks or so because my boyfriend is a restless sleeper and for some reason, I found the couch more comfy than the bed. I moved back to the bed a couple of nights ago but seems I can't quite get comfortable anywhere. I'm able to sleep on my side sometimes which is a huge relief since it was very hard for me to learn to sleep on my back for so long after the surgery. Still, my knee complains when I sleep on my side. The inside of my knee is achy sometimes and even when I try to put a pillow between my knees, my operated knee just doesn't like the pressure of anything on that side.....so, I wind up rolling back onto my back. Still, my knee hurts when I wake up nearly every morning.
 
It's completely different reading the articles now that I've had the surgery.
Ain't that the truth! I found the same when I had my knee done in January and I wrote them!
I've been fearful I might mess this up and cause myself prolonged suffering but I have to say that everyone on this site has helped me greatly.
Very, VERY pleased to hear that. Music to my ears!
I'm going to have to come to an understanding with my therapist. There won't be anymore fighting through the pain!
Good for you!
Do you find that it starts getting stiff as soon as you get up and are walking around? Does the pressure just kind of keep building until you lay back down and ice it?
The pressure and stiffness is the swelling building up. Did you read the article on the Swollen Leg?
 
have been able to minimize the use of pain pills but I don't hesitate to take it if I need it.
Take the pain meds as long as you need them---do not try to be a hero and cut back. If you are in pain, take the pain meds.

Many folks are afraid of becoming addicted. I discussed this with my OS---he said that, since I was taking the pain meds for a reason, that I would also know when to stop taking them.

He was correct.

One mistake that many folks make is trying to back off of the pain meds too soon--and you are still reconnoitering and are still in pain.
 
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