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Josephine

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I probably should not have termed what I am doing as exercise
Exercise, stretching, activity - it's all the same thing!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Zommom

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Sure. I can answer any questions you may have
 
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Zommom

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Had my second PT appointment this morning. Warmed up by doing some walking “heel to toe”. Bike for 5 minutes just pumping legs no rotation. We then measured from last week extension of 5 and flexation of 75 to this week of extension of 3 and flexation did hit 90! My swelling had also gone down. She wanted to push on it and I said No! My knee and my number! She was taken aback by that statement but knew I meant business. She said that It looks like I have been doing all those exercises she had given me. I sweetly said I have been working hard and mostly using ice therapy to bring down swelling and that is my 1st priority. I realized that what I say generally goes in one ear and out the other to her. It’s almost robotic on what they say and then have the same plan for everyone. She is nice enough but I think like most set in her ways. By the book type individual. I’m home now elevating and icing and ready for a nap! Contemplating forgoing further physio appointments.
 

Lindylee

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You're making great progress, so I'd stick to what you're doing. Enjoy your nap :sleep:
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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Zommom

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@Josephine
1. Aching, swelling and stiffness 1 - 2 while active, 0-1 resting
Burning sensation and heat around incision 2-3 at night before icing
Jolts of sharp pain 3-4 evening before bed

2. Prescribed hydrocodone 10/325 (no longer taking), Tramadol 50mg taking 1 at 6am 1 at 5pm and one at 9pm. Tylenol ES 1000 mg every 6 hours, Tylenol PM 1000 mg at 9pm

3. Swelling between slight and moderate

4. As of today 90/+3

5. Utilizing my cold therapy machine Icing 4 times during the day 1 -2 hours each. Nighttime I ice all night. I also utilize a cold gel pack behind my knee at night.

6. Elevating while icing daytime whenever I am off my feet and nighttime during sleep

7. Make coffee in the morning,,take dog out to potty 3 x daily, feed fish, make lunch, shower, straighten up bathroom, unload dishwasher, 1 load of laundry, wash, dry and fold

8. 3x sessions leg lift and bend while laying down 3 reps holding each at 10 to 20 seconds
3x sessions calf stretches laying down 3 reps holding each at 10 to 20 seconds
Walking around the house every couple of hours 5 to 10 minutes
I have 2 steps I go up and down a few times a day

Pt 1x per week today
5 minutes on bike slowly pumping the pedals
Walking 5 minutes (heel to toe)
Leg lifts 3 reps holding 20/seconds
bends 3 reps holding 20/seconds
Calf stretch 3 reps holding 20/seconds
Squats x10
Sitting with knees bent
 
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Josephine

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1. Aching, swelling and stiffness 1-2 while active, 0-1 resting. Burning sensation and heat around incision 2-3 at night before icing. Jolts of sharp pain 3-4 evening before bed
Okay
2. Tramadol 50mg taking 1 at 6, 5 and 9.
Tylenol 1000 mg every 6 hours
Very good
3. Swelling between slight and moderate
Slight to Moderate means another 2-4 points of pain. Swelling/pain comparisons
4. As of today 90/+3
Pretty good for 3 weeks out!
5. Utilizing my cold therapy machine Icing 4 times during the day 1 -2 hours each. Nighttime I ice all night. I also utilize a cold gel pack behind my knee at night.
Good
6. Elevating while icing daytime whenever I am off my feet and nighttime during sleep
Okay
7. Make coffee in the morning, take dog out 3 x daily, make lunch, shower, straighten up bathroom, unload dishwasher, 1 load of laundry, wash, dry and fold
That's a lot for 3 weeks out. Did you read the Recovery Guidelines in post #2? This one was in there
Activity progression for TKRs. If you read it now, you will see that at 3 weeks your activity should be like so
Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't
a) get obsessive about it
b) get into too much pain and
c) get too tired. Stop before you get to that point.

Week 3 - add to all the previous
Lengthen the walks to about 5-10 minutes as before
Activity: prepare yourself a small meal or a snack​

I suggest you cut back on your activity as indicated.


leg lift while laying down 3x sessions x3 reps holding each at 10 to 20 seconds - this is too much
bend while laying down 3x sessions x3 reps holding each at 10 to 20 seconds - also too much
3x sessions calf stretches laying down 3 reps holding each at 10 to 20 seconds - similarly too much
Walking around the house every couple of hours 5 to 10 minutes - also too much. See guide
I have 2 steps I go up and down a few times a day - this you can't avoid

PT 1x per week today
5 minutes on bike slowly pumping the pedals - okay
Walking 5 minutes (heel to toe) - also okay
Leg lifts 3 reps holding 20/seconds - too much
bends 3 reps holding 20/seconds - same again
Calf stretch 3 reps holding 20/seconds - and again
Squats x10 - no squats
Sitting with knees bent - don't spend too long doing this

Summary
You are doing far too much activity and exercises which is the cause of your pain.
Stop doing them.

There are many of us on this forum who never did any exercises at all yet we came through our recovery with excellent outcomes.

You see, it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
 
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Zommom

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Thank you for taking the time to review the above. Here I was feeling like a slacker on the activity level. I will definitely cut back. My hubby has been doing all the household chores, cooking and shopping so I feel a sense of guilt because he was also my caretaker for 6 weeks after my stroke this past September seems a lot to put on him but a shout out to him for not judging or complaining and stands ready for my RTKR in 4 months! :puppysmooze:
 

SnowHare

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I'm so glad to hear that you are healing well. Even where I am at, 7 weeks or so, i know that when I do too much I will pay. Enjoy being waited on hand and foot, because soon enough you might get stir crazy enough to start doing little things for yourself. My DH will still make my lunch for me, but I figure I can do that.

If it hurts, I'm not doing it.

I've had company for the past week, and now my best friend is here. All she wants to do is spoil me.

Keep up the great work.
 
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Zommom

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@SnowHare lessons are hard learned. I’m paying the price tonight with a hot swollen knee did more than I should have I guess. So nice to have your best friend visiting that’s truly the best medicine enjoy! :friends:
 

Lindylee

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I can sympathise. My knee has been swollen for a couple of days. I got carried away :happydance:and tried too many new things. Rest is definitely the best cure. I've tried the cling film wrap last night. I don't think I wrapped it tight enough, but my knee doesn't feel as stiff as it usually does first thing :)
 
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Zommom

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Thanks @Lindylee I know you understand the frustration one has when things are coming along well and then bam! A hot swollen knee! Little to no sleep last night and ended up having to take pain pills. I thought I was past that stage but glad I had them. So you and I need to not jump into anything new ha! Easier said than done! :kickedout:
 

Lindylee

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It's all too easy isn't it? We think we're doing ok and push that little bit more only for our knees to let us know in no uncertain circumstances that they're not putting up with it. I wonder if talking nicely to it might help :loveshwr:
 

SnowHare

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I totally concur. My first physio appointment was at 2 weeks. Even doing gentle exercise and taking the wheelchair from the parking lot, caused a nice upswing in swelling.

I'm taking it slowly in outside activities, as well as inside stuff too. As they say, it's not a race.

Decades ago, I had 2 emergency caesarians. I got right into the saddle when I came home, and guess what? I didn't heal in a timely way, and I got a really bad infection. I now know how important it is to take your time, listen to your body, and ignore the guilt.

Cheers
 
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Zommom

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Had a fun filled (insert sarcasm here) day today. Typical crappy night finally drifted off to slumber about 6 am was awaken by my doggy throwing up ugh! Hubby came in grabbed the dog and proceeded to strip off the sheets. I then showered - dressed and off to PT I went -I actually looked forward to it as my physio was just going to have me do some walking and to ride the recumbent bike and some massage therapy. I had a previous appointment on Tuesday where we measured ROM and was at 90/3 so when I arrived my physio was not there (family emergency) and I was assigned a replacement. She pulled my file and said “oh my”your flexation numbers are so low for 3 weeks out. I said no what she was reading was from my first appointment and not the one I had 2 days ago. I also told her that I was just here for some walking and the bike and a massage. She said that’s fine to warm you up but we need to check those flexation numbers! Well needless to say I said no we are not and she proceeded to tell me about the window of opportunity and I do not want an MUA do I? I was (excuse my language) ticked off. I bid a farewell but before I left I and stated my physio and I have a plan and what you are telling me is not on that plan and you will not be touching my knee. I turned got in the elevator and headed down. I realized I left my cane but I didn’t care. As I was leaving the receptionist chased me down with my cane. This petit little gal whispered “good for you” she can be such a bully! So apparently I’m not the only victim.My physio is head of that department so I will be asking her why someone like that is own her staff?

I did have a pleasant surprise when it came to ordering my pain meds. I was ready for a battle as they had only given me 28 tablets initially. They did not question me on “need” but said we will call it in at my pharmacy. I picked it up and lo and behold 45 tablets!

I did get a nice nap so not all bad
 

sistersinhim

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Good for you sticking up for yourself like you did! I don't understand why PTs have to be so aggressive. It's like they enjoy hurting people. I think you should ask your regular PT why she allows someone on her team like that.
 

Lindylee

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Well done for sticking to your guns. Success with the meds too, maybe not such a bad day in the end. I hope you had a better night.
 

Jockette

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Good for you for being firm with your plan!
 
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Zommom

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Thanks all, I’ve pretty much towed the line on following medical protocol all these years but this forum and my common sense have given me better insight on what I need ! Not the need for those numbers they feel I need. I have lived with arthritic pain for far to long with the last year being severe. So why go through unnecessary pain with rehab? Anyway small battles win the war. Now,I’m off to deal with my work disability insurers who seem to think that 5 weeks should be sufficient time off. I had to use a little over 6 weeks for my stroke recovery and they are counting this as part of the same claim. Which is company protocol as 1 year had not passed between claims so need to transfer over to long term - my company has been very supportive and wants me to take the time needed but the disability insurer is being difficult I have to prove my need and possibly working from home but I’m a supervisor and my approvals and needs are at the office . The paperwork is crazy and such a hassle! Having a baby you can take up to 12 weeks but a TKR less time? Sorry for the ranting.
Had the best night of sleep since surgery last night 7 uninterrupted blissful hours! :sleep:
 

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