2nd Physio and back 10 steps

Bones, joints and muscles
1

After fantastic support on here and my most positive morning so far, I attended my second physio appointment. I have been doing my physio religiously but have not felt much improvement (3 weeks today since op), I have been elevating and using ice cuff, I have been taking my medication despite some nausea and I felt so positive today. 

My knee bend bend has gone from 80(Hospital) to 60 last week to 50 this week. My physio is only one year into her career and called for a second opinion who said I was not presenting like someone three weeks. She said I should see my consultant asap and may need a manipulation. I was overcome with anxiety. The first physio said to give it another week before I ring consultant and massage knee as very swollen. Due to the knee length stocking all my fluid starts at my knee. In my area apparently you cannot get thigh length stockings. 

I am shattered and she also suggested physio every two hours. What do I do? I thought it was early days but they felt I should be doing so much better. I am also still not lifting my leg which I am really worrried about. I feel back to square one again. Should I ring consultant or give it another week? 

2

I had 115 in hospital and it was at 85 when I started pt. Is seems like 3 weeks out you're really still swollen. I wouldn't worry yet but maybe someone else on here has a different opinion. Take care.

3

Hi Susie

Three weeks in and your stressing dont forget this is a long process take a step back and don't overdo things a little bit of exercise more often works well than a lot rest your leg as often as you can as for lifting it don't be afraid to give it a little help i found my dressing gown belt helped put the middle of it under your foot and gently lift

good luck.

4

"I should be doing so much better..."...we have to get that phrase banned from the English language!!!

You are only three weeks!!!  I didn't start PT until 3-4 weeks.  It took 10 weeks more to go from -14 / +84 to -1 / +123.  There are advances, setbacks and plateaus.  Please be prepared for ALL of them.  I got stuck at -4 for weeks...sometimes very frustrating.  You have to do the home exercises...

https://patient.info/forums/discuss/tkr-heel-slide-exercises-526213

This takes MONTHS to overcome.  A good checkpoint is six weeks when you see your ortho for your alignment x-ray (they draw a straight line from hip through knee to ankle...everything is OK if they all line up).  He will tell you if something is amiss.  Meanwhile, find an EXPERIENCED PT!!!  Yours may be a difficult case requiring a more seasoned professional.  Then again, you may find yourself progressing the way we all have...slowly.  Very few people need an MUA.  Lots of ice and elevation to keep the swelling down...that may be interfering with your ROM.  Very good to start PT at 3 weeks to break down the scar tissue.

Stay strong!!!

5

Rediculously! It's such early days to expect so much. I'm 13 weeks post. Finally bend at 110. Specialist/surgeon happy. Saw physio for first time yesterday (live too remotely) and she's happy. I'm progressing slowly. Have never been subjected to pressure to mend really fast. I listen to my body. If I overdo it I pay the price. Surgeon said to expect swelling for up to a year at times cos knee has been massacred! Have patience and listen to everyones different experiences on here. Good luck!

6

3 weeks I was barely human. Only doing stretches etc they told me that was normal, second tkr first the same way. Hang a in there, ice alot, you will progress i could not lift my leg this time until 5 weeks. Thinking of you and wishing you the best.

7

Maybe to slow down and rest a little more would be a good start. A lot you are doing is correct....worrying at this point anyone of them. Givecthecleg a chance...give it a couple of days off. Then start slowly with the therapy. Hydrate (lots of water), elevate and let the swelling go down. Just a guess, the reason it won't bend is because its been over worked and swollen. You didn't mention the test of your schedule but my guess is you are trying yo eat the elephant in one bite. Stop cleaning house, doing the laundry, cooking meals and practicing futeball or soccer or whatever you call it.

Remember the golden rule of tkr recovery: it's a marathon, NOT a sprint. No gold stars are given to those who punish themselves the most.

Neither be discouraged nor dismayed at this point. When you consider the fact you have almost had your let cut off and a 3 pound hunk of foreign material cemented in place and then crudely put backs in place with needles, thread and little pieces of steel, no wonder it isn't working right. Eitgervtge 2nd or 3rd time I had a new appliance stuck in there I yelled at the nurse in recovery room and told them my damn foot was put on backwards. I never knew recovery room nurses were so lacking in humor. At least 15 or 20 of the other patients around me laughed.

Hang in there and be kind to yourself. Work but don't let others or yourself put you in pain. Just make sure the leg isn't hot (yes it will be warm) or has any unusual drainage. If that happens don't bother call your Dr just heat for the emergency room.

8

Hi. I had my third TKR 10 months ago and it is only recently the swelling had decreased. Excuse the pun but don't run before you can walk!!!

Shortly after the last op the surgical stockings were so tight they were cutting in. The surgeon told me not to wear them as they were doing more harm than good. That was 2-3 weeks post op.

Good luck

9

Completely agree,

10

It is early days of course and any excess swelling will impede bending. If you do too much physio and exercise, it is just as bad as too little, as the knee can get angry and inflamed - more swelling and stiffness - vicious circle.

​I am one of those who has lost bend since leaving hospital and cannot get it back. My pt also concerned and I'm waiting on an appt with surgeon to review as now 6 weeks post op.

​My concern is that I maight be one of the folk making excess scar tissue and my knee remains very swollen above the kneecap.

​One thing is, we seem to be regarded as "failing" by the pt and doctors and the comments we get leave us confused and upset. Even other folk who have had TKR can infer they were OK as they "did all they were all told" "worked through the pain" etc which makes it seem we are lazy or wimpy and not trying if not progressing. And well meaning friends or family may regale us with tales of "someone they know" who made much better progress, doing cartwheels and throwing away their canes within no time. Or just by saying " are you not doing x, y or z yet?"

​All this and us beating ourselves up can be quite upsetting - we are already vulnerable after on op, meds and pain, lack of sleep.

​We may be best to focus on any small steps forward and see the consultant or surgeon to make sure all is as it should be. If they recommend MUA, the that may be what we need to release scarring and move forward again. I sincerely hope we will recover without more interventions and get our lives back soon. It is a long haul with plenty of setbacks for sure.

 

11

Re the stockings - the ones that come to just below the knee are proven to prevent blood clots, whereas the thigh length ones don't, for knee operations.  I BELIEVE they use the thigh ones for hip ops though (rather than hip hop!).  Of course, we can't see how much your knee is swollen, but it is normall for it to be very swollen at three weeks.  I remember even when I stopped wearing my stockings at 5 weeks I could still see a line where they'd been - where the swelling of the knee started.

Don't ice before doing exercise - ice after.  There have been quite a few people on here who have found that moist heat helps before stretching and I tried this one day when I felt I was going backwards and it did help me.  I got a jug of hot water, three flannels and a bath towel.  Rinsed the flannels out in hot water and put them around the knee (I didn't put them over the scar) and wrapped in bath towel, and refreshed them a couple of times so it was for about 10 - 15 minutes.  Then when I tried the bend everything felt more relaxed.  Might be worth a go.  In the first few days after the op when it was more uncomfortable to lift the knee, while doing the bend exercise on the bed, I used my hands to help my thigh lift.  That might help too. 

 

12

Hi, I agree with everyone, 3 weeks is nothing.  I have no idea why they give TKRs to new physiotherapists. I'm in Australia and also got a brand new physiotherapist. If you can't get an experienced therapist then you need to keep on your toes with remembering that it was a HUGE deal to have a knee removed, it's no wonder you have problems. Everyone does. Except of course for the friends of friends who were supposedly perfectly back to normal after a week. Haha (yes, I have been told this a number of times). Try getting a new physio, if you can't, then filter out illogical stuff they say. Coming back here will help.  I'm back in on Friday for my 2nd knee TKR. It's been a long haul, been waiting for about 6 years. I think it's possible and seems logical to me, that a longer wait time for surgery attributes to a longer recovery time, because the knee and leg have had a longer time settling into bad positions.  Guess we won't know for sure.  Good luck with your recovery but keep in mind that it takes a long time to improve but you will.  Look at it in terms of months rather than weeks or days.

13

This is such a good point!  At three weeks I was still resting ALL day, apart from the odd time of doing my exercises (and believe me that wasn't a big proportion of the day LOL!) and using the aircuff all the time, rotating it round the knee.   I was on one or two sticks by then and only just starting to THINK about making a cup of tea!  I'm wondering if my easy recovery is hugely thanks to my husband who was literally like my slave for weeks!  Bless him - he even spread my clothes out on the bed, in the order for me to put them on LOL!  He waited in the bathroom in the early days while I had a shower, in case I felt faint (had a problem with blood pressure dropping) and did absolutely everything for me.  While I rested with leg elevated and played games on the laptop.

Just another thought.  When I asked my surgeon how high the leg should be elevated he said 'heart height'.  Well that clearly wasn't going to happen unless I was in bed, but during the day I was on a recliner and have noticed that recliners vary.  Mine happens to raise the whole leg a bit higher than the hip, and I'm guessing this is better than one that just raises the leg a bit but not as high as that, so maybe if people have a recliner that doesn't raise SO high, a pillow under the knee and lower leg might help?  Only a thought.

14

I had that problem after a different op.  The stockings didn't fit properly and the top kept rolling down, forming a really tight band which I thought was more likely to give me a DVT!  It was only on here that someone suggested if stockings don't fit correctly then ask your local GP's nurse to provide you with some that do fit!  This is important because it does save a DVT, so if the same thing happened to me again then I'd do just that!  Watching a tv programme last night I saw they come in a nice denim blue colour!  Would SO prefer those to white ones!:-)))))

15

Oh Susie please do not worry yourself into an early grave!!!!

This can be a difficult operation to recover from. Rehab is hard. I am positive you are doing all you can to make yourself better. Please don't think you aren't doing what you should!

Perhaps, with all your pt has said, now is the time to take a small break! Give yourself one day when you aren't trying to exercise it better! Have a rest, do the icing & elevating but NO exercise! Anarchic maybe but hey why not try it? Then start the next day, but break down the exercises into no more than 10 minute sets of exercise, or less depending on HOW you feel, do it throughout the day. If she is saying every 2 hrs then maybe that's what she means! Remembering QUALITYis better than QUANTITY! Little & often is better! But REST after each set you do, you really must rest, soooo very important at this stage! Keep warm & hydrated & rest!! I can't stress enough how much your body needs rest!! Also relax into exercise tension makes exercise harder! Think Yoga! Concentrate on breathing properly, exhale on the hardest part of the exercise.

Warm the joint before exercise, ice after exercise.

If the painkillers make you nauseous go to your GP get some different ones. I don't know what but your dr should be able to help. Or ask for referral to pain management clinic. Get your meds sorted & maybe it will make exercise easier??

At the end of the day, if you need MUA so be it! There is a post on here from someone who had manipulation & it wasn't that bad & resulted in a good ROM! Perhaps look back & find it, it may reassure you on that front! Physiotherapists tend to use MUA as a stick to beat to beat us with. It's like the ultimate threat! Like when as a child your mother would say if you don't eat your carrots you won't see in the dark!!

I have a theory that hospitals pick their physiotherapists up at Torturers R Us! They have not had TKR. Your pt, being new, has absolutely NO IDEA of what you're going through! She has no idea of how YOU feel! She may have been told WHAT TKR is but has NOT experienced it personally!

The stockings may not be the correct size for you? How do you put them on? I wasn't told to wear them after I was discharged from hospital, I only wore ONE in hospital on the unoperated leg! We were all told the importance of doing the ankle rolls & lifting toes up & down (the exercises you're told to do whilst flying) to stop blood from pooling in your legs.

I do wear compression hosiery (medical hosiery), due to another condition & couldn't put them on at 3 weeks as I couldn't bend my knee enough to PUT them on! So if you are doing that you are better than I was at 3 weeks! A better bend! So please calm down I have now managed to get to 120 without being tortured by a young pt. If I can do it so can you!!

Please relax. & take care of yourself. You WILL get there. Patience is the key.

All the best

Marilyn

XX

Sorry it's such a long reply!!

16

It is so early, too early to worry. ..easy said, I know, harder not to worry. I was shocked with how tired I was. I am still often shattered at 8 weeks! Be kind to your knee, do as people here have suggested. As long as you gently keep bending and straightening the leg regularly , little and often is what I did. I didn't have energy to do more. I think they can be a

bit paravoid about adhesions. I know this can be a problem but I don't to my knowledge think the percentage is huge and I don't think three weeks is time to even think about such things, personally! Try not to worry about the leg not lifting either, It will come, in time.

17

Thanks Serena I feel that I am doing well but PT disagree. I am using massage today around my calf (as advanced by PT) to try to loosen calf and swelling. Just off to second set of physio and only 10.30 am. 

18

Thank you and working hard to reduce swelling. 

19

You mention elevating and ice cuff . . I know everyone goes on and on about elevating, but I have to admit I didn't do a lot of that, as it basically involves being immobile.  I have to say I think that while resting, it is better to sit with the knee bent as far as possible, and every now and then, attempt to push it back a bit more.  As for lifting, provided there is not actually a serious physical reason, there could be an element of fear involved. If someone helps you repeatedly to lift the leg, you may find (I did but we are all different. . ) that you can finally do it yourself. i found that while I was trying to lift it, subconsciously I was holding it down afraid of the pain it was going to cause.  At three weeks, I was doing the exercises four times a day . . knee bends, pulling the leg towards me (heel slides), sideways movements across the bed, and leg lifts, and the pushing of the knee I don't know how many times a day . .innumerable!  It is really a full time job . . . They always threaten a MUA to make you take the exercises seriously, I think. . . but it is important. 

20

Susie you also need to massage the knee joint itself. That's where the scar tissue will be. Be careful of incision scar whilst the clips are still in but you can still massage the side & back of knee. Once the clips are out & the scar has scanned over you can them massage the knee itself & the incision! Once you can do that give it all a really good massage. Not just a quick rub over, if you do this before you exercise it should be a little easier. It's baby steps now & that's how you should approach your rehab at this time. Once you are stronger & your joint is moving better then go for it, not yet though!

The calf & quads need gentle stretching, havw a look online for stretches. YouTube is pretty good for exercises, there are some really good one for after TKR. In fact stretching is good all round at 3 weeks! Release some of that pent up tension.

Marilyn

XX

Ps/ get your physios to check the fitting of your compression socks. They're meant to stop DVTs not strangle your calf, no wonder it's tight!! X