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Old 01-03-2010, 02:10 PM   #1
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Question Advice for knee ROM

I am 52 years old and had right knee replacement exactly 4 weeks ago tomorrow. Hospital for three days with therapy beginning day after surgery. Had ROM of 77 when I left hospital and started out patient therapy three days per week and doing routine myself at home. At last therapy appointment ROM was 90, but therapist said it was like we have hit a concrete wall. Holiday weekend here so he encouraged me to really push myself at home for the four days before next appointment. Some pain but mostly the stiffness is my problem. Have a friend 25+ years older that had surgery same day and she is "running circles around me" in regards to ROM. Any advice to help increase ROM (exercises, what works for you, etc) would greatly be appreciated. Thanks!!

Last edited by TBar; 01-03-2010 at 03:36 PM. Reason: include age

 
Old 01-04-2010, 07:30 AM   #2
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Re: Advice for knee ROM

That is the thing about this tkr's, its not about age, and it not necessarily about conditioning before surgery although that does help. Its about how your body handles the trauma, and how fast it heals, how much swelling you have and the tightness of the soft tissues that have been stretched during surgery.
I made the mistake of comparing myself to others during this process, only to realize that my body would eventually get the ROM I was after in its own good time. My progress was slow and still is, but if you continue to improve, even in tiny increments, you are going to do fine. Sometimes pushing too hard causes more swelling to deal with and then more stiffness, so keep that in mind.
I have tried all of the things PT told me, sitting on chair and pushing leg back, standing on step and doing lunges, lying in bed and bending knee towards chest, lying on back and pulling it up with a towel towards my butt, etc. All of these help, I can't say that one type of exercise did it. It was just being patient and doing your stuff everyday that does.
It will come, do your exercises, and wait for your body to do its thing.

 
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Old 01-05-2010, 09:59 AM   #3
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Re: Advice for knee ROM

Corgi02--Thanks for the advice and the encouragement. At rehab this morning the therapist was pleased that I was able to do a little more after the four day holiday break. I've taken your advice and trying not to push myself too hard. It did seem that the harder I pushed in my home routine, it did seem to set me back as far as swelling and stiffness. I'm so glad that I found this healthboard as I had so many questions and finding that others have similar questions and concerns makes me not feel so alone in my recovery. Like you said--just have to wait for the body to do its thing. Thanks again.

 
Old 01-05-2010, 03:02 PM   #4
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Re: Advice for knee ROM

I agree with Corgi - it takes time to get your ROM to where you would like. I found for me it was little and often. I would do my exercises in small bursts many times a day and found that it actually helped with the pain as I always felt a bit better after doing them. From what I have read everyone achieves a different ROM but mine is much better than pre-surgery and I am able to do just about everything I want to do and find I can do more as time passes. Good luck
Margaret

 
Old 01-05-2010, 05:28 PM   #5
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Re: Advice for knee ROM

Tbar-ROM takes time and everyone is different. I had my tkr Nov 4th and my ROM still is not that great. I did try to compare myself to others which was the wrong thing to do. It depressed me that I was not doing as well as I thought I should. Right now I bend my knee 108 degrees and my extention I got down to 4%. So I am not the norm, but I can walk pretty good and take stairs. So hang in there. I will be

 
Old 01-06-2010, 08:13 AM   #6
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Re: Advice for knee ROM

Tbar,
Glad to hear you were doing well after your break. This is a great place to get encouragement from others. I have been happy to be part of this too.
This surgery is very hard, and no one else but those who have had it, know how difficult this is. And, when you go comparing yourself to others, it can depress and frustrate you. I did it too, and then, I finally realized that there are others out there who are mending at the same speed as I am, and I am not alone. Thats what reading some of these posts have done for me. If I had only some of the rapid healers from PT to compare to, I would still be depressed and frustrated. I am not one of the super stars of ROM.
I am feeling good, my knee doesn't hurt like it did to walk, I can now work out and get stronger and more fit, I can enjoy the pool and do some things in the water, my knee flexes enough to do most of everything I need to do, so I will thank the Lord that I am doing this well, and keep on working hard. I have to remember that there are some who are sadly unfortunate enough to have horrible complications from surgery, and have much more to deal with than I. I am thankful.
Keep a positive attitude, you will do well.

 
Old 01-06-2010, 05:43 PM   #7
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Re: Advice for knee ROM

So important not to compare yourself to others. Compare your own progress by how you do from week to week. (not day to day)

I'm now 3 months post-op and still do the exercises daily. One thing I found helpful, before I do the painful ROM -- is to use moist heat for about 10 to 20 minutes first, and then to massage the knee.

My knee still feels like a block of wood, but I can do more and more as time goes by.

Would I do it over again? There was atime, early in the recovery, when I wondered if I had done the right thing. NOW? I'd do it in a minute!

 
Old 01-06-2010, 10:32 PM   #8
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Re: Advice for knee ROM

Glad to hear that at even 3-4 months post op that some still have problems. Well...not wishing anyone problems but you know what I mean! I think one day I'm just fine and for some reason past few days feel the need to ice my knee.

 
Old 01-07-2010, 01:23 PM   #9
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Re: Advice for knee ROM

CharBerry - at 9 months out I still have times when I need to ice my knee, especially when I have been on my feet too much and not taken any time during the day to rest and elevate. Also have the odd sleepless night with discomfort - don't want to call it pain, as it is, although nothing like pain levels either before or post TKR, but frustrating all the same.

 
Old 01-09-2010, 12:48 PM   #10
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Re: Advice for knee ROM

Hi-It’s Tbar again and I’m just confused as ever. I am currently 4 weeks, 5 days post operative for right knee replacement. At hospital discharge I was at 77 ROM. I have been going to out-patient therapy three days per week and also doing the exercises at home and “rocking” on a recumbent bike (still can’t get a full rotation). Yesterday at therapy my ROM measurement was 85 (dropped 5 from last week). The therapist is being very compassionate, yet working me until I almost can’t take it—see stars! There is question about scar tissue development that may be inhibiting the bend. I did have a scope to clean up a torn meniscus approximately 6 months prior to the knee replacement and experienced continued pain and swelling. Two cortisone injections, two fluid removals, anti-inflammatory meds and then finally the knee surgery Dec.7th as the knee was no longer stable and supportive. I know I might just be impatient, but I am concerned about the possibility of scar tissue. The therapist told me that the surgeon can do a "manipulation" but that it is almost like starting over again. Any advice--suggestions--help--anything!!!!

Last edited by TBar; 01-09-2010 at 12:49 PM.

 
Old 01-09-2010, 01:24 PM   #11
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Re: Advice for knee ROM

Hi Tbar, I know your frustration. Don't give up. It is very common for we "tkr's" to have some scar tissue, that is why we keep working to break it up and to break down the tissue that is there. I know it is also common to have issues due to other surgeries or trauma's that have occurred before this surgery. I also know that many people, and I am one, that you feel like two steps forward and one step back often during this process. It is not unrealistic to feel you are going backwards. This could be from swelling or just some tightness of the joint capsule. But, if you keep at it, it will continue to go forward. At four weeks I barely had 90, but I found that all of a sudden one day, you are able to get there, and more. I have heard a lot of these manipulations, but I have also heard that people who have had them, do start over, only to find they are no further than they were before. My Dr does not recommend them, he says just keep at it. It may take a year to get where you want to be.
I have had to deal with swelling the entire time. I am now 12 weeks, and still have to watch that I don't overdue, or it will set me back a few days. The key is to do as much as you can without causing more inflammation and swelling in the joint so that you can move forward, not back. I think we often times put too much expectation on this new joint to function too fast, or just like everyone else's does. I know I did that earlier on, and it only frustrated the heck out of me. My knee is progressing on its own timeframe, I have finally surrendered to it. Hang in there.

 
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Old 01-09-2010, 07:14 PM   #12
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Re: Advice for knee ROM

My surgeon also said that manipulation wasn't always successful. He said just to keep with the exercises. I did and at 3months-1 week I can now do a full rotation on my recumbant bike. If I go a day without exercise, I know it. More stiffness and less maneuverability. As I said earlier, using moist heat just before the leg exercises -- especially ROM, makes a big difference in the ease of the exercises. When I force the leg to bend, it hurts but it is a hurt that means I am stretching it. I still ice my knee whenever I sit to elevate my leg. There is still swelling, but nothing like even a month ago. For any progress I just have to stay with it and push myself.

 
Old 08-14-2010, 04:26 PM   #13
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Re: Advice for knee ROM

I agree with everything Corgi has said. This reminds me of when we were young mothers with new born babies and from inexperience, we worried and fretted because someone else's baby was already taking solid foods, sleeping thru the night, sitting up, crawling , you name it before our baby was.
By the time our second or third one came along, we relaxed and realized each baby progressed at his or her own pace, despite how much we wanted them to be the first at whatever.
I was the same way in the beginning, wondering why this and that person was doing so much better than me, when my therapist told me I was doing so well , she didn't know why she bothered showing up.
But I thought I should be way ahead of the game, to be keeping up with everyone else when it came to activities and lack of pain.
I ve come to realize, our recovery , while it IS dependent on how hard we work at it, will still progress at its own pace . Acceptance, acceptance acceptance!
queenie
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Old 11-01-2011, 10:16 PM   #14
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Thumbs up Re: Advice for knee ROM

Well, I did have my right knee manipulated back in August 2011. The actual process wasn't too bad, although I had really bad pain directly after the procedure and the painful therapy that followed with an hour, despite having massive pain meds. I cried my eyes out in therapy.

It increased my mobility from about 85% to 118% in the first week. Then my knee stiffened again, went down to about 108%. I finally got sick and tired of the painful therapy and decided to start going to the Y and using the elliptical machine to move my knee and cut down the therapy to 2 x a week then to 1 x a week.

That finally worked, in that I now have mobility at 110%. I still have knee pain after 4 months of surgery. I was really depressed and was having a lot of really bad days. After taking control myself I began to lose this depression and just say to myself I would keep my knee mobile and simply do what I could do at therapy without causing the continuous tears due to the pain involved. This worked so much better for me. I actually have cheerful days now, even though I don't have full 120% plus mobility.

Even thoough I am now 4 months into recovery, I still experience pain after a lot of physical exercise. I am hoping that that gets better over time.

I would recommend manipulation to anyone, because the good seemed to outweigh the bad for this procedure. I feel that my knee developed scar tissue too quickly. I guess fast healing isn't always the best.

So dispite other's ability to go to 120% or whatever after their surgery with (seemingly) little problem, I think everyone heals at their own rate and should not freak out like I did. Easy to say upon looking back, but hard to see the forest for the trees as it is happening.

Apparently I am among the group that feels a lot of pain after this procedure. I really do not understand why some people seem to go through therapy so easily. Of course, the pain pills made me almost throw up I had to taper back on those or I wouldn't have been able to do any therapy at all. That was a great disadvantage.

I'll never forget this experience and I feel compassion for anyone who has to go through this procedure. Frankly, I will never do it again. Thank goodness that my left knee is holding up well at this point. Here's to another 20 years of life without a knee complicationz.

Pam

 
Old 11-02-2011, 08:32 AM   #15
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Re: Advice for knee ROM

Boy - this thread is right on the money for me! I am 2 months and 3 weeks out from my TKR and I'm having a lot of the same frustrations and issues. I had in-home therapy for the first 6 weeks before returning to work. In those 6 weeks I made steady progress and was at 112 degrees of flex. Then I started back to work and had horrible swelling (started having to wear TED hose) and my flexion went down to 104. And it has been hovering between 105-110 for the past 2.5 weeks. I'm was frustrated and discouraged, particularly when I overheard them telling another fellow in PT who was obviously not as far along in recovery as me as he still had a dressing on his knee that he was at 115! I called my surgeon and talked to my physical therapist about my frustrations. They both assured me that it was very normal to plateau and even go backwards during this process, and that (despite the folks I know who recovered very quickly and were walking fairs after a month without a cane or on the golf course at 2 months) I need to understand it will take a good 3-6 months before I'll be back to normal. My biggest challenge at this point is patience. I'm tired of pain, I'm tired of PT, I'm tired of swelling and I'm tired of being tired. I thought I'd be able to ditch the pain pills at this point and be on just tylenol (can't take NSAIDs - allergic - which doesn't help with the swelling issues I'm having). But I'm not - I still need something stronger to manage. I can see progress - albeit small - so I am not totally discouraged. My short term goal is just to be able to get a full rotation on the stationary bike - this rocking business is no fun.
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