Continued from the previous page.
WEEK THREE
The in-home therapist encouraged me to discuss my frustrations with the out-patient therapist and see
if he'd start giving me harder exercises to do. We talked at the next session (#3 with
him, #6 overall) and I think he heard me: I am not your average
68-year-old female patient who is sedentary and most likely overweight.
I told him then about getting my own bike resistance trainer and
beginning to ride it at a moderate pace (about 60 RPM) for 20-30 minutes
at a time with no pain:
Casey and Holly play nearby
while I ride the indoor trainer.
The remaining three sessions he had me warm up first on a recumbent
bike, then proceeded with increasingly difficult range of motion,
strength, and balance exercises.
Yay! I was happy with that.
He measured the degree of passive knee bend (112 that time, I think)
and ability to keep the leg straight (zero
degrees under the knee every time, which was the goal). I made progress each time I
saw him because I was working diligently on all the exercises at home.
At the end of Week 3 I'd had a total of seven physical therapy sessions (three
in-home, four out-patient) and had a 115-degree passive (without assistance) knee bend.
In his 4th session, my 7th total, the therapist had me doing more difficult resistance,
balance, reduced risk-of-falling, and strength exercises.
A new goal for Week 4 was getting up and down very slowly from chairs with no plopping
my butt down hard and without using my hands/arms. I hadn't consciously tried that at home
yet so it was a new challenge. It was hard do it with my hands on my hips but I
did better after several tries and improved after working on it more at
home. (Now it's easy after five weeks.)
At the end of the 2nd session of the 3rd week he predicted that
I would meet my goals within two weeks and could stop formal physical
therapy unless there was a setback. That surprised me. I reiterated that
I'm OK with continuing through November or even December if it helps my
other leg, too. I won't be having surgery on it until the end of December.
He also decided one session a week was adequate instead of two since I was moving so
quickly toward my goals, was compliant with doing the exercises at home,
and wanted to make sure I had enough remaining sessions available after
the second knee surgery since Medicare has a limit to what they will pay
each year for physical therapy.
A paranoid person might think the therapist was just trying to get
rid of me.
Maybe he was! I was just happy that he recognized I was working hard
on my recovery. It was more confirmation that I was doing what I needed
to do to reach my goals, regardless of a few skeptics and critics.
Pretty scene along the
cart/bike path where I like to walk; most leaves haven't turned in Oct.
yet.
By the end of the 3rd week I was also walking a mile a day with our dogs, riding
my bike indoors on the trainer for up to 30 minutes at a moderate RPM, and doing 45-60 additional
minutes of PT exercises on my own every day.
Pain management:
During the 3rd week I took Tramadol only twice a day -- when I got up in the morning
and before I went to bed at night. The prescription NSAID (Diclofenac), acetaminophen,
and/or ibuprofen took care of any knee pain when the Tramadol wore off.
My leg was still restless at night; I needed to get up every two to three hours
to move it a little bit. It ached or involuntarily twitched more than hurt. I was still
lying mostly on my back. I gradually began leaning toward my right (non-surgical) side
for some variety but sometimes that did hurt as I was moving my leg into position.
I was advised not to lie on my surgical side for several weeks.
Both the leg swelling and bruising were nearly gone at the end of the 3rd week. I still
elevated my leg and iced the knee several times a day because it was warm to the touch
after any activity. My toes were still purple into the 4th week.
WEEK FOUR:
The more progress my body made, the faster my leg/knee seemed to get even stronger
and the more motivated I became to get it to its "new normal."
Even with an implant, I should be able to reach the same range of knee motion I
had previously (the range the other leg still has) and I hope eventually the muscles
will be as strong as they once were -- maybe even stronger with all this physical
therapy!
Progress can be measured in many ways. During the 4th week I
hit several small but confidence-building "milestones:"
- I could finally see the definition of my left quads and the blood
vessels and tendons in my foot again (still not as skinny as the other
one, but close). The swelling in my leg was still there but minimal,
even after more activity and less elevation of the leg.
- I was walking some days up to four miles, including walking solo
or with the dogs on the nearby hilly bike paths, back and forth in the
house (I don't sit still for long), out in the yard, and shopping in
big box stores.
A new part of the bike path I
recently discovered (above)
has some steps (below) I can
practice on with my new knee.
- I continued cycling up
to 30 min. at a time on the bike resistance trainer.
- I got down to one Tramadol a day, taken when I got up so all that
activity and the PT exercises I did in the morning were easier.
I still had leg stiffness while sleeping and when I sat for more
than 20-30 minutes. That could last for several more months,
from what I've heard, read, and seen (with Jim).
Physical therapy:
In my 5th out-patient PT session (8th PT session total)
at the end of Week 4 my progress could be measured more than just anecdotally:
-
my L. (implant) knee, calf, and ankle were almost the same
circumference as the R. one,
-
my resistance was as good with the L. leg as the R.,
-
and I was able to bend my L. knee passively (w/out assistance) to 116
degrees and 122 with the therapist pushing it a little farther (active
resistance) until it just started to be uncomfortable.
The therapy
goal for me was to reach 120 degrees knee bend passively and 125 actively. The
"good" knee was
126 degrees passively, so I still had a little ways to go to reach both of those
numbers. It was an improvement over the previous week, though, so I was
happy.
I got to try several new things in this session,
which made me happy:
-
Going up and over
5", 6" and 7"
steps with 10# weights strapped to both ankles, double the weight I'd
been using previously. Those suckers were heavy but I could do the
5" and 6" steps without falling or having much pain in my implant knee. What
hurt was the other knee that needs surgery! The cortisone is
wearing off and it hurts at other times, too.
The 7" step was not comfortable for either knee with that much
weight so we stopped doing
that one.
-
Leg raises in two
positions (up/extension while sitting, up at 90 degrees in the back while
standing) with those weights on both ankles. That was easier on both
knees than going up and down the steps with the weights on.
-
Sitting down very
slowly without plopping onto a cushioned bench the therapist could
raise and lower. I was able to sit down and get back up from
various heights without using my hands. I still needed more practice
on that, however, because I favored the "good" side and sometimes sat
down too hard.
-
Using a resistance band to walk sideways in both directions, with the
loop at thigh level (easier) and ankle level (more difficult). I have
several different resistance levels of the bands at home so can make that harder
as time goes on.
Abduction/adduction morphed from moving the leg
in and out while lying down (above),
to doing it standing up, to doing it with a
resistance band and stepping to the R and L about 30 feet.
WEEK FIVE
This past week I've felt almost back to normal!
Now that's what I call progress.
-
By the end of the week I was off Tramadol (a mild opioid)
completely. I'm taking two Diclofenac (prescription NSAID) pills a day
and whatever supplemental acetaminophen and ibuprofen I need, if any.
The only reason I might need to resume taking Tramadol before I have
surgery on the other knee in late December is if that knee gets too
sore to walk comfortably as the cortisone wears off.
-
The swelling is almost gone in the implant
leg, although the lower leg and foot are a little more red than the
other leg and foot. Not sure what that's about, but I assume it
involves all the healing that will be going on inside for a good while yet.
-
I got my first massage since surgery and that
has helped my whole body feel better. It should help with any
lingering leg swelling, too.
-
I moved back into my own bed for the whole
night! My leg still gets stiff and ache-y after a few hours so I have
to get up once or twice during the night but our king-sized bed is
wide enough that I haven't been waking Jim up when I get up or change
positions carefully. The other bed is there if I get too wiggly . .
.
I am able to sleep on either side comfortably
and move the knee into place without any pain.
-
I continued doing one or two 45-minute PT
sessions at home every day.
-
I walked from 3-5 miles a day this week with
no pain and lots of enjoyment! It feels so good to be back out on the
hilly bike paths for longer walks again.
Some leaves are starting to turn near the end of
October, helping make Lake Peachtree look a
little
better while it's drained to construct a new spillway. The water is
usually up near this tree.
-
And I started riding my bike outside on
the cart/bike paths. I was afraid the hills would
be too hard but so far, so good. I plan my routes to avoid going up
the hardest hills until my knee has healed more. I'm being more
conservative ramping up the bike distance and speed than I am with
walking/hiking because riding the bike is more risky. I'm much less
likely to fall when walking than on the bike and if I wreck, I'll do more
damage.
After the last PT session I went to Walmart and
bought my own set of 10# ankle weights and used them all week in the
three exercises the therapist had me do while he watched my form. They
really made both of my legs tired so I did fewer reps.
Physical therapy:
At the end of Week 5 I had my 6th and final out-patient PT session.
When I told the physical therapist that I'd bought the 10# weights,
he recommended I take them back because they are too heavy for me.
I didn't realize he was just testing my strength that session. He said I
can build muscle strength much more effectively -- and safely
-- with 5# weights and more reps. We already have 5# weights at home so we
took back the heavier ones for a refund.
I was tested again in several ways for
resistance, strength, and range of motion.
My implant knee/leg still lay flat against the
padded table (full leg extension), the circumference of both knees and ankles were almost the
same, and the implant knee was at 125 degrees passive bend; the
therapist didn't even try to move it farther but he knew he could. My
other knee was 126 degrees passive bend so they were almost equal.
This is what Dr. Schmidt's "Commonly Asked
Questions" sheet says about knee motion:
"Range of motion after surgery will depend on
several factors, but your range of motion before surgery will be a good
indicator. At 6 weeks most people will be at 100 degrees of bending and
close to full extension. The average patient achieves approximately 120
degrees of bending one year after surgery."
Wow. I never realized I am as flexible as I am,
compared to the general population.
After a lifetime of long distance running and
hiking my massage therapists had so often said my quad, calf, hamstring,
and other leg muscles were tight. I never seemed to be able to stretch
as much as some other people could. So I was real surprised to have
reached this amount of passive bend in five weeks and discover that it's
more than average knee replacement patients achieve in a year.
In just four weeks I had met the therapy goals
set out in our 1st out-patient session at the beginning of Week 2! This
was my 9th session overall and 6th with the out-patient therapist. He released me exactly
five weeks post-surgery.
The only thing different I plan
to do re: physical therapy for the other knee replacement is to have home therapy for two weeks
instead of one. It's super-convenient and if I'm ready to use steps and
a stationary bike the second week, now I've got those options at home.
NOW WHAT??
I'll just keep on keeping on.
Today is five weeks from surgery and the day my out-patient physical
therapist released me from PT. I may have reached my therapy goals faster
than average and gotten an early release from physical therapy but it
doesn't mean I can slack off.
It can take a year or more for a knee and leg with an implant to
fully heal, especially at my age. Even a fit 68+ year old woman's
body just doesn't heal as fast as it used to. <another sigh>
Although I have met the immediate therapy goals, I will continue to do the
range of motion, balance, and strength exercises diligently at home so
I'll have the best outcome for both knees. My "good knee"
hurts more now than the one that had surgery because the cortisone I got
in it five weeks ago has mostly worn off and I can't get any more injections
before I have surgery on it two months from now. It's only going to get
worse by then.
I don't dread the second surgery, as I've heard so many knee replacement patients
apparently do. I'd do it tomorrow if Dr. Schmidt would allow it! I want
both knees to feel good without injections or pain pills so I can get back to
my favorite non-impact sports (walking/hiking, cycling, kayaking) and
other activities like gardening as soon as possible next year.
Path by Line Creek at Line Creek Nature Center in
Peachtree City
Another reason I'm eager to have the second knee replaced is the knowledge
I gained during the experience with the first surgery. Knowing what
to expect really helps. Even being by Jim's side after his partial knee
replacement last winter lessened the fear I had with my recent surgery
and recovery.
In retrospect, my first total knee replacement
wasn't all that bad.
In fact, at the time it wasn't all that bad!
(The first or second
out-patient PT session my therapist asked if I have a high pain threshold.
I told him anyone who has run 50- or 100-mile races probably has a higher than average
pain threshold, but I have no way of comparing myself that way to anyone else.)
I don't know if I'll respond as quickly after the second surgery as I did
with the first replacement because of the trauma my body has been through
for this one. I have to trust that after three months of healing I'll be
ready to handle it just as well. If not, I'll take it one step at a time
-- literally and figuratively -- and do my very best to suck it up.
The pain is temporary and I know for certain now that the outcome
will be worth it.
One more thing -- next time, I won't have any more self-doubts
when someone questions how fast I'm doing certain things after surgery.
I know what I'm capable of, how to proceed gradually, and when to stop
before I get hurt.
Next entry: Jim's surgery for Cubital Tunnel
Syndrome in his dominant arm and hand
Happy trails,
Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil,
Cody, Casey, and Holly-pup
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© 2017 Sue Norwood and Jim O'Neil