TKR ROM Work At Home
Posted , 25 users are following.
This is for everyone but especially for those who can't afford PT or are too far away to travel to one. Remember: The goal is to break up the forming scar tissue. Screw the pain...do the work!!! You want to walk with a limp the rest of your life?
#0... Warmup:
Nothing beats a stationary bike to get the blood moving and to warm up the knee. This is usually a given. Virtually all PT sessions start out by warming up the knee. Do this... No bike? Take a 10-minute walk...and walk correctly...
https://patient.info/forums/discuss/walking-after-a-tkr-593409?
#1... Heel Slides:
https://patient.info/forums/discuss/tkr-heel-slide-exercises-526213
When you use a belt to PULL your foot toward your butt, you will be increasing your bend to +120 and beyond. There is also a medical device to help with this (see picture).
#2... Squats:
Hold onto a chair and do squats. Deep as you can...hold...stand up...repeat. Start with three sets of 5 once a day. Increase to three sets of 10-15 multiple times a day over the course of weeks. Want more? Put some weight on your shoulders or hold onto some dumbells to pull you down.
Both the above home exercises will help with your bend. Do them diligently multiple times a day. When you see your doc again, he can measure your progress, although when doing the heel slides in the same location all the time, you can have a piece of masking tape on the floor; mark your progress with a pen and date it.
Now for straightening your leg...
#3... Gravity:
Lie on your bed face down with your knees just on the edge of the bed...NOT OVER IT. Lower your TKR leg (or both) and just let it hang...gravity will do the rest. This is one hell of a difficult thing to do. Count "x" seconds...bend the leg back up to vertical...repeat. You can do as many reps as you can handle for how many seconds you can endure multiple times a day. As you progress, increase the number of seconds and the number of reps.
The big thing to remember with this is that you CANNOT use your muscles to support the leg. You have to relax and just let it hang!!! When you get adventurous, strap on a 2-pound ankle weight. That will be INTENSE!!!! ...but worth it.
#4... The Gym
Once you get your ROM going pretty well, you'll need to hit the gym anyway to regain all the strength in your atrophied quads, glutes and core. Doing more leg presses and squats with increasing weight and reps will help finish off your ROM work to 0 / +120...probably beyond. You can also do this at home with a good set of exercise bands of increasing resistance to do the leg work.
Conclusion:
These are only some of the exercises you can do but, for me, they formed the core of my recovery. Do some research on the web, especially YouTube, for more ROM exercises. So, yes, a PT can be of immense help to you but if money or distance are issues, you can do this recovery at home, on your own, if you stay focused and diligent about the ROM work. You will NOT have a PT pushing down on your knee to break up the scar tissue but you can come close if you do the work!!!
Have fun...
11 likes, 35 replies
mary81398 CHICO_MARX
Posted
Everyone has suggested i look up your advice. I'm 4 1/2 weeks post L TKR
I'm doing a lot but i'll do all of these exercises regularly. Thank you!
CHICO_MARX mary81398
Posted
Once you get your ROM back, look up my Post-TKR Exercising post. Gotta rebuild your quads, glutes and core. Also lots more topics out there. Time, work and patience...
mary81398 CHICO_MARX
Posted
Thank you, i'm working at everything so far.
kathy63770 CHICO_MARX
Posted
thank you!!!!!
marylyn1944 CHICO_MARX
Posted
Thank you! Your experience and advice have been tremendously helpful! Am doing the prone -hang for extension. I am 5 points away from full extension. Also sitting with 5 lb. weight on knee after extending leg to another chair. Dr. says it will come back since he had it fully extended after surgery. Have really good range of motion, which is restricted when swelling is most severe. Leg also gets really red - Dr. says normal. Surgeon is very patient and attentive, takes the time to explain what is happening, and is highly respected . I also have excellent therapists. It just helps to know others have gone through these same bumps in the road and made it through with good results. I have more aching and burning than pain at this point. That is improvement. Exercise bike is on it's way, and am working at walking heel to toe, heel to toe. Onward!
CHICO_MARX marylyn1944
Posted
"Heel to toe..." Yeah, that's fun. It's like learning to walk all over again. Reminded me of my kids in band camp... It will seem awkward at first but that part resolved for me in a month.
#3 in the Home TKR Work will absolutely straighten that knee. I got stuck at -4 for weeks until breaking through. You can't expect constant advances; the "plateaus" are frustrating when one pops up.
I am a bit over 3 years post-op and my knee is just fine. 90% of the time, I don't even know it's there. Inactivity will bring back some stiffness. Long-term TKRers warn of this and it's true. Gotta keep the knee active...for the rest of your days.
bradley_33200 CHICO_MARX
Posted
great advise ive been following your post and im impressed i will be following suit as well even tho im over 120 degree bend but thanks for all your advice
CHICO_MARX bradley_33200
Posted
It doesn't stop at +120. Gotta keep the knee active forever so as the tightness goes away and you keep exercising, you can achieve a much better long-term ROM. I ended PT at 12 weeks with -1 / +123. I'm 3+ years post-op and more like 0 / +133. Just keep working and give it time.
bradley_33200 CHICO_MARX
Posted
yup i will i had a PKR before the TKR and that went well i almost reach my heel to my buttocks but this TKR is gonna be a long process had the surgery in 4/30/19 next morning after surgery i fell and had to go back in same day for a revision so thanks to the fall first day PT i had a 115 bend they were shocked when the measured me 😂😂
CHICO_MARX bradley_33200
Posted
Touching your heel to your butt is a flexion of +161 which may exceed the tolerance of the device, damaging it or reducing its lifespan. Every doc and PT I've ever talked to suggest that TKR patients should not exceed +140 unless they know the exact limits of their device or have one of the latest high-flexion implants. Caution: These newest devices have NOT been tested for decades so it is unclear if such flexion will not reduce the longevity of the device. But then, everyone makes their own choices.
debbie08326 CHICO_MARX
Posted
Chico,
What do u mean shouldnt do heel to butt touch, stretch?
i have been doing that 😦( after my walks and also i like to sit in chair kinda like a pretzel knees bended up on side of chair. ok seriously should i not be doing this ?? I may have loosened my appliance all by these errors . I always thought it was good that i could bend it that far.
I had partial and through all my therapy i did my self i was able to acheive this . everyone always talking about the bend i just thought this was a good thing .
Boy have i messed this up?
Debbie
CHICO_MARX debbie08326
Posted
The problem is that we don't know the limits of the devices...and each one (manufacturer, model #, etc.) may be different. I have talked to docs and PTs...none have recommended going past +140 (heel to butt is +161). No one knows the limits of the devices so everyone stays on the safe side. Will it damage the device or have some impact on it longevity if it's pushed too far? No one has ever gotten an answer on this.
I know there are newer ("triathlete") models out recently that are supposed to deliver greater flexion but I haven't heard of any specs, long-term testing, etc. I'm at +133 and my doc and PT told me not to exceed +140. I obey their restriction. In normal life, especially climbing stairs, all you need is +120 or a bit more.
Also, you have a PKR and I have no clue on the restrictions associated with a partial device. I'd ask my doc or inquire from other members regarding their experiences. I've been on here for more than 3 1/2 years and I haven't heard anything about pushing a knee device all the way to +161 and, if people did, what the result was.
In the end, I'd play it safe unless I had specific data from the manufacturer that the device can be pushed that far and if that flexion will affect its lifespan. We just don't know the answer to this. People may have opinions but you really need hard test data from the manufacturer before any claims can be made regarding the capabilities of any specific device.
bradley_33200 CHICO_MARX
Posted
this is the partial knee replacement not the full TKR im talking about bending
CHICO_MARX bradley_33200
Posted
But it's still an implanted device with stress limits. I'd do some research on the manufacturer and device before testing its limits. You want to get the full lifespan out of it. Just sayin'...
Dcweather CHICO_MARX
Posted
I will repost what I posted 15 months ago plus a bit more. I didn't get any response but I think it is important.
"Funnily enough I find #3 the easiest. A stationary bike is great but is impossible for me and probably many so may need other ways of warming up. We know you got great ROM but is essential for people to realise that it is physically impossible in some cases to achieve more than say 90 deg due to previous conditions etc. In fact forcing it is impossible anyway but could do serious damage. As you say every person is different and I wish I was as lucky as you with the rom and I appreciate this is all good advice for many but won't apply to everybody."
New.
I think Chico gives some excellent advice so don't jump on me for what I am about to say. But some of it can be disheartening for people who are unable to get this ROM. There is an implication that everyone can and those that can't aren't putting in the work or going through the pain barrier. As far as I know Chico is not a qualified surgeon or PT. He is a fellow recipient. Advice on another highly respected forum and from other surgeons and PTs says on no account do anything that causes severe pain, especially early on. I'm not saying Chico is wrong but opinion IS divided.
Do the exercises as best you can to obtain YOUR maximum ROM which may be well below 90 (mine are just above and just below 90).
I'm just off to the Gym 😉 , never give up and good luck !
Dave
CHICO_MARX Dcweather
Posted
Totally correct. Some people have a very tough time achieving the target ROM...some even undergo an MUA while others, because of previous issues, will never get there. My PT told me that you have to keep trying but, in some cases, it's just not going to happen so those patients have to learn to do the best they can with what they've got. Totally agree.
Dcweather CHICO_MARX
Posted
Nice one Chico 😃 18 months down the line and been slacking a bit lately so went to the Gym this afternoon. Was pleased to see that strength has improved and can leg press another 10 kg. No change in ROM but never say never!
CHICO_MARX Dcweather
Posted
It can come back in time. Finished PT in 12 weeks at -1 / +123. It's now been 3 1/2 years and the last trip to the doc showed 0 / +133. Just keep doing the work and stay active.