What ROM is needed

PS meant leg "would not straighten"

 

I can't remember where I read it, but I think it was saying that it was fairly common to lose some ROM after surgery, and not just straight after, but over a couple of years, with some people if the movement wasn't repeated often enough.  The whole thing seems incredibly complicated to understand.  I found some very good sites but by the time I'd finished reading I was utterly confused LOL!  I do remember it saying on a couple of articles that those who had a very good ROM before tended to lose a tiny bit and those who had a poor ROM tended to gain more, which was actually the opposite of what I'd expected.  Also, re manipulation, it gave percentages gained and how those gains went over a year or so, but I can't remember what site it was on, but you could google it if you want to find it.  The ROM seems to vary with different aspects - surgeon, replacement knee, tissues around it, scar tissue, obesity, and how much the person pushes it, bend before, and probably some issues I've forgotten!  But I hope you can get what you need for good quality of life!

We do tend to obsess on rom. But honestly I am happy to be able to do what I like to do, (or at least when no2 is done!) which is walking & gardening. Which is why I seldom measure.

Let's not forget that extension is as important as bending. I was told by my physio after arthroscopy, that it is very important to straighten the leg as without you will always limp.

Marilyn

XX

I agree. My straight is prett right on thankfully!

I was always bemused before this surgery by everyone talking about ROM.  Mine is mainly an issue since my knee is so stiff the physio cannot even get it to budge much.

?The knee seems very flat and not hard and the skin is tight when not bending even, so I suspect there is some contraction and scarring. It has been like this since a few days post op and was extremely painful as the meds did not touch it early on. I have lipoedema of my legs so that may be a reason as it can cause excess swelling and scar tissue apparently.

?But I will update when we know what the surgeon thinks. It is sooo confusing, the more you read up on all this. Most ppl seem to recover ROM in due course and a few suffer prolonged stiffness and pain. Maybe as they make more scar tissue or have arthrofibrosis.

?No-one ever cared about about my ROM all the years before surgery when I could hardly walk, now it is all about it! My husband got almost full ROM back after a terrible knee injury some years ago. Physio did not succeed, they tried to force it and there was great trauma but still no movement. He declined an op but it healed pretty well with time just exercising at home. Not a TKR I know but he is at least sympathetic to my situation!

?They need to rule out anything up with the implant etc and maybe will suggest a MUA (shudder) - I'm just frustrated that I cannot sort this myself. Thanks for all your info, you have really been delving deep.

Hi Cynthia

If you have to have MUA so be it! If you read back we've had posts from those who've had MUA & survived!! It tends to be thrown at like a parent would to a naughty child, which is all wrong! MUA should not be demonised to make us 'work harder', we're working hard already!! Give us a break! It should be mentioned as an alternative therapy, not stigmatised!

You can only do what you can do. The rest, as they say, is in the lap of the gods! Do your best, but don't stress, what will be will be.

All the best

Marilyn

XX

I didn't even know what ROM was before I joined this group though.  My physio never mentioned numbers - there was only a drawing on the leaflet of a man sitting on a chair, first of all with the stick parallel to the leg against the front of the foot, but several inches from the knee, and the second one showing him with the stick against the knee and the foot back so the stick was upright and that was what we were told to aim for.  It was the physios of the people on here where the numbers, and the goniometer came in.  When I went back for my six week check the physio was amazed I'd got a goniometer!  So my lot are much more relaxed!

Cynthia, I really wouldn't panic about a MUA.   IF it does need doing then they'll do the best for you.  At one point (three weeks) I thought I had impingement - where something was trapped at the back of the knee and was aware that IF it was this, it MIGHT need another op.  My first thought was panic, but then I thought 'if it happens, it happens, and I'll cope but they'll sort the problem out' and started to relax about it and the physio told me to stop pushing the bend so much for a couple of weeks.  One week sorted it out.  Hopefully yours won't come to that but just look on the long term - IF there is a problem that needs MUA, then it will be sorted out and you'll look back on this chapter of your life being able to walk well!

Cynthia, it sounds as though the lipoedema is having some effect here.  You are massaging the scar with something suitable, aren't you?  It's just not knowing what is normal swelling - which we're told can be up to a year, or what's excess. 

Yes, no-one ever mentioned my degree of movement before the op either, but then at my hospital they never mentioned ROM after, too LOL!

Thanks Marilyn, for your kind words!

?The professionals don't like to have any targets missed - in case it reflects on them I guess, physios being the first line of attack! That may be why they try to scare us.

It is strange how we are all so diverse in this recovery, that we are all told different things throughout the process. xx

 

I wonder when / if we ever will forget all about this ROM thing in the years to come? It may be the case if all settles and we resume "normal" life. Hopefully with knee implants that don't wear out anyway, lol.  Nice to hear your place had a relaxed attitude as it seems to get many people wound up about how far they bend, when I doubt most of us ever thought of such things previously.

?Yes, I have the bio oil and some other products i do massage - with great care as it can bruise lipoedema. I will no doubt know more after seeing the surgeon next week as regards what happens next. Meanwhile, keeping up the exercise with gritted teeth!  xx

Cynthia, I can't begin to imagine forgetting about ROM LOL!  I suspect we will though as normal life overtakes the constant thoughts about the knee:-))))  You are SO right - I NEVER thought about my bend before!

I've got swelling on that leg of the last knee op.  I came off a moped in Greece when I was 25 and the x-ray department was closed for lunch so they decided the ankle was sprained but I couldn't put any weight on it for two months.  When it healed  the leg wasn't straight and it's remained swollen since then - it's generally thought now that it was broken but just not picked up until a lot later.  I don't THINK though, that apart from that, the leg is much more swollen other than the knee swelling.  I don't  know if the compression stockings (came to just under the knee) stopped the rest swelling - I suspect they did because I could see a line when I took them off where it had swollen above them more.  Did you have compression stockings?

Yep I agree with that Chris, my physio never even measured until I asked her what my rom was, as I had read about it on here. They do seem a lot less demanding over here as to what is expected of us after TKR.

Can't say what's right or wrong, but if someone had pushed me into bending when I couldn't I think I would have just limped out!! Or hit them with my crutches!

Marilyn

XX

Defo gone for the crutches if they'd have got me in tears as some have said on here!!!

I know some have thought it was a poor show my hospital not providing any physio, but just leaflets, but it was good for me and I've been very happy with it all!  Sooner that than be bullied!

Two years and five months. . . the old goniometer only comes out every few months now!!!  Still can't resist a quick look occasionally just to make sure I'm not slipping back!  Even now, there is still that vaguely stiff feeling about the knee but  I'etween 130 and 134 most times I check!

Sounds good to me!

I do wear compression stockings normally but since knee op, they have been impossible to get on, they did not give me those TED socks for the op as I had swollen ankles while awaiting op because I had not put the compression on that morning, my mistake as I went in at 7 am as asked  but then found out op was put off until afternoon! Gruelling wait with no food and drink ensued and I saw all the meals coming in and could have any!!

​Going back to see lymph clinic nurse soon to review things.

​Unlucky about your past accident - did this contribute to needing the knee surgery?

It sounds as though your lymph problem is pretty severe and I reckon this is causing added complications for you - I hope they can help at the clinic.  I was reading last night that several places who tell you to wear the compression stockings for six weeks, say you can take them off at night!!!!!  If you have a TKR in the height of the summer, this could make a real difference to comfort so I'll have to ask my lot about that.  I've a feeling they'll say they've got to be left on all day AND night though.

Re the accident - I DOUBT it had anything to do with the knee because the other knee is just as bad.  What I DO think made the knees worse was that I was given insoles to tilt heels outwards quite a few years back - a couple of years before the knees really flared up badly and I don't think I should have had them - there was no wear on the inside of the heels on shoes, so I think that should have been significant.  I dumped them about two years ago.  But it is only a guess!!!!

Not all advice is good advice! We also get conflicting advice and research gets opposite results, such a minefield. You may be right aout your insoles, I feel we know our bodies better than anyone, though expert guidance is great.

?Compression has to fit properly to work well, not sure the standard hospital socks are good if they cut in -  re night time i'm not sure but don't wear my usual compression all night as the pain would be counter to sleep and my swelling used to occur through gravity - would wake up with nice relatively slim legs.

?Physio yesterday and it went quite well but woke today with a very stiff swollen knee. I hope to get some answers in the coming appts but on the plus side, I slept a bit better.

?Hope you have a good day!

?

Hope the knee calms down Cynthia.  I think most people tend to get more swelling after physio - physio seems to be much more intense than the little exercise bits we do at home, I'd guess.  You have a good day too, even if it's more resting than usual:-))))