What ROM is needed
Posted , 15 users are following.
After my surgeon telling me today that I don't need to worry about ROM at all now, I still wasn't sure what ROM would achieve the best. One article I read said to get up and down in a bath 'normally' you needed 135. But I just found a useful bit in the 'orthopaedics and trauma journal' online - scopic ROM in a PS knee is an average of 115° and a maximum of 145°. This functional range is adequate ... ROM after knee replacement. - That seems a fairly good guide! It went on to say in climbing stairs and rising from a chair (guess that depends on height of chair though!) 95 degrees are needed.
0 likes, 60 replies
jane37928 chris00938
Posted
Everyone gets dry obsessed with Rom. Mine was slow coming after the op - I'm now 24 weeks and it's between 95/100 and I'm very happy with it. When you are able to do what you need to there's a lot to be said for that. Happy healing.
Eizie jane37928
Posted
chris00938 jane37928
Posted
YES! For years I could do so little. Walk such a small distance - SO slowly, but when the other knee is done I'll be able to walk MUCH further, and faster! I've got the speed up a lot already, with just one leg, partly because it's stable, which the unoperated one isn't but it's all goals that can be achieved. That reminds me of when I'd sat in the waiting room at the hospital yesterday. We DID get there an hour early, so after a journey of an hour and a quarter, then sitting in the waiting room for an hour, you can guess what happened. When I was called to see the surgeon, the unoperated knee made such a noise that people looked round in shock and someone said 'we heard that! Ouch!' LOL! I think they guessed what I was there for LOL!
So as well as walking further and faster, my goal is to be able to get up and down from a chair without leaning on arms, and when we go round to son's house, to do their stairs! I started on the cross trainer, but the unoperated knee didn't cope, so stopped that:-(((( But at least I managed a whole minute, whereas before the first knee was done I couldn't even do one rotation!
I'm glad yours has done well Jane!
connie80069 chris00938
Posted
chris00938 connie80069
Posted
I'm 67 Connie, but after just one knee replacement feel 10 years younger! I think that is absolutely true!!!! After you get past the 90/95 that seems to be recommended for minimum it is absolutely a case of pushing it so you can do what extras you want to do IF there are extras you want to do! 120 seems to be what the hospitals aim for (my surgeon said they aim for this over two years, but if I hadn't asked, no number would have been mentioned) but when you think how we've lead such limited lives for years because of the arthritis, everything is a real blessing if we can do so much more than we did before the op!
CHICO_MARX chris00938
Posted
The "standard" is 0 degrees straight and +120 bent. I started at -14 / +84. Ten weeks of PT got it to -1 / +123...I'm now 0 / +133. The zero is very important to prevent limping for the rest of your life. My doc told me not to expect anything better than 140 but some people have done better than that. If you can sit back and have your butt touch your heels, that's 161...I don't think that's possible with a metal knee. I'm happy where I am.
Caution: The measurement is VERY relative. Ten PTs can come up with 10 different results...all similar but different. There is no absolute measurement as they just kind of "eyeball" the angle.
chris00938 CHICO_MARX
Posted
You're right Chico. I tend to ignore the 0 because I had that right from the start without any effort, and have NEVER needed to push that, but actually the reverse - as things were healing in the early days made sure not to over extend the leg, but now it feels stable. Reading up last night I'm a bit wary of pushing past the 135/136 I've got - I don't want to loosen cement! So although my surgeon said I don't need to be doing any bend exercises now, I'll keep up sitting for an hour in the evening pulling the knee up tightly from time to time, just to maintain, and check that once a week or so. Yes, again, I'm sure you're right - even with the goniometer, it's possible NOT to be totally accurate, but it does help to give us a guide as to how it's going and improvements, especially in those early days. And having the same person do it each time helps. For many of us, who don't have the luxury of a physio, it's a very useful tool at home.
What worried me reading up studies last night was that knees tended not to last so long on people doing a LOT of deep squatting, because the cement loosened, and this brings it home - we do need to look after our new knees and it's not just jolting the joint that can damage them.
CHICO_MARX chris00938
Posted
I was told by my PT that a ROM of +140 was in "athlete range". I took that to mean the kind of flexion I had during my goalie years in hockey (which was probably way more than that). So the question is:
If 120 is good enough to lead a normal life and if a really high ROM can cause damage to the cement, then why in hell are people obsessed with the damn number? Why would you even think of INTENTIONALLY pushing it past 130?
OK, I'm at 133 naturally but I have no plans to force it higher. I'm looking to rebuild my strength...period. My goal is to walk firmly and steadily with no more weakness or balance issues. It takes a lot of work to overcome all those atrophied muscles. And it's worse for me because my recovery was derailed last October by my L2/L3 stenosis problem. Exercise was out of the question with that condition sidelining me. Hope to get neuro clearance next week to resume, but that will only be to regain all my leg strength. At 15 months, I have zero pain, swelling, tightness or anything else...well, except the "clunking" which I believe is permanent. Who cares.
If you have a ROM of zero straight and 120 to 130 bent, YOU ARE DONE!!! There is no reward for +145 on the ROM-o-Meter. Consider the down side... Why even go there?
chris00938 CHICO_MARX
Posted
I'm inclined to agree Chico. I've got to 135/136 naturally and am quite happy with that - I've NEVER pushed it to the point of pain. If it does increase, as the surgeon said it is likely to over two years, then fine, or if it doesn't then fine but I'd like to maintain around the 130 - 135 range. But I think there are some who DO need the higher number for possibly work reasons or hobby reasons and if they want to work on that, then fine for them. The loosening of the cement seemed to be partly related to deep squats in the study I saw. It was based in Korea, IF I remember rightly, where squatting to cook or eat etc. was part of normal life.
To be honest, I think people have got obesessed with the number from this group LOL! I didn't even know what ROM meant when I got on here and wondered why everyone was talking numbers when I didn't have any info from the hospital that mentioned numbers BUT it is useful to know that you're making progress at the beginning. Also that you're maintaining what you want after you've achieved it.
But some of us are very flexible so will get more bend than they need and it is what it is. Pushing the bend to some means something totally different to pushing the bend to others. Some have struggled horrendously, whereas some have almost drifted into it. I told my surgeon before the op that I had Ehlers Danlos, which meant I was hypermobile so he could use an appropriate knee and the knee feels good! So some 'will go there' without really intending to - maintenance will lead them further into the bend over time. It's not 'forcing it' at all!:-)))) The only time I tried to push mine I got what I thought was impingement at 3 weeks post op (115 degrees) and my physio told me not to bend to that point for a couple of weeks, but it was OK after a week. But there has been no 'forcing' - like I know people have needed to use straps on chairs etc. - nothing like that, and no grabbing the leg to force the bend (apart from the first three days, I did that, as it was bruised so much but I helped the leg, rather than forced it!) - some of us just get a deeper bend naturally! Like straightening - I had to make sure I didn't over straighten the leg as muscles were building up again - we're all different and will naturally get different results from this surgery.
Guest chris00938
Posted
Saw my PT guy today and he measured me n i asked some questions. I thought Id better tell you b4 u twisted yourself into a pretzel
My right leg is now 137. Since ive gain muscle in calf and thigh i can bend as much as tissue is there. He said 125-135 is a normal leg wo surgery. You always get outliers for reasons unknown like Chicos bell curve. My left post arthroscopy w swelling/bruising is 127. I made the mistake of telling him how good i felt and we worked our way up to 2 flights of stairs,unassisted. And partial lunges with me holding 40 lbs- 20lb barbell in each hand! I thought my shoulders were going to tear off at the end. I iced after. The op report he showed me said it was a really big bone spur. He still wants me to alternate therapy/strength training w rest and ice.
Its been the best day yet despite feeling exhausted.
6mo off work is motivating me to get stronger. I have heavy loads at work to move around so this week and next mean a lot. Sure hope no setbacks from here on out.
:D
AuntE G
chris00938 Guest
Posted
Oh AuntEG - that's wonderful! I can't even imagine being able to do that. To be able to go up stairs - could you do that without dragging yourself with the handrail? If I could do that WITH dragging myself up the handrail I'd be delighted LOL! Phew - you sound really strong! I want to be really strong too, to be able to do things in daily life without struggling. I bet you can get up and down from a chair without leaning on arms???? That's my next goal:-)))) Well done you!!!!!!!!
In the old days (many moons ago!) I used to do squats with 144 lb when I was training for swimming. Now I think 4lb with tiny squatting would be pushing it LOL! But maybe after the other knee is done:-)))))
You must be really proud of yourself!
Guest chris00938
Posted
Chris,
Thank you! I am proud of myself! Yes, up n down no handrail for first time-6mo after op. Squats n lunges were partials. I started pillow in chair and progressed to lower bench wo arms. A person has to get strong butt muscles too, not just quads n hamstrings. Small exercise of one leg balance can help engage all those muscles.
I felt it all last night "pay the price"for a physio day but also, for first time after op my leg is a little puffy but not swollen up. Looking forward to arthroscopy stitches coming out and i hope the soreness around the sites goes away soon. Bruised/tender. Just keep plugging away!
:D
AuntE G
marilyn10235 Guest
Posted
Oh wow AuntEG! You really must be over the moon! I doubt my bend was that much BEFORE arthritis!
Good luck for the remaining rehab & your return to work!
Marilyn
XX
chris00938 Guest
Posted
Good grief - you're doing all this with STITCHES in as well!!!! Jaw dropping now! I'm sure you'll be so much more comfortable when the stitches come out! You are doing SO SO well! I'd love to go up and down stairs, first with the handrail used - that would be more than I've done for years and years, but without using a handrail - oh wow!!!! So I've got a goal of getting up and down from a chair without leaning on arms, and doing a full flight of stairs up and down, first using handrail, and then - what would be amazing - without using handrail. I've noticed with the one knee done I can get up and down from a chair just leaning on one arm - that's an improvement! Before the first knee was done I was using the bike on level 1. For a few weeks now I've been on level 7 or 8 - a huge difference!
It's very hard - to a great degree how well we recover from this op IS down to us, to get the bend and get strength back, but at the same time I don't want people who CAN'T get the bend to think it's their fault - sometimes there are problems that they aren't in control of so they shouldn't think they've failed! We can all only do our best and for some of us that will bring different results to others! I don't think this is anything to do with age, or even maybe fitness - there seem to be other factors affecting it.
jan01779 chris00938
Posted
I think we all get hung up.on ROM measurement I obsessed about it in the early days post TKR. Still.measure just not twice a day LOL!!
My physio said anything above -110 Is good and for me it's functuality that matters. I've always tried to keep fit but not ever an athlete . As long as I can cycle eventually am.happy. Before my TKR 13th Dec 2016 it took me 50 minutes to walk half a mile now its 10 minutes, I can do stairs , garden and can attend Aquatone and managing work. I don't think I realised how debilitating it was and like many gritted teeth and got on with it . I'm -125 to -130 depending on swelling from op or RA.. People are telling me I look 20 years younger ha ha don't always feel like it!!
I'm still not entirely staight but again my physio told me aim for 0 but -5 acceptable. Been told do ROM exercises at least 3 times a week for life once reach target . Its amazing different advise given Im aiming for 0 .
Surgeon much more relaxed about it all and very happy last week. So keep going and see at 12 months.
Can't believe someone doing squats on here with 120lbs weights. LOL could not do that before my op even. I'm happy using my 6lb ankle weights and resistance bands and water exercise which is slow but sure. Was advised by physio to do 3 days strengthening a week and am still doing ROM 6 days per week. I don't know how people in their 80s manage!!
Grateful pretty much sailed through this compared to some on here. My heart goes out to them. This forum has been great and am really happy with NHS care.
Thanks for all the useful info 😊
chris00938 jan01779
Posted
Jan, that's so interesting that you were told to do the ROM three times a week for life when the target was reached. Seeing that people DO lose ROM if it's not kept up I'm inclined to agree with that, whereas my surgeon seemed to think normal activities would keep it at a level I needed. Yes, they might, but if I've got more than I need day by day, then it might lessen and if I suddenly need a tad more than I'm generally using, it won't be there. If that makes sense - so it's the same old saying - use it or lose it! You've done so well with the exercise and strengthening! Before I asked to be referred for TKR's it didn't go through my mind that I could build up more strength than I had before, somehow, but it's SO good to be able to do that! Even with just one knee done I appreciate how much stronger I am!
I agree - I do feel for those having a difficult time, and I'm only too aware that in time if we need the replacements replaced as we're older, it could be those of us who have sailed through it the first time, struggling!
Has anyone else read about the 'donor knee implants' in the newspaper today? But they're only advocating them for younger people because you need to heal quickly and they reckon older people don't heal fast enough.