Beyond the First Five Weeks

I had a total knee replacement (TKR) on May 24, 2011 (a Tuesday morning at 7:30AM) at the New England Baptist Hospital in Boston.  I had read loads of information on the internet, had bought a TKR bible (Total Knee Replacement & Rehabilitation by Daniel J. Brugioni and Jeff Falkel), attended the knee class at the hospital, watched videos of the surgery and various rehab exercises, joined message boards and blogs, and even already contacted the rehab center I would be going to after my surgery.  I did the pre-op exercises, bought my raised toilet seat, unearthed my mother’s old walker, bought new bed linens and fixed up my bedroom, put in extension cords, cleared the table next to my bed, cooked meals in advance, and bought several pairs of pull-on shorts and T-shirts.  I was prepared.  This was going to be a cinch.  I knew what to expect and I was armed and ready.  As far as the first five weeks went, it was every bit as awful as I had read it would be.  The pain and swelling did not disappoint.


I looked every single day for one thing that was better than the day before.  In dieting we call it a “NSV” – a “non-scale victory.”  I was happy when I could lift my foot a little bit off the floor to get my underwear on instead of having to shuffle my foot into it.  I was happy when I could get my leg up onto the bed without using the opposite foot to lift it.  I was happy when I made it to the toilet in time to pee instead of having a puddle on the floor.  And, oh my goodness – when I finally could get up off the sofa it was a day to celebrate because it meant that if I got up in the middle of the night I could try to get some extra sleep on the sofa instead of sitting on the recliner until I dozed off again.


I did my home PT program faithfully – three times a day, no matter how I felt, how tired or emotionally exhausted I was.  I strove for the holy grail – the 90 degree bend.  After whimpering and whining I broke through from a 90 on a Friday to a 103 on a Monday.  Then, on Tuesday I went to see the doctor for my follow-up visit.  No “atta girl,” no” great job,” no “see you in six months.” Instead it was, “let me see you bend your knee.  Only 83 degrees? I’ll schedule you for a manipulation on Monday morning at 7AM.”  


Apparently it doesn’t matter what you reach after an hour of PT – it matters what you do cold out of the box.
I went home, so upset and disappointed in myself.  I took it as a personal failure.  Somehow I didn’t work hard enough.  I didn’t work often enough.  I must have slacked off.  After much reading and conversing with people (one of whom was my home-care therapist, and another one who is a friend and is also a therapist) I was assured that this was no reflection on me.  If my body produces scar tissue, then no amount of PT at home was going to break through (even though I had that small breakthrough the weekend prior).  I started to look forward to the manipulation (friends who had it for other reasons assured me I would feel SO much better).  I was sorry I had to wait all the way to Monday!


This was the first introduction to the fact that beyond the first 5- 6 weeks, which went by the book, everyone who has a TKR parts company and goes on their own path of healing.  Some are driving and back to work within 6 weeks, some, like me, will need more time.  Some will be hopping around in three months, some (I hope not me!) will take up to a year before they feel normal.  So, this is why I decided to write this blog.  There is so much information on the first six weeks, but so little on where a person with a TKR goes from there.  As I said, every single journey will be an individual experience, but maybe I will be experiencing something that would help someone else see their own situation.


I want to start this blog with my first day of outpatient therapy, two days after my manipulation:
We spent the time in a quiet darkened room, and she massaged my incision, and gently rocked my leg back and forth, and showed me several rocking exercises to get my right leg to “listen” to my left leg about what to do.  It was extremely gentle and almost “surreal” but it was lovely and absolutely did the trick.  Without doing ANYTHING I got my knee to 105 degrees.  (It was 113 under general anesthesia.)


Both she, and the intake counselor the day before, thought that I am emotionally blocking progress by FIGHTING so hard and being so ANGRY about lack of progress, etc. etc.  They said the more I fight to be a little soldier with my PT exercises, the further back, actually I am going to go with this. All this emotion is blocking the flow of fluid and energy in my leg and that’s why I feel like I have a cement leg.  (It’s actually that more than pain that is stopping me from full movement.)  I have to tell you, it might sound like hocus-pocus, but how I felt when I walked out of there was the best I had felt AND I was bending my knee AND in that visit I was able to give up the crutch and just use the cane for balance.  She also said I have to make friends with my new knee and start to accept it in my body and forgive it for the pain and discomfort.


I also told her that I am having trouble with pain in my medial meniscus compartment (where I had the bone-on-bone) and she said that is very common – that the body holds on to the memory of the previous pain, but actually, with the new joint, there is no reason for it (other than the memory, although your ligaments and tendons do get used to moving a certain way under stress and they might not be used to the new knee yet so are complaining!). I shared with her that I’ve started listening to my Positive Changes hypnosis tape about releasing pain and the the specific thing that it is about is that pain is just a memory and that you have to put it outside your body and let it go.  Interesting because it’s the same thing SHE said.


She said to just trust my instincts (in terms of how much to push, what to do, when to do it) and she feels that if I am doing something every hour it’s enough.  And if I feel like doing my instruction sheet three times a day that’s okay too.  I told her that I would be worried that I wouldn’t do anything if left to my own devices.  She said that’s not possible – I will WANT to get up and  move.  And besides I’m not giving myself permission to do nothing.  I am telling myself I have to do something every hour, even if that something is to do my massage and scar management.


Five weeks of killing myself has just gotten me frustrated, depressed, angry and blocked.  Actually, I was fine up until I found out I needed the manipulation – that’s when it all fell apart for me.  I knew what to expect with the recovery… I just didn’t expect it to be worse than what I was told to expect!  Anyway – with 90 degree weather and no AC in the house I’m liking her gentle approach!  Our pool is ice cold but I will see if I can dangle my feet in it at least… that will be nice – I think it will be too cold to swim in – I don’t want to send my leg and its nerves into shock – that won’t be good.  As soon as I go back to work, though, I am signing up for the recreation center there and getting in THEIR nice warm pool.


I’ve been doing my PT all week.  I’ve even added more range of motion exercises and balancing and walking exercises, but I’m approaching it in a kinder, more forgiving way.  I am extremely uncomfortable by the end of the day, but I don’t think I am doing TOO much.  It’s not pain (and I feel great the next day) so I know that I’m pushing myself just enough.  The trick is to find a balance between doing enough to make progress, but backing off I don’t kill the next day because I’m in pain and need to stay in bed.  I’ve cried off and on – not because of the pain, but because of the emotion of it all.  One morning this week I did fall apart because I didn’t make it to the toilet in time, and I really thought that was behind me.  Then this evening, for no reason, I just sat sobbing – but just a little bit.  I think I am just caught off-guard by all the emotion this is bring up.  Part of it is fatigue and exhaustion, part of it is disappointment at the recovery process, part of it is just enough of being stuck already…. but I did read somewhere – that instead of looking at this and saying – “I’m six weeks into recovery why is this taking so long?” I need to look at it this way: “I’m six weeks into a 52 week recovery.  Boy, I’m really moving along.”


My hope is that this blog will help other people face their recovery.  We may not have the same issues, but it’s important to see that if you aren’t driving, back to work, and running around by six weeks, you are not alone.  I also want to keep a diary so I can look back myself and see my progress.   I need to keep track of the four steps forward and three steps back nature of the recovery.  Otherwise I feel that I am taking four steps forward and six steps back.  That’s not the case, and having a diary of the journey will make me realize that.


My steps forward this week:  I have gained a nice range of motion (I don’t measure myself at home, of course, but I certainly can tell how far back under the chair my TKR leg is moving!).  Also, BIG: I moved the recumbant bike up from the very last notch, and I am still able to get around.  I did three minutes twice today AND went for a walk!


Welcome to my journey.  Please share yours with me!
Miriam