Clicking and clunking away on my noisy knee

Knee-plus-8 weeks, 24-Nov-04, Wednesday:
Exercise equipment now upstairs, except for the stationery bike. I am spending more of my evening in the upstairs living room, at least after my Mom goes to bed at 8 PM. Different “feel” in my torso, working on the carpeted floor versus exercising on a firm bed. No real difference noticeable in my legs.

We are discussing a return to full days at work next week. The trick will be to “make” time in the AM or PM to both walk and to continue AHPT. Going home for a long lunch, and spending 90 min walking/exercising may actually make the most sense. It’s nice to be the boss ...

The surgeon had warned me to expect the TKR device to make noises during this phase. I am having very little clicking or popping. It’s possible that the PT/AHPT has tightened up the tendons and ligaments to where there is very little “play” possible.

Swelling is also virtually gone, except after being on my feet for an extended period. Muscle definition in the thigh and calf of the TKR (right) leg continues to develop. I had not realized how much tone and strength I had lost in that leg during the past few years, but the PT people said that the muscles of right leg were about half the size of the left. Right leg is still “flabby” when compared to the left, but it is improving.

The end of hard-core PT

Knee-plus-49 days, 17-Nov-04, Wednesday:
Seven weeks. I began half-days at work yesterday.

Today was the last day of facilitated PT, although daily AHPT will need to continue at least through the EOY, if not indefinitely. I asked “How much longer?”. The answer: “You can be done today, if you like.”

125 degrees active flexion via standard on-back heel slide. PTist was very happy.

Another good night of sleep. Into bed at 11P, awake at 530A. A couple of ibuprofen before going to bed. This is working.

There is virtually no pain. I get a little achey if I sit in the same position for too long (easy to do in the office), but it dissipates if I take a little walk down the hall.

No pain, no cane!

Knee-plus-47 days, 15-Nov-04, Monday:
We have been sleeping upstairs since the middle of last week, and more or less successfully. I am still waking up at 3 AM-ish, and generally again at 5 AM. May or may not need to get up to urinate, depending on how much liquid I consume after 5 PM. Stopped percocets entirely last week (Dulcolax as well), and then stopped ibuprofen during the day over last weekend. There is no longer much in the way of pain, except from exercise. I am still using ibuprofen to get me through the night, though. Not sure if that is even necessary.

I stopped using the cane in the past few days, too.

I have also stopped icing down after AHPT. I think that I’m about as far along as I am going to get, at least short-term. The remainder is continuing to rebuild strength while retaining ROM.

Re range-of-motion (ROM): I can readily do wall slides at ca. 120 degrees, and can sit with my toes at the edge of the template (even with the front of the chair legs). However, I am still having problems coming down stairs, whether this is an ROM problem or a strength problem, who knows.

I also upped the weight regime to 5# on each leg.

Sleep improves, and walking is getting comfortable

Knee-plus-42 days, 10-Nov-04, Wednesday:
PT today went well. 120 degrees active (and easily from wall slides), 127 degrees at the point of pain. The chair trick seems to be working well.

Another full night of sleep. It may be time to move back upstairs.

Knee-plus-41 days, 9-Nov-04, Tuesday:
Progress continues with AHPT. At work 2 hrs/da.

Last night was the first night since surgery that saw no getting out of bed from 1030P til 530A.
Percocet use is down to 2 @ 730A, and 2 @ 330P. Ibuprofen every 4 hrs from 930A to 930P. I may just stop the percocet entirely after PT Wednesday.

Walking is very comfortable, and can be done at a good fast pace. I carry the cane, just in case, but I am walking mostly without it. 1+ mi: time: 25 to 30 min.

The joys of a CryoCuff

Knee-plus-37 days, 5-Nov-04, Friday:
AHPT. One full set in the AM, no walk at noon (weather); PM full set, with walk after short day at work. “Full set” including 16 min bike, takes a good 90 min.

The CryoCuff came last PM and is great. I can now “ice” pretty much for hours on end. Knee feels really good and tight after icing for an hour.

I also made a template to monitor foot-under-chair process from a piece of cardboard. I put the cardboard in front of a dining room chair, and made orientation marks on the cardboard where the chair legs touch. Each day, I simply trace how far back my toes can go. I should be able to calibrate “toe mark” on the template with degrees flexion after the PTist measures it each Wednesday.

I am making good progress on the stairs, too. Once loose, 10X up and down from the landing. “Up” continues to go smoothly. “Down” has that “pop” in it, whether from muscle weakness or just approaching current limits re ROM, who knows?

[daily entries will no longer occur after this date]

Getting through the flexion barrier

Knee-plus-36 days, 4-Nov-04, Thursday:
Full AM set, including bike. It’s raining, so the likelihood of a walk is pretty low. Once I regain more confidence in stability, walking in all weather will not be an issue, but right now it is.

Doing steps at home works IF I am fully loose before hand. Stretch, bike for 15 min, and then I can do steps. Going up is rarely a problem, but even fully loose, going down is still marginal. I need a few more degrees of flexion, and all the time. But it is going to work.

Sitting on a chair by the fire, putting my heel under the chair, and slowly sitting down on the right leg seems to be an effective mechanism to get that last few degrees of flexion. I hope that by doing this routinely, I can break through the plateau, and retain the ROM.

Stairs! I can do stairs!!

Knee-plus-35 days, 3-Nov-04, Wednesday:
I’m now on a once-a-week PT schedule. Today, I am still much more swollen than I like. Hoping that the CryoCuff helps, once it gets here.

I can now get 110 degrees on a wall slide without much problem. Working with the PTist pushing, I can get to 122 degrees with some pain, again on a wall slide. I think that the “heel-under-the-chair” plan to push beyond the 125 degree barrier is going to be the solution.

I tried to do the hamstring-dips today from a higher platform. Not good. I’m still at the lowest level --- maybe 4”.

I also had modest problems doing the one-leg calf-raises during PT today. Day 1 seemed so easy. AHPT began to be a little more difficult. PT was actually tough --- I had to break the 30 count down into 10, 10, 5 & 5. Maybe, I am just pushing too many of the same exercises into the warm-up?

I climbed steps for the first time today, 10X up and down, 4 steps. Not a problem so long as I am really loose. However, ROM re flexion is limiting not on the up-step, but certainly on the down. I’m almost there, but each down-step requires some adjustment to my foot or leg. I’m just not there yet, although it’s close. Meaning that I need to do steps as often as possible, but only after thoroughly loosening up each time.

Walking. Biking. Steps. Stretching. And building strength in every muscle group possible. The next ten weeks are going to be both hard and busy.

Time to buy a CryoCuff for home

Knee-plus-34 days, 2-Nov-04, Tuesday:
Election day, and physically, today is an achey day, for whatever reason. It could be that I am just reacting to pushing the AHPT pretty hard. It could be that the hour I stood in line to vote today was a little more than I should have done, especially since we followed it up with a post-voting Waffle Shop breakfast, meaning that the knee was bent and down for another hour after voting.

Regardless, I went ahead and ordered a CryoCuff for home. The swelling is keeping me in more pain than I want, and limiting my ROM exercising. Although this ice-water device is really simple, it costs $125. I ordered mine from Medco in Tonawanda NY. $113 plus tax and shipping took the total up to $132.87. I probably could have gotten a scrip for it had I been more patient, but ...

No walk today at noon, but went to work anyway. I’ll ice down as best I can when I go home, take some Percocet, and then do the PM full set of exercises. Maybe take the bike ride out to 30 min [I’ve been only doing 15, since the set is starting to get longer ...]

Daily exercise schedule, month 2

ON BED / MAT / FLOOR:
Quad sets (push downs): 30 @ 10 count, relax 10 count in-between [right leg only]
Straight leg raises (2.5# weight), 30 each leg [lift, hold 2, 3, down on 4]
Short arcs (2.5#), 30 each leg [lift, hold 2, 3, down on 4]
Side raises (abduction) (one side), (2.5#), top leg, 30
Side raises (abduction) (one side), (2.5#), bottom leg, 30
Side raises (abduction) (other side), (2.5#), top leg, 30
Side raises (abduction) (other side), (2.5#), bottom leg, 30
Rear raises (2.5#), both legs, 30
Elevated flexion (2.5#), both legs, 30 (as much flex as possible)
Quad lifts (bedside) (2.5#), both legs, 30 [do not exceed 45 degrees]

STANDING UP:
Calf lifts (2.5#), lift to rear, use walker or cane to keep thigh vertical, 30
Abduction, both legs, 2.5#, 30
To rear, both legs, 2.5#, 30
[remove weight]
Calf raises, single-leg, both legs, 30
Mini-squats, free-standing, 30
Dips, 3” [dictionary], both legs, 30
Mini-lunges, both legs, 30 [do on pads when available]
Balance, 30 count, 5X, each leg

STRETCH:
Calf, slant block, 5X, 20 count
Hamstring, stairs, 5X, 20 count

STATIONARY BIKE:
16 min, alternating forward/backward

ON BED:
Wall slides, 20, hold for 10 count. Take it “to the pain”. Wall slides all the way to the bed/mat are getting to be easier to do. I can readily get my heel to the mat (110 degrees), but getting the extra few degrees to get my foot flat against the bed is not always possible (120 degrees).

In addition to trying to do two full sets per day:
ONCE A DAY:
Walk 1 mi, ca. 30 min

Even more exercises

Knee-plus-33 days, 1-Nov-04, Monday:
PT to be reduced to 1X a week, but with increased rigor during AHPT. New exercises focusing on calf and quad strength, plus balance work. 115 degrees active, 120+ passive (sitting on bench and “sitting” down to get beyond 120. Swelling above knee continues to limit ROM, and we agreed to “work” on how to get past this barrier. The plywood top of the padded mat at PT is the height of the first hole in the cane, and the pad is to the second hole. When I put my right foot under the bench, I can then sit on it to get more flexion. The trick will be to figure out WHICH chair at home lets me get away with this one most effectively.

New exercises added at PT. One leg calf raises (30). One leg step-downs (new toy). Mini-squats on balance pads. Quad lifts (only to 45 degrees, do NOT lock). Lunges without bars. One leg balance (30 sec, 5X).