Range of motion - anybody get close to normal?

[main22]

Hi,

I am in discussions with my doc about knee replacement. Currently I do yoga which helps my back and other joints. Several of the poses (like Child's pose) have the knee bent nearly 180 degrees - like when you sit on your calves.

QUESTION: Is there any physical limitation of the replaced joint to regaining ALL of your original range? Or is it that the soft tissues and scar tissue effectively restrict the replaced joint?

Also, a partial knees better in this regard?

Thanks very much..

Main

 

[Jamie]

I know that many, many of our BoneSmart members have gotten back to excellent ROM.....usually in the 150-155 range for folks who really work at it and who had that range before surgery. I also know of members who have gone back to yoga successfully, although I believe there may have been some of the more advanced poses that were not possible .... at least in the first year or so after surgery.

But these are just my recollections and I hope some people chime in to tell you of their personal experiences.

I'm going to tag a couple of people to comment on your questions:

@Josephine: @alexthecat:

 

[alexthecat]

My experience, which is with a hip not a knee, is that I have regained almost all of my ROM. My hip will be two years old next month and I still see some minor improvements, but that is very gradual at this point.

After major surgery, it may be best to return to yoga with a beginner's mind. Just accept where you are and let your knee progress as it is ready to. It's sort of a long-term project. It took a year for me to get back to my advanced class and, even then, I wasn't advanced at everything. I think I am now though. Even before I had completely regained my ROM, I was still able to practice yoga in a way that was meaningful and rewarding to me.

 

[main22]

Thanks for the replies. Yes, returning with a beginners mindset will no doubt be key to success. And it is a long term process.

I think what I don't quite understand is whether it is possible *in theory* to regain all original function or just darn difficult to.

Right now my knee has excellent ROM and can fully touch my hamstrings. It looks like 180 degrees to me so I don't quite understand how far 150 is. Maybe I need to understand that...

Thanks.

 

[Roy Gardiner]

I didn't understand the numbers either, but if you think about it a bit, 180 means the upper and lower leg would be parallel - impossible, of course. 155 is 'sitting on the heels' territory, I believe.

To the best of my knowledge (just reading & surfing) the prosthetics themselves don't impose limits more severe than the body's.

 

[Josephine]

Quite right, Roy. There used to be a wide spread myth that certain knees were restricted to certain degrees of flexion but that really is a myth. I currently have about 135 degrees of flexion but I bet I could get an awful lot more if my legs weren't so fat! :th_heehee:

 

[Bumpa]

Well, I'm just an old fashioned chap. If your knee is stable and pain free and has a reasonable amount of flexion, great. Don't forget that the knee is not a hinge and has rotational abilities. :cat-kittyandsmiley:

 

[FrogFeathers]

It took me a little while, but I'm back to being just as bendy as I was before the surgery. The difference is that now I can do all the yoga poses when leading up to the surgery, the pain kept me from doing it.

I still don't like kneeling, but that's a personal preference thing, not a surgical/structural thing. :wink1:

I was about 18 months to two years out when I sat down on the sofa and did that leg-tuck thing so I was sitting on my own foot and about five minutes later, I realized I was doing that with my replaced knee.

 

[LinZee77]

Hi Main22
Welcome to Bonesmart ! Please take some time to browse the Library archives and almost any question you may have about Knee replacement surgery is here, & my appreciation for this site cannot be stressed enough.
I have a question for you-what condition brought you to needing to consider knee replacement surgery? Reason I ask is because I practiced yoga at a young age, and by the time I was 20, had my first knee problems (water on the knees). I'm not implying that yoga may have been the cause, but perhaps because I was mainly self taught through book illustrations. Since then, I have taken formal yoga classes, and other martial art type schooling, and never had another knee episode until I reached my 50's and developed Osteo arthritis. I have since curtailed most of my yoga and karate/king fu in favor of less jarring activities (light swimming and doing stretching poses in warm water while I rehab my left knee replacement ( 9 mos post-op) and try to build up my quads for my now advancing right knee OA. I am also trying to build up again to walking distance and land/beach hiking, but am hindered now only by the UNoperated knee.
I agree with the sentiment of some of the other posters. Your new normal may not quite be as it was before surgery but you have to weigh the benefits with the alternatives. It will be best to approach with a beginners mind once you have gone to the other side.

 

[sunflower]

I'm just a year out from my TKA and I am unable to sit back on my right heel. Only when I am in the hot tub can I bend my knee in the 125-130 range. I am doing leg presses to encourage more flexion.

 

[Roy Gardiner]

I am doing leg presses to encourage more flexion.

I recommend stretches for flexion, leg presses for strength.

 

[sunflower]

I recommend stretches for flexion, leg presses for strength.

My OS recommended leg presses to improve my ROM and I stretch in the hot tub to keep my hammies and calves happy. :biggrin:

 

[Roy Gardiner]

I recommend stretches for flexion, leg presses for strength.

My OS recommended leg presses to improve my ROM and I stretch in the hot tub to keep my hammies and calves happy. :biggrin:

Hmm, I am not at all sure that OSs know that much about this. Cutting, sawing, banging stuff in, OK; but do they know fitness physiology?

There is nothing to stop you doing both.

I am quite certain (I've been certain and wrong many times, but don't let that stand in the way) that strength exercises don't of themselves help, unless doing those exercises actually involves movement which extends normal ROM.

Riding a bike, for instance, won't help ROM beyond that required to ride a bike. It'll make you stronger, though.

 

[sunflower]

Roy, I believe part of the reason I don't have greater ROM is because my diseased knee had several large bone spurs, including one behind the knee, that impeded my movement. So through the years my flexion decreased because of it. :DOH:

 

[Roy Gardiner]

Roy, I believe part of the reason I don't have greater ROM is because my diseased knee had several large bone spurs, including one behind the knee, that impeded my movement. So through the years my flexion decreased because of it. :DOH:

Exactamundo, me too. But the surgeon has now removed these, so you can now regain that range of movement. But not quickly...

 

[sunflower]

...so you can now regain that range of movement....

In theory. :wink1:You learn to be patient with the TKA journey, that's for sure!

 

[alexthecat]

In order to effectively stretch a muscle, it needs to have a certain amount of mass. In cases of severe atrophy, it is necessary to build some strength first and then add stretches if needed. Often the increase in strength will be accompanied by increased ROM even without any stretching. So, it may be entirely appropriate for a particular individual to focus on strengthening exercises, rather than stretching, in order to begin to improve ROM.

 

[referee54]

I am at about 130-135 right now; I used to be a baseball catcher, and I took pride in squatting really low. I cannot do that now, but I can tell you this: I can do basically anything I want to do today with the ROM that I have.

Remember---these TKR implants are not as good as OEM stuff that we received at birth, but they are so much, much better than what we had that caused us all of that suffering and pain, and they allow us to do whatever we pretty much really want to do.l

 

[skigirl]

I have been attending yoga classes pretty regularly since about three weeks after my replacements. Yes, in the beginning, I had to adjust for some poses---but, now, I can really do almost everything. I can easily kneel--even on a hard floor--I routinely kneel on just my yoga mat on top of a hardwood floor. Sometimes, I cannot put my knees all the way to the floor when sitting crosslegged--but I think that is my hips and not my knees.

I think yoga is awesome, I can still put my entire hand on the floor when bent over. Also, yoga helped me to get up when I was down on the floor. Now, I kneel on one knee and push up with the other. Such a relief from having to push up with hands and feet to a baby pose so that I could get up. Kelly

 

[Roy Gardiner]

In order to effectively stretch a muscle, it needs to have a certain amount of mass. In cases of severe atrophy, it is necessary to build some strength first and then add stretches if needed. Often the increase in strength will be accompanied by increased ROM even without any stretching. So, it may be entirely appropriate for a particular individual to focus on strengthening exercises, rather than stretching, in order to begin to improve ROM.

I have no qualifications in physiology, sports training or anything relevant; I read a lot and have some personal experience only.

You can tell what's coming next, of course; I can't see the logic of what you are saying -- but perhaps you are a qualified person who can back it up.

I can't see how a strength exercise in and of itself would increase ROM, unless that exercise relies on movement through a greater range than normal. It contradicts everything I've read and that coaches and masseurs have said to me.

Some examples:

Cyclists, particularly racing and very high mileage people, have to be careful otherwise muscle shortening (calves in particular) caused by the exercise result in odd posture and gait.

We all know what body-builders look like, elbows stuck out and that strange waddling walk; this is not (as I understand it) caused by muscle bulk but simply by them being so tight as a result of their training.

So, excuse me for questioning what you say, no disrespect intended.