Muscles not getting strong after knee replacement (anyone else)

Sorry for your frustration. I’ve had that issue. I recommend walking, walking in a pool or aqua therapy, and riding a bike (outside or stationary). Don’t overdo it. Lidocaine cream/patches helps with pain. Take care.

It could be reconditioning because it's a long recovery, or it could be you may have developed central sensitization (central = central nervous system = your brain). It happens sometimes to people who have a surgery or an injury, or people with chronic pain conditions. Basically, when you're in pain for a long time, your brain starts to become overprotective to try to prevent you from having more pain.

Normally, pain is a warning sign that something is wrong. But in this situation, your brain starts sending our more frequent pain signals. It's sort of like an overactive car alarm--you feel pain signals even with activities your body should be able to tolerate. The treatment is slow, graded exposure. Or I did something called Graded Motor Imagery.

I haven't had knee replacement, but I'm a caregiver for my mom and she did have knee replacement. And I have chronic pain conditions, including central sensitivity I described above. My mom also had a really long recovery. She had to start really, really slow, only exercising to a pain level that increased no more than 2-3 points on the pain scale, and then she would have to rest for 1-2 days. The PT schedule they gave her in the rehab facility and outpatient was way too aggressive for her. And that's generally the approach I use with central sensitization too; I have to start low and slow.

Have you tried aqua therapy or pool therapy, as mentioned? That can be really great for this because it unweights your body so it can make your body feel "safer," which helps with central sensitization. And if that's not it, it's still really good for unloading your joints and it can give you enough leeway to continue to build muscle, which could be more challenging on land because of gravity.

The last thing I can think of is if you're super-frustrated, could you consider a consult with a physiatrist (physical medicine & rehab) specialist? They're internists and have training in physical therapy and look at the body and muscles more holistically. In my experience, ortho doctors and orthopedic surgeons aren't so helpful once the surgery's already done. I have hip dysplasia and ortho was helpful for diagnosis--not so much for treatment and what exactly I could do to make things better.

I can certainly tell you one exercise NOT to do, and that is work on a leg extension machine. You are seated with your ankles underneath some pads, weight is adjusted with a holding pin, and then you raise your lower leg up and the quads fire.

It looks good, the quads pop out. But this exercise has no functional value in daily life and it can cause damage due to the irregular tracking of the patella during the lifting. My surgeon told me to stay far, far away from this machine.

Beyond that, and maybe you're doing this, strengthen the quads through simple, non-weighted squats, just tightening your quads and holding for 30 seconds several times a day, or by spinning on a stationary bike.

I'd also suggest hiring a trainer with a degree in kinesiology to help you with exercises. I was fine after my TKRs, but a friend had the procedure and his quads atrophied and he complained of pain. And he stubbornly used the leg extension machine. That was almost a year ago and he still complains of pain.

If you don't want to spin, try a treadmill or an elliptical trainer, but challenge yourself and make it a real cardio workout, sweating and hard to hold a conversation. So many people in my age range - 65 to 75 - do a lot of resistance training but nothing for the heart.

All the best to you. It sounds like this is fixable, but get the right people involved, like a physical trainer who has worked with TKR patients. Joe

Good advice, especially about finding a Dr who is a specialist in Physical Medicine and Rehabilitation. These Drs are out there. I'm working with one who was referred to me by my knee ortho guy. And yeah, the ortho surgeons are really carpenters. They fix the underlying structure but they are not trained in rehab and recovery.

Thanks. That's a really good way to put it, to compare orthos to carpenters lol.

I have hip dysplasia that went undiagnosed and caused hip osteoarthritis, and it's been years now so was finally sent for an ortho consult. They of course recommended steroid injections, which I expected. But the trouble is that I have a connective tissue disorder and steroids are known to exacerbate the underlying condition, so I know there's a higher likelihood of side effects, but I'm not completely sure how this all applies to me. There's more risk of bleeding, the lidocaine could be ineffective, and the steroid injection could cause more laxity to already-overly-lax tissue.

I asked the ortho if she could help me understand the risks as it applies to my underlying condition and help me figure out how to communicate with the radiologist who would be doing the injection if I moved forward, and she had no clue. I don't think anyone wants to think of themselves as the sum of their imaging...but sometimes there's more going on than the x-ray >_< .

Good points emo. I'm sorry there isn't a straightforward answer for you. Your ortho had no clue and yet she would be ordering the injection. I doubt the radiologist would have an answer. This is one downside of specialization.

Maybe find a Dr in "Medical Rehabilitation", these are usually classified under sports medicine, probably because of the patient mix. But I believe they take a holistic approach.

I hope you find an answer that works for you emo. All the best. Joe