I have been lurking and reading posts on this site since I got home from the hospital and have found it very helpful. I thought it was time to share my recovery. The first 10 days of my recovery were very painful and although I was prescribed pain medication (Percocet) I did not have adequate pain management and was unable to complete most of my PT exercises. At 2 weeks, I was only 50 degrees and was still experiencing pain and stiffness, especially at night. I went to a follow up appt. with my surgeon and went to a PT session. Both my surgeon and my physio therapist were upset with my progress and told me I have to push through the pain. At my last PT session (3 weeks post op) my ROM was 56 degrees. I obtained this number through pain and tears. My knee is still extremely stiff and PT is quite painful. I have read your introductory reading and understand the bonesmart way - gain with no pain. How do I explain to my recovery team that I believe time vs force will help to obtain more ROM? And, at what point in my recovery do I begin to really worry about limited ROM? I am thankful to have found this forum and look forward to any feedback.
MUA Limited ROM - CRPS
- Thread starter Wrangler
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skigirl
Former BoneSmart staff member
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a stiff knee is always difficult for the patient. It is hard to believe that time will take care of some of the problem. Here is my own take on knee recovery---the first two or three weeks, you need to rest and recover from having bones sawed and tissues disrupted. I spent most of my time in bed with the knee propped up on three pillows
Elevating your leg to control swelling and pain
Using ice
After that, I began to work on the knee and getting a better bend. It is difficult in the beginning when you have so much swelling in the knee---we say here that you cannot bend a hose filled with water.
For now, I would simply tell the PT---who is your employee after all---she is not doing this out of kindness that you do not wish to be pushed to pain. She can say whatever she wants---but she cannot push your knee if you tell her not to do so. Those are the rules---you are in charge.
When to worry? I suppose that if you do not get more rom, your doc might talk to you at three months--but you have plenty of time to get rom. I will give you our recovery articles from our library. If you read them, you will have a better handle on how recovery works. all of them are short!
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs
Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
Elevating your leg to control swelling and pain
Using ice
After that, I began to work on the knee and getting a better bend. It is difficult in the beginning when you have so much swelling in the knee---we say here that you cannot bend a hose filled with water.
For now, I would simply tell the PT---who is your employee after all---she is not doing this out of kindness that you do not wish to be pushed to pain. She can say whatever she wants---but she cannot push your knee if you tell her not to do so. Those are the rules---you are in charge.
When to worry? I suppose that if you do not get more rom, your doc might talk to you at three months--but you have plenty of time to get rom. I will give you our recovery articles from our library. If you read them, you will have a better handle on how recovery works. all of them are short!
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs
Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
I think it's too early to worry. Do you have a lot of swelling still? Are you icing and elevating a lot?
Are you trying gentle heel slides a few at a time throughout the day? It will hurt a bit while you're doing it--but shouldn't be to the point of tears and it shouldn't make you worse feeling.
I found doing a little bit throughout the day and icing and elevating a lot helped. also, this time the PT put a lot of emphasis on getting the swelling down. She used something called a "Game Ready" (brand name, I'm sure there are others)--a super cold, compression wrap--on me several times. (By the way, that was at 4-6 weeks)
It was intensely cold, but definitely worked on the swelling. She could measure the difference. Before using that I'd get one measurement and after a session with it, I could get a couple of degrees more. It was the swelling holding me back.
referee54
Former BoneSmart staff member
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It is much too early to worry. I think that you are being forced to work too hard, and your knee is rebelling and is becoming more inflamed and swollen. You cannot accomplish gaining ROM by overworking the surgical knee---and it is too bad that the OS and the PT do not realize this.
Remember, it is your knee, and your body---and nobody can do anything like this punishment to you unless you let them---and don't you let them
The PT works for you---set the limits---set the ground rules, and if they do not agree, fire them and find somebody else---I am willing to bet that, after you take a gentler approach to your knee recovery, you will see the results---remember---the recovery takes longer than we would like it to, and it may be slwoer than we would like it to be, but you will feel better and see results.
How much are you icing and elevating? for how long, and how often each day? MAke sure that you are icing and elevating ALOT.
I would also talk firmly with your OS about your pain meds---that you are under-medicated. If your OS has a problem with it, please contact your GP.
Please take a look at those articles that have been posted for you by Kelly---what she has posted contain excellent information about all of the aspects of the TKR recovery.
Please keep coming back and post your questions or issues or concerns with us---we will be here for you.
Remember, it is your knee, and your body---and nobody can do anything like this punishment to you unless you let them---and don't you let them
The PT works for you---set the limits---set the ground rules, and if they do not agree, fire them and find somebody else---I am willing to bet that, after you take a gentler approach to your knee recovery, you will see the results---remember---the recovery takes longer than we would like it to, and it may be slwoer than we would like it to be, but you will feel better and see results.
There is no "window" for gaining ROM---this is a misconception. ROM can be gained for a year post-TKR---and beyond.
How much are you icing and elevating? for how long, and how often each day? MAke sure that you are icing and elevating ALOT.
I would also talk firmly with your OS about your pain meds---that you are under-medicated. If your OS has a problem with it, please contact your GP.
Please take a look at those articles that have been posted for you by Kelly---what she has posted contain excellent information about all of the aspects of the TKR recovery.
Please keep coming back and post your questions or issues or concerns with us---we will be here for you.
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1ELISEA
big-cheese
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Hi @Wrangler
I can relate, but in a different way. I didn't start PT until 3 weeks post op. My surgeon was "heal, rest, ice, get swelling down, theeeeeen work on PT".
And then by the time 3 weeks were over, I was put back on crutches as they thought I might have a complication. So there I am, on crutches, limited activity, and worried about ROM.
My physical therapist, who never ever believes in pain, started massaging and stretching my leg. I sat on the edge of the table and she would ever so gently massage and stretch, massage and stretch as I wasn't able to do much PT. But every session gained me a few more degrees of ROM. By the time I was allowed to walk again, my PT, by simply massaging and stretching around my knee gained me a huge advantage in my ability to bend my knee. I was shocked.
My suggestion is to find another PT, who does not cause pain, and preferably integrates physical activity with massage, lymphatic massage, and other types of modalities. You can interview them over the phone, if need be. I was fortunate to have interviewed several prior to my TKR based on those qualities I have mentioned.
Hope you feel better soon!
I can relate, but in a different way. I didn't start PT until 3 weeks post op. My surgeon was "heal, rest, ice, get swelling down, theeeeeen work on PT".
And then by the time 3 weeks were over, I was put back on crutches as they thought I might have a complication. So there I am, on crutches, limited activity, and worried about ROM.
My physical therapist, who never ever believes in pain, started massaging and stretching my leg. I sat on the edge of the table and she would ever so gently massage and stretch, massage and stretch as I wasn't able to do much PT. But every session gained me a few more degrees of ROM. By the time I was allowed to walk again, my PT, by simply massaging and stretching around my knee gained me a huge advantage in my ability to bend my knee. I was shocked.
My suggestion is to find another PT, who does not cause pain, and preferably integrates physical activity with massage, lymphatic massage, and other types of modalities. You can interview them over the phone, if need be. I was fortunate to have interviewed several prior to my TKR based on those qualities I have mentioned.
Hope you feel better soon!
OP
OP
Wrangler
member
Thank you all for the information, support and encouragement. I will give me knee and myself time to heal.
I have been icing (cryo cuff) and elevating. I try to use the cryo cuff for 30 minutes every hour or two. I have my leg elevated while I sleep (4-8 hours) and while I am resting during the day (4-8 hours). I will try and ensure that my leg is elevated any time I am at rest and I will try and get more time with my cryo cuff.
I went to my GP recently and have new pain medication (hydromorphone 1 -2 mg every 4 hours). I still find sleep difficult. I have set my alarm to ensure I get my pain medication on time during the night.
I have PT tomorrow and will be sure to be the master of my desti-knee!
I have been icing (cryo cuff) and elevating. I try to use the cryo cuff for 30 minutes every hour or two. I have my leg elevated while I sleep (4-8 hours) and while I am resting during the day (4-8 hours). I will try and ensure that my leg is elevated any time I am at rest and I will try and get more time with my cryo cuff.
I went to my GP recently and have new pain medication (hydromorphone 1 -2 mg every 4 hours). I still find sleep difficult. I have set my alarm to ensure I get my pain medication on time during the night.
I have PT tomorrow and will be sure to be the master of my desti-knee!
It's probably best to realize that you may not be able to convince others that the BoneSmart way works better than their plan to "push through the pain." These folks have not had a knee replacement and they were obviously taught this somewhere.
But the reality is that trying to push when you are swollen and in pain only makes things worse. Remember that you are in charge of your recovery, though. You have the right to tell anyone (including your surgeon) what you will and won't do. It's your body, after all!
Be firm up front with your therapist and say you will let them know if something hurts and you expect them to stop when you say so. With the surgeon, you may be more successful if you say that you'd like to try working on your ROM yourself a bit rather than any aggressive things he might be recommending. Fortunately you won't see him all that often.
In the meantime, try our recovery suggestions and see if it benefits you. If you see improvements with icing, elevation, rest, pain meds on a schedule along with just gentle bends and stretches throughout the day, then you'll have even more ammunition if someone tries to force you into something painful.
You are less than 4 weeks out from surgery. Lots of folks have been where you are and do just fine in the end. There is no hurry! No "window of opportunity" to get your ROM. Your body is in charge and will heal at it's own pace. Your goal is to reduce your pain and swelling.....THEN you'll find the ROM that is there but hidden in all that swelling.
But the reality is that trying to push when you are swollen and in pain only makes things worse. Remember that you are in charge of your recovery, though. You have the right to tell anyone (including your surgeon) what you will and won't do. It's your body, after all!
Be firm up front with your therapist and say you will let them know if something hurts and you expect them to stop when you say so. With the surgeon, you may be more successful if you say that you'd like to try working on your ROM yourself a bit rather than any aggressive things he might be recommending. Fortunately you won't see him all that often.
In the meantime, try our recovery suggestions and see if it benefits you. If you see improvements with icing, elevation, rest, pain meds on a schedule along with just gentle bends and stretches throughout the day, then you'll have even more ammunition if someone tries to force you into something painful.
You are less than 4 weeks out from surgery. Lots of folks have been where you are and do just fine in the end. There is no hurry! No "window of opportunity" to get your ROM. Your body is in charge and will heal at it's own pace. Your goal is to reduce your pain and swelling.....THEN you'll find the ROM that is there but hidden in all that swelling.
Minnie's knees
post-grad
@Wrangler I was at 60° at 3 weeks when I started out patient PT. I love my PT, she pushes and encourages me but no pain. If I go in with swelling she changes it up so she doesn't cause any additional swelling. I am now at 88° at 8 weeks. It has been a slow and frustrating process and I wish my ROM was higher but it is getting better. I continue to do my home exercises and I am going to PT 3 x week. Think about changing PT's if they are causing you pain, countinue to ice, elevate and work on gentle home exercises. As others have already said a painful, swollen knee is not going to bend. Stay positive and best wishes on your continued recovery.
OP
OP
Wrangler
member
Thank you Jamie for your suggested approach with my PT and OS. I had a PT session this morning and spoke with my therapist. She is willing to accommodate my request for a no pain approach. It was a good session - 53 degrees with no pain.
@Minnie's knees thank you for dropping in and sharing your story. It is very encouraging to read about your success. Good luck with your recovery.
@Minnie's knees thank you for dropping in and sharing your story. It is very encouraging to read about your success. Good luck with your recovery.
That's good to hear!
Remember that she works for you, not the reverse. If she can't/won't do what you request, you have the right to ask for someone who will.
The way I approached it was that I had to challenge myself a bit but not go crazy. A little pain for a few seconds while trying to bend is ok, torture is not. 
Wishing you the best as you work with your PT.
Wishing you the best as you work with your PT.
Djbrund
member
I'm so glad that you have new pain meds and now have your PT thinking our way. Good for you! I did notice that you mentioned "when at rest". I'm thinking you might need more "at rest" time. Be very kind to yourself and your new knee for at least a week and see if that swelling doesn't go way down. Take care! -- Joni
OP
OP
Wrangler
member
I had another PT session today. They are working with me to increase my ROM. At around 52 degrees, I get a very sharp and intense pain (8-9) on the inside of my knee. My PT said this could be caused by damage to the Medial Collateral Ligament. This pain is preventing me from getting any further ROM as it hurts too much to push through it. I am hoping with rest, ice and elevation that this pain will subside.
Had a blue day although I am more optimistic this evening. I find it hard to stay positive some days. I have been reading other members recovery stories and am finding strength from their successes.
Thank you Celle, Kneeper and Joni for your posts!
Had a blue day although I am more optimistic this evening. I find it hard to stay positive some days. I have been reading other members recovery stories and am finding strength from their successes.
Thank you Celle, Kneeper and Joni for your posts!
Please try not to get discouraged. Recovery takes time and you are really just at the beginning. These aches and pains are very normal for the first months of recovery and sometimes even later. Odd pains may come and go as you progress. It's just part of the package. But, in the end....you are way ahead of the old "you" with an arthritic knee.
kvhundley
member
@Wrangler has anyone mentioned a CPM machine to you? I know many OS don't use it, but I am on one here at home and I really think it has helped my ROM. It is awkward and heavy but I find the gentle stretch has helped me go from 68 to 90 in just a few days. Just a thought. Hope you are having a good day.
Djbrund
member
I used a tiny thing like a bicycle. It is a tiny frame with pedals. Sits on the floor. You place it far from you and try pedaling. If you can go all the way around comfortably, you move it a little closer. I started at 1 minute. You can buy these at Walmart, target or sporting goods stores. About $25. Take care. -- Joni
@Wrangler
Before you start looking for machines to help your ROM, consider this: at the moment, your knee is still swollen. Even if it doesn't look very swollen from the outside, there will still be swelling inside your knee compartments. It's a pretty tight fit in there and even a little bit of swelling will inhibit your knee's bending. think of your knee as being like a hosepipe. If it is full of water, it doesn't bend very easily. IF it is empty, it bends much more easily.
I think that much of your problem is that both you and your PT are expecting too much, too soon. Patience is the watchword here. Just concentrate on icing, elevation and lots of rest.
Your knee needs time to heal and no amount of exercise and PT is going to make it bend when it isn't yet ready. In fact, over-exercising and trying to force your knee to bend is going to do more harm than good.
That pain is most likely not caused by damage to anything. It's caused purely by your PT pushing too hard. PT should never hurt. Your knee is telling you to stop doing what hurts it. Pushing through the pain is completely the wrong approach to recovering from a knee replacement - do get rid of that idea!
Before you start looking for machines to help your ROM, consider this: at the moment, your knee is still swollen. Even if it doesn't look very swollen from the outside, there will still be swelling inside your knee compartments. It's a pretty tight fit in there and even a little bit of swelling will inhibit your knee's bending. think of your knee as being like a hosepipe. If it is full of water, it doesn't bend very easily. IF it is empty, it bends much more easily.
I think that much of your problem is that both you and your PT are expecting too much, too soon. Patience is the watchword here. Just concentrate on icing, elevation and lots of rest.
Your knee needs time to heal and no amount of exercise and PT is going to make it bend when it isn't yet ready. In fact, over-exercising and trying to force your knee to bend is going to do more harm than good.
That pain is most likely not caused by damage to anything. It's caused purely by your PT pushing too hard. PT should never hurt. Your knee is telling you to stop doing what hurts it. Pushing through the pain is completely the wrong approach to recovering from a knee replacement - do get rid of that idea!
OP
OP
Wrangler
member
Thanks @Celle. I am a bit impatient. I am 46 and did a lot of pre-hab. I guess I just didn't expect to have this result. It's almost 4 weeks and I am still unable to do a leg lift and my ROM is horrible. I have read numerous posts and have read all the recommended reading. I know that it will eventually get better but I can't help feeling a little bummed out. I also know not to compare myself with others but it's hard not to get a little discouraged looking around at the other TKR patients in my knee class. I will try a couple Holiday movies and see if that lifts my spirits. Thanks again to everyone for their comments and support!
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