TKR Sleep issues

[elbracey]

Left TKR done on March 29, 2021. First, I’m glad I found your forum. It’s great to read what others experienced with their TKR. My ROM on a good day vary from 95 to 105, with pain. I work out daily with pain afterwards. After working out and icing, I seemed to get stiff again after some time. Everyone says you must work through the pain. I don’t record my right TKR ( January 7, 2019) being so difficult for the recover.

Am I too impatient? What about scar tissue massage?

Thanks
Everett

 

[Jockette]

Hi Everett, Welcome to Bonesmart.

We are all impatient with this recovery because we just aren’t prepared for how long it is, an average of a full year for complete healing.

Everyone says you must work through the pain.

We do hear this often, and many do believe it, but it is not the only approach to recovery. Bonesmart believes that we will heal better if we treat our new knee gently so it can heal, then we can strengthen later.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

My ROM on a good day vary from 95 to 105, with pain. I work out daily with pain afterwards.

You may be working too hard to improve your ROM. Pain during and/or after exercise is a sign that your knee is not ready for that exercise.

Lose the Work Ethic While You Are Recovering!

Lose the Work Ethic!!! Article by Referee54 (Tim) Many of us have a tremendous work ethic---and for several reasons. I can still remember, to this day, my father saying to me on the morning of my first day on a “real job”, “Give them nine hours of work in an eight hour day.” I believe that...

bonesmart.org

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Jockette]

What about scar tissue massage?

Massage is ok if it feels good and you like it. Scar tissue can’t actually be massaged away. It’s part of the healing process and will lessen as you heal. We do hear a lot about “scar tissue” and it gets blamed for many things that it doesn’t cause. Without normal scar tissue, our wounds would not heal.

Scar tissue can be blamed for tightness. Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

The scar tissue we are usually warned about is actually called adhesions, and adhesions are rare. This article explains the differences between normal and needed scar tissue and adhesions.
MUA (Manipulation under Anaesthetic) and Adhesions

 

[Sisterpat]

Good morning, Everett and welcome to the forum.

Left TKR done on March 29, 2021. First, I’m glad I found your forum. It’s great to read what others experienced with their TKR. My ROM on a good day vary from 95 to 105, with pain. I work out daily with pain afterwards. After working out and icing, I Everyone says you must work through the pain.

Well, everyone is wrong! You must NOT work through the pain - you must rest, heal, ice and elevate and let that knee take its own time to recover. Pushing to the point of pain is counterproductive. It just takes time! But it will take even more time if you over stress that new knee.

 

[Ghostpipe]

Hi Everett. You said it yourself, too impatient! I had my knees done a week before you, and was doing far too much to start with, which just caused more pain and swelling. I stopped when I found this forum, at 9 weeks, started to take it easy, and my ROM got slowly better as the swelling decreased.
That aside, is your surname Bracey? That’s my maiden name, and I come from London, U.K. The name came over from France to the U.K. with the Norman Conquest in 1066.

 

[elbracey]

Thanks to everyone for your replies. I will review the links and do what’s best for my knee.

 

[Rollem1]

Thanks to everyone for your replies. I will review the links and do what’s best for my knee.

I concentrated on gentle stretches of quads and hamstrings and calf for the first 4 weeks and am only now moving onto strengthening but again very gentle - I found the more stretch the better the pain relief - gently waking those muscles etc is so important - imagine being asleep for ages and being woke up with a start - you’d complain too so gentle is the key ! Xxxx

 

[Ginger1210]

Hi elbracey i am a little after you PKR April 19 and i too am a little impatient but please listen to the good people on this forum. There advice and experience helps a lot. Having this procedure is a major trauma to your leg and knee and will take time to recover i agree with listening to your knee it will tell you when it is not happy i have gone back to work part time and light duties but boy is it hard. rest ice and elevation is key. Hope this helps.

 

[elbracey]

I normally ice after my workouts and when I’m experiencing some pain. How long should I ice at one time. My OS expressed some conc about too much icing, saying it can caused some damage to the TKR.

 

[Jockette]

This article is in our Recovery Guidelines:

Ice (Cryotherapy) to control pain and swelling

Updated 22 November 2020 Please note that though this article primarily talks about knees and hips, the information applies equally to shoulders and other joints as well. Using ice (cryotherapy) is an excellent means of controlling pain and swelling after joint replacement surgery and it...

bonesmart.org

 

[kneeper]

I normally ice after my workouts and when I’m experiencing some pain. How long should I ice at one time. My OS expressed some conc about too much icing, saying it can caused some damage to the TKR.

Everyone is a bit different, but at your stage of recovery I would ice for about 20 minutes after activity.

 

[FCBayern]

I normally ice after my workouts and when I’m experiencing some pain. How long should I ice at one time. My OS expressed some conc about too much icing, saying it can caused some damage to the TKR.

I used my ice machine 24/7 until I went back to work and then all evening and night for the first 4 months, ice was what prevented or treated my pain.

 

[BBCG]

Hi Everett, I’m among the impatient ones, too, and have joined the ODIC (the OverDidIt Club!) a few times! I have learned SO much from the generous folks here that this second time, I’m doing way better than I did in 2016 when I bought in to the whole “no pain no gain” mantra… until I found these guys!
Often, we kinda know what our instincts are telling us… am I being impatient? Should I really believe I should push this knee that was just cut, pushed, pulled, glued and or hammered!?! It’s a new baby knee abd needs your TLC, time and gentle support to heal best!

Glad you found us here! These guys really saved me from a much worse fate when I found Bonesmart late one night in my first knee adventure!

Welcome!!

 

[eaglemom]

Icing and elevating are great at treating pain. Remember you can move the ice around to the sides & back of your knee also. (Remember to have something between your knee and the ice.)

 

[elbracey]

It’s been almost 3 months since my left TKR and I am still having difficulties sleeping in my bed. I keep getting knee pain no matter what position I sleep ( back, stomach, or side). I have tried us a pillow between my knees, but that does help all night.

I sleep better in my recliner with my legs elevated. Even then, I have problems being comfortable so I can sleep all night.

Any suggestions?

 

[Jockette]

Most of us have a lot of trouble getting comfortable to sleep, until we heal more, the best thing is to sleep where you can, when you can. Wherever you can get comfortable.

What worked for me was sleeping in my bed, on my back, with my legs elevated. This was a major accomplishment for me as I had always been a side sleeper. I adjusted so well that I still sleep like that!

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you. You can always bookmark this thread so you can find it easily.

Best wishes on your continuing recovery!

 

[Sisterpat]

elbracey, you are not alone! My 2nd TKR was 2 days after yours and I still cannot sleep in my bed. I try every few nights and I can only stay there for a few hours and then back out to the recliner. Most nights I just start out in the recliner. Lately, maybe the last few nights, I have started being able to sleep better in the recliner. So maybe there’s hope for you. It does seem most people have a very hard time sleeping post-op. I take a few natural supplements, like melatonin. I also take Tylenol to keep myself comfortable throughout the night.
I hope things start to calm down for you.

 

[elbracey]

Hello everyone again. I’m back work which limits my exercise routine. I try to flex as much as I can since I’m on my feet for almost 10 hours,

My PT is constantly recommending MUA. Im still flexing around 90. I’m now considering changing my PT to someone would be more positive and find ways to help heal. What do you think?

 

[Sisterpat]

You always have a right to change PT’s! Sometimes a 2nd opinion can be very useful. Your work is exercise enough. I wouldn’t be adding any extra exercises. The swelling needs to go down for more bend.