TKR Back Pain<

littlesis

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Hi Everyone! I had my right TKR on Sept 14/18 and am having more trouble with my lower
back than my knee. Could this be from the block? Any suggestions?

I've been icing and trying to stretch it but I'm not getting much relief.

In comparison, my knee is doing great! I can get 102 flexion, having some trouble with extension because of swelling out the back of my knee (I had a large Baker's cyst that I'm not sure was removed). I can't get comfortable which keeps me moving lol, so that's good in a way. Thanks for any advice.
 
Welcome to Bonesmart! The back of the knee and calf areas are a common complaint shortly after this surgery. You have to realize that the surgeon is moving your knee all kinds of ways during this surgery, making sure the knee is moving correctly. My calf was extremely painful, so much that I didn't even want to walk on it. As the days went by, it lessen. Your will, too.

I will leave you our recovery articles. Following these will help you to have a less painful recovery.

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
5. Here is a week-by-week guide for Activity progression for TKRs


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 a 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 history before providing advice.
 
Yes. Just about the time my knee started being good and functional, ( 10 or 12 weeks out if i remember right) my lower back started acting up. It was horrible for weeks. It eventually passed. I think it may have been the new gait and different weight distribution. I limped for years and I think my muscles just got used to it. It may take a while, but hopefully it will pass for you too. Keep walking and moving around as you are able. Ice or heat on your back might help too.
 
I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Hi @littlesis I had LTKR almost 3 weeks ago and I’ve had lots of low back pain. I meant to ask my Dr about it yesterday and forgot. I was thinking it’s because I’m carrying myself differently - meaning my weight distribution has changed and/or it’s because I was in bed so much the first week. At times it would be hard for me to sit up from laying down because the pain was so bad in my back. I’m up and moving around more and it seems to be better but that low back pain is still there. The pain meds do help it.

Overall, it sounds like your knee is doing great! I’m happy for you.
 
Hi! - yes, I have had a few quite nasty twinges of lower back pain especially in the last week. I think one of the exercises I am doing (which stretches the back of my leg) is probably to blame as it does put pressure on my back. Think we are all using muscles we'd forgotten we had during the recovery process and I'm sure this can't help! It sounds like you are doing amazingly well though!
 
Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
1. My pain level is about a 3-4. Mostly uncomfortable. My lower back gave my grief the first week. I still have a pain in my butt from time to time.

2. In hospital, Toradol and oxycodone that made my blood pressure drop, Oxy (A5/325) at home that I had changed to Tramacet (37.5/325), Apixaban 2.5 mg.
Extra Strength Tylenol throughout the day if I don't need the Tramacet.

3. Swelling is moderate. I believe the OS did not remove my large Baker's cyst.

4. Flexion was 102 at the PT, extension was at 5.

5. Icing with ice packs front and back every 2 hours for 20-30 minutes when awake. Especially after exercises.

6. Elevating on an ottoman the same level as the chair intermittently thoughout the day.

7. I cruise around the house on crutches, go for walks in the driveway, shower.

8. Exercises done at home:
foot pumps whenever I'm sitting around.
heel slides 10 x 3 a with a robe belt around my foot.
quad sets (pressing down on a rolled washcloth at the back of the knee) 10 x 3 a few times a day. Holding for longer periods of time (10 sec)
dangling the legs over the side of the bed in sitting position,
lifting the foot up using the quad 10 x 3 a few times a day. Holding for longer periods of time (10 sec)
Placing a bolster under the knee, try to lift the foot using the quad 10 x 3 a few times a day. Holding for longer periods of time (10 sec)

These are exercises that the PT showed me when I was there on day #4.

I get my staples out on day #12. I go back to physio on day #14.
 
Extra Strength Tylenol throughout the day if I don't need the Tramacet.
What dose do you take? Or how many tablets? and How often?
extension was at 5.
Is that a plus or minus 5? Plus means it doesn't quite straigten and - means it straightens a little more than straight
I believe the OS did not remove my large Baker's cyst.
Did he tell you he was going to remove it? Baker's cysts are rarely removed. a) because the access to them during a TKR is impossible and b) because the bursa is very close to major blood vessels and nerve.
 
Extra strength Tylenol is 500 mg. I take one as I need to during the day.
Take 2 Tramacet every 4 hours for the night hours.

Extension is a + 5 (I can't straighten my leg flat).

I see my surgeon next week and will ask about the Baker's cyst.
 
Thank you. I do hope you are not hoping he will excise it because that would require a fairly large incision at the back of your knee. Not something that will enhance your recovery! But he won't, anyway. He just might aspirate it though.
 
1. My pain level is about a 3-4. Mostly uncomfortable. My lower back gave my grief the first week. I still have a pain in my butt from time to time.
I suspect that might be Piriformis syndrome - a pain in the butt!
2. Extra strength Tylenol is 500mg. I take one as I need to during the day.
Take 2 Tramacet every 4 hours for the night hours.
Your pain med routine could do with some adjusting. If each tablet is Tramacet 37.5mg/ paracetamol 325mg then you are seriously under medicated and need to either be taking two tablets at a time, spaced at 6hrly intervals. Maximum daily doses are Tramadol: 300 mg per day and Acetaminophen 2600 mg per day.

I think you would do much better to ask whoever is in charge or your prescribing, if you can transfer to Tramadol and take this with Tylenol as per this chart, perhaps just for the next 3-4 weeks.

aa Tramadol routine 1.JPG


3. Swelling is moderate.
Okay - you did factor this in to your pain score, didn't you?
4. Flexion was 102 at the PT, extension was at +5.
That's not at all bad for week 1! So don't fret about it. It will improve in time.
5. Icing with ice packs front and back every 2 hours for 20-30 minutes when awake. Especially after exercises.
You accomplish little or nothing in 20 or 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
6. Elevating on an ottoman the same level as the chair intermittently thoughout the day.
That is NOT elevating! That's just putting your feet up! Read this Elevation: the do's and dont's

The key is 'toes above nose' which looks like this

elevate 2-horz-horz.jpg


7. I cruise around the house on crutches, go for walks in the driveway, shower.
That's about right!

Exercises done at home: did you notice all the articles that were left for you in the second post of this thread? Did you read them all? Because the ones I'm leaving you here were in among them and it seems like you never read them!

foot pumps whenever I'm sitting around - these are only for when you were immobile. Now you are walking around the house so they are no longer needed
heel slides 10 x 3 a with a robe belt around my foot - well never use 'assistance' to make your knee bend! Read this Heel slides and how to do them properly
quad sets pressing down the back of the knee 10 x 3 a few times a day. Holding for longer periods of time (10 sec) - these are also not required because your extension is +5 already. so stop them!
dangling the legs over the side of the bed in sitting position - you don't say how long for but it doesn't matter because they are unnecessary anyway!
lifting the foot up using the quad 10 x 3 a few times a day - straight leg raise but once you can do them, you don't need to do them any more!
Placing a bolster under the knee, try to lift the foot - a half leg raise. Same as above, not needed!

These are exercises that the PT showed me when I was there on day #4
I would suggest that you don't comply with her exercises because you don't need them. You said your ROM is already 102/+5 which is more than excellent. If you continue to do exercises like these, you will cause more swelling which in turn will impede your ROM (that's flexion and extension)

In summary, I would say that there are a LOT of members here who have done their TKR recovery with no exercises whatsoever and yet obtained excellent outcomes. What I am saying is, cancel the PT sessions and don't do any exercises at home! Truly! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
 
Thank you for all of your suggestions. This forum has been such a source of information and support.
I am going to be more relaxed about the exercises. I do think that I'm doing well (except for that dang piriformis).
As for the pain meds, I'm going to try taking them every six as hours as you suggest. I find if I skip them during the day and take a larger dose at night, I wake up feeling gross.
Do you have any information about RA and TKR? I have RA and have been off my celebrex and leflunomide since before the surgery. I'm not supposed to start the celebrex until the apixaban is finished as they both thin my blood. It was recommended that I start back on the leflunomide but I am reluctant to do so because in impedes healing and is an immunosuppressant. My RA has not been bothering me at all. Any thoughts?
 

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