MUA 1 Week post op

[kneeper]

It sounds like PT is worth a try. I know for my last knee I had a lot of swelling and PT did some intensive cold therapy (the swelling went down measurably (millimeters) within 15 minutes (though not permanently) and I could bend a little bit more. Massage might be useful for you too.

Like the doc said, you can still have MUA later if needed.

 

[Wrangler]

Hi,
Just checking in. You are doing great!! It's very hard not to compare yourself to others especially when others are doing so well. Our hospital offered PT sessions for TKR patients as a group. Everyone was better than me - it was hard to swallow. I think it's even harder when you have been a competitive athlete as you are used to conquering it all.

I have found (by reading other threads) that a fair number of young female athletes requiring TKR have had slow and challenging recoveries but have all done really well in the long run. I'm an exception but my TKR is sound it's the #CRPS that causes me grief. From what I have read on your post you are doing well and will get there. For once you are the tortoise and not the hare. Be patient and kind to yourself and you will get there.

In my limited knowledge, there is nothing you have reported that would indicate #CRPS if that's a worry for you - I know you have read my story. My PT, OS and my brother (ER Doc) all suspected #CRPS by 4-7 weeks based on the look of my leg (mottled and really shiny), allodynia (pain from a stimulus that is not normally painful), limited ROM and extreme pain (hard to tell after a TKR). It's hard to explain, but I knew something was wrong too.

Keep posting and continue to feel supported by all the fabulous bone smarties that are checking on your progress. I know they pulled me off the ledge a few times. One day at a time ....

All the best!!!!

Forgot to add - if you have a smart phone you can download a goniometer app to measure your ROM.

 

[Josephine]

Well I must say, I AM relieved as I began not to trust my own advice! One always has to remember there are always exceptions and I really began to think you were such a one! But I would still urge that you not do crazy amounts of exercise at home, especially not things like lunges and squats. I shall be interested to see how you progress.

 

[Wanttobebiking]

Glad to hear your OS appointment went well. And good luck with the PT. I was thinking about you yesterday.

 

[KameronSteele]

You guys are ALL so wonderful..I mean that sincerely. I appreciate you taking the time to read my thread and then comment and as wrangler mentioned... Talking me off a ledge. It really helps!

@dtmbf, where did you apply the k tape? And what kind of massage? Myofascial, deep tissue or what?
@kneeper? What is "intensive" cold therapy? Is that different than the usual ice wraps pt does after the session? So your swelling went down but returned..why do we do pt if our knees are aggravated by it?
@Wrangler, yes tortoise and not the hare. Ugh. And it's so interesting that younger females seem to have a longer more difficult recovery. Maybe due to pushing it more in the beginning? How and when does one move past crps? And how does one acquire it or a better question, prevent it?
I actually have 2 gionometer apps on my phone and iPad and still trying to figure out how to use them properly.
@Josephine, you were most certainly correct.. I have scar tissue. OS just hopes it will dissipate w/pt, ice and elevation. And most def taking it easy on the exercise..I have what seems a lot of ex to do everyday so not really sure what constitutes overdoing it. As everyone here mentions.. I suppose ill just listen to my knee.

My first pt session 8/25/2015-Wednesday
He said I certainly was behind the 8 ball but felt I could get to 100/0 by 6 weeks as my OS wants. My first official measurement was 75 on my own, W/pt help 85. It was extremely uncomfortable but I got there and he said there will be discomfort but I'll need to deal w a little to get gains. Extension was 12.

I did the following ex which are also my homework to be done 2x day, 10 reps,2 sets each ex.
Straight leg raises- I have quad lag big time
Heel digs
Towel under knee and push back of knee into towel
Heel slides w towel/belt..gently until resistance
Lying bridges
Short arc w/foam roller under knee
Toe/heel rock back and forth
Toe/calf raises
Weight on thigh to stretch back of knee
Calf stretches
Hamstring stretches

He then put ice pack on and did estim to reduce swelling. Said we will do massage Friday (not sure what kind).

I go to pt again Friday and will do pt 2x week for 4 weeks and everyday ex on my own at home. Is this too much? After I got home knee didn't seem too angry , no more than usual and I did not hurt afterwards. I asked pt since it is still swollen inside (he agreed based on heat, stiffness and tightness) wouldn't pt be counter productive? He said it can be if not done properly (gently no torture) and proper measure afterwards, such as ice, estim etc.

Soooo, I felt good afterwards, emotionally and physically. I'll feel better after I can get off crutches. Pt said Russian stim next time for quad lag. Not sure what the diff is between stim I did yesterday and Russian stim.

Question for everyone: while doing pt, is it normal for knee to feel tight and perhaps like I need to gently push thru that tightness and stiffness while doing pt? I guess Im asking this shouldnt be a breeze should it?

Thanks gals and guys!

Wanttobebiking.. Thank you for thinking of me..so very nice...

 

[Wanttobebiking]

Hi Kameron,

I have had 2 PT sessions a week since surgery July 13 and it has worked for me. I never pushed to the point of pain, but discomfort and trepidation was and still is part of it. I see my OS in a week and am hoping to reduce PT to once a week at that time.

Since surgery I have vacillated between worrying whether I am doing too much or not doing enough, which I guess has also worked for me. Every morning I discuss with my husband how my knee is feeling and we develop a plan for the day...take it easier or try to build strength and endurance.

On days I think I am doing too much, I ice more and do stretches and a maybe a walk or stationary bike. Early in PT that equated to a few quad sets, heel slides, and leg raises.

Your PT program is nearly identical to my early program, except I did not do any bridges and I was not lucky enough to get massage. I still get swelling but not much, both when I do too much and when I do too little, such as lay in bed most of the day icing.

I know we are all different and I can't say where I would be without PT but I am very grateful I am doing as well as I am.

Wantobebiking and plan to be someday!

 

[Josephine]

while doing pt, is it normal for knee to feel tight and perhaps like I need to gently push thru that tightness and stiffness while doing pt? I guess Im asking this shouldnt be a breeze should it?

for tightness and stiffness read swelling and PAIN! So get on your meds again and the elevating and icing. Rest in between times. It's not going to be a breeze but only because of the physical effort. Do not let it be because of pain.

Straight leg raises- I have quad lag big time
Heel digs
Towel under knee and push back of knee into towel
Heel slides w towel/belt..gently until resistance
Lying bridges
Short arc w/foam roller under knee
Toe/heel rock back and forth
Toe/calf raises
Weight on thigh to stretch back of knee
Calf stretches
Hamstring stretches

I truly do not see the value of bridges except to irritate your IT band, nor the toe/heel rocking which will do likewise. Weight on your knee is going to cause pain, swelling and stiffness so make sure it's a very light weight and of very short duration.

When listening to your knee, remember to listen to the whispers as well as the screams! By which I mean things like tightness and stiffness. Don't fall for the temptation to work it harder - you'll only get more rebound swelling.

 

[PolarBear60]

You may experience some discomfort as you stretch to the desires position. If you experience any pain, tell the PT, "This hurts." The right answer from them is, "Don't do it then." And, "Try this instead." That different technique should be better. If it isn't, repeat above conversation until it is. PT is interactive. Don't forget. Feel free to ask questions about anything they are asking you to do so you understand why and what it is designed to help with. They should be happy to explain. (Good PTs like curious, engaged patients. )


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[kneeper]

@kneeper? What is "intensive" cold therapy? Is that different than the usual ice wraps pt does after the session? So your swelling went down but returned..why do we do pt if our knees are aggravated by it?

My PT used the Game Ready cold machine on me. Much colder than my at home polar ice machine.
By the swelling returning, I mean that it's not like you use it once or twice and the swelling is gone. But over time (think weeks) it went down considerably. The fact that I got better bend right after icing indicated to me that the bend was "in there" but currently impeded by swelling.

Icing, elevating, a little exercising and a lot of laziness worked for me.

 

[Wrangler]

How and when does one move past crps? And how does one acquire it or a better question, prevent it?

Mayo Clinic Website says: The cause of complex regional pain syndrome isn't clearly understood. Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible.

Treatment is multimodal. The web page below provides a lot of information.
broken link removed: https://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm#266883282

Studies say that you can prevent it by taking Vitamin C. I would encourage anyone having a TKR to take Vitamin C! 500-1000mg for 45-50 days after surgery.

https://www.jhandsurg.org/article/S0363-5023(14)01151-4/abstract

broken link removed: https://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Vitamin%20C%20is%20Effective%20in%20Preventing%20Complex%20Regional%20Pain%20Syndrome%20in%20Adults%20Following%20Trauma_Pickering.pdf

 

[bdink21]

@Wrangler that's very interesting. My OS starts all of his joint replacement patients on vit C 500mg twice daily for wound healing so double bonus I guess.

 

[dtmbf]

I applied the K tape as a solid strip over the incision line, starting from just below the incision to just beyond the top of the incision.. It was cut a bit smaller than the incision as my PT told me to put about a 70% stretch to the tape when pulling it up and anchoring it. There's a whole technique to the tape application I was totally unaware of until she taught me. Real important is cleaning the skin with rubbing alcohol so your skin is free from any oils. Tape sticks way better that way. AND my OS wasn't thrilled with it going over the incision even tho I was 8 weeks out & the incision was completely healed. So I actually stopped using the tape for a couple of weeks, even tho it was helping with the stiffness (& even if it's all psychological I don't care - I felt better), but I trusted his concern. I started using it again at about 12 weeks. It did and still does help me - my 1st knee never really has let me forget I have had the TKR.

The massage was different with each knee. The 1st knee was awfully swollen so the PT did both tissue massage (not the deep tissue) and then lymphatic drainage massage which is a whole special technique I couldn't even begin to replicate. For the 2nd knee the focus was on the myofascial massage which help tremendously with all the soft tissue issues I was having. In outpatient PT now the PT is using a technique called gua sha. I never heard of it before & it does seem to help as I still get quite stiff at times.

In all cases it was my PTs who initiated the treatment approaches. You might want to ask your PT what they could offer you given their assessment of where you're at in recovery.

 

[KarriB]

Just to add on, check out YouTube for applying K tape (as you are resting and icing). I have friends who have used it to help them with K tape application.

 

[Josephine]

How and when does one move past crps? And how does one acquire it or a better question, prevent it?

Just as clots are a fairly uncommon occurrence, so #CRPS is actually rare. What isn't so rare is having a spell of neuropathy or nerve pain but that is usually resolved fairly easily with a course of gabapentin or similar.

Nerve pain usually starts because a nerve has been bashed during surgery, either by instruments, bandages or something else. This sets up an abnormal amount of messaging to the brain which then deals with it abnormally. Gabapentin will dampen down this messaging or electrical activity in the brain so the pain is extinguished like a candle - that's the theory anyway!

Nerve pain also feels like you have a gremlin with a blow torch inside your skin, hosing the inside with the flame!
Least that's what it felt like to me!

Just as a matter of interest, now I've given you the mini-lecture! - what makes you fear you'll be prey to it?

 

[KameronSteele]

@dtmbf, i have KT tape but havent taped like that..i will now tho!
@Wrangler, now that I know ab CRPS i will get some vit c and start loading up!
@kneeper, gonna see if i can get my hands on a game ready..

i posted this link on @Wrangler's thread yesterday but i think after what happened to me yesterday i need to post it here on mine. ive had this APS machine the study is referring to, for years. I JUST used it last nite for 4-back to back treatment sessions totalling 32 minutes. I AM NOT KIDDING YOU WHATSOEVER NOR AM I EMBELLISHING-I CAN NOW WALK WITHOUT ANYTHING FOR THE FIRST TIME IN 6 WEEKS!!!!!! Just over nite, this has happened. I did the treatment last nite and woke this am with slightly more ROM and havent used my crutches at all today! I tried during the day yesterday to walk w/o them and my knee was flopping all over the place. So what did this? ONE pt session on Wednesday or the APS machine? I dont care but i know i WILL continue to use this machine and do pt.
i CANT WAIT to ride my mountain bike!!

posted on wrangler thread- here's a link for you..even though it doesn't specifically mention TKR it does talk extensively about knee flexion, mobility, stiffness and swelling and lack of mobility due to swelling. and I have one of these machines!!! I was a dealer rep many years ago. I just had my first session on the machine so ill let you know if I think its doing any good. I truly think it cant harm but please read when you have time. even the sections about issues that have nothing to do w/knees is great!!
https://www.apstherapy.com/wp-content/uploads/2014/01/APS-Therapy-Research-2014-05.pdf

 

[bdink21]

Hey whatever works....good for you!

 

[KameronSteele]

Just as a matter of interest, now I've given you the mini-lecture! - what makes you fear you'll be prey to it?

oh I don't think I will even tho anything is possible..i was just curious. If I do have odd symptoms that haven't been part of this tkr thusfar, I can now have an idea of what it is or is not. everyone is so knowledgeable here and I am learning so much. (and I obviously just found these cute emoticons, lol)

 

[analysta]

Hey, that's absolutely great! You go!

One of the things that struck me in reading your thread was the difference between passive and active ROM. I think we all tend to use the active ROM number when the passive one might be a lot more important - it shows what's possible for your current system. The active ROM measurement adds in the factors of muscle strength, level of re-activation, muscle knots, and so on, (and of course one's level of pain control at that moment), which are limitations but are not good indicators of the **more important** underlying limits of bones, ligaments, bursas, tendons, and of course scar tissue. The passive ROM measure tells you about that.

One of my PTs only measures the active ROM and I think that's wrong. My current PT does both.

 

[KameronSteele]

@analysta, my pt measures both as well. And I too believe passive is more important. Heck, Im sure my pt could get me too 100+ right now but what's the point if I can't get there myself and/or it causes more swelling? And I can't take him w me for the rest of my life and when I need the bend have him do it! Silliness!

Quite a while ago I remember reading here that one day I'll just turn a corner. I did that last week when I just woke up one morning and was able to walk unaided and the day after that got more, very noticeable ROM. Yesterday I woke and got 90 easily with zero effort and hardly any stretch or tightness at all. The day before that I was at pt and got 90 but it was SOOO tight and uncomfortable and it was difficult. I of course am apprehensive , fearing if I do my daily exercises and push too much I'll lose my passive ROM. As I write I'm still at a very easy 90. I have pt in 2 hours.
I think my APS machine is a great help in reducing that internal swelling and stiffness. Even tho it's still hot and I still ice, it's certainly 100% better than this time last week.
Ok gotta get ready for pt...see you all this afternoon.

 

[bdink21]

@KameronSteele its really great to see your progress. It does seem as though you've turned a corner. As far as your fear of doing too much and going backward well I think it's all about getting the right balance of PT and rest, you'll know if you're pushing too hard, you've been there before and you also know what to do when you join the ODIC (over did it club) lol.