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TKR 10 Days After Surgery Back Flaring

Cstucky

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My left knee was replaced 10 days ago. When I woke from surgery my back was achy, but this pain was soon overshadowed by the feeling that I had a small truck sitting on my knee. The truck sat there for a couple of days, probably more weighty because I only took two narcos for pain...I’m freakishly avoidant of oxy anything but am embracing extra strength Tylenol.
After a rough two days of pain, I had some relief and began what I thought would be a linear recovery. Wrong..a few days later I had back to back pain days, not truck time, more like a bowling ball on my knee. I have a wonderful PT who told me that recovery isn’t linear but rather a series of small roller coasters. Yesterday, I arose to euphoria, well almost. Despite nearly sleepless nights, I felt like me again. I could do this and I proceeded with therapy twice as prescribed.
By 5 p.m. I was discouraged. I had back twinges in the shower that caused anxiety that my tricky back was going to flare up. The rest of the night it ached badly. This was a concern all along because I have a couple of herniated discs I keep in check with avid cycling and yoga.
So here’s the conundrum. I’ve always enjoyed walking and cycling, and am super motivated to do my therapy, but I don’t want to sacrifice my back with exercises like straight leg lifts, which I’m cutting out.
I would appreciate others input on this, as well as how any of you weathered the near sleepless nights that warrant bed to recliner, back to bed, night tromps,
thanks!
 

Jaycey

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@Cstucky Welcome to BoneSmart! Your PT is spot on - recovery is roller coaster!

First I would suggest you stop doing any exercises that cause pain. Yes, for those if us who have back problems straight leg lifts can cause lower back flare. Don't be pushed into doing this.

Unfortunately sleep problems are a big part of this recovery. Many of our members sleep in their recliners in the early days.

Are you icing and elevating? Ice is a natural pain killer. Ice and elevate for at least 45-60 minutes several times in the day.

I'll leave you with some reading. The articles are short and should answer questions you might have about this 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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 
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Cstucky

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Jaycey,
Thanks so much for the articles and encouragement. I’m scared this back issue will derail my knee therapy and recovery. So In addition to the support from this forum I need to practice mindfulness and learn to focus on breathing and being positive.
 

Jaycey

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Please don't worry about any therapy. Many of our members on the knee side had little or no therapy post TKR. It's not aways necessary and in your case you do need to work with someone who has experience in spinal issues.
 
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Cstucky

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Oh thanks! I’m a workout exercise lover, have been all my life. But have struggled with disc issues in the past. I’m sure the uneven gait is affecting me at present. Prior to surgery I beefed up my cycling to get legs strong. Perhaps I was mistaken in thinking I couldn’t miss a day of therapy because the first two weeks are so important, or so I’ve been told. Your comment buys me some time to rest this weekend and walk about to see if the back improves. Do appreciate the support!
 

Jockette

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Keeping our new joint mobile is important. However, 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.

And I have back issues also and refused the leg lifts, and anything else that made my back hurt.
 

tlfiore

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@Cstucky welcome to the forum. I know you will find tons of useful & supportive information here. Not sure what I would have done had I not found BoneSmart and the wonderful people on the site.

I am not a narcotic person either and if you read any of my recovery info (it's a bore-lololol), you'll see the challenges. With that said, I think for most people, certainly for me, this TKR post-op pain is unmanageable without some type of narcotic analgesia. A few folks have not needed narcotics after post-op day #2-3 but most need some help.

I tried doing without anything but Tylenol XS 1300 mg po TID about 4-5 days after surgery. I thought this would be a linear process, as well. I am a believer that my pain DOES mount and intensify as the day moves on & nighttime approaches. I've had several nights where I've cried myself to sleep due to pain.

I decided to break-down and give in to the help & recommendations. I like to think I am super-stoic; yet I find as life has marched on and I've had many maladies, I do not want to be in pain, if possible.

Go easy on yourself and take care. REST, ice, elevation, calm, pain management...absolutely necessary.
 

Celle

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Perhaps I was mistaken in thinking I couldn’t miss a day of therapy because the first two weeks are so important, or so I’ve been told. Your comment buys me some time to rest this weekend and walk about to see if the back improves.
As Jockette told you, it's actually not the exercises that give you your knee's Range of Motion (ROM) - it's time and healing. It takes time for your knee's swelling to go down and that swelling is going to physically prevent your knee from bending or straightening properly. During this time, all your knee needs is to be kept moving gently. Trying to force it, or working through painful exercises, is going to slow down your recovery, because doing those things will make your wounded tissues angry, which will prolong the swelling.

You might be interested to know that my surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
 
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Cstucky

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That’s amazing. In our area it’s all about PT immediately. What you’re saying makes complete sense because right after surgery I walked around and had such flexibility that one of the nurses said, are you sure you’re the one who had knee replacement?
Now I know that occurred because there wasn’t yet any swelling. Since home, I vary positions, getting up at least one an hour to walk around our house, then sit in a Stressless chair we bought for my back, then lay in bed with a pillow under my knees (so grateful I can do this today without pain). I really appreciate your input. It appears recovery isn’t a one size fits all!
 

Celle

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No, recovery isn't a one-size fits all and there are lots of differences in the protocol between surgeons as well.

Your knee is going to heal and regain its ROM with or without formal PT, as long as you treat it gently, don't force it, and don't do exercises that hurt. Just move your knee gently, walk around a little bit as you are doing, and make sure you rest, ice and elevate it.
 

tlfiore

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That’s amazing. In our area it’s all about PT immediately. What you’re saying makes complete sense.
THIS is what frustrates me and makes me feel badly for those of us who just cannot do a lot of the PT right out of the gate. Seems like common sense, no? Really makes me wonder.
 
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Cstucky

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Not sure about the rest of you, but nearly 2 weeks in the nights remain the hardest. I get antsy sometimes but I do see slim progress. I can now sleep on my back with my leg elevated for a couple of hours. That brings me to my question.
What/how is the best way to elevate?
Also wanted to note a few things that have helped me. Visits from friends, journaling, and using making a grateful list too, meditation, junk TV, a light, cozy blanket, using a cookie sheet as a tray so I can eat in my recliner, reading about others who have it worse than I do, eating plain food, (lots of veggies and fruit), feeling the yucky feelings of frustration reminding myself that this too will pass, and using this God send of a forum for support.
 

Jockette

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What/how is the best way to elevate?
This article is in the Recovery Guidelines that Jaycey gave you. If you haven’t read through them, you should. There’s a lot of helpful information there.
 
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Cstucky

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What/how is the best way to elevate?
This article is in the Recovery Guidelines that Jaycey gave you. If you haven’t read through them, you should. There’s a lot of helpful information there.
What great resource offered here on elevating
 

Jockette

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There are a lot of gems of information in those recovery articles.

Bonesmart also has a library of even more information. Here’s a link to the whole list of articles is the Bonesmart Library. Lots of topics there!
https://bonesmart.org/forum/threads/library-index.14830/

Also, you don’t have to quote a post to answer it. Just scoot down the the reply box and reply. Often the staff reads back through a thread for information so we can advise you properly, and extra quoted posts take up space for us to check through. Of course, you can always quote a section to address something specific, but the whole post isn’t necessary. Thanks!
 

KneeHelp

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I was having back spasms before my surgery. We were getting my mother's bedroom ready for Hospice and I couldn't stop when my back was bothering me. My GP thought it was from the way I was walking and told me it would go away after knee surgery.

I also live in an area where aggressive PT is prescribed. I had 2 sessions of therapy the day of surgery and started again the next day. It takes a few days for the nerve block and the heavy meds to wear off so they were not painful.

By then getting in the vehicle to get to therapy was hard and painful. After 6 weeks I stopped going and they called with horror stories about I may never walk again lol.

I was doing well and at 4 months started on the cycle at the gym. My back hurt so badly I could not walk. GP visit was useless as he advised more PT. He said it was from sitting too much.

I found this forum and realized I had piriformus syndrome. I immediately added my back to my icing and stopped exercising. It took months for my back to heal. My GP should have known this, IMO!

The aggressive PT made my healing much slower. If I have another TKR I will know better! We are put into a 'one size fits all' rigorous exercise plan and my body rebelled.

At 10 months I am wearing a back brace for the gym and taking it SLOW, lol. Finally, I am seeing improvements and I know how to strengthen my muscles without pain.

I have found ice, tens, massage, plenty of rest help. All the things our admin of this forum recommends!

Lots of people have made remarks about my slow recovery, still using a cane, etc., learn to ignore them!
 
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Cstucky

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Oh my! Back spasms are literally the worst! Great idea to ice the back too. I think much of recovery seems to hinge on us knowing our bodies.
My recovery is more positive since I found Bone Smart. I had no idea how much relief I’d get from elevating with ice.
 

Celle

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I think much of recovery seems to hinge on us knowing our bodies.
That's right. Listen to the messages your body sends you.

Know, also, that you are in charge of your recovery and you have the right to say what happens to your knee. Others, such as your surgeon and your PT therapist (and friends and family) may advise, but you have the right to choose whether or not to accept that advice.
Saying no to therapy - am I allowed to?

Work with your PT therapist, to do what feels right for your knee and your body. Don't get pushed into a one-size-fits-all formula, or a frantic chase to achieve ROM numbers.
 
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Cstucky

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I’m so frustrated. The therapist just left and I caved, didn’t wholly stand up for myself and I’m paying for it. Can’t get comfy at all in any position. She was working on me walking without a limp and now the pain in the back of my knee is awful. I’ve never had that before. Any tips for settling the pain down? I’m elevating and icing. I’m two weeks in today and was so happy. Appreciate any input anyone has. Thank you.
 

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