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MUA 10 weeks after TKRS and not yet happy

Thank you Cratchit. I am up in the middle of the night here with some of the worst knee pain that I have experienced. The knee must be talking to me. Maybe I will take a few days off of exercising all together other than some light water stuff.
 
That's an excellent idea. Be sure you are icing and resting as much as possible and take something to stop that pain. It's a cycle when you have untreated pain. It results in swelling (the body's natural reaction to pain) and then that swelling gives you even more pain. Swelling can be very slight inside the knee capsule and you may not even see it. But it's there and it's stopping you from having the recovery you want.
 
BARBRI said:
Maybe I will take a few days off of exercising all together other than some light water stuff.
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Try taking at least two weeks off all exercises, including those in the water. You won't lose the ROM that you already have.
It sounds as if your knee needs a long rest, so that the inflammation and swelling can settle down. This won't happen in just a day or two.
 
@BARBRI, I, too, am a 'water baby'. Before TKR, I did water aerobics twice a week, and then laps for 1.5 hrs afterwards. In the summer here, I also do some exercises in my home pool.

I am now on my 7th week post op. A week ago today, I did 15 min of gentle flutter kicking in the pool - I didn't think much of it - it didn't hurt at the time. But I also didn't take into account the added resistance the water provides. Needless to say, my soft tissues swelled, my leg hurt, and now I'm caught in an impingement syndrome where my swollen tissue gets 'pinched' in my implant every time I move or walk - thus, causing it to swell even more. Ugh. I'm now at least 2-3 weeks behind now.... *if* I take it easy and ice and elevate all the time.

My point is, have your PT actually feel around your leg, push and prod (gently) to find out what the issue *really* is. Then decide which, if any activities will help or hinder the healing of that particular issue. Swelling is damage that your body is trying to heal. Cuts, bruises, insect bites/stings... They all swell as they are healing. But if you work or overwork damaged tissue, you undo the healing. It can be a vicious cycle.

For me, if I did aggressive PT, I'd never break my cycle. My OS also put me back on Celebrex. So here I sit going stir crazy in bed. But I still will gently flex and extend my leg 2 times a day to make sure I'm not losing my ROM.

It's difficult not knowing what the right balance is - I still haven't found mine. But I do know the definition of insanity (according to many) is doing the same thing over and over, expecting a dufferent result.

ME, I'm not touching a pool again for a looooong time. I'm fed up enough with this recovery - I don't want to do anything to make it longer :wink:
 
Good morning. I am up in the night for an hour or two due to leg pain [7 or 8] as has become my nightly ritual. Can anyone offer me any pain killing med suggestions other than anti-inflammatory [NSAIDS] medication [cannot take these due to high blood pressure]. Other than this everything else seems to be getting slowly better [ROM,reduced swelling,etc]. Thank you
 
Usually when you experience pain like this during the night, it means that you have been doing too much during the daytime. Did you cut your exercises right back, including the water therapy?

Take pain medication just before going to bed, and ice during the night.
 
Basically I am doing stretching at home,10-15 minutes of daily stationary biking at a low tolerance level as well as the water activity for 30 minutes 2-5 times per week. I do not find the water activity stressful at all and I think it is helping my rehab with ROM maintenance. I take my pain medication before I go to bed [2-500mg of tylenol extra strength] and ice before I go to bed and during the night as required. I also use volteran cream during the night. None of this seems to help the nightly bed pain and discomfort very much if at all.
 
@BARBRI

Please explain to us, in detail, what exactly you are doing in the water? Kicks, walking, marches, treading water, jumps, swimming, etc

This will help us help you, I think.
 
Usually water activity doesn't hurt at the time, it causes achiness later. Because the MUA started your recovery again Jan. 17, it's really early to be doing aqua therapy which means resistance. At 2 1/2 weeks post MUA your soft tissue is still feeling the effects of the MUA, add water activity and you have night time pain.
 
L.I.T. you asked what I do in the water. Well here goes. Walking forward,backwards and sideways,squats,step ups,pedaling under water,marching,leg stretches,knee bends on a stair/ladder,legging swinging,toe and heel lifts,knee bend and hip turns. There are a couple more,but I forget what they are called. I normally do the water stuff twice per week,but this week I did it 5 times because I had cut back on some of the other harder stuff.
I should also mention that we live in a two story house and I am up and down the stairs multiple times each day. Also have been looking after two of our neighbors homes for the past few months and both are two story as well./ So lots of up and down stairs.We had a good sized dump of snow yesterday so I had two shovel a couple of driveways. Will be at that again today. Does not seems to bother me.
 
@BARBRI, holy canoli, batman! You are a machine! If I had done all that, my knee would be so swollen I wouldn't even have any ROM left!

I'll tell you what my PT told me. He said 'at this point, you have a choice... You can either push through the swelling, and get back to some of your activities now... Or you can take it easy for a few more weeks, let the swelling go down, and then resume. It's up to you to decide which is more important.'

I would imagine it would be the same for you, except switch out 'swelling' for 'pain'. If you want to do all those activities, you will have to deal with the pain. If you want to get rid of the pain, you will have to significantly decrease the activities.

Me, I have a tendency to build extra collagen (scar tissue) when healing - so I'm not willing to risk excessive swelling. Hence, I'm trying to go with somewhere in the middle.

It's hard, I know. I'm bored as all get out. But I want to do this right the first time...because the one thing that would be worse than boredom would be to have to go through all of this AGAIN! :shocked: LOL

Wishing you the best of luck!
 
Thank you for your feedback L.I.T. I am going to try a happier median,but I can honestly say that increased swelling has not been a problem for me. Just the night time pain. I also feel that I need to continue to do some harder activities to maintain ROM and to break down scar tissue.
By the way my wife and I have visited Zion in the past when we were in St George,Utah for the Huntsman Senior Games. Beautiful location. I play senior softball/slo-pitch. We will be back there again for the Games this October.
 
@BARBRI
People keep trying to help you with your night time pain, but you are just not listening.

The fact is that, if you are having severe pain during the night, it means that you are doing too much during the day.

We've all advised you to stop your daytime exercising - including the water therapy, which is pretty strenuous - and yet you keep on doing it and suffering night pain as a direct result. Shoveling snow on top of that was just asking for trouble.

It might not feel as if you are doing too much at the time, but the pain tends to be cumulative and it hits you at night. That's your knee, giving you a message. It's telling you it's still a baby and it needs more gentle treatment.

You don't have to keep exercising in order to maintain the ROM you already have.
It's not exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. Your ROM is there right from the start, just waiting for all that to happen so it can show itself.
 
I agree with Celle---when your knee is replaced your quads and hamstrings are not functioning as well as they do later. So, the joint itself has to support the leg. Since your muscles are not 100%, you are putting extra stress on the joint itself---hence the nighttime pain. Listen to your own body instead of the need for frantic activity.
 
Guilty as charged. I am just so concerned about scar tissue building up again.
 
Ordinary scar tissue is normal and necessary. It's what forms when your wound is healing and it holds your tissues together. Without it, your wound would not heal, but would stay open.

Bad scar tissue (more accurately called adhesions) is far more likely to build up through over-activity. If you do too much, your soft tissues get hot and inflamed. Hot, inflamed tissues become drier than normal. Drier tissues are more likely to stick together and form adhesions.
So, all this frantic activity is working against you and making you more likely to form adhesions.

In any case, from reading your past history, it is unlikely that you ever had adhesions. It's more likely that your initial problems with ROM were caused by over-activity prolonging swelling and inflammation.

These articles may help to explain:
Scar tissue and adhesions - what's the difference?
MUA (Manipulation under Anaesthetic) and Adhesions
 
Celle is quite correct. Please take her and Skigirl's advice to heart. All this exercise is making you much more likely to develop a chronic pain problem. We've seen that happen with some members and it's not pretty. You can read about it under the topic #CRPS. You will never develop adhesions by taking care of yourself.
 
BARBRI said:
Hello to fellow forum members. I had total knee replacement surgery almost 10 weeks ago and I am not at a point where I am glad for having had the surgery. Despite working out just about everyday in the gym and the pool including with a PT my knee continues to be very very sore most all the time and swollen.My range of motion is not where I think it should be either. Very difficult,no impossible, to get a descent nights sleep. Pain medications including prescription meds are of no help. Feeling frustrated. Your feedback would be appreciated.
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Hey there, @BARBRI. This is your very first post on this thread - before you got your MUA, if I am correct. If your MUA was needed because you developed scar tissue, it seems to have happened in spite of your vigorous exercise routine to avoid it.

In a later post, you said.....
BARBRI said:
Being a life long gym person I cannot seem to quit on the exercising.
Click to expand...

I think this *may be* the real issue. There are lots of ways to maintain the ROM without aggressive exercise (as bonesmart outlines), even if you don't believe that it will still be there if you simply rest and let things heal. There are a lot of stretching and light exercises that will keep the ROM without vigorous stair climbing, snow shoveling, and aqua therapy (which is even harder on the knee b/c of the extra resistance of the water).

BUT if the real problem is that you just can't quit the exercise, that's a different issue. My husband has that same affliction. For him, it's a matter of endorphins and feeling healthy. He ruined a rotator cuff surgery b/c he couldn't let his shoulder rest - sure, it healed, but not well.... And 2 years later he tore it again, and they cobbled something back together - but now he has permanent weakness and has lost some function.

If you don't want to stop the exercise (which is the feeling I'm getting from you) and you want to help the pain, perhaps your best option is to ask your OS for some stronger pain medication. But keep in mind, it couldn't hurt to try the RICE system for a week.

Congrats on the senior games, BTW! One of my aqua aerobics friends and I volunteer for the women's badminton every year, and our estate lawyer played (and won) his basketball category a few(?) years ago. I am always very impressed with the level of athletic individuals who participate. I hope you can continue to play in them - I don't think they could have chosen a more beautiful area in which to host the games!

Good luck!
 
why not dial in to some exercises that do not need the joint to support the knee? I have an exercise bike and ride about 30 min a day. I hasten to add that you need to ride 10 min--how are you doing? swelling? 5 min per day, no swellinb? 15 min per day---repeat as necessary.

I have used a rowing machine---stopping the stroke at discomfort.

I cannot use a treadmill, but I do walk at least 2 miles a day with my dogs. walking, .5 miles first, no swelling? then 1 mile---I am sure you get the picture!!!

Most of all avoid heavy lifting like snow shoveling where you are loading up the joint itself. That is not good for the knee at all.

I have found that when I am in the gym, I do 20 min at each machine that I like. 20 min on bike, elleptical, rowing machine for instance. It keeps me from becoming bored and it does not give me repetitive motions. I would start with 10 min.

But, most of all avoid loading your knee with heavy weights, extensive single exercises or just too much of everything.
 
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