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TKR 12 weeks post op TKR

Jah66

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Hello all. My TKR was 9/28/20. I am happy to have found this site as I have so many questions / concerns and I find the surgeon's office pretty much 'drops you' after the surgery is complete. I also didn't have much luck with in-home PT. I am doing my own PT at home with youtube videos (Total Therapy Solution Physical Therapy is very helpful).
I still have quite a bit of pain day/night. I cannot take narcotics due to sensitivity. I take one gabapentin at night to help me sleep. Not sleeping puts me in a terrible state of mind. I still can only sleep on my back with pillows under my leg. quite frustrating.
Monday I started doing gentle yoga again. more for my brain than leg. I'm going for walks twice a day with cane assist. I do bending PT 3-4 times a day. (stationary bike / squats / strap assist bending)
I am a little past 90 in bend. My thigh and calf muscles ache constantly - ankle bones as well. All in all I'm quite frustrated and have begun to 'hate' my new knee.
I'm almost 55 years old and was (would like to be again) quite active prior to surgery.
Am I doing too much ? Is that why I have constant pain?
Does anyone else use OTC pain meds vs narcotics? Which ones? I'm taking 2 aleve twice a day.
Thank you all for your posts! It helps to know I'm not alone. = )
 

Jaycey

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@Jah66 Welcome to BoneSmart! Which knee had the op? I'll put the information in a signature for you.

Can you take Tylenol/Paracetamol? The combination of Aleve and Paracetamol can be very effective. Also, icing your knee will decrease the swelling that is causing all this pain.

It sounds like you are doing too much. Your knee is telling you to slow down. There is no need for all that PT. Your thigh and calf muscles hurt due to all that exercise. Gentle stretches are all that is needed. You are not in training - you are healing.

Here is more information that might help you get back on track with 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.
 

Jockette

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Hi and Welcome!
I'm going for walks twice a day with cane assist. I do bending PT 3-4 times a day. (stationary bike / squats / strap assist bending)
Am I doing too much ?
Yes. If it was me I’d keep the walking, but cut it back some, stop the other things, and then just do your daily activities, which will give your knee plenty of movement so it can heal well.

At this stage some pain is still to be expected, this is a rough surgery, and, recovery takes an average of a year.

Trouble sleeping is also to be expected for a while. There’s an article about it in our Recovery Guidelines.

At your stage I was taking 1000 mg of Tylenol every 6 hours, including a dose during the night, and I alternated with Ibuprofen, also every 6 hours (but only during the day) which gave me pain medicine every 3 hours. I still had pain but it was manageable.
 
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Jah66

Jah66

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thank you! It was my right knee that had TKR. Due to AVN from 16 months of high dose steroids 2002-03 for autoimmune disease (in remission).
The reason i'm doing so much PT is that my surgeon's office is considering MUA - next appt 12/9. Im trying to avoid that as i'm due back at work 12/20. And anesthesia affects me badly. And i cant take prescribed pain medication afterwards if it will cause increased pain!
I will definitely try to add in the tylenol mid day to see if that helps w the aches/pains tho.
I've always been hard on myself - yoga 6-7 days a week for years. Situps / pushups 4 x /week. Aging gracefully isnt easy!!
thanks again. i will continue to read others posts -- helps a lot.

= )
 

sistersinhim

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Too much exercise has the opposite effect on ROM. It causes more inflammation in those already inflamed soft tissues. That increases swelling and pain and that harms your ROM. The best way to improve that ROM is to rest, elevate, and ice that knee. That allows the fluid in there to go down. When that happens the ROM improves. Think of a water hose that you have filled up and kept the nozzle closed. Try to roll it back up. You can't. The knee is the same way. Get the water out and it will move so much better.
 
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Jah66

Jah66

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OK - but what about my surgeon office sweating that ROM and wanting to go back in and crack me? Looking at your signature - I think you may know more than them tho ... = ) that's a lot of surgeries!

Makes sense tho - as the stretching of the knee causes a decent amount of pain and in the back of my mind, i'm thinking "that cant be good!". I will ease off the PT this week and see if I feel a difference.

I appreciate your input !! thanks !!
 

sistersinhim

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I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!
 

Celle

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OK - but what about my surgeon office sweating that ROM and wanting to go back in and crack me?
It's your knee, not your surgeon's, and he can't do anything without your permission.
Tell him you'd like to wait a bit longer.

Try decreasing the exercises (specially the squats and strap-assisted bending) and spend more time resting, icing and elevating, to try and decrease the swelling that is preventing your knee from bending further.

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 knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase naturally.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

You are in charge of your knee's recovery, not your surgeon and not your PT therapist. While they can advise, you have the right to choose whether or not to accept that advice.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

It's a great temptation to think that the harder you work at rehabbing your knee, the better the result will be but, unfortunately, that isn't so after a knee replacement.
Knee recovery - Lose the Work Ethic!!

Complete recovery from a knee replacement takes a full year. Although you'll be able to do most things long before then, you are here for the long haul. The good thing about that is there's no need to rush anything. You have plenty of time for improvements.
 
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Jah66

Jah66

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Im so glad to hear this. I've been feeling a bit "behind" in my recovery due to surgeon/PT input. Lately the more and more i stretch, the more my incision hurts. I have been using coconut oil and lotions during the day - but man the pain there is unbelievable - esp while stretching my knee w force. My PT guy advised me to "SCREAM thru the pain" and just BEND the knee!! It's very hard to inflict pain on oneself. = (
So I might just cancel this 4 week MUA appt on 12/9 and let them put me back to work on 12/20. i have a desk job and can walk around as needed.
I've been reading the bonesmart 'not to do' PT exercises and am pleased that pulling the leg while lying face down with a strap is not recommended. I am crossing that off my list! I am going to reduce my squats too. I've been as worried about the strength of the leg as i am about the ROM! I dont want to hobble the rest of my life!
But it appears that the more I do, the more inflammation/pain I am causing.
I'm so happy I found you guys. = )
 

Celle

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I've been as worried about the strength of the leg as i am about the ROM! I dont want to hobble the rest of my life!
You will lose a bit of strength at first, but it will gradually come back, as your knee recovers and as you use it in your daily life.

The first thing your knee needs to do is heal from major surgery. At this stage, forcing painful exercises on your knee is just slowing down its healing.

It's too soon for strengthening exercises. "Heal first, then strengthen" is the way to go. You can start strengthening exercises at about 3 months post-op.
 

Jockette

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I'm almost 55 years old and was (would like to be again) quite active prior to surgery.
The biggest thing I’ve learned through my replacement experience is that there are many different/conflicting opinions about this rehab. But that’s all they are, opinions. Your opinion counts, too, so you get the ultimate choice to do what you feel is best for your knee. Give your knee the time time it needs, you will be active again, but you must heal first.
 

Celle

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My PT guy advised me to "SCREAM thru the pain" and just BEND the knee!! It's very hard to inflict pain on oneself.
Your PT guy is wrong.

Doing it his way would just increase the inflammation and swelling in your knee and that would prevent it from bending better.

Slow and gentle progress is the way to go - and you won't get that by forcing your knee to bend.

It's not even 2 months since you had this major surgery and ROM can continue to increase for a year, sometimes even longer. There's no need to rush. You have all the time in the world for improvement.

Have a look at what bertschb wrote about the slow development of his flexion:

I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!
Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees
I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.
 
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Jah66

Jah66

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thank you!! it's been a few days since i've been easier on the PT and myself. = ) Still have a lot of pain at nite - but I'm enjoying yoga (amending poses as needed) and have looked into QiGong exercises to try to broaded my 'less violent' options. I so appreciate all your input and replies. = )
Im giving myself the break that you've all recommended. I do feel better MENTALLY - not feeling inadequate or behind w PT and ROM.
You are all angels in my book! = )
 

Celle

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Try not to let anyone make you think you are behind or inadequate - because you are not.

All that's happening is that your knee is recovering on its own schedule, not on some artificial, one-size-fits-all agenda.

Your knee knows what it's doing and it's going to finish all right - just give it the time it needs.
 

kneeper

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For my OS, 90 by 6 weeks told him I was on the right path. At that point, he said just keep doing what I was doing-- the heel slides and increased activity as the knee allowed. I continued to gain bend over the next several weeks without doing anything dramatic.
 
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Jah66

Jah66

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Hello and I’m in very much the same boat w TKR 9/28/20. The only nights I get sleep is when I’m totally exhausted. The pain is sporadic and not caused by anything specific. I’ve stopped aggressive PT, gentle yoga and stretching only. I can fall asleep but 3-4 hours later I’m awake with pain. I sure hope this is normal! Pain meds are limited to naproxen/Tylenol. Lately I use heat vs ice as it’s hard to tolerate ice in winter. My question is WHY is the pain still so bad at almost 10 weeks post op? Is it normal? i see others say they still have pain months after their surgery. Very disappointing, I hope we all feel better soon!
 

sistersinhim

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Lately, I use heat vs ice as it’s hard to tolerate ice in winter. My question is WHY is the pain still so bad at almost 10 weeks post-op? Is it normal? I see others say they still have pain months after their surgery.
Unfortunately, pain is still common on a knee as young as yours. At one month out, your knee is only about 1/12 of the way healed. We have found that heat causes more inflammation in the early months of a TKR. That inflammation is causing more pain and swelling. Ice reduces inflammation and swelling. You should wrap up in a blanket or use an electric throw, anything that helps you keep warm. But, you need to ice and elevate that knee.

Also, doing too much too soon causes increased inflammation, swelling, and pain. Cut back on your activities. I was alone most of the time during my recovery and quickly learned that too much activity led to an extra painful knee. Listen to your knee and learn from it. It is the boss of you for another few months. Obeying it will make the both of you much happier!
 

Celle

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Lately I use heat vs ice as it’s hard to tolerate ice in winter. My question is WHY is the pain still so bad at almost 10 weeks post op? Is it normal? i see others say they still have pain months after their surgery. Very disappointing, I hope we all feel better soon!
Although heat is comforting at the time, unfortunately it does tend to increase swelling in your knee, which isn't a good thing.
Since icing isn't easy to appreciate in winter, try just using something cool, rather than frozen - or put more layers of material between your skin and the icing medium.

Although at 10 weeks it seems as if you've already been recovering for an eternity, you're really only a short way into recovery. Your knee has been through one of the most major surgeries it could have and it's going to need a long time to recover. This is what you had done:
TKR surgery - WARNING: real life photos

This isn't the sort of recovery you can bounce back from in just a few weeks, it's a year-long recovery. Where are you in recovery?? (TKR)
 

kneeper

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I used heat on the thigh muscles but not on the knee itself. Sometimes when you're in pain you unconsciously tighten your muscles and heat can help you relax. Maybe you can try ice on the knee and heat on the muscles a bit away from the knee itself to avoid the potential issues Celle and sistersinhim mention above.
 

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