PKR 2happy's Recovery<<'

[Celle]

That sounds like a good follow-up appointment. Well done!

 

[zzevi]

@2happy it's nice that your dr, did ask you not to over do it. Your lucky most of us have been given the lecture of pushing ourselves or face MUA. Glad to hear it all went well for you.
It would be nice if somehow we could get the surgeons and P/T to understand better the patients side of recovery, wonder how much of a input in the information that is written and provided to us is written by people who've went thru tkr. At least when you return to the health care field as a nurse you will have more empathy after this journey. Sometimes it takes a person to go thru an experience before than can show empathy in those situations. I am speaking more on the ones that actually preform the surgeons and rehab, but we all grow from being thru an experience like this.

 

[2happy]

@zzevi , you are correct about having to experience knee replacement to fully understand the pain, rehab, blues and the expectations of MD / PT. Physical therapy session last evening was interesting, I told PT I was not going have my knee forced flexed until I was in pain and near tears....she seemed shocked. I was asked to stop using cane 'because it is holding you back'. Hubby voiced his concern is limping and listing to side acceptable because I had tried not using cane. I said I would try not to use cane but if my hip starts hurting them I am back to cane..
Ugh it's all about PT expectations but I don't want to go backwards

 

[zzevi]

I am easily influenced, and this whole experience soured me on professionals. You go thru so much and all any of use expect in return is treatment that will be beneficial for our recovery and honesty in our recovery process. I remember telling p/t in the beginning I want you to be honest with me. Which I think opened the door to take advantage of my down and out feelings during recovery, they could easily make me feel bad after a session, by just saying I wasn't were I should be at x amount of weeks with my ROM. It also seem to be them pushing and expecting better, don't think after the first couple sessions that they ever felt I was doing as well as I could. I guess with so many of us having the same issues regarding p/t it must be in the way they are taught in their schooling. That in order to achieve results you have to make the patience feel they are not doing enough towards their recovery. To make you feel that you need these extra p/t sessions, which keeps them in business and gives them a job. I look at it now as a form of sales, they say and do what ever it takes to keep you coming back.
I don't look at using devices that help you as a way of being held back. I used my walker (it was a rental )until my husband thought I needed to return it, but it gave me a lot of support in those early recovery days, I used a cane also, but gave that up fairly soon. But I got myself this device to help get socks on my feet and I kept using it till I misplaced it while cleaning for Thanksgiving, love that device there will still be days that I will use it again in the future when I am stiff, but I needed something to help me get over the hump in recovery and allow me to be independent. Otherwise I needed my husband's help to get my socks on for a while.
I feel like I give the impression that movement is bad during recovery, I actually did more than my share of regular everyday living, so I really wouldn't have needed all those p/t sessions looking back in hind sight. I worked harder at getting ahead, which really put me behind. Because most days I probably over did it, and had more swelling and didn't ice and elevate as much as is recommended on here in the beginning. I've been a slow learner. I think the best way is just going about daily living and doing the elevating and icing a letting our body heal from the trauma of surgery. P/T is fine, but you can't allow them to push you or hurt you, or bully you that your not working towards your recovery hard enough.

 

[kneeper]

I was asked to stop using cane 'because it is holding you back'. Hubby voiced his concern is limping and listing to side acceptable because I had tried not using cane. I said I would try not to use cane but if my hip starts hurting them I am back to cane..
Ugh it's all about PT expectations but I don't want to go backwards

I think your husband is right. Better to use the cane with an even gait than limping and listing without. My PT told me there was no rush to ditch the cane for that very reason. I bet you'll naturally find yourself needing it less in the next couple of weeks.

 

[Celle]

Using the cane will not hold you back . I disagree with your therapist. There's no need to try to conform with her/his agenda.

If you are still limping, you need to use the cane until you can walk without limping. Try not to put weight on the cane, but just use it to steady you and prevent falls.

 

[2happy]

Now 7 weeks post op. Flexion 90, extension is good, started doing steps...walking without cane and less limp. Yesterday at PT they started 'cupping', supposed to help with swelling and pain. Knee felt great after, extension improved and knee less stiff. My sleep is same 4-5 hours then pain wakes me.
Anybody else try 'cupping'?? Anybody tried 'dry needling'??

 

[Celle]

Cupping after a TKR is unusual.

There is a specific reason for dry needling.. No need to have it done routinely.
Dry Needling Technique
Frankly, I wouldn't let anyone stick needles into my knee so soon after this surgery.

Your knee will heal in its own sweet time, without these added procedures. All it needs is time and gentle treatment. Nature is very good at her job of healing and will do a good job, without needing any intervention.

 

[2happy]

@Celle.....I am not doing dry needling even though Ortho recommends it. Where I go for PT they do cupping on a lot of knee patients, all that have spoken to says it helps. PT used 3 cups on medial side and I can saltiness sceptical but I saw improvement..I have no bruising.

 

[Celle]

That's OK then.

 

[2happy]

Puzzled, woke up this morning with swollen hot knee, painful to walk. I massaged knee to get flexion to 90. I have taken ibuprofen and alternate with Tylenol. I try not to use the oxycodone. My husband said he could hear me tossing and turning all night. As day went on the swelling decreased and the knee not hot..I have not slept more than 2 hours during night for last 3 nights due to pain and restless leg. Advice appreciated !!!

 

[Celle]

Have you increased your activity in the last few days?
I'm going to ask @Josephine to advise you.

 

[Josephine]

My husband said he could hear me tossing and turning all night. I have not slept more than 2 hours during night for last 3 nights due to pain and restless leg

That's a pretty good indication of under medicated low grade pain.

Perhaps you would answer some questions for me, if you don't mind, and 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)

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?

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.

 

[2happy]

@Josephine
1- at rest pain 4-5, with activity6-8
2- Tylenol 1000 mg every 8 hrs, Aleve 1 tablet morning and night (220mg ?)
3-slight with minimal activity
4-flexion is 90, extension is normal
5-icing and elevating throughout day
6-elevate whenever I am not on it, my activity level is 20-30 minutes of activity then rest
7-I do short spurts if activity none greater than 20-30 minutes
8-exercise at home : heel slides, go from sitting yo standing position 2 sets of ten twice a day, walking around house, sitting and massaging knee to get flexion 3-4 x day
PT exercises, was going 3 x week, referral at 6 week follow up indicate 'aggressive' PT but put 2x an. I have 40 minutes of exercises: heel slides, hamstring pulls. slides leg to side, all are 15 times, quad stretches 15 times, heels on big ball and slide back 15 times, squats 2 sets of ten, one step with rt knee 2 sets of ten, wall slides 10 times. No bike yet. PT dies flexion of knee while I lay prone
I do not use cane unless I am out of house where there may be crowds.
My Ortho says my recovery will not be typical due to previous surgeries ( last November had neuroma of Inferior saphenous nerve excised and had 2 scopes with meniscusectomy and chondroplasty)

 

[2happy]

@Josephine forgot I take oxycodone 5 mg as needed but usually with PT, trying not to take

 

[Josephine]

1- at rest pain 4-5, with activity 6-8

Ooh! That's high!

2- Tylenol 1000 mg every 8hrs, Aleve 1 tablet morning and night (220mg ?)

You're clearly under-medicated, my dear. If you're going to cope with Tylenol, then take is every 6hrs. But I think you need something more than that. And Aleve (naproxen) is only an anti-inflammatory and not a pain killer.

3-slight with minimal activity

okay and what with more activity?

4-flexion is 90, extension is normal

I think your swelling is probably internal so hence the reason for the low ROM.

5-icing and elevating throughout day
6-elevate whenever I am not on it, my activity level is 20-30 minutes of activity then rest

You haven't told me how you ice/elevate for!

7-I do short spurts of activity none greater than 20-30 minutes

activity doing what?

My comments in bold
exercise at home :
heel slides -heel slides are very easy to do badly - read this Heel slides and how to do them properly.
go from sitting to standing 2 sets of 10 twice a day - much better you just do these naturally when you are getting up to go to the bathroom or kitchen. Doing 20 is too much in one go. And once a day is plenty
sitting and massaging knee to get flexion 3-4 x day - do you mean you are pushing your knee to flex? This is not a good thing to do. Much better to allow it to come with normal activity
walking around house - walking round the house for its own sake is poor therapy. Walking when you need to visit the bathroom or get something from the kitchen and so forth is much better.

PT exercises, was going 3 x week, referral at 6 week follow up indicate 'aggressive' PT but put 2 times.
40 minutes of exercises:
heel slides x15 - see above
hamstring pulls x15 - do you mean stretches? They're okay but no more than 15 at a time
slides leg to side x15 - not a good exercise - causes pain
quad stretches x15 - not a good exercise - causes pain
heels on big ball and slide back x15 - not a good exercise - causes pain
squats 2 sets of 10 - not a good exercise - causes pain
one step with Rt knee 2 sets of 10 - not a good exercise - causes pain
wall slides x10 - definitely not a good exercise - causes pain
PT does flexion while I lay prone -and this is the biggest no-no of all!

You really don't need all these exercises and I strongly recommend you quit the PT and stop doing exercises at home, with the except of gentle heel slides. Because it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success. Read this BoneSmart philosophy for sensible post op therapy

My Ortho says my recovery will not be typical due to previous surgeries (last November had neuroma of inferior saphenous nerve excised and had 2 scopes with meniscectomy and chondroplasty)

Really? I don't see why. The neuroma is something and nothing and the area that had the chondroplasty is no more so I really can't see why they should influence your recovery at all!

 

[2happy]

@Josephine
I am almost 8 weeks post op so my concern is the continued pain. Should I take the oxycodone, I get tight feeling like vice around knee when I am up on it to do cooking or just for exercise. I am confused if this feeling is pain, which leads to no sleep at night.

re : questions
I ice for 30 minutes throughout day leg elevated. My activity is indoor walking to and from bathroom, cooking, dishes, and to therapy.
I noted your comments on PT. I guess it's good I only go 2x week, and I have to attend since my injury is a workmen comp case and adjusted is not a sympathetic person, so I have to have progress documented.
I was injured working as pediatric RN from careless co-worker.

Thank you

 

[Celle]

That tightness is another way in which you feel pain. I think it's telling you that you are doing a bit too much for this stage of your recovery - particularly if it's disturbing your sleep at night. You think you're getting away with doing things in the daytime and then your knee says "I'll get you for this later," and keeps you awake and uncomfortable at night. Your knee's giving you a message, so listen to it.

Since you have to keep going to PT, take control of what you do there. Ease off all those exercises you've been doing and just do a few gentle ones. Your knee doesn't need the exercises anyway.
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.

You need to ice for at least 45-60 minutes each time for it to do much good. The longer you can ice, the better. You won't do any harm by icing, as long as you have some material between the icing and your skin, so that you don't get frost bite.

 

[2happy]

@Josephine Thank you so much, wasn't sure what tightness was. One more question : at 8 weeks post op is it common to still need oxycodone?

 

[KarriB]

You may find if you ease off the exercises at home you won't need the oxycodone or as much because that tightness and pain will diminish. Every one and every knee is different though.