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[TKR] 4th week major backslide?<

Discussion in 'Knee Replacement Recovery Area' started by plaidwndr, Sep 12, 2018.

  1. plaidwndr

    plaidwndr junior member
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    Hello

    I had a TKR in my right knee on August 15th. Surgeon had me start PT a week after, and things were very smooth for the first 3 weeks of recovery. Last week, I was very excited for how things were, I could take long strides when walking around the house - even if only for a few minutes at a time before it wore out. Swelling was very minimal. I even got a few items at the grocery store, and was only mildly uncomfortable by the time I got back to the car. I could go all the way around on bicycle after a minute of rocking to warm up.

    At the start of my PT appointment on 9/7 I had 120 flexion, and 2-3 from zero on extension.

    Then came "we need to get those last few degrees straight right away" They had me prone hang for 2 minutes, which was getting things agitated. Then was another straightening exercise on the floor. My heel in a band attached to something, then I pull back so there is a slight tug on the leg. Grab the shin and tilt laterally, then quad set and push down on shin. Repeat 20x.

    After this day the knee was far more agitated than it had been, and I did not even want to walk around the house. On Sunday I was feeling that I had recovered from the extra soreness.

    PT appointment 9/10 I told them it was too much last time and they said that we would not do the prone hang as it was the most aggressive thing. The on floor tilt, quad set, press down they suggested helping me with the tilt/push-down to make it easier. We got to 10x and I had to call it off as it was very agitated.

    My knee swelled considerably after this. So much for going to straightening as with the swelling I am far less straight! No more long strides with my steps either. I started icing again (had stopped because it was so good) and called in to surgeon's office. The return call after them checking with doc was to continue ice/elevation and to stop other therapy and try the stationary bicycle for 30 minutes 2x a day to get rid of the swelling.

    I did a few blinks at that and asked if they were sure. They said yes, it would pump out the fluid. This just seems a bit much. I've done 8 minutes in PT - I actually can't go fast enough to even make the bike turn on. I know with that short if I lose track and start going a bit faster that I get sore.

    So now it's 2 days after that PT appointment, and the swelling is still a good 50% worse than usual. I did a little of the stationary, but around 12 minutes it just doesn't feel good, it certainly didn't get rid of any swelling.

    Any thoughts?
     
  2. DLR

    DLR graduate

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    Sounds like you need to stop everything but icing and elevating. Remember to ice the back of the knee too. I was getting very inflamed a week ago and my PT told me to ease off and just focus on getting the pain and swelling controlled. It has helped so much this week. My surgery was the day after yours. Be kind to yourself let your knee heal
     
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  3. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Oh my, you were doing so well until PT got their hands on you. PT is so unnecessary and this painful therapy actually sets your recovery back. It's doing you more harm than good. I will leave you our recovery articles. Following these will help you to have a less painful 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
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    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. Here is a week-by-week guide for Activity progression for TKRs


    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.
     
  4. plaidwndr

    plaidwndr junior member
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    From reading those it seems like 2-3 from zero on straightening isn't even something to worry about at all. Why would they be so obsessed with it?
     
  5. Jacimarble

    Jacimarble junior member

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    If only there were a magic formula for getting the balance right between "enough" and "too much"!! Yesterday I crashed and had a very tired, grumpy, frustrated day - I even ended up going back to bed for an afternoon nap, which I haven't done for a couple of weeks. I've been pushing it a little, to try and get to the stage where I can drive, but it backfired on me! I have PT today - if he tries to get me to do anything too much he is going to get a very firm No. Or he is going to have tears flooding his office!
     
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  6. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Your experience is exactly why I won’t go to PT next time. I wil recover better without them and with less needless pain.

    Physical Therapy can be helpful, but is NOT necessary to do in order to recover from a knee replacement. Not all surgeons prescribe PT. It all depends on their opinion about it. And there are many opinions. Which means there is not just one way to recover. Which then means that you get to choose how you will rehabilitate your knee.

    Physical therapy is an option, not the requirement we thought it was.

    Many people have not gone to PT but have used the movements within the normal course of their activities to rehabilitate their knee. It’s done as they are able, as they heal.
     
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  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

    All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!
     
  8. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I had my own PT set backs. Not next time.
     
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  9. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @plaidwndr, you asked
    It’s because this PT group gets evaluated by achieving certain goals, one of which are the ROM numbers. That’s why it’s important for YOU to clearly establish what you expect and want to achieve. If you don’t, then you put yourself at their mercy and you see what happens. In my case, I made it clear there would be NO pushing on my knee and there would be no activities that cause pain and add to swelling. To the contrary, their focus would be to reduce swelling and to aid with improving flexibility (you notice I didn’t say ROM). They achieved this by doing more stretching and massage than activities that are geared towards building strength. That is not what is needed right now, down the road (a long way down) there will be time for those. Up to you, do you want to experience that again or do you want to take ownership of YOUR rehabilitation?
     
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  10. plaidwndr

    plaidwndr junior member
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    I remembered something else that was new in the last two visits, balancing heel to toe on a 2 inch foam pad. When things were going so great all we were doing was some gentle stretching, quad sets, and massage! I guess they don't adhere to it if it's working well, don't mess with it.

    After reading all the articles, especially on swelling - it seems insane they would try and push for 2-3 degrees of extension. I bet once the swelling goes down it just automatically gains that much.
     
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  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    EXACTLY so!

    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  12. plaidwndr

    plaidwndr junior member
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  13. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    Using a static bike for mobility exercises
    • Set the bike to zero resistance
    • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
    • Gently turn the pedals, through discomfort but without pain.
    • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
    • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
    • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
    • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
    Here is a bit more chat and some pix and how 'healing' and 'training' are different

    My take on ROM, Extension and Quad exercises http://bonesmart.org/forum/threads/rom-and-extension-stretches.13159
     
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  14. plaidwndr

    plaidwndr junior member
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    If these are the ones I see in other threads I'll go ahead.

    1. 3-4 pretty much always since Monday. Pretty much zero last week (

    2. vicodin 5/325, haven't taken any since 2 weeks(which was only at bedtime. Daytime I think I stopped on day 4)

    3. Leg? not really except within 2 inches of knee, I'd say mild overall with lumps of moderate.

    4. 120 flexion, 2-3 from zero on extension

    5. Yes, I started again this week. I can get about 5x a day in with the icepacks I have, I just leave it on until I move or its completely not cool 40-50 minutes I'd say

    6. Yes, I had been just keeping it up on couch/bed. This week I started a pillow stack again. It stays elevated except when moving around house, about 95% of the day.

    7. This week, very limited. Warm up some food, but not actual cooking. Couple drive through trips. Much less than last week.

    8. I haven't since Tuesday when I did the stationary and it didn't fell great either. PT appointments cancelled per Dr, but I can't do the insane 60 min a day stationary he suggested!
     
    Last edited: Sep 13, 2018
  15. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Oh, jolly good! Thank you. Much appreciated!

    Not bad for 4 weeks out!
    You should be taking something because even that level of pain is bad for your knee. Try just taking Tylenol 1,000mg every 6 hours.
    See you do have some swelling and I hope you noticed my notes that swelling is pain so you must treat that too.
    Excellent!
    Okay
    Toes above nose, I assume?
    Good, good
    I should think not! There have been many of us on here that did our recovery with no exercising (or PT) at all! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)
     
  16. plaidwndr

    plaidwndr junior member
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    Not quite but close, I've got a tall torso so I'd really have to lay back.
     
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  17. plaidwndr

    plaidwndr junior member
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    Oh I also have to say that I think the Dr. oversold the "minimally invasive easier recovery" spiel. He told me his last patient in my age group was hiking a small local mountain at 5.5 weeks.
     
  18. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @plaidwndr, don’t discount that claim, it’s still possible. Some people heal faster than others. I hiked a little over a mile and a half (half way) up the Watkins Glen gorge and back down at a little over 8 weeks. Paid for it for a few days, but I knew that going in. You can read about it and see pics in my thread. PKR is not quite as traumatic as TKR since the entire knee is not replaced, but it is close enough, I agree.
     
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  19. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Surgeons and the manufacturers of the implant often oversell the "easier " recovery.

    While there may be a few lucky people who do recover faster, I believe the majority of people still find that recovery is a long, hard grind.
     
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  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    @plaidwndr No disrespect to NavyGuns but there is a fair difference between 5½ weeks and 8 weeks! A lot can happen in 2½ weeks!
     
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