TKR Amy's Right Knee

[kneeper]

How's it going?

 

[Celle]

@Josephine
RunWithSmoke has answered your questions, in Post#17.

 

[Josephine]

At the worst times now I would say about a 5. Other times it's about a 3

okay - I think maybe you're not telling it as it is but I'll accept that!

Celebrex didn't do anything for my pain and it also made my stomach hurt.

If it gave you gastric pain then you should not EVER take NSAIDs. Read this t understand why and see the huuuge list of NSAIDs in there. Stay away from them as they are dangerous for you.

my husband had some hydrocodone tablets leftover from another procedure. I'm not sure of the strength, but the label says 10-325 sub for Norco. I took a half tablet of the hydrocodone. It helped a lot and I've been taking a half tablet twice a day for three days.

Half a tablet? That's not enough! When you get the new prescription, please make sure you take them as prescribed.

3. I ice my knee 4 times a day for 20 minutes.
4. I elevate my leg 5-6 times a day for 30 minutes.

You accomplish little or nothing in 20 minutes. Ice and elevate for at least 40-60mins at a time and more than 4 times a day.

I can bend my leg very well, and it seems like it was at about 125, but straightening is hard. I work on it a lot though.

Please DON'T work on it! That's the way to get lots of pain. Just rest it, ice and elevate and take your pain meds.

doing yardwork, and I have done some sweeping and raking in the driveway and front yard and picked up branches in the woods on the side. Also, I go upstairs, a full flight, about six times a day.

Honey, you're only 6 weeks out. Far too early to be doing yardwork and such. The stairs are okay though as long as you do them carefully one at a time. No rush.

My comments in bold
Exercises done at home: 2 sessions a day - one session a day is quite enough and take rest days on Saturday and Sunday
Heel slides x24 (reps) - the absolute worst way to do heel slides. Read this Heel slides and how to do them.
Quad presses x30 - 10 do only, that's quite enough
Straight leg raises x10 - you know, once you can do SLRs, you don't need to do them any more! You cracked it,leave it be!
I stand on step with heels hanging and stretch the back of my legs. x30 - this is designed to cause you pain in the calf and knee ligaments. Please don't do it
Toe taps, front back, side x30 each - don't know what these do, never known them used before! Are you learning to tap dance?

My summary is that you are doing far too much exercise, not taking enough pain meds and not icing/elevating enough. Please bear in mind and believe me that you don't have to 'work hard' for ROM. It's there, just waiting for you to let up so it can reveal itself. And it will if you give it a chance. I promise you that.

 

[RunwithSmoke]

Josephine,

Thank you so much for all of your advice! I've been off the forum for awhile, but I will check back daily starting today.

I've been overdoing it again. In fact, the reason I got back on here tonight is because the knee is swollen and hurts. There are so many people who, when they hear I had a TKR, tell me to be sure to do all of my PT and to work hard at it as early as possible, and keep working at it, or I won't get my best ROM. I've heard this from about 15 people. It's hard to ignore all those well meaning words. I know they are wrong. You, the forum here and my knee are telling me that they are wrong. I am so impatient. I just want to be well.

I have been taking my pain med, hydrocodone, as prescribed. I'm cutting back on my ROM work, as I think that is what is causing me the worst inflammation, particularly straightening. I guess I just need to have faith that it will come. Will my knee ever be able to straighten? I'm worried that it will stay bent.

I didn't know that about NSAIDS. I will avoid them.

Thanks again,
Amy

 

[RunwithSmoke]

Celle,

Yes, that makes sense about pain being a warning. I am not very good at heeding that warning until the pain starts shouting at me. When I want to move from chair to other chair to bed to chair, etc., I know I have done way too much and I am trying to run away from pain, which does not work. I have taken it very easy today, but need to elevate more. I changed my signature.

Thanks,
Amy

 

[RunwithSmoke]

I have stopped trying to straighten my knee and leg and have been elevating and icing the knee for longer and more frequent periods. The swelling has gone down and the pain is reduced. It's nice to feel better. I just worry that my leg will never be straight. :(

 

[referee54]

just worry that my leg will never be straight. :(

It will be---these things do take time and try your patience.

Patience, Grasshopper, Patience!!!

 

[referee54]

Have you tried gentle (and I do mean gentle!) hamstring stretches?

I had issues with extension after my BTKR, and I would lie face down on my bed with a heating pad on one of my hamstrings. I would then hang the leg over the edge of the bed and let gravity slowly and gently stretch the hamstring. I also used very small ankle weights later on to help.

After I did this, I would ice and elevate the knee.

 

[newlybionic]

I'm so sorry to hear about all your problems. I hope things get better soon for you. I have been learning the hard way what to expect during my recuperation. It looks like I'm about 6 weeks ahead of you. Don't do more than what you can handle. Up until weeks ago I had ice on my knee as often as possible. I left the pack on for at least an hour. It did help with the pain. I would suggest you find a therapist that really helps you. I've learned also that if I'm told to do something 10 times that didn't mean 20. Stop when it starts to hurt. I have suffered from depression for several years and I felt so low because I wasn't healing as fast as I thought. There are many sites that say in 3 months everything is wonderful. Don't let that get you down. Read through many of the threads here and you'll see that seldom is the right answer. You do have people that will recover in that time but the majority take longer. Stay strong.

 

[RunwithSmoke]

I do the exercise where you hang your legs over the end of the bed while laying on your stomach. I do the knee exercise in bed where you flex the ankle, tighten quads, press knee down. I do the exercise where you put your feet on a stool and let gravity pull your knees down. I try to stand with my leg as straight as possible. I feel the tightness and the slight lengthening, and I see that the leg looks a bit straighter.

However, I'm afraid that, while these things may be helping my leg get straighter, they are also causing a lot of inflammation. My knee became much more swollen, dark and painful a few days ago, and it was probably due to me doing those exercises with too much gusto. Thankfully, the knee is a little better tonight since I've been resting it for a couple of days.

But I feel damned if I do the exercises, damned if I don't. It's frustrating and scary.

 

[Josephine]

There are so many people who, when they hear I had a TKR, tell me to be sure to do all of my PT and to work hard at it as early as possible, and keep working at it, or I won't get my best ROM. I've heard this from about 15 people.

Well you can't really blame them. This myth has been trumpeted loudly and often by the medical fraternity at large that it's moved into intransigent folklore! But now you know better.

I am not very good at heeding that warning until the pain starts shouting at me.

Think of your knee as a toddler who's being made to walk round the shops - I have the perfect image for that

I do the exercise where you hang your legs over the end of the bed while laying on your stomach. I do the knee exercise in bed where you flex the ankle, tighten quads, press knee down. I do the exercise where you put your feet on a stool and let gravity pull your knees down. I try to stand with my leg as straight as possible. I feel the tightness and the slight lengthening, and I see that the leg looks a bit straighter.

That's three exercises for the same objective. Look at the image above and then rethink this. Do ONE of them and not too much. I suggest the foot on a stool hang.

What is your extension, anyway? If it's anything less than -8, then don't worry about it. It will sort itself out on it's own if given time and NO pressure (for which read exercise). Problem with exercising for extension is that it creates pain and swelling which reduces the measurement exponentially, meaning the more you work at it the more it swells and the lesser result you get. Sound familiar?

But some advice: whatever exercise you choose
1. don't do it when it you're in pain
2. only do it 2-3 times a day
3. do only 2 reps at a time with at most a 10 second stretch as long as it's not hurting
4. stop as soon as it hurts
5. remember that normal walking is the best remedy for reluctant extension

 

[referee54]

But I feel damned if I do the exercises, damned if I don't. It's frustrating and scary.

I think it is important to stay within the envelope---we want to recover faster, and deep down inside of us, we feel that we need to work hard to move forward.

Simply fight the urge to work hard---it is not about "working harder"---you have found what it does to your knee---and to yourself, too. By 'working smarter", you can move forward---slowly---but it is moving forward all the same.

As Josephine has stated, "Less is more" and it works.

 

[Thesoutherncook]

Josephine and Celle and the other advisors are exactly right! Do as they say and you will be FINE!
I'm at 3 mon and still have a little less extension than I would like, but I can tell it gets sloooooowly better each week. Hang in there, check in with @Braunzie who is always in search of that elusive PATIENCE ATM. When she finds it, we are ALL storming it!

 

[RunwithSmoke]

Aaah, Josephine, thank you. I'm thinking I will walk then, and do the "put my foot on the stool" exercise just 3-4 days a week. So I should only put it there for two reps of 10 seconds each time, 2-3 times a day? I've been leaving it there for 15-20 minutes!

I walk around in the house and yard quite a bit, and enjoy it, so it's great to hear that that's the best remedy. I'll do my walking with plenty of long rest, ice and elevation breaks.

Is it true that it's ok to put a heating pad on the back of the thigh? My hamstrings seem tight.

I love your approach!!!

Amy

 

[RunwithSmoke]

TheSouthernCook, I certainly want a share of patience if Braunzie finds it. What a gold mine that would be! I'll have to poke around the forum and read about that!

 

[referee54]

Is it true that it's ok to put a heating pad on the back of the thigh? My hamstrings seem tight.

When we exercise, we talk about "warming up the muscles." By warming the muscles (either with light exercise or with heat) it makes the muscle more elastic---better able to stretch. You can then stretch the muscle more effectively.

I would ice the muscle after you stretch it to reduce inflammation.

Never, ever, apply heat to a joint---as heat will bring blood flow and fluid to a joint, causing it to swell more---but heating a muscle prior to, and during gentle stretches, will help you, as you are making the muscles to become more elastic.

 

[RunwithSmoke]

Referee54, I like what you said about fighting the urge to work harder. In my twisted mind, I'm thinking that is something I can work hard at, lol. I will work hard not to work hard!

And thank you for the advice about warming up the muscle, but never a joint. If I use heat I will be careful.

 

[referee54]

These articles should help you out:

Life in the slow lane
Lose the Work Ethic While You Are Recovering!
TKR: work “smarter” and not “harder”

 

[MimiMimi]

Goodness, what a time you have had! I hope you get to feeling better soon.

 

[RunwithSmoke]

Mimi, thanks. I just finished 21 days of wearing a heart monitor today. Yippee! The neurologist is still trying to find out why I had a stroke. They've scanned my legs, neck and heart (twice), and I'm looking good in there, lol. I think now they suspect atrial fibrillation, so I had to wear the monitor all that time to see what my heart is actually doing. I think the stroke happened during that terrible epidural they had so much trouble with. The pain was horrible, all the needle sticks for so long, and then the painful burning going down my leg. I was screaming NO, but they wouldn't stop. My adrenaline was through the roof and I tried to get away. I remember the relief when I felt the sedative start to take over. I will never have an epidural again.