MUA and still in pain

[Roy Gardiner]

Hi, Renew, I bet you're getting the message now ?

Don't do stuff that hurts. Simple.

 

[kneeper]

I think I iced something like 20 minutes on, 10 minutes off all day long. Also be sure you're elevating most of the time.

 

[Josephine]

Renew

​

One thread for your recovery please?​

As the notice says, I merged your two threads. This is because you had several answers to this question in your other thread but don't seem to have read them or taken notice of them. You were also given a set of recovery articles in post #3 but have you read those either?

What pain medications are you taking (name and strength) and how often are you taking it? Demoral 100mg

Is this all you are taking? You need something better than that. I suggest you have a talk with your surgeon and tell him this isn't working for you and can you try something else like Tramadol.

How frequently are you doing therapy exercises and what do you do? Three times a week for an 1-1.5 hrs with PT and then the exercises I am to do at home 3 times or more a day. Walk, knee bends using lower stair, knee lifts (put juice can under knee and try to lift foot), also push knee into can to strengthen muscle, bend knee put strap around foot and try to get knee to bend more

Far too much far too soon! No wonder your knee is swollen! Cut out the ones I have added a 'strike-though' on. Do them twice a day at the most.

How much walking around the house are you doing? I try to walk a little every hour or so

Far too much! Just walk when you need to visit the bathroom or get yourself a drink.

You need to rest, elevate, ice and take your pain meds by the clock a lot more and remember
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

At 4 weeks out, you are still in the middle of the 'angry tissue' phase and need to do less rather than more. Trust me, the answer to this is not MORE exercise but less! Read those articles in post #3.

 

[maryo52]

The bike is a great idea in most circumstances, but when someone's ROM is so impaired by swelling, even some pedaling may be too much.

 

[fisher01]

I've been worried too, Renew, about my ROM until i joined this forum! This forum is a lifesaver. I've learned so much! My PT is on a mission to get my ROM to 115 by next week (my surgery was June4). He pushes on it till I almost pass out. For what? To measure and log it in my notes. I get home and I'm in so much pain I need the next day to recover. SO, I'm taking control next week and may change PT if I have to. As someone posted, I am paying them; I'm the customer.

 

[bottomshollow]

fisher01, it's your body and you are in charge of it. No one should be causing you pain and misery. Your knee will get there in it's own time.

 

[Dulcimer Diva]

You will get there when you get there. (Sounds maddeningly Zen but it's true). 50 degrees flexion at one month suggests your knee does not feel it's ready to go further, for whatever reason--most likely swelling. Keep taking a steady level of pain meds to stay ahead of the pain, icing and elevating and doing only the gentlest of exercises: ankle pumps, foot circles, quad and glute sets, very slight lower leg lifts and very conservative heel slides (aided by putting a Baggie on your foot if you don't have a smooth slide-board). None of these should cause you pain--if they hurt beyond the discomfort you feel at rest, back off. Your knee is the boss, and we all know what happens when we make our boss angry, right?

 

[Renew]

Hi There: I had my TKR on May 30th have had major swelling and pain was only at 65 ROM, so on Aug 22 my surgeon did an manipulation. Now I am at 83 ROM but swelling is even worse and pain is almost as bad as it was after the TKR. I am really having a hard time. I am icing it and elevating it but no change in swelling. Can anyone help? I am getting discouraged and ready to give up. My husband is helping me with my exercises but it just doesn't want to bend. Please any help would be appreciated!

 

[maryo52]

My husband is helping me with my exercises but it just doesn't want to bend.

First, stop the exercises. They are feeding your swelling and inflammation, and the inflammation will inhibit your progress and feed adhesion formation. Goal number one is to deter the swelling and inflammation. How? Number one, rest. Keep your activity to a minimum. Any knee efforts should be gentle range of motion. I used a CPM machine and did gentle stretches only that were slow and which I held 30-60 seconds (10 stretches in the morning followed by icing, and 10 stretches in the evening, same icing routine). Scuttle any strengthening exercises for the first four weeks. There is no need to strengthen muscles when your problem now is stretching, and strengthening exercises will only cause inflammation.

Number two, NSAIDs will help with pain, inflammation and swelling.

Number three, how often and for how long are you icing and elevating? I'd suggest a minimum of 30 minutes every two hours, your toes above your nose!! Hopefully hubby doesn't mind trading his PT role for waiting on you hand and foot!

Number four, medicate adequately. If your surgeon is stingy about prescribing pain meds, then go to your regular doctor.

Another thing that helps psychologically and maybe physically is massage. After going through surgery, PT (which hurt), and manipulation, my knee was ready for some tender lovin' care, and lots of it.

Last but not least, the gains after a procedure like this are very very slow. Personally, I trashed the whole measurement thing. It made me feel too watched. It was better to try not to pay attention to the bend. The focus has to be on the process of gentle efforts rather than the goal of getting bend, because when we're hell-bent on bending, we push the knee and the knee rebels. It was weeks after my last intervention before I passed the 90 degree mark and I felt as though I was home free. You're already at 83 and so even two degrees a week, in a month's time, will have you past 90.

 

[Jamie]

Mary has made some excellent points! Your poor knee sounds like it's been worked pretty hard these past three months. My guess is that you've had this swelling all along. And, as we know....any swelling in your knee will limit your ROM.

So your first order of business is to get the swelling down!!! Make ice your new friend. Frankly, I'd keep ice on it all the time when you are not up. And you shouldn't be up and around all that much right now until things settle. Be sure you ice both the front and back of your knee and even at night when you're sleeping. Not only will the ice help with swelling, but it numbs the knee and reduces pain. Just be sure you don't have your ice source directly on your skin. There should be a kitchen towel or some fairly heavy fabric in between it and your knee.

The other really important thing will be to manage your pain properly. If you have prescription pain meds, go back to taking them on a schedule. If you don't feel you need prescription pain medication, you can use a combination of ibuprofen and acetaminophen. Here is a thread that provides a schedule for you.

Keep any exercises you do limited to very gentle stretches and bends. Anything more will keep the inflamation going. There is plenty of time for strengthening later. Don't push your knee beyond just a mild discomfort when you do your bends.

If you do this for a week or so, I think you will see some improvement in your pain and swelling. Improvements in your ROM should follow. Please let us know how you're getting along and don't hesitate to come here and post if you have any questions or concerns. We understand what you're going through!!!

 

[Roy Gardiner]

:iagree: with both of the above. Don't do anything that hurts your knee, or causes swelling over the 24 hours after doing it.

 

[Josephine]

Renew Yet again I've had to merge your threads. Please don't keep starting new threads as you then miss the replies you've had that people have taken the trouble to leave you. That's not polite. Also please read this explanation of why we prefer you to keep all your recovery stuff in one place and not scattered around the forum One thread for your recovery please?

 

[Josephine]

I would suggest that your present situation proves you did NOT have adhesions at all, just an excess of swelling and pain. Now your surgeon has made that worse and you are going to have to be pretty strict with yourself in the rest, elevate, ice and medication departments! Swelling can take a heap of time to settle down. It cannot be rushed, pushed, bullied or otherwise 'encouraged' to go away!

- take not only the NSAIDs Mary suggested but proper pain meds too.
- ice all the time you are elevating
- elevate most of the day
- only recommence exercises when the swelling is going down
- until then, do gentle stretches and heel slides, nothing more

 

[Renew]

I had my TKR on May 30 and got to a 65 ROM and then could not seem to get any further,
so on Aug 22 my surgeon did a manipulation and my first physio following that I had gained 20 more degrees, so I am now at 85 ROM was really happy. But thing is I am now experiencing a lot of pain today and having a real hard time walking on it and
awful pain when trying to do my bending exercises. My knee was and still is very swollen and I am getting very depressed crying at night and feeling like I have failed when it comes to my recovery. I am now having to go on EI as my sick time has run out and this is also a worry
as I really thought I would be back to work by now and now I wonder when I will.
Is this normal has anyone else gone through this? Does anyone have any tricks that will help
me increase my bend and also help get the swelling down. A very scared and nervous Total Knee Replacement Person Please Help!!!!!

 

[Deedles8]

I don't have your answers but will tag the wonderful Josephine and possibly she can give answers.

I hope you can find relief.

 

[Buddhabear]

Oh, yes, hang on- I can absolutely guess what Josephine will have to say - listen.

 

[Whimsy3]

Renew, I am so sorry you are having such a difficult time. DeeDee tagged Josephine and she will give you some great information. I do know that you can't rush your knee. I can offer you support and prayers for you.
Mari

 

[maryo52]

This is hard. And confusing. You got stuck in your ROM, had a manipulation, and then what? What's wrong is that the "professionals" believe they have to drive us hard in PT to beat the scar tissue, and that is dead wrong.

Beating scar tissue necessitates not allowing the tissues around the knee to get inflamed. So all our efforts must be directed at reducing swelling and inflammation: rest (no activity except what is necessary to eat and go to the bathroom); elevation; frequent icing (front and back of knee); NSAIDs. And what about PT? Only gentle stuff. No strengthening exercises are needed now, and doing them will cause inflammation so don't do them. Do only range of motion twice a day: straightening and bending just to the point of discomfort (no pain!). Medicate adequately for pain.

Please trust me. I've been where you are except I didn't follow this method. I continued to go to PT and have them push my bend and my scar tissue re-established itself.

The knee will improve its bend but only after you've gotten the inflammation and swelling down, and then the progress will be slow. Think about this: 2 degrees a week is a snail's pace, but 2 degrees a week for 10 weeks is 20 degrees and that's a big improvement. So think like a snail, proceed like a snail, and you will surely get there.

I'll let Campervan detail her slow but sure ROM progress for inspiration.

 

[Clarrox]

I too still have a lot of swelling, and I am almost 5 months post-TKR. There is no longer any pain when I walk, but bending my knee still hurts. I think I'm at about 105-107 ROM. I am reading, listening to and following the wisdom of folks on this forum. Maryo52's snail is progressing faster than I am. But I'm no longer discouraged about that. When I start to sink into that awful feeling, I try and shift gears and focus on what has improved. After years of pain, it's so easy, for me, to only listen to pain..every other experience can get drowned out, ignored, neglected..making me feel even worse. Are there things in your life, in your recovery, that you can feel good about? Try to find at least one thing, one other good thing. Remembering it won't take the pain away, but it may help you bear it. You and I will get to the other side of this. Of this I am certain.

 

[scaredinCA]

I'll leave the advise for the experts on this forum to give you, but I can wish you well and say a prayer for your recovery.