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TKR Back pain when sitting^

vlambert

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Hope someone has some suggestions for me.

Had a TKR on Thursday June 6. One thing I was not prepared for is I can’t get comfortable in a chair. I have a sofa with an ottoman and get home from hospital and sat in that chair for a bit and it made my lower back hurt. So went back to bed and back got better - then tried a different chair and same problem. Changed chairs to eat dinner at the dining table and did a bit better (though my leg is down for the meal).

Just need to know if anyone else has had this issue and if I should buy a recliner. I have tried putting a lot of pillows behind my back when on the sofa but so far does not really help.

I have had back surgery and I know that the back pain is from sitting “wrong” without the right support. I have a “flex” bed so can get comfortable there. Just scared if my back goes out completely that will put me way back.

I did a LOT getting ready for the procedure (22 years ago my Dad died after TKR). Bought the ice packs, borrowed a therapy ice machine, got the shower chair, removed the rugs, got a knee buddy pillow, moved a computer and set up so I could work out of my house for a while, bought a recumbent stationary bike, etc. Even did one session with therapist before surgery to make sure I was on track and doing everything I could for a positive outcome.

Had three months to prepare as I had an injection and had to wait three months for surgery. My knee after the injection was not really painful at all so I did all the exercises and was even biking 6 miles per day.

If anyone can give me suggestions. Just want to be able to concentrate on the knee and not worry about the back.
 

Jockette

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Hi and Welcome to Bonesmart!

I have back issues, too, and I totally understand what you are going through. My back is very uncomfortable if my leg is stretched out at the same level as my hip. (like if I was sitting on the floor) For me, my ottoman is just a little lower than my couch, and it’s comfortable. It is not the ideal level of elevation, but it worked for me when I was not in bed. Any time I was in bed, my leg was properly elevated on my foam wedge.

You just have to experiment to find what works for you. I was very compliant my first month post op but right away refused to do anything that was not in my back’s best interest, as it took a long time to get it to a manageable level.

Also, you don’t have to keep your leg totally straight, a slight bend will be more comfortable and won’t do any harm to your knee.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

We do have an article about elevating which is excellent, but you may have to tweak it a bit to find your comfort zone.

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. At week 4 and after you should follow this
6. Access to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Pumpkln

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@vlambert
Welcome to BoneSmart, glad you joined us!
A recliner chair may help, you may be able to rent, or purchase a used one. Suggest you try one out before purchasing.
Here are some tips about purchasing a recliner chair.
Recliner chairs: things you need to know if buying one for your recovery.

Since the dining room chair (usually firmer) is more comfortable suggest you sit there, you can try putting your leg up on another chair or ottoman of some sort.

If you are being seen by OT or PT they should be able to help you with setting up a more comfortable seating environment.
 

Tmgrl3

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Hi viambert,

Welcome

I too have back problems and have for 40 years. All my vertebrae are herniated or stenosis. I also have radiculopathy and neuropathy, with some of this from severe nerve compression at L5-S1. My surgery is 11 weeks ago today. My first 10 weeks were a time of insomnia and of inability to get comfortable almost anywhere. By night my feet and ankles often were burning and hurt as bad or worse than my knees. I was told to ride out these early weeks, since everything is affected by the TKR. The bundles of nerves from the back run down backs and sides of legs.

I had bilateral knee replacements so was literally stuck on my back until about two weeks ago and no place was comfortable. I was only on tramadol 50 for pain for first four weeks and as knee pain got better, stopped the tramadol, but my sleep got worse as my activity increased...so a week ago I went back on tramadol just at bedtime.

My recliner was always the most comfortable chair but it made my feet and ankles worse. Best was a club chair with an ottoman. Raising my legs on pillows was the worst. So you have to find what will work for you but actually you are only a few days into recovery and nothing feels right and everything seems to hurt.

The suggestion to rent a recliner is good. We rented one for two months for my husband who had a triple lumbar fusion September 5. Nine months out now and he can sit anywhere, but for first two months, the recliner that raised up to standing position electrically and then lowered was only place he could sit.

Also, remember, your pain medication protocol is meant for “pain” not just in your knees but for other areas the surgery affects.

Last night after 10 weeks of mostly 4-6 hours of sleep a night I slept for 9 hours. I went back on tramadol 50 a week ago, just at bedtime. With Tylenol and I started to get some real sleep since I had no position in bed that didn’t hurt by time I went to bed.

I have had great knee healing. 130degrees flextime, could stretch both legs out flat by second week, have been walking without even a cane for weeks now...almost feels like I didn’t have knee replacements til evening approaches.

I am 76 so overall healing probably a bit slower. Also, in the hospital I had four blood transfusions in two days because of blood loss. This whole healing thing is trial and error, up and down and one of searching for a few hours a day in the beginning where you can get comfortable and of taking the meds you need to get sleep. Sleep is critical to all of it. I had terrible depression, 32 pounds of edema in the two legs, and since then lost all of that plus another 8 pounds because of no appetite and intermittent nausea.

So...Your back doesn’t know what to do right now and you just have to try things. Heating pad in am is a must for me. Also middle of the day and when I do my final knee icing at night I also ice my back. Gradually the back, feet and ankles are getting better. I have a pillow in the recliner with another towel roll to put behind my head so I can sit in family room and watch tv. This chair used to be my best seating.

Just hang in there, take your pain meds now. Don’t be a hero. Remember we tighten up from severe pain, all over and pre-existing issues come into play. You will get better!!! I was so proud I had stopped the tramadol just a month in and then let myself suffer every night not sleeping enough.

Keep us posted. Wishing you good recovery. Patience and trial and error and toleration of the good and bad days as being normal are the key...rest and don’t rush it. At ten weeks I can see the light at the end of the bilateral knee replacement tunnel.
 
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vlambert

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Thank you so much! I bought a recliner and it helps so much. Tried sleeping in the bed again and have decided I am going to stick to the recliner for a while. It is MUCH better. I only had one knee done and feel like such a wuss.

I was doing the pain meds (Tylenol with hydrocodone 7.5 ) every 4 hours like the script says (every 4-6 hours). I was doing really pretty good those first few days and then my Dr’s nurse told me I was taking way too much (this was on day 5 after surgery) and they would not refill. She made me feel like a drug addict. She said I had better back down to every 5-6 hours. So it has been hard.

So glad to know that there will be a light at the end of the tunnel. I am on day 10 post surgery. You are amazing having two done at once and doing so well.
 

Jockette

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That is so mean, treating you like a drug addict, telling you that you can’t take your pain medication as it was written. Goodness, it’s not like you took more than you were supposed to.

I’m so sorry this is how patients are being treated.
 
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vlambert

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Me too. But I am sort of figuring out pain med then three hour Tylenol then three hour pain med and so on. I am hoping that will help.
 

Jockette

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I was doing the pain meds (Tylenol with hydrocodone 7.5 ) ever 4 hours like the scrip says (every 4-6 hours). I was doing really pretty good those first few days and then my Dr’s nurse told me I was taking way to much (this was on day 5 after surgery) and they would not refill. She made me feel like a drug addict. She said I had better back down to every 5-6 hours. So it has been hard. So glad to know that there will be a light at the end of the tunnel. I am on day 10 post surgery.
But I am sort of figuring out pain med then three hour Tylenol then three hour pain med and so on. I am hoping that will help.
I am going to tag @Josephine,
our forum administrator and nurse director, to come and talk to you.
 

Josephine

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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?
 
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vlambert

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I just saw this post and I am sorry I did not reply. I am on week 4 and really could use some help. Luckily I was measured by a PT prior to surgery. They told me to tell my Doctor that my surgical leg was 3/8 inch shorter than the non surgical leg. I called Dr office and told him that. They said they measure and not to worry.

After getting up at hospital a few hours after surgery I told them my leg was WAY longer. They sort of ignored me.

I left the hospital on a cane. By week two+ I was crying from so much pain in buttock on surgical side. Called Dr office and told them it was spasming and they got me a muscle relaxer.

At PT they determined it was piriformis muscle and it was so tight it was like a band. Deep muscle massage for two sessions and my entire buttock at the area was solid black from bruising.
That started getting better but still back ache and pain thru groin.

Went to Dr for 2 plus week removal of bandage.
They said not to use cane anymore and I mentioned leg length. Nurse did a basic hip measurement and said “wow - yeah they are different”. I again said about leg length to PT and they measured.

So my surgical side is 3/8 inch LONGER now. So that means 3/4 inch difference. We put some lifts in on my non surgical side shoe.

Went another week and then had pain that kept getting worse and grew to tremendous pain and I told PT I thought it was Si joint. So at PT they determined that I have a very inflamed Si joint.

When they manipulated brought me to tears. Called dr. They asked if I had a pain management facility. Of course I don’t have a clue about that. I would think they should tell me where to go.

But because last week was a holiday week here in the USA they said most likely could not get me into a pain management facility that could inject my si joint.

They agree that most likely the problem is the leg difference. They said There was so much deformity to the knee that most people with that amount of deformity have it on both legs.

So them fixing just one leg ended up in a big difference that there is no way my body can adjust for. So we just need to get the leg difference figured out with the lift size (which we think we have but not sure as we just added lifts - no real measurements) and then try to get the SI joint issue resolved.
Since it is flared up we need to get it to calm down OR I may have done damage to that joint.

I may need an MRI. But they started with a steroid pack for 5 days and then if there is no relief call them Monday to schedule MRIi and I could ask about pain management facility again.

Steroid pack helped a little. Still lots of pain in lower back and groin. Knee has really not been painful like the other stuff. Pain meds don’t help a lot for the SI - just sort of dulls it and they don’t want to give me more prescriptions.

I am currently taking 1 - 2 tramadol during the day.
I go to PT / work / and run errands. Am very mobile. Walking without cane.

I take 2 hydrocodone during the night. One around 7 pm and then middle of the night. I ice the SI joint/back during the day. I also use some Tylenol during the day and Benadryl at night.

Any suggestions would be great to help with the leg length and the SI pain.
 
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Jockette

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Josephine will be better able to help you if you agree to answer her questions.
 
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vlambert

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I would be happy to answer questions - just not sure where to do that at or where the questions are that I am supposed to answer.
 
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vlambert

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Perfect! I will keep an eye out for the questions.
 

Jockette

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Josephine is not always on every day, so it might be another day or so.

I don’t know what to suggest for you particular leg length issues. Just remember that you are still in early days in this long recovery. Treat your body gently, don’t do things that make it hurt more, and don’t let any therapist force your knee to bend.

A lot of aspects of this recovery do “fix” themselves if we just give our knee the time it needs to sort itself out. I don’t know if that applies to your leg length situation, but it will apply to the general healing process for your knee.
 

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I can't relate completely to your leg length discrepancy, but I wanted to chime in on the SI Joint disfunction and pain. I'm no Dr, but I've had 2 times in life where I went 6-10 months with my left SI joint 1/2 inch above my right and no damage occurred either time. It was miserable, I cried daily, I could barely sleep, sit, exercise. I had knots in my buttocks and severe pyriformis syndrome---but no damage!!!! SI Joint disfunction is actually super common and caused by SOOOO many things.....

Mine began with a car accident in college, resulting in a chronically "loose" left hip with severely stretched ligaments. Once a PT fixed the 1/2 inch hip/leg discrepancy, I managed it for 14 yrs by doing light PT exercises almost daily, plus stretching and occasional massage. I gave up anything involving lots of hip twisting or rocking.
However, when I got pregnant 14 yrs later, everything started all over again. :holysheep:I had 7 months of pregnancy misery, resulting in a difficult labor and traumatic birth, as I was SOOOOO crooked "down there". My ObGyn admitted after the fact that I should have never delivered vaginally. The postpartum recovery was even worse than after the initial car accident yrs before. Thankfully, having been down that road before, I demanded PT. We finally figured out my left SI joint was 1/2 inch higher than my right hip again, and the joint was inflamed from all the stress imposed by pregnancy and things being so far out of alignment. (I still get twisting of my L3,L4, and L5 vertebra, and sometimes my sacrum because of this loose ligament problem). I can't forget the debilitating sciatica either! After 5 months of things worsening even with PT, I finally begged for injections into both SI joints. THAT was my solution, though complete return to normal took almost 2 yrs (regaining flexibility and strength, plus teaching certain tiny abdominal muscles to help stabilize the hip :) ). I was told though that EVERY pregnancy would cause this to recur, and there was no way to prevent it. That was 1 of a multitude of reasons we chose to stop at one child and be grateful for him.

I guess I'm just saying try not to worry about damage at this stage. You have enough to worry about with healing from your TKR right now, and the level of SI joint pain doesn't necessarily correlate with the severity of the problem. It doesn't take much AT ALL to make your SI joints 100% miserable. My thoughts are with you, and I hope you get answers and relief soon.
 

Josephine

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Here y'go then!

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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?
ai63.tinypic.com_eta39s.jpg


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.
 

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