TKR brianm's recovery. Why does lying down hurt?

[Jamie]

It is normal to have some swelling following this very traumatic surgery. It can last for 6 months or maybe even longer in some cases. Did you have an opportunity to read the articles that were posted for you? If so, you will see that this healing process is not linear and it lasts over many months. You cannot hurry your body's healing time frame. And at a little more than 4 weeks out, you are still very much in the healing stage of recovery.

Previous posters' suggestions to continue with your pain medications, ice and watch your activity levels are right on target. Your body may not always give you a direct "cause and effect" result where swelling and pain are concerned. Some days you might be just fine doing that mile walk and cycling in the neighborhood. Then the cumulative effect of doing that for several days could give you swelling all of a sudden. When you have the swelling and pain, that's your cue to scale it back a bit for a few days. It's a roller coaster ride for sure.

If nighttime is difficult for you, do what works. If that means taking prescription pain medication for several months at night, then do it. You could also try a 1000mg dose of Tylenol (just be sure to stay within the maximum dose of no more than 4000mg in a 24 hour period). The use of ice should help as well at night. I think that the reason you had a recent poor experience with icing was because your pain had gotten out of control and at that point you really did need the medication as well as ice.

From what you describe, I'd agree with your medical team that your recovery is going very well. You just need to give yourself some time. Most people don't really begin to feel "normal" again until about the 6 month time frame.

 

[Josephine]

1. Pain level about 3. Not constantly, but periodically throughout the day and consistently at night when trying to sleep. Pain is accompanied by swelling (doesn't look too swollen, but feels so.)

Good for you for realising that. Swelling=tightness=pain

2. OTC Aleve, 1 pill morning and evening (my choice, not prescribed). Norco 7.5 mg, 1 or 2 pills through the night, none in daytime.

So I'm guessing you're taking some Norco at bedtime about 11pm, yes? And then nothing more until you get up about 8am. That's a 10 hours stretch with no meds. Plus things are always worse at nights so you need to be little more proactive here and take Tylenol or Norco halfway through the night.

3. icing: About 3 times throughout the day, 15-30 minutes. 3-4 times through the night; typically leave the gel pack on 15 min or until the gel pack is no longer cold (~45 min). Sometimes I go to sleep for brief periods with the gel pack on. according to my therapist who told me if it doesn't hurt, its not cold enough to do any good

Your therapist gave you some dangerous advice there. Ice should never be painful, just comfortably soothing. Do you use a cloth between the ice pack and your skin? If not, you seriously risk getting freezer burn which is just like scald. Always use something between your skin and an ice pack at first - you can always ditch it when the ice pack "cools down"!

Apart from that you accomplish little or nothing in 15-30 minutes. Ice for at least 40-60mins and more than 4 times a day.

4. elevating: Not much. Tried it for a while, didn't seem to make significant difference. Now mostly lie flat on bed

Elevating is not an instant fix kind of thing and if you are resting on the settee, then put your legs up! Your legs will thank you for it!

5. Extension around 0 degrees (calf can touch the floor when sitting on floor with legs extended). Flexion 120 degrees+.

120/0? That is excellent for 6 weeks out!

6. Normal housework and puttering around the house/yard, but I do a little less of it than normal, and avoid strenuous lifting, etc. Drive the car to shop.
I generally walk a mile and ride my bike a mile around the neighborhood each day. Flat surface, leisurely pace. You might accuse me of "overdoing it," but walking and riding are very comfortable and there's obviously no trauma involved.

Problem is that you absolutely don't get problems while you're up and about. It's at night when you get the pay back! Did you read the articles I left you? Especially the one on activity progression? Mind you, you are 6 weeks out now so you'll be getting into the stage where extra activity is okay.

7. I do the following routine at least twice a day and whenever swelling and pain becomes excessively annoying:

Never use exercise to control pain and swelling as that only causes more pain and swelling! Did you read the article on pain management?

Your exercises - my comments in bold
You never told me how many times a day you do these. I'm guessing it's not just once!

Knee/leg stretches (both legs):
Calf stretches, leaning against wall. 30 sec each leg, x2 - okay IF you are having problems with your calf muscles - are you?
Hamstring stretches, heel on stair, 30 sec each leg, x2, pressing down on knee to increase ROM - okay IF you are having problems with your calf muscles - are you?
Quad stretches, foot on bed behind me, 30 sec each leg x2 - okay IF you are having problems with your calf muscles - are you?
Heel raises, balls of feet on stair, 20x both legs together, 10x each leg alone - these are very hard on your leg which has just undergone major surgery. I'd cut them out

These are all okay
Upper body/core/cardiovascular:
Stomach crunches lying on back on floor, 30x
Plank resting on forearms, 1 minute
Chest expander springs
20 push-ups
9 pull-ups

I'm curious about the healing process and how it is affected by "overdoing it." If I walk an extra mile with the knee working smoothly and no pain or apparent trauma, can that impede the healing process in some way? If so, how?

It depends how far out from surgery oyu are as to what negative effect it can have. However, having said that, overdoing it causes an increase in pain and swelling which can result in a situation where it becomes almost impossible to get rid of it. In extreme cases, the result can be as in the first post here PT: the seriously grave consequences of doing too much of it.

yet makes no distinction between twisting one's leg like a pretzel to increase ROM and walking or biking an extra mile using the knee for the purpose it was designed.

Oh yes we do! The first is very counter-productive (see previous comment) and the second is wise and tempered activity. Post number 2 in that article very poignantly details the possible effects of the pretzel effect!

Generally I think you're doing extremely well, my friend. The only thing I think you should adjust a bit is your pain meds. You maybe don't need to go overboard with it, just adjust what you take for the night time as that's always a problem for us all. You now know it and we certainly do!

One other thing you might want to consider and test out is this Night pain solutions using moist heat and clingfilm. I found it wonderfully helpful with my second knee.

 

[KYata]

You are doing fantastic! If your knee is bothering you at night then you might be overdoing it. Just for one day cut back all those reps and miles by half to see what happens at night. I am just about where you are and am at 1 day short of 16 WEEKS. My poor flexion was holding me back, had a painful 90 degrees at 6 weeks and is now an effortless 120. If your knee's flex is pain free and functional then I can see why you are doing so much so well so early but your bones were still cut and pounded on and there is still a lot of healing that needs to happen.

I do mini checks when trying out something new. I was dying to get back to gardening so set my phone to chime at 5 minutes. When phone chimed I sat down for 20 minutes and decided more weeding a bad idea. Knee had been hyper extending and I was feeling off balance so kept going back for 5 minutes every few days until I felt more stable which took a couple weeks. I MUST sit down when doing evaluations like this or I will just plow ahead and over do it. Did just that last week. Had a great time chopping down a shrub, when phone chimed I thought about 2 seconds and decided to get back to it. Worked for an hour and boy was I beat after. Getting over tired doesn't necessarily mean knee swells and hurts, means I cannot sleep well even if knee isn't a problem.

 

[brianm]

In extreme cases, the result can be as in the first post here PT: the seriously grave consequences of doing too much of it.

Your example is excellent. We senior citizens with a lifetime of athletic history tend to regard recovery from an operation as just another situation we can exercise our way out of. Some of the misguided advice we get unfortunately reinforces this attitude. When I left the hospital after back surgery in October, I was advised to "walk as much as you can bear," in writing no less! Two weeks later at my first physical therapy session, my therapist recoiled in horror when I told him I was up to four miles a day, along with all the other regular calisthenics I'd been doing before surgery. He told me to cut everything in half, and I walked out fearing that I had damaged my back. (The back is OK after all.) It wasn't until then I understood that some healing processes can't be hurried. Shortly after, my neighbor, a firefighter whose idea of a good time was riding his bike from San Francisco to Los Angeles, was preparing for the same operation I'd had. He told me he planned to tackle his therapy enthusiastically and be back in the saddle in record time. We had a heart to heart talk.

 

[Angel1978]

Just checking In on ya. Sounds like ya doing well. Have you found any way to rest at night?


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