TKR Bumps on the Recovery Road<

[Gimpy54]

Could a moderator please change the title to "Bumps on the Recovery Road".

Thank you!

 

[newlybionic]

What you are going through is completely normal. Your knee was telling you that that PT session was way more than your knee was able to do. It's telling you to take things slowly. It will get better as time goes on.

 

[Pumpkin]

My guess is you are doing too much for your knee after that aggressive PT session, sorry to hear they set your recovery back. Suggest you skip the PT, and follow the Bonesmart Mantra Rest, Ice, Elevate, and Medicate on schedule as prescribed, and let your knee heal.
I am going to tag @Josephine to address your concerns.

 

[Jamie]

I've changed your thread title for you! Let us know here on your thread if you want something else later. We're happy to make the change for you.

 

[Josephine]

I have managed to taper down the Percocet. I'm now taking four a day, one every six hours, sometimes two at night. Although, when I miss a dose, I'm hurting. Frustrated, because I'd hoped to be completely off it at this point.

Not a good idea and I know very few people who were able to be off pain meds that early

I was really pushing it, as I wanted to get well quick. Then the PT tech put me on the table pushing it down and bending it. Geez louise, that hurt like a you know what. My big issue now is inflammation. Going to the grocery store this week

Your big issue now is that you are over doing it big time! And your knee is not just inflamed, it's HUGEly swollen! You should not allow your PT to do that to you. And you cannot hurry this recovery, you will only succeed in slowing it down.

I'd like to ask you some questions if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery! )

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?
4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: (enter number) of sessions each day
enter exercise : enter number of reps and sets
enter exercise : enter number of reps and sets
enter exercise : enter number of reps and sets

At PT
enter exercise : enter number of reps and sets
enter exercise : enter number of reps and sets
enter exercise : enter number of reps and sets

 

[Gimpy54]

You guys have really helped me to see that I have unrealistic expectations of my recovery. I'm supposed to go to PT today, but I think I'm going to cancel. It's actually feeling a bit better this morning, swelling down a bit, and I want to give this a chance to settle in.

For Josephine

1. When I'm on my meds, the pain is very low, maybe a 2/3. But, when the Percocet wears off, it's an ugly 8.

2. I'm on Percocet, 5-325, one every six hours. Sometimes I take two for the nighttime dose. Celebrex 200 mg, twice a day for the inflammation.

3. Icing 4 times a day, until the ice is no longer cold. I have an ice machine, but I prefer the big packs, they're colder.

4. I'm pretty much laying on the couch if I'm not up and doing something, and I'm not doing very much. I've been trying to do one short trip to the grocery/dry cleaners, etc. every day. Very light housework. Hubby is doing most of it. And I have my pillows stacked the way it was recommended here.

5. The PT doc measured me this past week at 110 degrees bend, and 5 degrees from flat. The swelling on the front seems to be keeping me from getting it flat, it's like a huge bubble on the front.

6. Very light exercises at home. Leg lifts, front and to the side, standing/bent lift at the counter. Toe raises, light hamstring stretch at the counter. Balance exercises, side to side, front to back. Lightly stretching it straight with a strap. Ten reps, 1 set, once a day. Pretty much the same thing at the PT Sessions, only two sets, with leg press and extension machine as well, and then minutes on a recumbent bike at the beginning of the session.

I can walk fine without a cane, but I'm using it when I go out, just in case it starts to hurt.

I'm six weeks out today, and I can definitely feel a difference. After reading through this board, I've decided that I will never allow a therapist to push my knee/bend it down like that again. I wish I'd been more assertive when that happened.

Thank so much for your encouragement and input.

 

[Libby01]

Gimpy, with the first knee I tried to do everything the PT said, whether it hurt or not. I followed the No Pain No Gain Motto. I had my second knee done around the same time you did and this time I have done things my way. Basically I'm just following the Bone Smart Mantra. I know that no two knees are alike but icing, elevating and taking it easy with the PT has made such a difference in this recovery compared to my other knee. So, definitely draw a line in the sand with those PTs and don't feel guilty about it! :cool:

 

[Josephine]

1. When I'm on my meds, the pain is very low, maybe a 2/3. But, when the Percocet wears off, it's an ugly 8.

Proving that you do need to take them!

2. I'm on Percocet, 5-325, one every six hours. Sometimes I take two for the nighttime dose. Celebrex 200 mg, twice a day for the inflammation.

Okay

3. Icing 4 times a day, until the ice is no longer cold. I have an ice machine, but I prefer the big packs, they're colder.

Jolly good!

4. I'm pretty much laying on the couch if I'm not up and doing something, And I have my pillows stacked the way it was recommended here.

Jolly good!

5. The PT doc measured me this past week at 110 degrees bend, and 5 degrees from flat.

Excellent for only 6 weeks out.

I've been trying to do one short trip to the grocery/dry cleaners, etc. every day. Very light housework. Hubby is doing most of it.

You did read this, didn't you?
Activity progression for TKRs. and note the comment "Weeks 6 and onward - add to previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out."

My comments in bold
Very light exercises at home, 10 reps, 1 set, once a day
Leg lifts, front and to the side - a tip about straight leg raises - once you can do them, you don't need to do them any more! As for the 'front and side' thing - forget it!
standing/bent lift at the counter - in other words, these are squats which are very tough on the knee
Toe raises - another 'very tough on the knee' exercises! And of no value whatsoever
light hamstring stretch at the counter -why, do you have tight hamstrings? If you don't, then don't do these
Balance exercises, side to side, front to back - this will only stress your ligaments and muscles. I advise you not to do them
Lightly stretching it straight with a strap - stretching them in what way? Whatever, you should never use a strap or any other form of 'assistance'

PT Sessions, only 2 sets as above plus
leg press - never use a leg press, very bad for a new knee
extension machine - same again, this involves going against resistance which is a BIG no-no
recumbent bike a few minutes - okay

I can walk fine without a cane, but I'm using it when I go out, just in case it starts to hurt.

That's a very good idea. But you need it just in case you have a stumble or a weak moment too.

So my final assessment is that your exercises are not suitable for a new TKR and it really beats me why PTs think they are. You're only 6 weeks out and should be spending most of your time resting and allowing your knee to heal. It's just had a great big knock about, cut and hammered and it needs to heal. It cannot do that and heal. It really can't. Plus you need to stop obsessing about the (imaginary) risk of drug addiction and take your meds when you need them. This will only be for another 3-4 weeks at the most and soon after that you'll be able to stop them altogether.

Do go and read the recovery articles again and realise that every facet of them applies to you! Remember your ROM is excellent. So do less, rest more, quite all exercising and PT - yes really! But keep up with the bike as it at least makes you feel like you're doing something even though you don't really need it!

 

[Gimpy54]

Gimpy, with the first knee I tried to do everything the PT said, whether it hurt or not. I followed the No Pain No Gain Motto. So, definitely draw a line in the sand with those PTs and don't feel guilty about it! :cool:

It's good hear that from someone who has done it both ways. I need to be more assertive and just tell the PT tech exactly what I'm willing to do. My next session is this Thursday. Really not looking forward to it. Gotta put my big girl panties on.

And Josephine, thank you for your long post and recommendations. Your story makes for good reading. I've noticed that you Brits have a more relaxed attitude to just about everything, and that's a good thing. I've tried it their way, now I'm going to do it your way. They (the PT people) just have this way of scaring me. Based on what I've read here, that PT tech had no business pushing/bending my knee at 3 weeks, 3 days post op. I had good ROM, and it was pointless. Meeting with my surgeon tomorrow, going to discuss this with him.

It's feeling/looking even better this morning. Being a total slug here on the couch. With my cane by my side.

This is a link to the strap I mentioned. I use it to try and straighten it. I won't be attempting that again until the swelling goes down a bit more.

https://www.amazon.com/OPTP-Stretch-Out-Strap-Poster/dp/B000QIOJ58?tag=ate362da-20

Someone had posted a message in this thread stating that they were in the same boat, feeling as if they were backsliding. I came here this morning intending to respond to that message and it's gone. I've been pretty miserable and wallowing in self pity. Please forgive that I didn't respond quickly.

 

[Josephine]

They (the PT people) just have this way of scaring me.

And don't they seem to revel in it? That's what gets me. I'm in discussion with a professor in the UK (I'm a lay member on his research team) and I've discussed this approach with him. At first he was dismissive but then he had a change of heart and is now of a mind to make a research project of it! I think the comment that changed his mind was when I said "We have to stop brutalising these people just because they had the misfortune to have a knee replacement." Watch this space!

Meeting with my surgeon tomorrow, going to discuss this with him.

Well okay but don't expect him to be sympathetic or contradict his PT. Don't forget that he thinks like that too.

Someone had posted a message in this thread stating that they were in the same boat, feeling as if they were backsliding. I came here this morning intending to respond to that message and it's gone.

It was a new member - her post was moved to her own recovery thread. I think you can find it here brzy's recovery thread

 

[Gimpy54]

And don't they seem to revel in it?

Yes, they do. And I know they're not bad people, but they tend to treat me like I'm a child.

I have noticed something a little weird. I can bend my knee much better while lying on my back. If I roll to my side, and try to bend both knees up (like I normally sleep), I feel a good bit of resistance to that. Like the torque is a bit too much for it from that angle. I'm planning on discussing this with my doctor tomorrow. Maybe I'm doing it wrong, or it's just going to get easier with time? It's an odd/uncomfortable feeling.

 

[Josephine]

It's just the alignments of muscles. On your back, your abdominal muscles are much more engaged than they are on your side.The abdominal muscles play a big part in flexing at the hip.

 

[Celle]

Meeting with my surgeon tomorrow, going to discuss this with him.

Well okay but don't expect him to be sympathetic or contradict his PT. Don't forget that he thinks like that too.

It really doesn't matter whether your surgeon agrees with being gentle to your knee, or not. Remember that it's your knee and you have the absolute right to say what will happen to it. No one else can do that and it's crazy to hurt a knee that is already wounded.
Just tell your PT something like, "That hurts and it feels bad for my knee. I won't allow it. Don't do it."

I have noticed something a little weird. I can bend my knee much better while lying on my back. If I roll to my side, and try to bend both knees up (like I normally sleep), I feel a good bit of resistance to that. Like the torque is a bit too much for it from that angle. I'm planning on discussing this with my doctor tomorrow. Maybe I'm doing it wrong, or it's just going to get easier with time? It's an odd/uncomfortable feeling.

I don't think you're doing anything wrong. This is just one of those weird things that happens along the road to recovery.
Have you tried putting a pillow between your knees?
You don't have to sleep any particular way - just do whatever is most comfortable for you.

 

[Gimpy54]

My doc responded pretty as you guys said he would. I decided to just let the issue drop. Went to PT today, and told them I was going to take it very easy. Just did the recumbent bike (rocking) heel slides and tiny toe raises (they didn't hurt), and then they put me on the ice machine. I love that thing. It's called a "game ready", and it's amazing. Wish I could afford to buy one.

 

[Celle]

Well done!

PT is OK, as long as it's gentle and doesn't ask too much of a new knee.
Always bear in mind that it's your knee and you are the one who decides what will happen to it.

 

[Josephine]

tiny toe raises (they didn't hurt)

It doesn't matter if they don't hurt at the time, they will cause trouble in the long run and their usefulness is, at best, dubious.

 

[kneeper]

I found the GameReady awesome as well. Keep on using your common sense in PT.

 

[Gimpy54]

I'm twenty weeks out now. I've made a lot of progress, but it's frustratingly slow. I thought I was going to be so much further along at this point. This problem is the ongoing post op inflammation. It's not as bad as it was, but it's still with me. Still going to PT once a week. We're working on range of motion and strengthening my hip flexors and ligaments around the knee. Doing all of my exercises at PT without much pain, but I do get some swelling afterwards (on top of the inflammation that is always with me). I am at 0 extension and 110 flexion. I have gotten it to 115, but this ongoing inflammation is causing issues with that.

My doctor tells me that I'm just one of those who has this issue with ongoing inflammation. He says that it will most likely resolve itself over the next months, but that it could be with me forever. I have bought a used Game Ready Unit on Ebay to help me with this, and that has helped a lot. Going on short walks around the neighborhood with my new little doxie (avatar), with no pain, but swelling afterwards. Also jumping on the recumbent bike a few times a week, depending on the swelling and pain.

Completely off my pain meds, other than my Motrin or Celebrex for the inflammation.

Open to suggestions.

 

[Celle]

This problem is the ongoing post op inflammation. It's not as bad as it was, but it's still with me. Still going to PT once a week. We're working on range of motion and strengthening my hip flexors and ligaments around the knee. Doing all of my exercises at PT without much pain, but I do get some swelling afterwards (on top of the inflammation that is always with me). I am at 0 extension and 110 flexion. I have gotten it to 115, but this ongoing inflammation is causing issues with that.

You know why you have this ongoing inflammation? Because you are still going to PT at 5 months after your TKR. There is absolutely no need for PT at this stage. And having increased swelling after PT is an indication that the PT is too much for your knee.
If you want to get rid of that inflammation, stop the PT.

By 5 months, you should be letting your everyday life be your PT. With everyday use, your muscles will continue to strengthen. Your ROM can still improve spontaneously, as long as you don't keep on working at it and irritating your knee. I did no PT at all and no exercises for my last TKR. My knee is strong and reliable. It straightens fully and has a bend of over 125 degrees. I found that the bend still increased a little, even after a year had passed.

 

[Gimpy54]

I thought the PT was the problem too, but I had a three-week spell in June, where I didn't go to PT and the swelling didn't get any better. If anything, it was worse.