Jennszoo
post-grad
How cool that your nerves healed after 5 years, Josephine!
PKR Can't do exercises<
- Thread starter RobJF
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RobJF
new member
Thanks to everyone, I've been on the web and using forums for twenty years and I don't think I've ever had such a response! Here are my answers to Josephine's questions.
1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
Most of the time 2-3 with occasional short bursts or stabs 4-5. Overall very much better than the first 2-3 weeks. It might help if I say I'm the sort of person who has more trouble with anxiety about what a pain might mean than with the actual pain itself.
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
Paracetamol 2*500mg four times daily
Oxycodone 2*5mg four times daily (sometimes take just one)
Ibuprofen 1*400mg three times daily
3. how swollen is your leg compared to these?
It's been varying between slight and moderate, but very recently (maybe since I started elevating properly) it's been slight 90% or more of the time.
4. what is your ROM - that's flexion (bend) and extension (straightness)
Just did this for the first time, not confident of accuracy, but at the moment I think about 60/10. The flexion got noticeably worse very recently, see below.
5. are you icing your knee at all? If so, how often and for how long?
Yes, now using a cryo/cuff maybe 90% of waking hours, not overnight yet though I've been thinking about how that might be managed.
6. are you elevating your leg. If so how often and for how long?
I have a recliner that I use all the time. However until a few days ago, when I read on this site about "toes above nose", I was not putting the back down much, so feet and knees were just a bit above hips. That's still the case while eating (from lap) or using laptop, so if icing is 90% of time, full elevation is maybe 60-70%.
7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
No shopping, groceries are delivered, putting them away is a pain but it's only every two weeks.
Almost no housework, I've washed the bed linen once in five weeks!
Food preparation: I'm eating mainly ready meals, overall I'm active in the kitchen probably 10-15 minutes at a time three times a day, plus a few mins, a few times a day, for hot drinks and replenishing the cryo/cuff ice.
Otherwise I spend 7-8 hours a night in bed (sleeping quite well, considering) and the rest of the time on the recliner.
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!)
I was doing just a few heel slides and straight leg raises a day but stopped a few days ago. About the same time I began to avoid putting weight on the bad leg. Yesterday I decided to try using it again and noticed that it was much more stiff. I have to travel to the GP on Wednesday, also the hospital in a week's time, and need at least the flexion I had before, to get in and out of vehicles, so I feel I have no choice but to start the heel slides again. Also, just in the last 24 hours, the wrist on the bad side has become painful, so I'm now using just one crutch.
Thanks very much for your time.
1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
Most of the time 2-3 with occasional short bursts or stabs 4-5. Overall very much better than the first 2-3 weeks. It might help if I say I'm the sort of person who has more trouble with anxiety about what a pain might mean than with the actual pain itself.
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
Paracetamol 2*500mg four times daily
Oxycodone 2*5mg four times daily (sometimes take just one)
Ibuprofen 1*400mg three times daily
3. how swollen is your leg compared to these?
It's been varying between slight and moderate, but very recently (maybe since I started elevating properly) it's been slight 90% or more of the time.
4. what is your ROM - that's flexion (bend) and extension (straightness)
Just did this for the first time, not confident of accuracy, but at the moment I think about 60/10. The flexion got noticeably worse very recently, see below.
5. are you icing your knee at all? If so, how often and for how long?
Yes, now using a cryo/cuff maybe 90% of waking hours, not overnight yet though I've been thinking about how that might be managed.
6. are you elevating your leg. If so how often and for how long?
I have a recliner that I use all the time. However until a few days ago, when I read on this site about "toes above nose", I was not putting the back down much, so feet and knees were just a bit above hips. That's still the case while eating (from lap) or using laptop, so if icing is 90% of time, full elevation is maybe 60-70%.
7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
No shopping, groceries are delivered, putting them away is a pain but it's only every two weeks.
Almost no housework, I've washed the bed linen once in five weeks!
Food preparation: I'm eating mainly ready meals, overall I'm active in the kitchen probably 10-15 minutes at a time three times a day, plus a few mins, a few times a day, for hot drinks and replenishing the cryo/cuff ice.
Otherwise I spend 7-8 hours a night in bed (sleeping quite well, considering) and the rest of the time on the recliner.
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!)
I was doing just a few heel slides and straight leg raises a day but stopped a few days ago. About the same time I began to avoid putting weight on the bad leg. Yesterday I decided to try using it again and noticed that it was much more stiff. I have to travel to the GP on Wednesday, also the hospital in a week's time, and need at least the flexion I had before, to get in and out of vehicles, so I feel I have no choice but to start the heel slides again. Also, just in the last 24 hours, the wrist on the bad side has become painful, so I'm now using just one crutch.
Thanks very much for your time.
That adds up to 45 minutes on your feet per day. Plus any other time you're up and about. So you're probably doing more than you think.
I used a cane for at least 6 weeks. Some type of aid helps you take the pressure off the new knee but you're still using the leg, which is good. A few heel slides, taking your leg through its range should be ok. Just don't go nuts. ;)
When I used the recliner I just put a bed pillow under my leg to increase the elevation.
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RobJF
new member
Update: there's been a sudden improvement. I was much more comfortable overnight and almost jumped out of bed this morning -- relatively speaking anyway! I believe it's due mainly to what I read on this site about proper elevation and icing and I'm very grateful! 
Maryanne
new member
Hi Rob,I had a TKR on 24th March so a day after you,I am also in the U.K.which I am very grateful for after reading about the trials and tribulations in USA especially getting pain medication,I can get what I need straight away and it is delivered to me and I live in rural Wales.Also due to waiting times I went to a private hospital paid by the NHS,which I am very grateful for and I know I was very lucky.Like so many people I was completely unprepared for the pain and immobility post op.I have generally had a relatively smooth recovery compared to many others.I went to aqua aerobics on Tuesday and just did what I could but that gave me hope that the flexion is there somewhere.I rested,iced and elevated for the next few days along with my normal daily activities and gentle walking of about a mile with my dogs but on a flat firm surface.I was doing well then Friday and Saturday I developed a new pain on the inside of the kneecap,this really set me back,But now it has gone and I feel I have taken another step forward.I think maybe it was where an area that was quite numb got it's sensations back.This really is a strange healing process and you really do need patience.I am so fed up with not working as I haven't worked for over a year due to chronic pain before the operation,it is very difficult to stay sane and positive,but at least the worst is behind me now ( I hope).Good luck with your recovery.
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RobJF
new member
Jennszoo
post-grad
She's giving me hope with all that activity, too!
newlybionic
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Rob I'm happy to hear that you are now seeing some improvement. Just remember that this recovery is not a smooth path. It has many ups and downs and twist along the way. Try not to compare yourself to any other person. You will eventually be able to do the activities that you want to do.
Now, that you are feeling better, be sure to not overdo and then join that awful club we hate; the ODIC, (over did it club)! When you're feeling good it's so easy to do too much and then pay for it later on.
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RobJF
new member
Too late! That already happened. Now it's back to hot and achy. Still feeling good though, knowing that improvement is possible after all...
Oh no. Well, you know the routine! The BS way is the best way!
Josephine
NURSE DIRECTOR EMERITA
Okay, I understand!
Fine
Good.
Oh dear!
okay
Glad to hear it!
Sounds about right for 6 weeks!
Are you telling me you are still using crutches? That's not good. As for 'no choice but to start the heel slides again', forget that! You'd be much better off walking more. Usually i'm nagging people for doing too much but in your case, you appear to not be doing enough! Though you are only 6 weeks out so it's quite likely that you will have these set-backs but it's far too early to be worrying about pre-set targets set by your surgeon or physio and any mention of MUAs should be gently fended off by telling them you'd rather wait and see how things go for a while yet. Don't let them scare you into agreeing this soon. If it's really necessary, it can be done any time, even up to several months later.
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RobJF
new member
Thanks very much @Josephine. More walking, and without crutches, absolutely.
Yesterday started out great but I overdid it and today it feels like I've gone backwards by a couple of weeks or more. Walking is quite painful but I'm guessing I should be trying to do it properly even so...
Yesterday started out great but I overdid it and today it feels like I've gone backwards by a couple of weeks or more. Walking is quite painful but I'm guessing I should be trying to do it properly even so...
Oh boy, that club visit yesterday! The vast majority of us have visited it at least one time. Usually, that's enough and we are very cautious to stay away from it. It will probably take at least a few days or so for your knee to get back to where it was. So, be sure to get lots or rest and follow the guidelines that you know work so well! I hope you snap back quickly!
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RobJF
new member
It's been a while, nearly two weeks, during which there was the six week followup clinic. That meant an x-ray, filling in a pain and activity questionnaire, and having my ROM assessed. As expected, at 60 degrees that was judged not good enough, requiring an urgent physiotherapy referral. (I think urgent in this case just means skipping the usual 12 week waiting list.) Also, I was given a new exercise, sitting with legs free to swing, crossing good over bad and using it to force flexion.
Of course that's against the Bonesmart philosophy, and for several days I struggled mentally, but eventually the conflict was resolved. I realised that the difference is just a matter of degree, and decided to do as I was told, but starting with just light pressure.
So I've been doing that for a couple of days -- not necessarily using the good-over-bad thing but certainly using some effort to gently force it. There's been some pain but not a lot, and this morning I was able to stand in the shower on the good leg and wash the other foot! That might meet with disapproval in some quarters for safety reasons but it made me happy!
I'm seeing the physio on Tuesday and of course I've no idea what his or her attitude and approach might be, but I'm certainly feeling better about it now than I was before! :cool:
Of course that's against the Bonesmart philosophy, and for several days I struggled mentally, but eventually the conflict was resolved. I realised that the difference is just a matter of degree, and decided to do as I was told, but starting with just light pressure.
So I've been doing that for a couple of days -- not necessarily using the good-over-bad thing but certainly using some effort to gently force it. There's been some pain but not a lot, and this morning I was able to stand in the shower on the good leg and wash the other foot! That might meet with disapproval in some quarters for safety reasons but it made me happy!
I'm seeing the physio on Tuesday and of course I've no idea what his or her attitude and approach might be, but I'm certainly feeling better about it now than I was before! :cool:
Jennszoo
post-grad
I don't think anyone says to not do any exercises. Gentle stretches, working the legs to discomfort but not pain, but just not like 100 reps and forcing flexion.
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RobJF
new member
It's just over five months since my left partial replacement and I'm feeling really quite down about how things are now.
I've had a problem with flexion not meeting expectations since the first few weeks. Compared to some cases on here I think the expectations were very reasonable. At worst it was 60 (though I don't think that was a good measurement), at best 90.
I said to the PT last time, 2-3 weeks ago, it simply seems every time I try to improve flexion, the knee flares up to the extent that I have to not only stop the exercises but minimise all activity for several days. But it's worse than that now.
He suggested I temporarily give up on flexion and focus on quad building instead. In his opinion that should not cause flareups, but I found that it did. Now I've stopped almost all avoidable activity, not exercising or leaving home for the last week or ten days and the knee is still flared up quite badly, at times really painful, though the worst pains don't last long. (Strangely, they only seem to happen when I'm sitting or lying quite still.)
I'm using ibuprofen 400mg and paracetamol 1g three times a day, with RICE as much as possible. At least I'm off the opiates now!
The PT also mentioned the possibilities of revision to a full replacement, and being stuck at 90 permanently, both of which ideas scare me, which might have been the intention I guess. And he said something like "you're obviously very aware of flareups" which got me thinking maybe it would be better if I was less aware and more gungho.
At twelve weeks the surgeon reviewed x-rays (taken at six weeks) and examined the knee and was very reassuring, saying he could see nothing wrong and I should eventually make a good recovery. He measured flexion at 90, with some assistance but it wasn't too painful. He said they wouldn't do MUA because that might make it worse.
In fact the knee must have been quite good at that point because there was a fair bit of walking for the hospital visit and the next day I went to a "knee class" and there was no flareup. I'm now judged not up to doing the knee class and I'm seeing the PT one-to-one instead.
I see him again in ten days and have a GP appointment the next day but I'm doubtful either of them will have anything to offer except to continue meds and RICE and exercise when I can. What else is there?
I've had a problem with flexion not meeting expectations since the first few weeks. Compared to some cases on here I think the expectations were very reasonable. At worst it was 60 (though I don't think that was a good measurement), at best 90.
I said to the PT last time, 2-3 weeks ago, it simply seems every time I try to improve flexion, the knee flares up to the extent that I have to not only stop the exercises but minimise all activity for several days. But it's worse than that now.
He suggested I temporarily give up on flexion and focus on quad building instead. In his opinion that should not cause flareups, but I found that it did. Now I've stopped almost all avoidable activity, not exercising or leaving home for the last week or ten days and the knee is still flared up quite badly, at times really painful, though the worst pains don't last long. (Strangely, they only seem to happen when I'm sitting or lying quite still.)
I'm using ibuprofen 400mg and paracetamol 1g three times a day, with RICE as much as possible. At least I'm off the opiates now!
The PT also mentioned the possibilities of revision to a full replacement, and being stuck at 90 permanently, both of which ideas scare me, which might have been the intention I guess. And he said something like "you're obviously very aware of flareups" which got me thinking maybe it would be better if I was less aware and more gungho.
At twelve weeks the surgeon reviewed x-rays (taken at six weeks) and examined the knee and was very reassuring, saying he could see nothing wrong and I should eventually make a good recovery. He measured flexion at 90, with some assistance but it wasn't too painful. He said they wouldn't do MUA because that might make it worse.
In fact the knee must have been quite good at that point because there was a fair bit of walking for the hospital visit and the next day I went to a "knee class" and there was no flareup. I'm now judged not up to doing the knee class and I'm seeing the PT one-to-one instead.
I see him again in ten days and have a GP appointment the next day but I'm doubtful either of them will have anything to offer except to continue meds and RICE and exercise when I can. What else is there?
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RobJF,
Sounds like you are on the slow train to recovery.
You are going to have to continue to nudge the edges of what your knee can and cannot handle to keep the flares from happening so often.
Recommend you seek a second opinion for your PKR, from a surgeon specializing in Revisions. They have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.
@Josephine is in the UK and may be able to suggest someone for a second opinion.
Keep us posted on how you are doing.
Sounds like you are on the slow train to recovery.
You are going to have to continue to nudge the edges of what your knee can and cannot handle to keep the flares from happening so often.
Recommend you seek a second opinion for your PKR, from a surgeon specializing in Revisions. They have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.
@Josephine is in the UK and may be able to suggest someone for a second opinion.
Keep us posted on how you are doing.
