TKR Concerned with slow, painful recovery<

[Celle]

And to think a couple of weeks ago, I was told that I needed to do more by pushing myself harder at home!

Yes, you were wrongly advised there. Unfortunately, too many therapists still believe that you have to exercise aggressively.

 

[Josephine]

1) before PT, 3-4, after PT, 5-6. Including stiffness.

Okay

2) As of this week: (Oxycodone 5mg. Generally taking after PT. 2 tablets, every 6hrs.

okay

3) Moderate.

okay

4) ROM as of this morning: 105, unassisted. Extension: -5 unassisted.

The only number that counts is the one you do in your own strength. 'Assisted' flexion doesn't count!

5) icing: at PT: 5-10 minutes. At home: on average, 4-6hrs a day.

You accomplish little or nothing in 5-10 minutes. Ice for at least 40-60mins and more than 4 times a day.

6) I keep it elevated around nine hours a day.

But are you elevating correctly? Elevation is the key to controlling pain and swelling

7) I go grocery shopping once a week for an hour or so. I take my wife and children to the mall once or twice a week for a few hours, of which I sit down for 40 minutes. I do very little housework and occasional one or two block walks around my neighborhood.

Too much - much MUCH too much!

My comments in bold
I go to PT five days a week - why?
just gentle stretching/bending, extension and heel slides. Really not much at all, and never to the point of pain - this doesn't answer my question which was

- how many sessions you do each day
- enter exercise by name then number of repetitions of each​

PT :
bike, 10 minutes. Takes me a couple of minutes to feel okay going full way around - this is okay
stationary walker: 10 minutes walking forward on an incline, and five minutes walking backwards on an incline - an incline is not a good idea - too much stress as is walking backwards!
Straight leg lifts with then pound weight: 30 count - never, never use weights and 30 is also far too many. Bit tip about SLRs, once you can do them you don't need to do than any more! Certainly not at 12 weeks out!
Standing on one leg, while passing a ball overhead: 30 count - balance exercises are a bad substitute for walking well.
Hip exercises, pushing my right and left knee outwards with a 10lb weight: 30 count, on each knee - don't need hip exercises for a knee!
Table exercises: laying on my stomach with a 10lb weight on my ankle for extension 10 minutes, then I reverse and have the weight on my knee for 10 mins - never ever use weights! Plus you already have extension of -5 so this is totally unnecessary.
Deep tissue massage and manipulation while on the table. Sometimes the therapist also uses a metal rod to go over my incision. - none of this - it's responsible for your pain!
90 reps and 50 mins - far too much

Standing on one leg, with the other in the air bent: 30 count performed while standing on a mat. - balance exercises are a poor substitute for walking well!
squats: 30 count - far too many and squats are bad for your knee
Heel slides: 30 count - again, far too many. You should read this Heel slides and how to do them properly
Knee bends: 30 count - you are doing 4 different flexion exercises - totally unnecessary!

my good leg on top of the cube while I force my knee (in a straight position while standing on the floor) x 30 - forced extension? When your extension is already terrific?
step up then down x 30 - steps not good
Lastly on the last cub I sit down and then get up x 30 - nor these
game ready for 10 mins/or slight heat for 10 mins - ice is okay but not heat on an already hot and swollen knee
hook up electric patches and I have to tighten my knee x 10 mins - also appalling!

I've worked out that PT are having you do 160 reps and over an hour on other things. Without a doubt it is all this that is causing your pain, stiffness and low ROM. If you want to improve, you have absolutely got to stop all that exercising both at PT and at home.

Read these
BoneSmart philosophy for sensible post op therapy
Saying no to therapy - am I allowed to?

You should also read this to see how bad things can really be. It's scary but it's a factual case PT: the seriously grave consequences of doing too much of it

 

[Templar1974]

@Josephine: Thank you for the advice. As far as reps and excercise time goes at home: honestly not much at all, due to pain and stiffness as I am sure you can imagine. I would gestimate, maybe 10 minutes total each day.

To answer some of your other questions:

Prior to my manipulation on March 27th, I was not doing much PT. I would go, and my knee was so stiff, swollen and painful it just screamed. I would not let the PT do anything other than massage, and ice. Finally my Doctor told them and me to cut back to a maximum of two days a week.

Once I got the manipulation, I was given a script for agressive PT five days a week. I argued with the Doctor about this, but ultimately relented, and of course am paying the price. I was told, exactly what you expect and undoubtedly have heard thousands of times. I have arthrofibrosis, and if I don't keep ahead, I'll lose everything gained during the manipulation. I was even guilted by being shown pictures of how far my knee was bent during the procedure.

I then saw a Physicians Assistant a week later, and I told her about the pain/stiffness I was having with PT. she asked what I was doing at home. I explained that at max, I was doing thirty minutes of gentle stretching a day. She prescribed the Oxycodone, as I was only taking Motrin, and told me that I needed to push through the pain in order to keep the arthrofibrosis at bay and keep my gains from the manipulation.

And here I am today, with pain, stiffness, and new pain, which feels like a tear/pulling in the outside left and right of my knee, along with what feels like a pulling/knot on part of my hamstring. I originally lost two inches of swelling in my knee (measured after the manipulation), of which I have gotten one inch of swelling back. The back of my knee is swollen and painful and I can't pivot my knee to the left or right or walk without pain.

It is an awful position to be in. You want to not overdo anything, yet please the Doctor and follow instructions at PT. I absolutely hate and loathe going to PT, but at the same time I just suck it up, all the while as pain is evident to my Therapist because of guilt. I feel bad for my wife and children because I know they need a Father who can go back to work and make full pay. It's tough being out of work for so long making a fraction of what you were, while your financial obligations stay the same.

I really didn't realize that I was overdoing it, the little I do go out. I guess it is hard for me, as I used to be so active for ten to twelve hour days at work, only sitting for maybe half an hour of that time, then coming home and being active as well.

Fortunately my Doctor gave the go ahead to cancel all PT remaining this week until I am seen on Friday. I'll discuss all this at that time.

Your absolutely right. I am hindering my recovery, and will likely only get worse following the direction and PT I was on.

Again, thank you for your advice.

 

[Jennszoo]

I'm sorry youre in this position. its easy to go against dr/pt orders and follow the BS way when you're seeing good results from it, but when youre struggling, I know it's not so easy to buck the system. I've read on here that you basically have to start over with babying the knee after an MUA so maybe think of your knee as less than a month old and spend the rest of this week doing extra TLC til friday. Focus on proper elevation and icing around the clock, even overnight. I hook my polar cube up and sleep with it. It's basically on maybe 22-23 hrs a day. Your prime directive these next few days is to focus on getting that swelling down. Best of luck to you!

Also, love your profile pic! I'm a big SW fan myself, my profile pic was from running the Star Wars race at Dsineyland this jan. It was a half marathon, but my knee was toast, so I only made it 5 miles. But I met Chewie, so I was happy!

 

[Templar1974]

@Jennszoo: thank you, the TK in my profile has been temporarily retired to a mannequin in my den. During healthier days, I was a member of the 501st Legion and trooped in the armor. I also go to a lot of conventions. I am envious of your Disney trip. Hope to make it there once Star Wars land is finished.

The polar cube is a life saver. Fortunately the hospital that I had my TKR at, gave one to me during my outpatient TKR. I have been increasing my usage lately, and am hitting close to 17hrs of use.

Going to further baby my angry knee by using a motorized shopping cart when I go shopping this week. I am hopeful that I will be able to sit through a film later this week. Promised my son that he will be at the Guardians Of The Galaxy premiere.

 

[Josephine]

I argued with the Doctor about this, but ultimately relented, and of course am paying the price. I was even guilted by being shown pictures of how far my knee was bent during the procedure.

Yes but that was before all this stuff! And you were unconscious to of course they could get a great bend. Actually, all it proves is that you had no adhesions.

I think I've given you this before but you really do need to read it again Saying no to therapy - am I allowed to?

 

[Templar1974]

My knee today, and last x-ray(at week 2).

 

[Templar1974]

I just feel so discouraged about this whole process. The bright spot to my week was going and seeing GOTG with my son. Fortunately, I only dealt with stiffness from sitting so long in the same position.

When I saw my Doctor, I was told the fluid that had been drained from my knee "looked like it had come from an inflamed angry joint". Offered to release me back to work unrestricted which I felt was absolutely insane, considering I just got done telling how much pain/stiffness I have after walking or standing no more than forty minutes.

Fortunately my PT is now no more than twice a week, with gentle strengthening only. Woke up multiple times last night. Felt like a drill going through the center of my knee.

I'm hoping somehow/someway I feel dramatically better in a few weeks when I am released. Can't imagine working eleven hour days, bending and lifting considering how I feel now.

 

[kneeper]

Well, yeah, your knee is plenty angry with that aggressive PT.
I'm not surprised you have pain and stiffness standing for 40 minutes at your time in recovery--especially given everything your poor knee has been through. Sure, I was back to work at 3 months but stayed off my feet as much as possible and kept my leg up all evening. I also wasn't doing PT by that time, just some gentle ROM stretches in the morning and evening.

We've had people with MUAs (not me) and I think they usually say they kept the ROM exercises frequent--a couple of times per day ( but gentle and brief.)

You mentioned the GameReady. I found it pretty intense. PT only used it on me for 10 minutes at a time. But I found it helpful for the swelling.

 

[Celle]

It is an awful position to be in. You want to not overdo anything, yet please the Doctor and follow instructions at PT. I absolutely hate and loathe going to PT, but at the same time I just suck it up, all the while as pain is evident to my Therapist because of guilt. I feel bad for my wife and children because I know they need a Father who can go back to work and make full pay. It's tough being out of work for so long making a fraction of what you were, while your financial obligations stay the same.

You're caught between a rock and a hard place and I know it's difficult. But it's not your fault, so please stop feeling guilty.

You can't please everyone and right now the most important person you have to please is your knee. It is making it plain that it doesn't like the treatment it has received until now, which obviously hasn't worked for it. So, you have nothing to lose by taking charge and doing what feels best for your knee.

Treat your knee right, and do everything you can to keep it happy, so that its inflamed tissues can calm down again and heal better. This could take as long as a month, but after that you should see forward progress. Giving your knee a break from therapy won't necessarily slow down your recovery. It could even speed it up.

It is your knee and you have the absolute right to choose what happens to it.
Saying no to therapy - am I allowed to?

 

[Jamie]

I agree with Celle. You've been going at it hard with your knee for weeks and it's going to take a significant amount of time before it settles down. Trust your gut feelings! No one knows your body better than you do.

If you are still having pain, you need to be treating that. It doesn't have to be with narcotics. You could get a prescription for Tramadol or take scheduled doses of 1000mg of Tylenol every 6 hours so that you are not taking any more than 4000mg in any 24 hour period. The pain will keep inflammation going, so you need to stay on top of it from here on out.

 

[Jennszoo]

I'm glad you got to see GotG! We went today and loved it. And it was nice to have some normalcy in going to a movie, even if I did bring my ice pack and pillow and specifically got the theater with the recliners. My kids didn't complain about the fancy seats.

 

[Templar1974]

Thanks everyone for the great heartfelt advice. I regret that it has taken me this long, but I am going to do what's right for my body finally. I have six sessions of PT left, and am not going to let a single visit hurt me. If I need to cancel them, I will.

I am hoping to get to the point where I do not regret the surgery. Hopefully, I will be able to keep my bionic knee for twenty plus years when the memory of this painful journey has faded enough for me to endure it again, if need be.

@Jennszoo, wish I would have thought to bring an ice pack and pillow! Good call! I'll have to remember that, if I end up venturing out to see Alien Covenent this week. GOTG was a trip. Loved seeing Kurt Russell.

 

[Templar1974]

The stiffness is such a drag. Most days I start the day off feeling pretty good now, then the more I walk ( very minimal) the stiffer and more painful it becomes. I've cut back on everything (significantly), PT just one or two days, and I do very little when there (light stretching, ten minutes stationary bike), non the less the stiffness gets worse.

I guess this is the arthrofibrosis? I mention this to my Doctor who does not seem phased, and seems to feel that since everything looks "A" okay on the x-rays, I should be good to go.

My swelling with the exception of a pocket behind my knee does seem better though since I cut back on PT. ROM still at 105 and extension still at -5.

 

[Celle]

It's not necessarily arthrofibrosis. Your knee tissues were subjected to aggressive therapy and overwork for so long, when all they wanted was a little, gentle movement and lots of rest and peace, so they could heal properly. It does take a long time for all that irritation and inflammation to calm down again.

Most of us still have some degree of stiffness at 3 months post-op.
Don't give up hope. This could still get better.

 

[agarrett]

And I thought I was bad, RTKR was my sixth surgery, third open incision. They said that because of my past trauma recovery would be longer and tougher. Find some comfort in that. First three months were tough, four month mark made a difference for me.


Sent from my iPhone using BoneSmart Forum

 

[Templar1974]

@Celle , thank you. Definitely looking ahead to better days.

@agarrett , I know, right?! I'm definitely seeing improvement with decreasing swelling, and just an overall feeling of getting better...especially when I look back to the first week post op. just hoping to see the tightness and pain I get with minor activity to finally let go of me.

 

[Josephine]

I have six sessions of PT left

WHAT? Was all my advice in post #22 wasted? STOP THE EXERCISING!! It's like banging your head on a brick wall and then complaining you have a headache!

I guess this is the arthrofibrosis?

No it's not! It's too much exercising!

seeing GOTG

What is that?

 

[kneeper]

Are you taking anything for pain--even OTC pain relievers? That can help with the feeling of tightness and stiffness, believe it or not. It did me.

 

[sistersinhim]

Stiffness was the last thing to go away for me. And I agree with Josephine completely, stop all exercises and let your tissues heal. It's a domino effect...the more you exercise that knee, the stiffer it'll get and the less your ROM will be. If you stop all that exercising for at least a month, you'll see much improvement. Spend lots of time reading threads on here and you'll see that aggressive exercising does not work rehabbing a tkr.