TKR Crunching & Thunking

[sistersinhim]

PT said scar tissue builds up from the moment they cut you open, so how does the slow/gentle method keep that from happening?

If that scar tissue didn't build up, your cut tissues would never grow back and remain opened. What he's trying to lead you to believe is that adhesion is building up that fast and that's just not true.

Yes, the number-obsessed PTs will rattle on about it as if the big. bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[Julia1911]

Sorry. but I have no "happy pills." I have an OxyCodone with Tylenol and Rx strength Naproxen.

I take the Naproxen regularly, which probably helps with the inflammation/swelling, but I had given up on it before knee surgery when I could barely walk anymore before surgery because I noticed no relief from it anymore. I have to take Nexium with it to keep from developing stomach ulcers -- nothing happy about that.

I take the OxyCodone when the pain becomes unbearable for me even with constant icing and elevation. It does make the pain bearable, but it still hurts--a lot. I get no "high" or happiness from it AT ALL.

It makes me very nauseous, fatigued, sometimes dizzy and can be constipating. In the hospital, it made me throw up.

That is not my kind of "happy" and makes the situation worse for those of us who have had many joint/other surgeries in the US, have always been extremely responsible with opiods after surgery and now have to suffer because of all the addicts.

 

[katies12]

Sorry Julia1911,
When I said happy pill, I meant an opiod. Didn't mean to me slight of hand.
I am very wary of these pills, because of the crisis out there, I don't want to get hook on these things.
I am sorry you are having a tough time, meant no disrespect.
Hope you have a better day today.

 

[Helizabug]

When I think of the demolition and renovation project that went on in the tight space of my knee, I am amazed that we can recover at all.

There are lots of people on BoneSmart who can reassure you that you’re not sacrificing ROM by refusing PT that brings tears to your eyes and takes a day to recover from. And, even for those of us for whom ROM has been a challenge, there are solutions.

It seems so early to be fretting over a permanently limited ROM.

 

[Celle]

Now really worried about ROM and scar tissue building up due to taking day off (do some exercises, just not really painful ones) between every other day PT visits. PT said scar tissue builds up from the moment they cut you open, so how does the slow/gentle method keep that from happening?

Your PT is feeding you a bunch of half-truths.

Of course scar tissue starts arriving as soon as you've had your surgery. As sistersinhim explained, you need scar tissue, to heal your wound. That's a normal process, part of normal healing.

What your PT is talking about - and naming incorrectly - is adhesions, or bad scar tissue. And doing too much exercise, too soon, is one way of encouraging those adhesions to form. Re-read sistersinhim's post, to see why.

Stopping doing your exercises for a day won't make your knee seize up for ever. That's another misconception. All your knee needs is to be kept moving gently, and walking will give it that exercise.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase, without any need for you to do painful exercises.

 

[Julia1911]

Hi all,

Well, the days got much better very quickly from last Friday to Monday. For that I am very grateful and optimistic.

Except for some painful knee bending, where I told her it was excruciating and she had to back off (terrible pain from hip down to knee), last Friday home PT just made sure I had balance issues and ability to get into/out of shower and on/off toilet OK. Nights were still hard, but got a little better thru Monday this week.

Monday went to doc to get 2-week x-Rays and staples out. He showed me x-rays with everything lining up nicely (did not look so "frayed/jagged" as pre-surgery x-rays anymore). Didn't want to hear 1st 2 weeks had been rough (said most patients feel "lots" better by day 4 or 5, but that is when my whole leg swelled-up for a week and became 1 big bruise), but did say I had bone on bone and lots of erosion. PTs did admit I was pretty much having same issues as everyone else after TKR at those points.

Yesterday started out-patient PT. Seems I have IT Band issues, thus the sharp pain from the outside hip down to knee. Knee bending was painful (took 2 Alleve 4 hours before and 1 Advil and 1 OxyCod 1 hour before session), but after a few tries PT guy did some deep massage around the out and inside of the knee.

Some felt great, some very painful, but seemed a little looser right afterwards. However, got very painful later at home and thru the night. Will try gently today to do the exercises on my own pace. PT again tomorrow, then not until next Tuesday again.

After google-ing and looking at IT band issues on BoneSmart found some good hints/stretches.

Has anyone had any luck with a foam roller to help the IT band issues?

Thanks again.

 

[Julia1911]

Oh, and I chickened-out on the synvisc type material for my right knee.

Just got the tried and true cortisone shot while at doc's again.

 

[Jockette]

Worse for me is sleeping on my back and with knees mostly straight.

I found elevating my legs helped a lot when sleeping on my back. Also, it’s fine to have a slight bend in your knees. Keeping them totally straight is very painful.

Elevation: Doing It the Right Way

Updated June 11, 2024 by Jockette Proper elevation is one of the best ways to help with pain and swelling following either hip, knee, or ankle surgery. Many people elevate improperly, which can dramatically lower the effectiveness. In the weeks following your surgery, make sure you elevate...

bonesmart.org

 

[Jockette]

. Knee bending was painful (took 2 Alleve 4 hours before and 1 Advil and 1 OxyCod 1 hour before session)

Please don’t allow your PT to cause you pain, at all. There is no need for that, and it will set your recovery back. It does seem to be the normal, but it really isn’t necessary. There are surgeons and PTs around the world who disagree with painful rehab, there just seems to be an abundance here in the US.

 

[Jockette]

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

 

[Julia1911]

Well, after painful PT Tuesday, spent most of Wednesday feeling sorry for self and crying on and off. Hard to sleep for more than 3 hours again without waking from pain. Knee swelled up again.

Wednesday took shower with swollen knee and top "steri-strip" bandage put on Monday after staple removal popped right off between water and swelling. Ugh! Saw 1 1/2 to 2 inch length of incision that had about 45 degree scapel slit going into leg at least 1/4 inch deep.

I'm very squeamish, so asked hubby to look at it. He said "call doctor, but no meat underneath that he could see or blood." Had to make quick visit to doc's office. Nurse said swollen so probably popped off strip. Did not think incision opening up into flesh though. But looks like 2 separate levels of skin hit by earthquake with deep crater in between. This is going to be ugly I think.

Mostly laid in bed and cried Wednesday night. Thursday not thrilled to go to PT. Told him what happened and he said "would go light today." Made me do about 60+ leg extensions with 1 lb. weight. But actually could do those. Only a few small ROM exercises. Lots of swelling in afternoon, but icing and elevating (feel like Arctic Rockette) rest of day. He does do a really great massage afterwards that loosens everything up. Only taking 1 Oxy at bedtime (still wake up with pain every 2-3 hours) and just before 2x weekly PT. About 8 Aleeve/Naproxen spaced out over a day otherwise.

Until next Tuesday, just going to heal and go very slowly with leg slides a few each day.

 

[Qdogpa]

60 leg extensions with a 1 pound weight? Seems like way too much..I am, I believe ,1 week longer post op then you, and haven’t used any weights.. most of consists of attempting to use cybex bike, and only once have gotten 1 revolution.. then it’s a set or two of light extensions, and some balancing, and a few heel pulls....

i have similar sleep issues, and use OXY as you describe..
Hope it gets better for you!

 

[Helizabug]

All of that pain and swelling seems to be from so much painful PT. Can you give your knee a rest? Like a real rest, not the kind of rest where you can’t tell you’ve overdone it until hours later. I often can’t tell I’ve overdone until later because I’m so glad to have been able ‘do it’ at all.

 

[sistersinhim]

Made me do about 60+ leg extensions with 1 lb. weight. But actually could do those.

This is a huge . Quit going to PT until your swelling goes down. All these exercises are doing is inflaming your knee and setting back your recovery. All your knee needs to recover is your daily activities, rest, ice and elevation.

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.

 

[Celle]

Told him what happened and he said "would go light today." Made me do about 60+ leg extensions with 1 lb. weight. But actually could do those.

Please don't ever let him do that again.

First, 60 repeats of any exercise is crazy and totally unnecessary.
Second, your poor knee isn't lazy of unfit - It's wounded, having comde through major surgery kist a month ago. Weights are absolutely contra-indicated and they can do harm.

The other thing you need to learn - and fast! - is that you do not have to do what your PT wants. It is your knee and you are the only one with the right to say what happens to it. While others can offer advice, you also have the right to choose whether or not to accept that advice.

You are in charge of your knee and its recovery - you, and no one else.
You don't have to please your PT therapist. He has to please you. He works for you, not the other way round.

What he is making you do is bad PT. No PT at all is better than bad PT, so take a few days off. Then, if you can, talk to that therapist and tell him you're not happy with the way he's managing your knee. tell him what you will allow and what you will not allow - Allow only gentle exercises and massage.
Don't allow forced bending or straightening of your knee, weights, multiple repeats of exercises, or anything that hurts or makes your knee more stiff or swollen, at the time or later.

In case you think that you can't do that, read these articles:
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

If you feel you can't set the rules for your PT (I know, it can be hard), then look for a place that will treat your knee more gently.

And remember that there is no need to rush to get ROM, because it can continue to improve for a year, or even longer. There's no deadline you have to meet. Your knee won't set for ever at what it is now, and you won't lose ROM of develop adhesions if you cut your exercising right back.

 

[Jamie]

Please do not take pain medications right before your therapy. I know this is probably something you've been told to do, but it can be a problem. Pain is your body's primary signal to tell you when you are overdoing things. If you go to therapy medicated so you feel less pain, you're likely to do too much (like the sessions you've been describing) and get swelling and pain later. It's much better when you have a therapy session, to just go and tell your therapist you will not do any exercise past the level of just mild discomfort. You want to avoid swelling afterwards as that hinders your recovery. As long as you're having any swelling and pain in the days following therapy, stay away from any weights. Your body has been telling you it's too soon to do what your therapist thinks is appropriate. Trust your body. There is no "one size fits all" recovery. And, should your therapist tell you that you only have a certain amount of time to get your ROM (the old "window of opportunity" story), just smile and say you understand but stop the exercise at the "mild discomfort" stage. You have plenty of time to gain your ROM and your knee will not freeze up if you don't push harder.

 

[aperture]

I had the same surgery date as Julia (Jan 27th). I feel like we are all so vulnerable and at the mercy of doctors and physical therapists. It seems to vary so much from person to person, and each hospital's protocol and the physical therapists sent to us. Where I had my surgery (Cleveland Clinic) I have been sent a twice a week in-home therapist, but I had to fight to get the same one, as the substitutes all had slightly different interpretations of the "handout" exercises and could not tell me what progress I was making. I find that for me, walking seems to be the best therapy to regain strength. I try to incorporate all the torture stuff daily (those slides, oh boy!). But boy, doesn't each day vary! I was sort of feeling bionic and powerful and then wham! kneecap pain set in and back to the oxy, which I take reluctantly but feel it does help cut the intensity of the pain. Nice to be part of the forum now that I have figured it out.

 

[Peaches0000]

Feel your pain, Julia- I had my TKR on my right knee on January 9, the first 2 weeks feel like a blur now, honestly my brain blocked the misery out, I am on week 5 and doing much better- it still feels tight & swollen. Thank God for this Forum-I keep quoting it and my PT was annoyed today and said, you can't believe everything that you read online, because I no longer let him put weights on my legs as I lay on my stomach, bend my knee back so far, that the pain almost made me bite my tongue-I'm doing it my way now, I have him massage my leg first and I finally could ride the bike today. I was so worried about scar tissue, that I have been exercising to much at home, plus formal PT 3X a week. It was all to much- it just made my leg more swollen & tight. I have gone back to mainly elevation and icing it several times a day, light exercises at home and finally my ROM is going past 90. Its scary, but I am getting my left knee done April 2- I feel like if I don't do it now, I never will.I miss my old life, this does have a way of making you depressed after awhile. I just keep thinking short term torture for long term traveling, no painful knees anymore, and living my best life.

 

[Julia1911]

Thank you all. Just feeling I should make more progress, and PTs look at my less than 90 degrees ROM and shake their head and indicate I should be way ahead. Knee still swollen, but ankles almost normal now.

A week after surgery, I got on the scale and had gained 5 pounds over morning of surgery!!! After eating very little all week (due to meds and just feeling weak). But yesterday, almost normal. My leg was about 2x normal size for that 1st weighing.

Since I have Friday, Saturday, Sunday and Monday until next PT session, I have been trying to gently, but firmly (uncomfortable but no real pain) do heel slides, stair stretches, and working to go up stairs.

Did a few stairs upward yesterday and today until felt moderate pain, then stop, rest, ice. I can go up a few at a time, which gives me some hope for normalcy, but no way I can bend knee enough to go down even 1. Got plastic exercise benches (from about 20 years ago from "The Firm" an exercise program) from my basement. the smallest is about 1/2 the height of my stairs. Doing just 1 or 2 each downward a day to try and loosen the knee, but it feels like unmovable bands all around it.

Also now officially going stir crazy, but still getting very tired mid-morning and afternoon while doing "nothing." Still, stir-crazy is a lot better than depression and feeling sorry for myself. Worried, however, because steroid shot in right knee hasn't "kicked-in" yet. I've got to get thru another year before I get that one done. Just to know what the light at the end of the tunnel and full healing looks like before I go thru this again.

Doing some laundry today (but let hubby carry it up/down -- he went to visit 98 YO father 30 miles away in AL; I just can't get comfortable in a car for that long). Been trying to sort my coupons for a week (a really hard job, LOL), but just when I think I can do something, the fatigue sets in.

Just guess my 67 YO body if telling me something.

 

[Celle]

PTs look at my less than 90 degrees ROM and shake their head and indicate I should be way ahead

That's their schedule, not your knee's schedule. Their schedule is a one-size-fits-all theoretical schedule. To achieve good ROM fast makes them look good, but it isn't necessarily what your knee needs - and what your knee needs should be the most important thing.
.
.Your knee is going to take longer, because it was so badly swollen - but that's all right, because you have all the time in the world. You know that ROM can continue to improve for a year or more after surgery. There's no need to rush. Just let your knee take the time it needs. It knows what it's doing.

I can go up a few at a time, which gives me some hope for normalcy, but no way I can bend knee enough to go down even 1.

Can I suggest you stop doing stair exercises? It's much too early to be worrying about them.
Most people take a couple of months before they can go up stains one foot at a time. And going down one foot at a time always takes longer - sometimes as long as 4 months. That's quite normal.

Remember that this is a year-long recovery. It's a marathon, not a sprint, so you have to pace yourself.
You don't have to achieve lots of milestones early in recovery. Your knee will continue to improve over a whole year, so time is on your side.

Right now, less than a month from surgery, your knee is still in the early stage of healing. It's had massive surgery and it's not reasonable to expect it to perform as if it's almost healed. Please give it the time it needs.