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HyperZen

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Sep 28, 2009
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Hi. I'm a 42 year-old female and am 6 weeks out of TKR surgery. My PT has been frustrated by my ROM and I am getting frustrated as well. Friday I got to just 100 degrees of flex, which is the best I've had on my own (no assistance with a strap or the PT pushing), but today I was stiff and swollen and back to only 93. I am getting scared and frustrated. Is this normal? I feel as though I am headed down the road to manipulation. If so, will I get a better ROM almost immediately following? I like to know what to expect because I can be very hard on myself. I will push as much as I can, but I feel as though there is something that stops the progress - something tight and stiff - even though my PT says I have more range "in there"...if it's in there why can't I acheive it?
 
Not at 93 you are not heading for manipulation.

You are right something is stopping the progress. Ever thought you are pushing too hard. Good ROM one day tight stiff next day.

You are over doing. Your rom is fine for you at 6 weeks.

The swelling that causes the stiff and tight and sore is what makes
you not get the rom you got the day before.

Your PT should know that.

Rom will come, you are doing great for being at 6 weeks and at 100.

Try taking it easier and I think you will see the rom going up not back.

I never pushed and I never had the day of lapse because of pushing.

My rom is great. You will do fine, so take it easy and let it heal
in there and go a little slower. Remember HASTE IS WASTE.
 
My PT is right out of school. I guess she believes that since I am younger and had good ROM before surgery, I should just bounce back. My OS mentioned manipulation at my 4 week appointment, where I was measured at 96...They think I should get to 120. But when? I feel like I am overdoing, but I keep getting told to push through the pain. I do still swell after effort, but when I mentioned that to my PT she acted nonplussed.
 
Hey there welcome im 42 as well i was only being at 68 then i needed an manipulation.....But you are 6 weeks and swollen i dont think 100 is bad.........hang in there a lil longer and see ...take your meds before you go to pt for sure..........post anytime......)
 
Thanks, Texas. We 42 year olds have to stick together. It helps to hear other people's experiences. I have had a hard time understanding what to expect from recovery. They did a great job prepping me for the procedure and the days to follow, but once I started in out-patient PT, I got no information.

I take my meds but my doctor has only approved one more refill. They said they don't usually prescribe more after 6 weeks, so now I feel like a junkie for asking. Ha.
 
Yes we do and we will......you post anytime at all.....Well if your in pain and your OS wont give you more after 6 weeks then call your reg Dr they usually help out......Thats kinda hard doing PT with nothing......Are you sleeping ok?
 
Haste is waste! I like that, Pat! That goes in my book of overused phrases (it will be overused by the time I'm done!)

HyperZen, do not panic! What loggon said is true in every respect. Most early flexion problems are caused by swelling, nothing more. And the more you push it, the worse your swelling is, the harder it is to get any increase.

Now, are you taking enough pain meds? Is your pain properly controlled? Are you elevating and icing several times a day? You should also remember the vicious circle - pain causes swelling and swellin is painful! You can't get good flexion if you are swollen and in pain. Just won't happen.

So tell me what pain meds you're on and how often you take them, what you pain score is on average and how often/long you ice and elevate.
 
Hi Josephine. Thanks so much for the input. I am trying to learn to take it easy, but it seems like all I hear in PT is push push push and do my exercises 2-3x a day. I also am trying to go back to work part-time (was there for the first time today for four hours in the afternoon after PT -and after icing - and got very swollen. Am icing again now.) I'm not sure if I can hack it part-time at a desk yet or not, but I feel like I am falling out of touch with things and am worried about it. (Can you tell I am type A?)

I was taking Vicodin but it was bothering my stomach so the OS switched me to Darvocet. I just picked up my last prescription. He said he's cutting me off, as they don't prescribe after 6 weeks. I only take them before PT and then I take two, which helps. I am not sleeping great, but am sleeping okay. I am taking Tylenol before bed (two extra strength.)

Pain score on average is not bad, 3-4, when I am sitting with it down and bent. It's not comfortable but it's not terrible, and that's not all the time. If I am sitting with it elevated, I have almost no pain. During therapy I'd say I get to a 7 when they are pushing on me (literally). I ice two to three times a day. I have a Polar Care Kodiak that a friend lent me that is awesome.

I know I'm not doing as bad as I think I am, but I am afraid of it being stiff or not getting flexibility back. And I have a hard time knowing when to push and how hard (since all I hear in therapy is push through the pain) because like you said, then it swells and hurts and I am basically done. I guess because my therapist is new, I need to not take her word as gospel. She keeps telling me to push and anytime I am sitting I need to focus on increasing the bend, but the longer I do that the more swollen it gets after a while...Vicious cycle is so true!
 
Well, for starters you should not be back at work at 6 weeks! Way, way too early! This is major surgery you've had here and you need an absolute minimum of 8 weeks, probably 12.

Secondly, you're not taking near enough pain meds. If your OS is stingy (he should try it!) go see your GP and if he won't, find a pain clinic. 3-4 is still much too high and needs bringing down a lot more if you're going to be able to make if with the PT.

Thirdly, why are you only using that ace ice machine a couple of times a day? Use it all the time. You don't mention elevating your legs which is just as essential. If you don't elevate, you'll never get the swelling under control.

So, to recap
1. go bang some desks about getting some better pain meds. You need something like Tramadol or oxycodone 4hrly for few more weeks,
2. ice a lot more and elevate - rest as well
3. quit working for a few more weeks. Look after yourself first, no-one else is going to it you don't!
 
I'm sorry to sound like an idiot but what do you guys mean when you say "you may need manipulation?" Is this some form of therapy aside from the exercises PT will require?
 
It's when the surgeon forcefully bends the knee under general anaesthetic to break down the adhesions or scar tissue that is sticking the muscles and ligament together and preventing their 'glidability' factor. There's more about adhesions and MUAs in the Information Centre (link above) in the Recurring Knee Info section.
 
Wow, Josephine. Now those are some marching orders. ;-) I will go forth and hopefully be marching myself soon.
 
Hi Hyper Just checking in to see ho you were doing if yo changed your mind on work..........If not take it easy and rest when you are home..........Hugs..........

Hey Bernie I had to have a manipulation it worked great i had so much scar tissue I was getting no where...........Hope your doing well..........)
 
Thanks for checking. I'm home again. Still working but from my couch so I can elevate and ice as often as necessary.
 
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