I am at 5 weeks post TKR and am now booked in for a manipulation. I came out of hospital and rehab with only 65%. Since being home trying to do PT on own, pool work in cold pool, no physio or heated pool due to holidays avail. i have now only got 50%. i didn't go on the machine in hospital only in rehab a week later for an hour twice in that week. Do you think that is why I have not got enough % or is it because I can't go over the pain barier too much?
Feeling Depressed
- Thread starter chnuf
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AlaskanTKR
graduate
chnuf -
First of all - take your meds and get some pt quick! Next - dont worry about the manipulation - It is a piece of cake!
Hang in there!
Marianne
First of all - take your meds and get some pt quick! Next - dont worry about the manipulation - It is a piece of cake!
Hang in there!
Marianne
United KingdomGosh, that's quick to get adhesions though it does happen occasionally. You really must be feeling low. So let me first put your mind at rest - this is quite probably nothing to do with not having done enough PT or been 'good enough' in what you did.
Here is my standard mini-lecture on the subject so read and absorb ...
All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.
Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the inside of the body, cool and dry. The natural reaction is that fluids evaporate and tissues cool. This makes the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.
Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of reasons some known, most unknown, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and begin to stick or adhere to one another. This is why they are often refered to as 'adhesions'.
NB: Some people (and surgeons!) often refer to this as scar tissue which is a bit of a misnomer. Scar tissue is abnormal or fibrous tissue that's grown in a place as a result of trauma like an incision. Adhesions are just normal tissues stuck together.
Anyway, if this occurs and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's all a manipulation is.
Here is my standard mini-lecture on the subject so read and absorb ...
All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.
Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the inside of the body, cool and dry. The natural reaction is that fluids evaporate and tissues cool. This makes the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.
Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of reasons some known, most unknown, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and begin to stick or adhere to one another. This is why they are often refered to as 'adhesions'.
NB: Some people (and surgeons!) often refer to this as scar tissue which is a bit of a misnomer. Scar tissue is abnormal or fibrous tissue that's grown in a place as a result of trauma like an incision. Adhesions are just normal tissues stuck together.
Anyway, if this occurs and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's all a manipulation is.
carolinacooker
junior member
I had a manipulation with a surgery prior to mr TKR, you just wake up with a sore and swelly knee. Its not nearly as bad as it seems. You just hang in there, we all fight the same depression and have much of the same anxieties. Take it one day at a time, do your very best, and do what the docs say.
Dw
Dw
Nursepair
supremo
Hi Chnuf and welcome. I am one of the 5%, I have swelling still and a ROM of about 100-110 still after a year and a manipulation. The MUA was OK, I was about 6-7months before I had it done. I was also slow getting a decent ROM at first. Took me many weeks to get all the way round on the bike, it was very frustrating and depressig. It will come, the MUA helped me go from 93-97 then several more weeks of PT before a 100. My OS said it may take me 2 years before I get a better ROM. but I don't have any pain and I can do most things. Can't get up and down from the floor without looking like an Ewok, coming downstairs is still difficult but not impossible and getting out of the car the same.
So hang in there it will come, you are still very early days yet!! Good luck....Sue
So hang in there it will come, you are still very early days yet!! Good luck....Sue
carolinacooker
junior member
I'm right with you sue, about 110 or so. OS said not to expect much more. Your right, getting in and out of vehicles and downstairs are the most difficult. I have cried out some colorful language when I go to swing my leg up into my truck and whack it on the door jamb when my brain told it to bend more than it was able to do!
Dw
Dw
Doug
alpha
Dw, your post brought back an early recovery incident. I drive a 4X4 truck. I had my TKR on my right knee.
At about three months post op, I went to step down out of the truck and forgot my knee wouldn't bend well without me making it.
I got my left foot on the ground and my right foot got hung up under the brake peddle. I ended up rolling forward on the ground. I laid there laughing then wondered if anybody had seen it..
Folks, just keep on working them and then you'll start getting little "surprises" when you do something with your new leg and then realize you couldn't do that prior to the TKR.
At about three months post op, I went to step down out of the truck and forgot my knee wouldn't bend well without me making it.
I got my left foot on the ground and my right foot got hung up under the brake peddle. I ended up rolling forward on the ground. I laid there laughing then wondered if anybody had seen it..
Folks, just keep on working them and then you'll start getting little "surprises" when you do something with your new leg and then realize you couldn't do that prior to the TKR.
calling_all_angels
big-cheese
Dear Chnuf,
I really do understand how you are feeling, and you are right about this being a great place!! Everyone here really cares. And just thinking about scar tissue scares the B--gees out of me. (I come from a long line of scar tissue
scares)
Are you worried about having a maniputation? I thought that Jo really explained it so it was easy to understand. (She is the greatest)
Chnuf, I woke up with my leg in one of those machines plus a cold polar
machine. I got home on Sat. But could not get in to PT till Wen. And
I had droped from a 100 to a 86. And I am not sure why either. Are you
all by yourself? And trying to do it all on your own? I think that you will
see a big difference after the maniputation. Hope you will keep us up todate on everything. I am just a few weeks behind you.
^i^
I really do understand how you are feeling, and you are right about this being a great place!! Everyone here really cares. And just thinking about scar tissue scares the B--gees out of me. (I come from a long line of scar tissue
scares)
Are you worried about having a maniputation? I thought that Jo really explained it so it was easy to understand. (She is the greatest)
Chnuf, I woke up with my leg in one of those machines plus a cold polar
machine. I got home on Sat. But could not get in to PT till Wen. And
I had droped from a 100 to a 86. And I am not sure why either. Are you
all by yourself? And trying to do it all on your own? I think that you will
see a big difference after the maniputation. Hope you will keep us up todate on everything. I am just a few weeks behind you.
^i^
calling_all_angels
big-cheese
Ohh DW and Doug thank you for bring tears of "laughter" to my eyes I was begining to think that I was never going to smile again.
But you both made remember what happen 15 years ago when I had my first knee surgery on my right knee. It just was not getting better after 3 month of PT.
It was a snowy Sunday and as I was going down the steps at Church I slipped.
The pain was unbelieveable I made it accross the Street to my house and by 30 minutes
I could feel such a differance in my knee!!! It moved freely and the pain was gone!!!
Thanks my new friends for making me remember that!
I had forgotten that things have a way of working out.
^i^
But you both made remember what happen 15 years ago when I had my first knee surgery on my right knee. It just was not getting better after 3 month of PT.
It was a snowy Sunday and as I was going down the steps at Church I slipped.
The pain was unbelieveable I made it accross the Street to my house and by 30 minutes
I could feel such a differance in my knee!!! It moved freely and the pain was gone!!!
Thanks my new friends for making me remember that!
I had forgotten that things have a way of working out.
^i^
Rowdy66
graduate
Doug, you always manage to put a good light on the problem. I can see you rolling around on the groung laughing like a loon then looking around to see if anyone noticed. I did something similar last week and I have great range of motion, I just get in these weird fixes. I was in the living room and decided to get down on the floor and clean under the big tv. I got down and then couldn't get back up, I am sitting there laughing and talking to myself when suddenly from behind me my oldest son say "Mom, you need a hand getting up?" I thought I was by myself and he had been sitting quietly in the recliner watching me the whole time. Now, he is worse shape than I am in so I got myself up off the floor, it just took me a second and probably saved him a herniated disc.
CHNUF, You know I think we all have issues of one kind or other as we go through this process they refer to as post-op and it is different for each of us. I have adhesions in one leg and great range of motion and extention so I am leaving it alone. I am just not anxious to have my knees fooled with anymore when I am doing so well right now. I hope you get better, you must be terribly frustrated. I can't imagine what you must be going through and will certainly keep you in my prayers. Rowdy
CHNUF, You know I think we all have issues of one kind or other as we go through this process they refer to as post-op and it is different for each of us. I have adhesions in one leg and great range of motion and extention so I am leaving it alone. I am just not anxious to have my knees fooled with anymore when I am doing so well right now. I hope you get better, you must be terribly frustrated. I can't imagine what you must be going through and will certainly keep you in my prayers. Rowdy
AlaskanTKR
graduate
Chnuf-
Hope you are doing ok - My tkr was 7/14 and I had the mua on 10/18 or 10/20 ( I cant remember anymore). My OS felt this was at the end of the optimum window for best success. I tried several different ways to avoid it and what a waste.... actually... not a waste but I should have had it done sooner had I known the difference. The best thing I did though was to take the week off that I had the mua. I made sure to do ALL my exercises, ice constantly and whenever seated or resting or sleeping - elevated. All of that eliminated additional swelling ( I had enough of that already I didn't need more) The pain was controlled with meds and really no worse than what was taking place at pt during stretching /ROM times. I immediately felt a difference in the knee on the way out of the hospital. Hubby forgot the crutches. Didn't need them at the hospital but going from car to house I ended up walking on it and WOW - I had so much more bend I immediately came up from the depths of frustration! Now I did loose some of that initial gain but holy cow what a differnece at PT! It was worth it for me and really not painful!
Whatever your decision - I hope you have found some suppirt here. I couldn't have made it through without all the great people here at BONESMART!
Marianne
Hope you are doing ok - My tkr was 7/14 and I had the mua on 10/18 or 10/20 ( I cant remember anymore). My OS felt this was at the end of the optimum window for best success. I tried several different ways to avoid it and what a waste.... actually... not a waste but I should have had it done sooner had I known the difference. The best thing I did though was to take the week off that I had the mua. I made sure to do ALL my exercises, ice constantly and whenever seated or resting or sleeping - elevated. All of that eliminated additional swelling ( I had enough of that already I didn't need more) The pain was controlled with meds and really no worse than what was taking place at pt during stretching /ROM times. I immediately felt a difference in the knee on the way out of the hospital. Hubby forgot the crutches. Didn't need them at the hospital but going from car to house I ended up walking on it and WOW - I had so much more bend I immediately came up from the depths of frustration! Now I did loose some of that initial gain but holy cow what a differnece at PT! It was worth it for me and really not painful!
Whatever your decision - I hope you have found some suppirt here. I couldn't have made it through without all the great people here at BONESMART!
Marianne
Hi all it is great to hear all your replies. they really help. Thanks to josephine for explaining all the ins and out. I have been exercising in the pool daily and still not getting the movement so waiting for the Manip. Just wondering how long it took everyone to get back to work. I drive a bus in the gas fields.
Chnuf....it make take longer than you think to get back to work. Everyone heals differently. And especially a driving job might be a little more difficult to get back to full time real quickly. Your best bet is to just try and take things a day at a time and continue with the good work you're already doing exercising your knee, icing, and elevating. Be sure to get plenty of rest and food and take you pain meds on schedule (that helps both the swelling and the ability to do your PT at max levels). Quite frankly at 5 weeks, I was just beginning to get out and do things slightly. And when I would attempt somethiing, I was ONE tired puppy!!! So expect to take LOTS of naps. That's your body telling you it needs to regain some energy. Healing takes a lot of your body's energy and the extra rest is needed. Good luck and keep us up to date!
A bus driver, huh? Well, in that case you should give yourself extra time.
Plus, if the PSV (public service vehicles) licensing people are as strict in your country as they are here in the UK, their medics will want to go over you with a fine tooth comb before they let you back. You will, after all, have the lives and wellbeing of others at your mercy!
Plus, if the PSV (public service vehicles) licensing people are as strict in your country as they are here in the UK, their medics will want to go over you with a fine tooth comb before they let you back. You will, after all, have the lives and wellbeing of others at your mercy!
Calling All Angels
Your experience 15 years ago was kinda like your own manipulation. After a previous surgery I had my knee was also stiff and not moving well. My OS closed the door to the exam room and leaned against it. Then he told me to stand against the wall and to slide down the wall in a squat position. I did that and stopped when I felt like I could not go any further but he kept telling me to keep going and that we were not leaving till I did. Well I kept going and all of a sudden I felt a sharp pain and hear what sounded like things tearing but a few minutes later the knee was moving freely.
Probably doing it under anesthesia would have been easier but this worked. He was a very good OS so I am sure he knew what he was doing .
Simon
Your experience 15 years ago was kinda like your own manipulation. After a previous surgery I had my knee was also stiff and not moving well. My OS closed the door to the exam room and leaned against it. Then he told me to stand against the wall and to slide down the wall in a squat position. I did that and stopped when I felt like I could not go any further but he kept telling me to keep going and that we were not leaving till I did. Well I kept going and all of a sudden I felt a sharp pain and hear what sounded like things tearing but a few minutes later the knee was moving freely.
Probably doing it under anesthesia would have been easier but this worked. He was a very good OS so I am sure he knew what he was doing .
Simon
calling_all_angels
big-cheese
Ohhhhhhhhh Simon,
I would like t believe that I could be as brave as you.
But I know I could not have been. To force your knee to
go down is like WOW.
When I slipped I was just glad that I did not fall completely.
My Hubby was only worried that I would... oh who knows
what he thought. But you, you were very brave.
^i^
I would like t believe that I could be as brave as you.
But I know I could not have been. To force your knee to
go down is like WOW.
When I slipped I was just glad that I did not fall completely.
My Hubby was only worried that I would... oh who knows
what he thought. But you, you were very brave.
^i^
btilelli
junior member
They did threaten me with this procedure also. I am at about 95% bend in P.T. and I can get up to 105 on my cpm machine but I am still very stiff, especially in the mornings, my range is much less then. I'm 28days out. I hope the procedure goes well for you and isn't too uncomfortable. Take care and keep us posted.
Bridget
Bridget
btilelli
junior member
Just wondering if anyone has had pain on the bottom of their foot of the affected knee. I 28days post-op and all my bruising is gone but stiffness and swelling of the knee still there. I didn't remember, in my pre-op class, anyone telling us to expect posterior foot pain. Any ideas?
Bridget
Bridget
calling_all_angels
big-cheese
Btilelli,
Pre-op class? Dang that is cool. No one told me anything except when to show
up for New Knee. I go in for my 2 week check up Thursday and I think I need to
talk to my Doctor and see why he did not have my Pain Meds sent in to my Pharmacy
on Friday. Why some Doctor I did not know gave me 50 MG of Ultram?????????
And the Nurse that I talked to when I called back up told me no one is sent home
with only Ultram for a TKR! So if he is going to do the other knee I think we need to clear the AIR a little because right now I just do not trust him.
^i^
Pre-op class? Dang that is cool. No one told me anything except when to show
up for New Knee. I go in for my 2 week check up Thursday and I think I need to
talk to my Doctor and see why he did not have my Pain Meds sent in to my Pharmacy
on Friday. Why some Doctor I did not know gave me 50 MG of Ultram?????????
And the Nurse that I talked to when I called back up told me no one is sent home
with only Ultram for a TKR! So if he is going to do the other knee I think we need to clear the AIR a little because right now I just do not trust him.
^i^
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