MUA Getting Back in the Saddle

[HorseyLady]

Hi Diana,
Our posts crossed over! The meds are a problem because my OS says go to GP and my GP won't give me anything stronger. Thinks I should be coming off the Tramadol too. Thats why I am asking Josephine what I can take together to see if I can mix and match paracetamol, Naproxen and Tramadol so it is most effective. However, if I don't push on my knee then I don't need many pain meds because day to day pottering around is just fine now the bruising is getting better.

I agree, 2 different views is so confusing and I worry that if I follow the mantra then I will stiffen up completely but if I push myself then the knee gets hot and the adhesions grow. I can't seem to win!

Saw my horses today and thought of you! Lots of lovely cuddles and they were so pleased to see me. My lovely husband even poo picked the field for me while I sat in my chair

Tomorrow I will try icing in the cpm

 

[maryo52]

I'm wondering if you had a chance to read my advice about what progress to expect. I think I related to you that I did not get beyond 90 until 4 weeks out from this procedure. You sound as if you disagree with the PT's guidance, and I would too!! I set the CPM for the setting that felt like a good stretch without pain. You are in control. It's your knee.

 

[HorseyLady]

Thanks for the reminder maryo52 Yes of course I read your advice I am just pretty expert at expecting too much of myself when it comes to making progress. I seem to get very disheartened after the Rehab team have been!

 

[maryo52]

The disheartened part of getting through scar tissue, I remember too well!! I disheartened myself plenty. Then one little word of negativity from PT sent my spirits plummeting. They problem is THEY expect too much.

My ortho said that the word "arthrofibrosis" at a conference had the same effect as the word "bomb." It would cause people to scatter. Orthos fear arthrofibrosis because it's so hard to treat. You are lucky that your ortho knew what to do. But most PTs also don't know what to do. They take the direct approach -- if a knee doesn't bend enough, well then, make it! -- but that's the wrong approach. And when you don't take well to their direct approach, they have a way of letting us know we are misguided.

I didn't tell the PT folks but even before I had arthrolysis, I planned to ditch them. They had always told me "if I worked hard" I'd get my ROM. Either they were wrong, or I didn't work hard, and at no point in life did I not work hard at something I wanted. My whole head got a little screwed up in the PT place even though I liked the people and they meant well. I spared myself a lot of grief but doing my final recovery "on my own." I have the results to prove it was a good decision.

 

[HorseyLady]

Sounds like you went through the whole thought process that I am going through! It is so good to hear from someone who knows and understands! I feel quite upset when I get accused of not working hard. I have a horse waiting to be ridden, a dog that needs walking, a baby grandson, a job to go to etc. Why would I choose to not be able to do any of those things for a life of disability? I really want to get back to living my life.
Better day today and I am feeling more positive. I got to 90 on the CPM this afternoon Knee is always lovely and loose after but soon seems to go backwards so I am trying to do several shorter sessions rather than longer ones. Still feeling painful when walking so just pottering around today

 

[My way]

Hi HorseyLady I'm so happy to hear you feel better. I don't know what makes people say things that bring a person down and makes them feel they are to blame for the curves life throws us sometimes. I think you are right to do shorter and more frequent sessions. Your body will let you know what is right for you. It worked well for me. I only went to PT for checkups but, she always said you only have 8 weeks to get a good ROM. I ignored her doom and gloom and exercised my way. I saw the OS yesterday for my 8 week checkup and his attitude is you will improve slowly for months. Where do the PTs get their info?
take care and listen to your knee. Sounds like it's working!
wanda

 

[HorseyLady]

Thanks My way for your reassurance about listening to your body. I am going to make a determined effort not to listen to the PTs and get so disheartened after their visit. I must listen to my knee and do what it tells me That started this evening when I had some stabbing pain and swelling and made the decision not to go on the cpm as I was supposed to be doing but to ice and elevate instead. I am sure it is nothing to worry about as it is around the stitches and holes from the arthroscopy - maybe all the bending has pulled them a little.

My knee is in charge

 

[new knee in June]

Dear Alison,
Bravo for rom of 90 so it is possible. I think before your p.t starts working with you,
You should tell them of your "slow & steady" approach to recovery. If they don't know your feelings,
How can they work with you ? You need to be on the same page with them then you both can work on what is
Best for your recovery.
Stand tall in your own convictions......they are usually right.
Like Wanda says......it's your knee, you know best.....plus you have Mary & josephine
Have a wonderful weekend,
Diana

 

[Josephine]

I seem to be getting used to the Tramadol and it is not as effective as it was. I have been taking 2 paracetamol plus 1 50mg Tramadol at breakfast, lunch and tea - then 2 paracetamol with 2 Tramadol at bedtime

I find this a very common problem amongst you American ladies! You take an inadequate dose of something and then say it doesn't work! As you progressed in your exercises and caused yourself more pain, you should have upped your dose of Tramadol to 100mgs instead of sticking with 50. There were times I took 150mgs when the paint was that bad.

I could put it roughly like this regarding pain score and Tramadol:
3-5 ..... 50mgs
5-7 ..... 100mgs
7 + ..... 150mgs

I started Tramadol when I had my TKR so wondered if 10 weeks of it was too long and my body is used to it?

It's a bit of a myth that bodies 'get used' to narcotics. Invariably it's because people are scared of the 'A' word and don't take enough as I've explained. I took Tramadol for 12 full weeks and shortly thereafter got a torn meniscus so went back on it, a few weeks after that, I got piriformis and trochanteric bursitis and was back on it again! Don't be fearful of pain meds. Use them to help you and you'll be fine.

 

[maryo52]

You are doing great if you got to 90. And great that your are responding to your body's signals such as doing shorter sessions.

I would start low on the CPM (maybe 60) and inch up about 1-2 degrees every 5 minutes. So it took me two hours to get to the fullest bend possible which was uncomfortable but not painful. But then what I'd do is stop the machine at the highest degree and just let my leg adjust for a minute.

 

[HorseyLady]

I find this a very common problem amongst you American ladies!

Josephine I am in the UK! Much as I think my PT and surgeon follow the American style and I would love to live in Florida, California or somewhere hot sadly I live in Yorkshire. I will up the Tramadol if needed though, thanks for your advice.

maryo52 Yes I am following your advice on this. 90 only comes after inching up very carefully. And sometimes, particularly in the evening, I don't get there. I am getting better at listening to my knee and ignoring my PT who says it should never be set less than 90

Blisters are healing. This is because I have removed the dressings early and let the stitches get some air so they are less sore when bending. My knee does not look very pleasant according to my family but who cares, it feels better District Nurse is coming on Monday to remove them so not long to go.

 

[puffin]

Alison - a ROM of 90 sounds like good progress to me - isn't it around 50% higher than your pre-procedure ROM? AND you still have stitches and swelling from the procedure which is bound to reduce ROM in the short term.

Glad to hear that you are feeling more positive - it is always the way that these small progressions make you feel much better. I think you are doing the right thing letting your knee decide the pace of exercise and not the bullying PTs. Make sure that you are taking enough painkillers as you had an operation 1 week ago

 

[Josephine]

Josephine I am in the UK!

Blisters are healing. This is because I have removed the dressings early and let the stitches get some air so they are less sore when bending.

Jolly good! I worked with a surgeon once who never put dressings on his wounds. He said he would prefer it to be exposed to "God's good clean air"!

 

[puffin]

Hi Alison - hope you are having a good weekend with plenty of resting and icing and not over doing the

I am still taking Tramadol but I have slow release tablets that are taken twice per day - 150mg and 100mg - I also have some 50mgs for severe breakthrough pain (like when I am in the ODIC). Hope you get the right meds

 

[HorseyLady]

Hi puffin
Do you find the slow release tablets work better than the standard ones? I am considering asking my doctor for these when I next renew my prescription.
Bit stiff this evening as I went to watch a horsemanship clinic today and did not go on the cpm until tonight I was sat down most of the time but my knee still wanted to stiffen up. Still, I had a very good day which was much needed emotionally. Sometimes we have to do these things
Hope you're having a good weekend and are not still a member of the ODIC

 

[Renew]

Thank you everyone for all your best wishes and advice. It is really really appreciated as at the moment I just feel so alone with this. Coming on here is giving me some much needed friendship and support from people who know and understand. My family are trying to be helpful but I have 2 grown up sons (27 and 24) who still live at home and think I just need to "man up" and "push through the pain". My husband is very consoling and is taking care of everything practically but doesn't really know what to say. He is taking me to see the horses later, just for some cuddles which will be nice

I had a good nights sleep but my knee is very stiff and not bending this morning so I have taken a painkiller cocktail (thanks Josephine!) and added back my Tramadol - and had a session on the cpm machine. I got to 85 eventually and was on for an hour or so but then my knee started to get very hot so have come off it now for some resting time.

maryo52 do you have any advice for me? I know you have arthrofibrosis and had arthroscopic removal of scar tissue too.

Hi there: I have been reading over your post and it has been so much help to me I had my LTKR May 30 and struggled just had a MUA on Aug 22, but am having a hard time went from 63 to 83ROM but now knee I really swelled and sore and having a hard time with the bend will know on Tuesday but I think I have lost some ROM. Here in Ontario they do not use the CPM machine anymore I wish they did because it helped me in the past on some of the other knee surgery I have had done. Would love if you could give me any advice on how things have worked for you and what you find has helped you the most. Thanks Melodie

 

[HorseyLady]

Renew Hi Melodie,
Great to hear from you! I had my MUA and arthroscopy on 23rd August so just one day after yours and yes, I am still struggling too. These knees seem to just want to stiffen up all the time unless they are gently moving. Unfortunately the only thing that seems to be working for me is many hours on the cpm machine. Not set to cause pain but just to keep the knee moving and gently stretching. Without it I would be stuck! Literally
Have you investigated hiring a cpm machine? In the UK there is a company that hires them out. It is fairly expensive but well worth it. I had to do this after my original fracture and it really helped. Not sure if you have this in Canada? Worth googling though. Fortunately I have one from the hospital which was given to me by the Rehab team, I just hope they don't take it away any time soon!
The only other thing my PT suggested is incorporating bending into every single activity you do. For example, every time you go upstairs do 10 pushes on the bottom stair. When you're walking practise bending back and forth. Every time you pass a certain chair, hold onto it and do 10 hamstring bends etc. Also practise your walking gait and make sure the knee is actively bending. I know I was walking stiffly but I didn't realise how much until I caught sight of myself in a window
I really hope you feel better soon. I was told to expect to go backwards initially after the MUA and that it may take several weeks before the ROM shows itself. I am only actively bending to 80 myself so I also have a long way to go. Fingers crossed for us!
Alison

 

[maryo52]

Here's Campervan's answer to some of these questions:

 

[Renew]

Hi Alison: Gonna try your tricks- every time I go upstairs do 10 pushes on the bottom stair. When you're walking practise bending back and forth. Every time I pass a certain chair, hold onto it and do 10 hamstring bends etc.
Thank you for sharing reading your comments has helped me realize I am not alone in my struggle as you and I seem to have had our procedures close together and are experiencing the same issues with our ROM. I have seen people mention the CPM machine on this site, I think that sounds like the machine they uses after my other procedures but my PT says they no longer use them? not sure way. But I am going to see how much they are and if there is away I can get one here in Canada. Is CPM the actual name or is that a short form? I will keep you updated and again thanks for sharing.
Wishing you a speedy recovery and that things start to get easier for the both of us

 

[HorseyLady]

Hi Melodie, Renew
CPM stands for continuous passive motion. There are numerous actual makes of machine and they do them for knee, hand, elbow, ankle etc. The one I have is an oldish version made by Danniflex but I used a quieter one in hospital, think this was made by Toronto and was model L4D. You just plug them in, set the degree of extension and flexion and away you go. You can also set it to pause at each end so you get a good stretch! To hire in the UK they are about £230 a month and to buy about £2500!

You are certainly not alone in your struggles! Looks like our procedures were done at similar times and we have similar problems. Also you are "young" as my surgeon says, seems we often have more difficult recoveries particular if we have had numerous knee operations as a result of trauma. He also said he doesn't normally use cpm's for knee replacements but that this a "traumatic" knee not an "arthritic" knee and it has different needs.

Stay in touch and let me know how you get on