TKR Getting really concerned<^

[Josephine]

I failed to go to PT on yesterday and instead went out and purchased a Polar Ice machine so I could better ice my knee. I certainly thought the ice packs were going to make things feel better. Right now after I ice my knee, it is still stiff, sometimes stiffer than when I started.

You expected a change in 24hrs? You're not expecting much, are you!

I don't want to go back to PT because it doesn't seem to be helping, it seems to be hurting more than anything.

Actually a very wise move.

I wonder if I have done some damage because I have been trying to sleep on my side sometime.

There is nothing you could do that would cause damage to your new knee. It might strain some soft tissues but that's about it.

There seems to be so much that is bothering me right now I think I am beginning to get depressed.

Let's talk about it then. First let me start by asking you some questions. It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home and how many sessions you do each day
enter exercise by name then number of repetitions of each
etc., etc.

At PT (how many times a week)
enter exercise by name then number of repetitions of each
etc., etc.

 

[2helpme]

Thank you and let me see how much I can provide you.

1. My pain level would be about a 5 if we take into consideration the stiffness I am experiencing. (this site has taught me that stiffness is pain also)

2. Percocet 5-325mg and tramadol 50 mg are the pain Meds I have been prescribed. I take one tablet (Percocet) in the morning and one before bed, and I fill in during the day with the tramadol during 6 hour increments during the day. Since my knee is swollen I also began taking Naproxen 500 for the swelling for the last few days.

3. Moderate to huge

4. Guessing ........ I would say around 70 right now. When I was doing mild therapy at home it was at 105.

5. I am icing my leg. I got the Polar Bear Ice machine on Monday and I have been keeping it elevated and iced about 4 times a day because of ice issues right now. The machine seems to use ice faster than I can get it. I was icing before then but not with any consistency.

6. Yes, I am elevating it. It is elevated at the same time it is iced. About 4 times a day. I have noticed that when I get up to get something to eat or to wash clothes if I stay up (out of the bed) too long (maybe about 3 hours) it swells. Meaning I need to keep my butt in the bed as recommended.

7. I have been doing all of the things mentioned in #7. I am going to stop doing all of them and only get up to go to void.

8. At home:
heel slides in the bed in sets of 10
Flexing my foot as often as I can
In PT:
Heel slides - 3 sets of 10
Leg lifts - 3 sets of 10
Leg lifts on a bolster with knee not lifting off - 3 sets of 10
Leg presses - 130 lbs.... 3 sets of 10
Total gym machine pushing my self up with my legs as far up and down as I can go 4 minutes
Standing on a balance board doing left/right rotations side to side and front to back 3 mins each
Got me walking my leg up on wall and pulling it down the wall to bend it and using the right leg to pull it down as far as I can. 3 mins
I am sure there is something else I need to add but I can not remember it right now.
I am usually in therapy for an hour and 30 minutes.

 

[little red canoe]

Balance board rotations?? Sounds like sports training for skiing. There is lots of lateral force there.. Pulling down leg on wall and holding for three minutes. Leg presses... you are supposed to be healing not strength training...

What sort of PT is this?Your implant into the tibia is healing and I would think in my naivete that the last thing you want to do is to stress it laterally.. I did not walk on sidehills for about six weeks and then it was a noticeable stress to the new knee.

I am not surprised you are losing ROM.
@Josephine

 

[FlaGranny]

That's just a crazy amount of working out. No wonder you are swollen and stiff and very painful. You are not permitting your knee to heal and just continually aggravating it.

 

[newlybionic]

With a pain level of 5 you probably need to take your medications more often during the day. You need to elevate your 'toes above the nose' and ice for about 60 minutes or more at least 4 times a day. All the weight training should be stopped for now. it is too soon for leg presses and most of the exercises you are doing at PT. You really need to give your knee and leg time to get rid of the swelling. Just doing that will help you gain range of motion. Your knee will swell when you have your leg down and that is normal for where you are in your recovery. You can continue to have some swelling for up to a year or more to some degree. Here is the activity progression of what you should be doing along your recover.
https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

Here again is how you should be elevating your leg.

 

[grabbit97]

It was interesting reading about your discussion about sleeping on your side. I just about four days ago discovered that I could not sleep on my side with my knees together. I was trying to sleep with a pillow between my legs but it got tangled up in me and I got rid of that. Are used something like Volteran Gel called Ibuleve on an area to the left of my operated knee and it seemed to help being able to put my knees together and sleep on my side. It just happened three or four days ago. Keep the faith it will happen I am seven weeks postop and really have no pain anymore and I'm probably taking Tylenol when needed so it does happen keep the faith

 

[2helpme]

Thank you all for your replies. I called the clinic and rid them I was not coming back this week. They called me to see what what going on but I was sleep. I don't understand how they try to push us and why so many people let them.

At any rate I am not going back until I feel better if I go back at all. Thank you all again for all this good info! I am using the machine as much as I can for as long as I can going forward. I can tell I am my A's stiff as I was before I started the rest, elevate, ice process.

 

[KarriB]

I'm glad you're cutting down on PT. As others have said, it's WAY too early for weights. The more your leg is down, the more it will swell, so keep it elevated as much as possible. You don't have to stay in bed. Elevate on the sofa or in a chair with an ottoman or bench. If I wasn't in the bathroom or kitchen, my leg was elevated. I couldn't keep my leg down for three hours until I was 12 weeks post-op.

 

[Josephine]

1. My pain level would be about a 5 if we take into consideration the stiffness I am experiencing. (this site has taught me that stiffness is pain also)

Have you also notice that there are other covert forms of pain - such as soreness, burning, stabbing, throbbing and
aching?

2. Percocet 5-325mg and Tramadol 50mg are the pain meds I have been prescribed. I take one tablet (Percocet) in the morning and one before bed, and I fill in during the day with the Tramadol during 6 hour increments during the day. Since my knee is swollen I also began taking Naproxen 500 for the swelling for the last few days.

It seems your schedule is a little underwieght. I would suggest perhaps you take the Tramadol every 4 hours and/or maybe take two sometimes.

I would say around 70 right now. When I was doing mild therapy at home it was at 105.

And what does that tell you? Your PT is to aggressive!

I am icing my leg. I got the Polar Bear Ice machine on Monday and I have been keeping it elevated and iced about 4 times a day because of ice issues right now. The machine seems to use ice faster than I can get it. I was icing before then but not with any consistency.

'faster than you can get it'? Never tell me you are buying ice? Don't you have a freezer at home? Or an ice box in your fridge? If you can freeze at home then get some small drinks bottles and fill them with water (not right full!) and you can use them over and over again!

6. Yes, I am elevating it. It is elevated at the same time it is iced. About 4 times a day. I have noticed that when I get up to get something to eat or to wash clothes if I stay up (out of the bed) too long (maybe about 3 hours) it swells. Meaning I need to keep my butt in the bed as recommended.

Well you are only 5 weeks out and considering your activity, I am not at all surprised!

7. I have been doing all of the things mentioned in #7. I am going to stop doing all of them and only get up to go to void.

That's a bit all or nothing which is exactly what you shouldn't be doing! You should be up and about to do ordinary things like prepare yourself a snack or a drink, you could do a little bit of washing up and take a few walks around the house every couple of hours.

My comments in bold
At home: you've not said how often which is just as important for me to know
heel slides in the bed in sets of 10 - heel slides are a very easy exercise to do badly and assuming you are doing these 3-4 times a day, that's badly! Read this Heel slides and how to do them properly.
Flexing my foot as often as I can - do you mean foot pumps? Those are just anti-clot exercises and since you are so active, there is absolutely no need to do them any more.

In PT:
Heel slides - 3 sets of 10 - comment above applies
Leg lifts - 3 sets of 10 - a tip - once you can do leg lifts there is absolutely no need to do them any more
Leg lifts on a bolster with knee not lifting off - 3 sets of 10 - those are half leg lifts and equally unnecessary
Leg presses - 130 lbs.... 3 sets of 10 - NO WEIGHTS of any kind for anything! Besides which - are you using a machine to do these? One like this - if so that is a great BIG NO-NO! No machines, no weights

Total gym machine pushing my self up with my legs as far up and down as I can go 4 minutes - and is that this machine? Because that's another big no-no!

Standing on a balance board doing left/right rotations side to side and front to back 3 mins each - more NOOOS! Stop doing that at once. It's an exercise for healthy people, not someone still in recovery.
Got me walking my leg up on wall and pulling it down the wall to bend it and using the right leg to pull it down as far as I can. 3 mins - wall slides - more no-nos! Refuse to do these any more!
I am usually in therapy for an hour and 30 minutes - well, I've heard enough anyway. You're not in training for the Olympics! And I'll warrant even professional athletes don't do this much.

I dread to think what the 'more' is but I can tell you this - your ROM will never improve if you keep going to this facility. In fact it will just get worse and worse. If you want to improve, stop going to this gym and let your leg rest, heal and recover.

You need to read this, paying special attention to the second post BoneSmart philosophy for sensible post op therapy. But don't confuse no PT with no activity. They are poles apart. Read this again Activity progression for TKRs.

 

[2helpme]

Have you also notice that there are other covert forms of pain - such as soreness, burning, stabbing, throbbing and
aching?

Yes, I am aware these are other forms of pain but I didn't mention them since they were not present.

I mentioned I was only going to get up to void. I am getting up to get water, a snack, more ice for the machine and to wash clothes and fold them.

Ice: I do have an ice maker in my fridge. I didn't have it turned on until I got the ice machine. Cause I don't like the taste of the water where I live. I have also frozen several bottles of water for use as well. The machine just seems to need new ice about three hours. I use it for about an hour then off an hour. And I repeat.

This is the Total Gym machine they have:

Oh well I think I am going to get better by following the groups suggestions.

Thank you again for your insight.

 

[little red canoe]

That machine is great for....later.. My gym has one.. I do about five reps on it.. but I am almost 11 weeks out.

 

[2helpme]

Wow and at 3 weeks they had me doing it for about 3 mins! I am so glad I found this forum. I didn't feel good about doing them. However, you know what happens when you don't do what they want you to...... they even told me I was behind on my recovery.

 

[Celle]

You don't need "help" like that from a PT team.

What they don't seem to realise is that you have had a major operation that caused huge trauma to your leg. The poor thing needs time and gentle treatment, so that it can heal in peace. It's not lazy - it's wounded!

You wouldn't try to do those exercises if you had a broken leg, would you? Well, what you have had done is just as much trauma as a broken leg.

It's not exercising that gets you your ROM anyway - it's time. Time to recover, time for swelling and pain to settle and time to heal. Your ROM is there right from the start, just waiting for all that to happen so it can show itself.

 

[FlaGranny]

I haven't been to many PT establishments, but I've never seen that type of machine in the ones I've been in. That is gym equipment.

 

[ACDCJen]

When I was going to OP PT for my first tkr, they had me doing the new gym for 30 reps...at 8 weeks! Nope! I stopped going. Good for you for advocating for yourself.

Jen

 

[Chili]

I am 14 weeks or so and have been experiencing some of the problems with my PT also. I have stopped going and have started taking pain medication again as I am having very broken sleep.
It's really good to know you're all out there and that we can encourage each other. This is my second TKR and I forgot how long it takes to recover from this operation. I have had a set back in the operation as the operating doctor cut my medial ligament and repaired it before closing.
I believe it's one day at a time.

 

[2helpme]

Hello Everyone!

I wanted to let you know the elevation and ice has finally gotten rid of all my swelling. The only issue I am left with right now is the tightness of the band around my knee. I think from what I have read there is nothing that can be done about that. Am I correct in that thinking?

 

[little red canoe]

some have the tight band feeling for a long time.. my sister in law had it for many years.. that said there could still be internal swelling.. I have some and I am a month ahead of you. I can tell when the joint is loose and when it swells.. It feels just like too many ace bandages around the knee.. There is swelling that you can't see and from what my surgeon tells me the various bursae in the knee are limited in room.

Patience You are still very early in recovery..

 

[newlybionic]

The best thing to do is to make sure you ice and elevate when you have that tight feeling. it does eventually lessen but you may find that when you have a lot of activity you may feel it more.

 

[2helpme]

Tightness just won't let up! Has anyone out here ever had a situation where the right. And feeling seems to never go away? I had surgery 11/10/16 and I am still bothered with the right band feeling on my knee. I have iced and elevated at least three times daily for three hours and it is still there. Should I be concerned about this feeling?