1. Pain levels: 6-7 when exercising, 1-3 for normal activity
If your pain score during exercising is that high, then you're doing it wrong.
2. Medications: Oxycodone 5 mg. As of the last two days I take 2 at bedtime and 1 or 2 during the day
Acetaminophen: 500 mg. I take 2 in the morning and 2 at bedtime
Gabapentin: 300 mg. I take1 at bedtime
Meloxicam: 15 mg. I take 1 at bedtime.
Oxycodone: you should be taking them as prescribed which usually is at least 4 times a day.
Acetaminophen: assuming the oxycodone has no acetaminophen in it, then you should take this 4 times a day at 6hrly intervals
Gabapentin: I don't understand why you are taking this at only 4 weeks out. That's much too early. Has your doctor told you it's a pain medication - because it's not. It's an anticonvulsant medication used to treat muscles spasms (cramp). If you think it's for pain management then I suggest you have a word with your doctor or pharmacist to ensure you're not having contradictory expectations from it
Meloxicam: or Mobic among others, is a nonsteroidal anti-inflammatory and therefore only a very mild pan killer. I suggest you focus your pain management on the Oxycodone and acetaminophen rather than the others.
Did you factor this in to your pain score? Because moderate swelling would add a factor of 4 to your pain score.
4. ROM: I’m sorry, the PT measures when she visits and she is happy with the measurements but I don’t really pay attention to the numbers. I know myself and if I paid attention to the numbers I’d be ordering my own goniometer and tracking the numbers. So, I’m trying to focus on how I feel when exercising and my perception of progress.
But not being able to actually
see you, it's the only way I can assess your progress. Perhaps next time she calls and measures you, you could make a note of the numbers (flexion and extension) and let me know. I can't offer full advice without it.
5. Icing: if I’m not exercising or doing something around the house, like making tea or folding laundry, I’m icing. I even ice at bedtime and sometimes fall asleep with the icing cuff on. I tend to then wake up after maybe 3 or 4 hours. At that point I turn the machine off and remove the cuff until the morning.
Good to hear that!
6. I elevate toes above nose about the same amount of time I ice.
That's the way to do it!
7. Activity level: I walk to our mail box once each day. Around the house I make tea or coffee, lattes, toast but no real cooking. I do some laundry , wash and fold and not much else. Our house has 10 steps from the garage/laundry room to the first floor which is essentially our living room. The we have 8 steps from the first floor to our main floor with the dining room, family room, kitchen and powder room. This is where I spend most of my time. Finally, we have 8 steps , a landing and then 8 more steps to our bedroom. So, I’m getting pretty comfortable walking up and down steps.
I suggest you go back to the Recovery guidelines in post #2 of this thread and read this one
Activity progression for TKRs. I also suggest you follow the timetable closely.
Home exercises
Heel slides 1 set of three with each slide held to a count of 30. I do these every hour -
that's too much. Read this Heel slides and how to do them properly
Press my knee as flat as possible: 10 held for a count of 5. I do these every hour -
Also too much. do 5 at a time. However, these are not good for extension. The best way to get an improvement is to walk. And leave it alone, it will come back on it's own. Doing any extension exercises simply increases swelling and thus DEcreases the extenstion (this is also why I need your ROM numbers)
Stationary bike 5 minutes. Most of the time spent pedaling back and forth.-
5 mins too much. Try one minute and slowly increase every few days. BY which I mean increase by 30 seconds at a time!
Walking 5 minutes once each hour.
Remember your pain score. A score of 6-7 means you are doing far too much.
Exercising (or PT, whatever you want to call it)
should NOT cause you pain AT ALL.
The last three days I have been able to do three or four counterclockwise rotations and two or three clockwise rotations each session. The exception to this is the first session in the morning, where I am too stiff or swollen to do more than a back and forth pedaling.
You're pushing it too hard. You shouldn't be at this stage until about 6-8 weeks.
Home PT visits twice a week. I do all of the above exercises and the PT does some measuring.
Reduce as I've suggested.
In summary:
let me know your ROM numbers as soon as you get them
amend your medications as suggested
cut back on your exercising considerably. You don't need all this, you really don't. Remember this
It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself.
In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
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