Going Backwards -- Increasing Stiffness

[Simon]

Hi Folks

It has been a month since BTKR and I seem to be going backwards. When I left the rehab floor a few weeks ago the left knee was around 96 and the right one 94. I had home PT for 1 1/2 weeks and started outpatient PT on June 29th. The ROM is now around 90 for both and they are super stiff and just don't seem to be moving as freely as they did 10 days ago.

I do my exercises 5 times a day and in between I have been using one of those peddlers for about 2 to 3 minutes (all I can do) or walk around. I saw the OS on the 3rd and the tibia fracture has held so I can put 100% weight on the right and I was able to get rid of the walker. He was happy that we did not have wound healing problems where the new scar crossed the old ones and that the alignment is good. He would have like to see more ROM though.

Pain has not been a problem so far. I have stopped the extended time release MS-Contin with no problems. I take 4 mg Hydromorphone before PT and that has been ok. I use Tylenol if things start feeling sore. I also use alot of ice.

I started back to work part time but I work from home so I can take breaks. I found I can't sit at the computer for more than about 1 1/4 hours before I have to get up and move. My original plan for a laptop fell through but I have one on order that should be here in a couple of days. That will help as the recliner is much more comfortable to work from.

Like everyone sleep is difficult and the OS said he would write a Rx for Ambien but I declined. I am sure that problem will work itself out.

Anyway if any of you have any ideas on why things are getting stiffner and what to do about it I would appreciate it.

The ROM before surgery was only about 95 and the multiple previous surgeries do factor into the equation but the OS thinks we should be able to get over 100.

Thanks

Simon

 

[Skeet]

Simon, I wonder if you are doing so much more than you were that maybe you are experiencing more swelling and that is impacting your ROM? Mine went up and down as well - going up 5 then down 2-3 then up 5-7, etc. So maybe it's part of the normal recovery. Keep working on the bike, that helps. I also used our hot tub to warm up the joint and then bend it as far as I could, hold it for liek 30 seconds, release and repeat. I iced it a lot when I got out. Wish I could be of more help, but that's my two cents worth.

God bless!

 

[NJW]

Hey Simon,

On Monday, I will be 4 weeks post BTKR. I thought it was my imagination but I feel stiffer now than a week ago. I think it is just a normal progression. At my last PT (Wednesday) my ROM was about 125 (forced by my therapist) and about 118 on my own. I have not been as diligent with my exercises and I'm afraid by Monday, my ROM will be less. I can pedal for 20 minutes with little pain and walking is great. I need to work more on plain old bending. I do have a tendon just below my right knee cap that throbs when I'm not standing. The surgeon had to do some tendon repair work on that knee so I guess it is something I'll have to put up with for awhile.

I can't even consider going back to work anytime soon. I work part time so it's my decision when I return. I have to strap on lots of heavy equipment; there is alot of walking and getting up and down out of a chair. Can't use a cane. I've got at least anther 6 weeks before I'll even consider it. I really have to be 100%.

After reading other posts from folks who are farther along, I get the impression this whole healing business is all about 3 steps forward, 2 steps back. Patience is the one thing I must constantly work on.

 

[beachcomber]

Simon,

Did your PT *tell* you to do your exercises 5 times a day? My "prescription" was a good PT workout twice a day followed by ice. I also walked and did balancing exercises and other "lifestyle" activities throughout the day that helped get my knee back to normal but only did the real "workout" twice a day.

At about 3 weeks PO I did decide that I probably knew more than my PT and that if twice a day was good--- then 6 times a day must surely be three times as good----- but my knee and my PT both set me straight on that! I think my knee and muscles and tendons,ligaments, etc. needed both the therapy--- AND some recovery time---- and if you are doing the exercises too frequently they are not getting a chance to recover...

Just my thoughts..... hope it all settles down soon.

 

[Simon]

Hi Beachcomber


Yes it was the PT on the rehab unit that said do the set 5 times a day. These are pretty basic exercises (leg lifts, various knee bends, quad tightening) and there are 10 of them.

I do have a good physical therapists and now that we are 100% weight bearing I am sure the routine will be changing. I will check with him.

I just so want this to work out, that I am doing everything I am told.

I will probably go a few more weeks part time but I have a desk job so it is not a strain.

I like the idea of heat but I have been told by all the PT's not to do it.

Well I guess we just have to take each day as it comes.

Thanks to all

Simon

 

[beachcomber]

Wow-- I bet weightbearing will change what they have you do and also changes the stress points in your knees. I know you are doing your best... just keep it up and know that it will get better--- but at your own rate. Work hard, but be patient and listen to your body.

Heat can feel really good--- but my PTs were not too big on that either for a long time. It was a month before my OS would let me in my hot tub but I did find the heat very beneficial for loosening up my knee and soothing my back once they let me in.

Take care and try to stay positive. Set a target for something you really want to do---- and you WILL get there! It is a long journey. but there is a "normal life" out there for you again. Six months post-op PKR I just got back from our annual vacation in Mexico. I was absolutely determined to go and set my goals for my rehab to get there and go sailing and snorkeling--- and I did. You can too!

Thinking of you and hoping for better days ahead soon!

 

[Rowdy66]

Simon I don't see how you can do the exercises five times a day. I just plain old couldn't manage to do them that much. How many sets are you doing at a time? I found I did better when I spread my exercises over the course of the day instead of clumping them all together and doing them all. I do three sets of 15 on the basic exercises and like I said spread them out. Now at 8 weeks post op for BTKR I only do one set or three in the morning and then ride the bike mid-afternoon. At night and in the morning after I have gotten my husbands breakfast and lunch done and I am ready to go back to sleep (I have to get up at 2:30am to get him off to work) I ice my legs and elevate them while I sleep and then repeat it before bed in at night. I think, and this is just my opinion, that the stiffness is directly related to swelling. I feel very fortunate that I had very little swelling post surgery and at the first hint that I am getting stiff I ice and elevate. I have also been very fortunate with ROM as mine has been way above the curve they expected to see. I think a lot of it is dependant on the way we heal and that is different for each of us. It is the end result we are all working towards and as long as we keep that in mind and stay focused we will reach our goals. Simon, you had an extremely difficult time with the surgery and I am so impressed with the progress you have made and the way you have persevered. You have overcome such tough situations and just keep on going. You know it hasn't been that long since you had your surgery and then to top it off you had to spend ten days in rehap. So when you are wondering how you are doing I think you should be applauding yourself and the progress you have made against steep odds. Look at what you have accomplished in a very short time. You are an inspiration to us all. Rowdy

 

[Simon]

Thanks Rowdy

I do think the problem is swelling as the right knee is still very fat, the left is a little better. My physical therapist has changed by exercise to focus more on extension especially on the right as it is -14. So know I due 5 exercises, 3 times a day and if I can do it, a bit of the peddler.

I guess the lack of sleep (still having problems with that, the doctor offered a prescription but I am trying Tylenol PM instead) and still not much of an appetite is not helping. So as you said, just take it day to day.

I also use alot of ice. I will try the elevating though I was told to be careful with that due to the lack of extension.

Thanks for the encouragement.

I am working 4 hours a day and I sure hope the laptop arrives in the next day or so as sitting at the computer is difficult.

Well to another day.

Simon

 

[Teach4]

Simon:

I'm at 7 weeks and having the same problem. When I went for my post op the doctor wasn't happy that my ROM was only 85, so I've been working hard with the PT doing my exercises, riding the stationary bike. Last week I got to 95, then today only 89. I was very frustrated! My knee has been VERY stiff the past couple of days. I'll be interested to hear if others had this problem. I just wrote in today of my frustration. My PT had me just walk tonight and not do the stationary bike, resting my muscles. We'll see about the stiffness tomorrow. I'm worried because I go back to the doctor Friday, and if they don't feel it's improved, they're going to "crank" it themselves! Keep in touch.

Teach4

 

[DaleMc]

I am at 3 weeks post op and I hit 90 last Friday but then this Monday I was only at 80. They forced it back to 90 but the knee is so tight it feels like it is going to bust. I personally do not like this rollercoaster ride.

Dale