Good morning new friends
- Thread starter maryo52
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OP
OP
I'm trying to maintain a home routine consisting of gentle stretches and a few rounds on the pedal exerciser (5 minutes) after first warming my knee. I think this is very moderate (at 6 weeks post TKR). I can understand there would be some increased aching later, but mine seems like a lot of achiness. To do this routine 3x day, I really need to take either 2 percocets q 4 hours, or take one every 2 hours (5/325). All PT efforts have been very very painful from the get-go, and flexion is less than 90 and probably more like 80. I'm supposed to see the OS Tuesday and this of course is all going to get discussed (each visit he talks about weaning off narcotic yet doing more stretching). I guess maybe it's time to verify with him that there isn't a surgical explanation for this . . . maybe an xray is in order? It'd be nice if the PT were a little more rewarding and/or less punishing.
The exercise you're doing does seem like a fairly moderate routine. But...."moderate" is a relative word. If this activity is causing you pain and swelling, then there is something that is a bit much for you now.
Since you refer to this as a "home routine," does that mean you are also seeing a physical therapist on a regular basis? How much other activity are you doing in a day....errands, household chores, cooking, cleaning, etc. All these things add up and if you are up and about a good bit of the day, it may be the combination of all of it that is giving you the pain.
I do agree with your thought, though, that as you are starting to increase activity it is NOT the time to decrease pain meds!
Since you refer to this as a "home routine," does that mean you are also seeing a physical therapist on a regular basis? How much other activity are you doing in a day....errands, household chores, cooking, cleaning, etc. All these things add up and if you are up and about a good bit of the day, it may be the combination of all of it that is giving you the pain.
I do agree with your thought, though, that as you are starting to increase activity it is NOT the time to decrease pain meds!
OP
OP
I have an Rx with a new physiotherapist to increase ROM to 95. So far (two sessions) he has pushed flexion and extension (I tell him "when"). Plus massaged and gently moved my kneecap. I like him and he seems to know what he's doing.
I am doing very little activity wise. In the past week I have cooked dinner twice, vacuumed once, walked down the driveway 700' each way once. These take a bit of a toll. But not like the PT routine. Certainly my tissues get mad fast. My leg is rarely dependent, often iced.
I am doing very little activity wise. In the past week I have cooked dinner twice, vacuumed once, walked down the driveway 700' each way once. These take a bit of a toll. But not like the PT routine. Certainly my tissues get mad fast. My leg is rarely dependent, often iced.
Josephine
NURSE DIRECTOR EMERITA
I think you need more effective pain management. But it's still only 6 weeks so don't let him start scaring you into having an MUA just yet. If things haven't improved in another 6 weeks, maybe then would be a good time to think of it. You've still got plenty of time to see improvement. It's often a long term project.
OP
OP
Tomorrow I see my PT for another stretching session, and Tuesday the OS for my 6 week followup. I'm not measuring or watching but I can tell there's been no appreciable change in ROM, so of course that will come up. I figure it's reasonable to take a wait and see approach over the next 6 weeks. I'm wondering, is it reasonable to ask for verification there are no surgical reasons for the stiffness? Would that entail an xray?
Do they ever give cortisone to help knock down the inflammation? Even though I'm taking celebrex, both knees are inflamed. I've also read that sometimes they aspirate fluid from the knee. I'm curious if immediately after, the knee bends better.
Any thoughts appreciated.
Do they ever give cortisone to help knock down the inflammation? Even though I'm taking celebrex, both knees are inflamed. I've also read that sometimes they aspirate fluid from the knee. I'm curious if immediately after, the knee bends better.
Any thoughts appreciated.
Josephine
NURSE DIRECTOR EMERITA
I try to be! 
I can tell you, though, that an xray won't reveal a thing. Mostly what causes it is adhesions which are soft tissue, MUA (manipulation under anaesthetic) and adhesions.
I can tell you, though, that an xray won't reveal a thing. Mostly what causes it is adhesions which are soft tissue, MUA (manipulation under anaesthetic) and adhesions.
OP
OP
Today I had my 6 week ortho follow up, then PT.
My ortho pointed out my extension is going well (by the way, the knee is extending better as the swelling goes down, not because of any herculean efforts on my part) but the flexion is still stuck. So MUA was discussed. I actually appreciated a chance to talk about it, and to ask questions about my surgery -- was anything at all out of the ordinary with the surgery? (No). My ortho does about 1 or 2 MUAs out of a 100 TKRs. He's not big on MUA but felt the adhesions would give easier sooner than later. He emphasized that it was not my fault that this has happened. He wanted to set a date, and I was OK with that. I figured it would be my Plan B. Plus I was curious to see how my PT would react. Would he say, "Oh yeah, that's a good idea?" Two experienced professionals making the same recommendation carries a lot of weight.
As it turns out the PT very much thinks with a little more time we'll get some decent flexion and recommended holding off at least another two weeks. The PT, his assistant and I had a very productive discussion, and I feel very hopeful. Even the ortho mentioned as I left today that setting a MUA date might turn out to be a great motivator in PT.
I was put through my paces In PT today, but it's amazing what you can do when you trust who you're working with. They said it looked as if I got about 90 on one of the stretches, and I couldn't help but shed a few tears of joy. Fortunately neither they nor my ortho measured me. It makes me feel overly watched.
I will be returning to PT on Thursday with the maximum of pain med on board and renewed hope.
My ortho pointed out my extension is going well (by the way, the knee is extending better as the swelling goes down, not because of any herculean efforts on my part) but the flexion is still stuck. So MUA was discussed. I actually appreciated a chance to talk about it, and to ask questions about my surgery -- was anything at all out of the ordinary with the surgery? (No). My ortho does about 1 or 2 MUAs out of a 100 TKRs. He's not big on MUA but felt the adhesions would give easier sooner than later. He emphasized that it was not my fault that this has happened. He wanted to set a date, and I was OK with that. I figured it would be my Plan B. Plus I was curious to see how my PT would react. Would he say, "Oh yeah, that's a good idea?" Two experienced professionals making the same recommendation carries a lot of weight.
As it turns out the PT very much thinks with a little more time we'll get some decent flexion and recommended holding off at least another two weeks. The PT, his assistant and I had a very productive discussion, and I feel very hopeful. Even the ortho mentioned as I left today that setting a MUA date might turn out to be a great motivator in PT.
I was put through my paces In PT today, but it's amazing what you can do when you trust who you're working with. They said it looked as if I got about 90 on one of the stretches, and I couldn't help but shed a few tears of joy. Fortunately neither they nor my ortho measured me. It makes me feel overly watched.
I will be returning to PT on Thursday with the maximum of pain med on board and renewed hope.
Just Judy
member
Mary it sounds like you are making good progress. You are still early in recovery . I am glad things are looking up for you. It is indeed a process. I am a good bit ahead of you and I still feel like I have so far to go. I am about 14 weeks and still have pain, swelling, etc. It feels like this will never end even tho I know one day it will only be a memory. I am sending you good wishes for a good pt day on Thursday. When you said that you shed a few tears of joy at 90 on one of your stretches I know exactly how you felt. It is the small steps that really help get us thru this. The surgeons certainly do not prepare you for what is ahead. I had a great OS and I have been like a deer in the headlights. I dont know what I would do if not for a wonderful and supportive husband and all the great people on this site. I hope you get a decent nites sleep tonite and can start the day fresh tommorrow !!!!!!:dogkiss:
That is really promising, Mary. I like how your medical professionals actually TALK with you. I know it also helps for you to have some knowledge also so you know what questions to ask. Your description of the meetings is how things are supposed to go all the time. You are working with an excellent team.
And, you're right....you will get there!!!:thmb:
And, you're right....you will get there!!!:thmb:
OP
OP
Today I took a walk. :th_yay: We practically live in semi-wilderness. Our driveway is 700' off a remote road. It was such an amazing wonder after all this time (6+ weeks) to do something normal and walk the dog down the driveway to the road and get the mail. Wowee zowee! Cute how Sammy senses my vulnerability and moves ever so carefully when near me. :dogkiss: One of the cats has spent a lot of time laying on my operative leg. Seems to think he's a faith healer of some kind. 
Back tomorrow to physio doubled up on pain med :egdnc:. These smileys are addictive.
Back tomorrow to physio doubled up on pain med :egdnc:. These smileys are addictive.Just Judy
member
Mary that is great news !!!!!! And yes the smileys are addictive.:smile:
:dogkiss:
:dogkiss:
OP
OP
My flexion got measured yesterday. I appreciate that they saw me for four PT sessions before taking a measurement. At one point my stretches looked like they were near 90 and there was quite an upsurge and hope about my "turning the corner." But after all was said and done, I was still at 80, which is where I've been since day one. Oh, I got up to 85 on the CPM one day but otherwise it's always been 80. My extension lost ground for a while but then seemed to come right along as the swelling subsided.
I don't know how to search this forum for the answer to the following question, but are there people who like me were stuck below 90 for a long time and who at two or three months started to gain flexion? I would love to read their stories.
Also, are there people who have been identified as having "adhesions" who overcame their limitations without MUA? How?
Very discouraged today.
I don't know how to search this forum for the answer to the following question, but are there people who like me were stuck below 90 for a long time and who at two or three months started to gain flexion? I would love to read their stories.
Also, are there people who have been identified as having "adhesions" who overcame their limitations without MUA? How?
Very discouraged today.
Josephine
NURSE DIRECTOR EMERITA
Well of course there you're feeling down! But there's really no need to be. There have been plenty of people on here who have been in very similar situation but I'm afraid they are amongst the number who have got it all done and gone on their way. I would point out, yet again, that you are still only about 7 weeks out and that's still far too early to be making judgements about needing MUAs.
And if it does come to having an MUA, that's not the end of the world. Don't see it as either a) inevitable or b) a failure. It's just another route to recovery.
And if it does come to having an MUA, that's not the end of the world. Don't see it as either a) inevitable or b) a failure. It's just another route to recovery.
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