TKR Got the blues and PT causes me 3-4 days of misery<

[Doupie]

@Celle, I second that thought....

 

[Josephine]

I went to physical therapy on this past Friday and learned that my bending went from 93 degrees back to 85 degrees but here again I was swollen and stiff with lots of rain and humidity outside.
My therapist from the week prior told me not to worry about it as I am swollen but my other therapist just made me feel like I wasn’t doing something right to cause the decline in bending.

I did really well on the bike was able to petal first backwards and then forwards which is vast improvement for me. New exercises were added.....laying on my stomach with a strap attached to my ankle and pulling it towards my head forcing it to bend more.

I was also placed on weight machines, leg press and another one where your sitting with your legs under a cushioned roller and your pushing up with your legs. Both of these work the quads.

Well, my quad is weak she told me and causes the knee to buckle at times. So these exercises with weights is to strengthen my quad muscle.

I had to drive home 30 minutes after my PT session which is daunting. By Saturday the following morning I was so sore and swollen I could barely walk. Now I was hurting in my lower back and both hips and my TKR knee was super stiff and swollen. I hobbled around like never before. It was a full day of icing, elevating, massage and pain meds.

Today (Sunday) I’m a little better and am icing, elevating, massaging and took a 8 hour Tylenol for arthritis. I did try and stretch gently on my reclining bike and then iced immediately afterwards. I’m getting upset as it’s difficult to walk as I’m walking with a limp and it throws my back out sciatica issues.

It’s tight feels like bands around my knee which was getting better until Friday’s weight machine exercises.

It was my 13th visit to PT and I have one more visit left before they resubmit to my insurance for more and it’s up to the insurance company whether it’s approved or not.

It’s 98 degrees here and I can’t walk in the heat although I may try tonight as the sun goes down. I would like to be able to finish house cleaning but I cannot do it more than 20 minutes at a time.

I was told not to vacuum
because the motion of it causes swelling. I have 1st hand knowledge of this now. I’m just feeling overwhelmed, tired and depressed. Is it going to get better soon? I’ve got the whines today can’t help it.

@Jaderose26 was this your answer to my questions? Because if it was, you haven't answered them in a way I can use them. Remember I said "It would be very helpful if you would answer each one individually - numbered as I have done"

 

[Jaderose26]

Let me go look maybe I missed your questions? I must have missed it somehow

 

[Dzina]

Please listen to all of the above about doing too much and stopping the Outpatient PT. I was in your situation last year with my LTKR and didn’t find BoneSmart until my 7th or 8th week. By that time I was miserable and depressed with the painful knee and the tight knee clamp feeling around my knee. It took quite awhile for the knee to eventually settle down and for the clamp like feeling to disappear. All opinions thought it was do to overdoing the PT. Now with my RTKR I’m following BoneSmart advise and it makes a world of difference. So please listen to the advise of all these experts so you can begin to feel better. Rest, rest rest, ice, ice, ice, elevate elevate elevate!

 

[Jaderose26]

Dzina, will do, thank you!

 

[Celle]

Let me go look maybe I missed your questions? I must have missed it somehow

They are in Post #12 - I did tell you that in a previous post.

 

[Jaderose26]

1. When I’m not on my feet per se my pain level is about a 5.
When I’m on my feet for more than 20 minutes it begins to get very painful like an 8 or 9.
I get occasional stabbing pains that are an 8 to 10

2. In the beginning I was prescribed hydrocodone/acetaminophen 7.5/325 to be taken every 4-6 hours.
Then about 3 weeks ago he backed the hydro down to 5/325 every 6 hours
I had about a 1 week supply and then switched to Aleve which he said would probably suit me better as I have a lot of inflammation, 2 in the morning and 2 at night.
It seemed to help a little bit about a week ago I started having chest pains and feeling rather odd kinda sick at my stomach at 3 am for two nights. I decided to back off the Aleve is as I cannot take Mobic or Celebrex.
I did purchase 8 hour Tylenol that helps some but does nothing for the inflammation.
I do have some Tramadol 10 mg but haven’t really tried that as of yet.

3.) My leg swelling is better than it was of course in the beginning but sometimes with physical therapy or weather it can really swell which gives me terrible pain. Sometimes the swelling is super apparent other times I feel like it’s situated deep inside my joint.

4.) flexion of 85 when it had been 93 for the first time the week prior.
extension is a 2 and the week before that it was a 5. It’s like back and forth right now

5.) I use my ice packs about 4-5 times a day. Was icing for 30 - 40 minutes in the beginning but my PT said no longer than 20 minutes at a time as it would cause more swelling? Then I read some articles with Bonesmart and went back to icing 30-40 minutes again.

6.) I don’t sit with my leg down often as it is uncomfortable so I usually have my leg up. If I’m icing my leg is up for about 30-40 minutes at a time.

7.) It takes me all day where as normally it would take me a couple hours to clean the entire house. I vacuum but swell from it so bad it’s hardly worth it! If I wrap my knee it seems better when I vacuum. I am up in 20 - 30 minute intervals trying to clean. Then I’m just exhausted. I have two dogs that I take out 4 times a day. Shopping my sister does for me and she has been doing most of the cooking at dinner time. I have gone with her to shop but I can’t walk the entire store it’s just too painful and tiring.

8.) I have been doing some exercises at home mainly stretching and my reclining stationary bike.
2 times a day
Stationary bike 10-15 minutes
Heel raises 1 x10
Squats 1 x10
Hamstring stretch 3 hold for 30 sec
Leg lifts 1 x10
Quad stretch on my stomach with strap 3 x30 seconds

This is what I do at home as well as a hamstring stretch if I have not suffered too much from PT
PT last 2 weeks have been once a week before that it was twice a week.
All the same exercises but with added
steps back and forwards 2 x10
steps sideways 2 x10
band and flex then straighten x30
leg press machine with 40lbs x20
Leg extension machine x20
on back, pulling my foot with strap 2 x10.
on side and lift my leg up and down 2 x10
After all that I receive stim and ice for 20 minutes and then go home and collapse and then the following 3 - 4 days is full of pain, stiffness and swelling to a point it’s hard to do anything but ice, elevate and whine.

I get tired thinking about it and just about when I’m feeling some what better it’s time to get back and cause some more hurt.

 

[Jaderose26]

I found it and I have now answered the questions. thank you

Yes, I feel that it’s too much so I'm going to try and back off a bit. You know I try to follow the advice of the doctor and physical therapist but sometimes it’s not always right for everyone. I also have lupus which gives me even a little bit more inflammation. Thanks for the input.

Yes, that sounds like good advice. You know the PT is always talking about scar tissue and how if you don’t participate in all the exercises you’ll become stiff and then have to possibly go in for a MUA. With that being said I was just trying to do what I thought I was suppose to do even though I was in pain. I know in every other surgery I have ever had I was told to rest and recover not go run a marathon. It seems that resting, icing and elevating would be ideal for sure so I don’t understand why they work you out so much after this very extensive and intensive surgery? It’s beyond me. I was up walking 6 hours after and they had me walking the halls and going to physical therapy everyday when I was in the hospital.

mom2fencers, you are right, it feels like it’s too much for me right now. Thank you for the input.

Celle, I’m learning bear with me. New to this. I did find and answer the questions tonight. I had not seen that message from her. Appreciate the help.

kneeper, yes, you are right, it is too much too soon. Thank you

ChrissiG, thank you

ChrissiG, yes, I am trying to get to a happy medium when it comes to PT because it really makes me miserable afterwards. I do get depressed when I’m stiff and in pain constantly. I’m looking for the light at the end of the tunnel so to speak. I’m trying to be mindful of the low moods recognizing what my body has been through and to not expect miracles overnight. It takes time to heal. It’s hard to rest sometimes when your mind wants to do things but your body doesn’t cooperate. Thank you

Great Advice!

SusieShoes, it does help thank you. As for my nickel allergy if wear a chain around my neck and it has nickel in it I get a rash that gradually spreads until I remove it. Then again, maybe it’s not nickel that’s causing it maybe it’s something else.

For some reason I cannot open these links o my iPhone 8 Plus. Do I need to open them on my MAC?

 

[Josephine]

1. When I’m not on my feet my pain level is about a 5.
When I’m on my feet for more than 20 minutes it begins to get very painful like an 8 or 9.
I get occasional stabbing pains that are an 8 to 10

Gosh, that's high!

2. In the beginning I was prescribed hydrocodone 7.5/325 to be taken every 4-6 hours.
Then about 3 weeks ago he backed the hydro down to 5/325 every 6 hours
I had about a 1 week supply and then switched to Aleve which he said would probably suit me better as I have a lot of inflammation, 2 in the morning and 2 at night.
It seemed to help a little bit about a week ago I started having chest pains and feeling rather odd kinda sick at my stomach at 3 am for two nights. I decided to back off the Aleve is as I cannot take Mobic or Celebrex.
I did purchase 8 hour Tylenol that helps some but does nothing for the inflammation.
I do have some Tramadol 10 mg but haven’t really tried that as of yet.

I'm glad you stopped the Aleve since, as you said, it is an NSAID and it was very remiss of your doctor (or surgeon?) to prescribe it without checking if it was a problem for you. If you look here you will find an absolutely enormous list of drugs that are NSAIDS! But this article will be of immense help to you as well Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers. So then you will know what that pain was that you had in your chest and stomach! Heart burn and reflux!

The 8hr Tylenol is only 650mg which isn't very helpful. In fact, you'd be better of using extra strengt Tylenol which is 500mg per tablet. So you should take 1,000mg 4 times a day. Much, much better for managing pain. BUT if it doesn't help with the 8-9 pain number, perhaps you need a little something extra - perhaps some Tramadol. And if your surgeon won't oblige, ask your GP.

3.) My leg swelling is better than it was of course in the beginning but sometimes with physical therapy or weather it can really swell which gives me terrible pain. Sometimes the swelling is super apparent other times I feel like it’s situated deep inside my joint.

I thought I'd made it clear by posting three photos of knees marked HUGE, MODERATE and SLIGHT but you ignored them! I need to know what your swelling is like!

4.) flexion of 85 when it had been 93 for the first time the week prior.
extension is a 2 and the week before that it was a 5. It’s like back and forth right now

I can answer that - but later!

5.) I use my ice packs about 4-5 times a day. Was icing for 30 - 40 minutes in the beginning but my PT said no longer than 20 minutes at a time as it would cause more swelling? Then I read some articles with Bonesmart and went back to icing 30-40 minutes again.

Jolly good!

6.) I don’t sit with my leg down often as it is uncomfortable so I usually have my leg up. If I’m icing my leg is up for about 30-40 minutes at a time.

Are you elevating properly though? As in "toes above nose"? Or like these

7.) It takes me all day where as normally it would take me a couple hours to clean the entire house. I vacuum but swell from it so bad it’s hardly worth it! If I wrap my knee it seems better when I vacuum. I am up in 20 - 30 minute intervals trying to clean. Then I’m just exhausted. I have two dogs that I take out 4 times a day. Shopping my sister does for me and she has been doing most of the cooking at dinner time. I have gone with her to shop but I can’t walk the entire store it’s just too painful and tiring.

And I bet you've been doing this since week one, haven't you? You're doing too much, my dear! Much too much!

I have been doing some exercises at home mainly stretching and
my reclining stationary bike - ah but you never said how long?
2 times a day - once a day is plenty and none at all at the weekends
Stationary bike 10-15 minutes - okay s long as the seat is as high as possible and there is NO resistance
Heel raises 1 x10 - don't do these, they will cause you pain from over-stressed muscles
Squats 1 x10 - squats are very bad - don't do them
Hamstring stretch 3 hold for 30 sec - okay
Leg lifts 1 x10 - some advice about leg lifts, once you can do them, you don't need to do them any more!
Quad stretch on my stomach with strap 3 x30 seconds - never ever use straps. If you can't do this in your own strength, don't do it

This is what I do at home as well as a hamstring stretch if I have not suffered too much from PT - well that's a bad idea!
PT last 2 weeks have been once a week before that it was twice a week
All the same exercises but with added
steps back and forwards 2 x10 - not good, causes pain
steps sideways 2 x10 - not good, causes pain
band and flex then straighten x30 - not good, causes pain and I said earlier NO BANDS
leg press machine with 40lbs x20 - NO gym machines, they over stress your muscles
Leg extension machine x20 - NO gym machines, they over stress your muscles
on back, pulling my foot with strap 2 x10 - not good, causes pain and I said earlier NO BANDS
on side and lift my leg up and down 2 x10 - not good, causes pain and I said earlier NO BANDS
After all that I receive stim and ice for 20 minutes and then go home and collapse and then the following 3 - 4 days is full of pain, stiffness and swelling to a point it’s hard to do anything but ice, elevate and whine - I'm not at all surprised! Dear me!

I get tired thinking about it and just about when I’m feeling some what better it’s time to get back and cause some more hurt.

PT or any activity should NOT HURT!

All that I have crossed out are entirely responsible for your pain and shooting pains. You really must stop them, completely! Right now. Cancel your PT as well. Because if you don't, your pain and swelling will get worse and worse and your ROM will likewise get worse. If you want things to improve all round, then please do as I've recommended and within a few weeks - 4-6 or so - you will find things improving all on their own.

Many of us here have come through our knee replacements without doing any exercises whatsoever.
I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

You see, 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.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Jaderose26]

Hi Josephine, my swelling in my leg is moderate or a little above that. In the beginning it was 2 inches larger than my other leg.

I pedal the reclining bike about 8-15 minutes at a time about twice daily. I can’t pedal forward all the way around on my reclining bike as I think maybe the seat is too low as it seems my leg stretches out more when pedaling. I can’t pedal backwards all the way around. At physical therapy I can pedal both directions.

My last physical therapy session was this past Friday and I had a very difficult time explaining to her that I was not going to allow her to force push my swollen leg to give an end result for my therapy thus far. She had a hard time taking no as an answer. I did the stretch on my own and ended up with a 91 degree flexion.

She told me that I probably wouldn’t be coming back to therapy as I’m past the 90 degree flexion and was out of danger so my insurance may not approve it which is fine with me!

I don’t know whether I need a different type of stationary bike or what. Today I stretched gently and rested mainly. Did a few little things but nothing major.

My knee is still getting super swollen and hot off and on and it’s when I’ve been on my feet or at therapy.

Thank you for all your great advice. I hope I answered everything as I am lying down to sleep and am kinda groggy,

 

[Celle]

@Jaderose26
Don't worry - we're used to new people learning how to use BoneSmart.

Here's something else you can learn.
You don't need to quote a post in order to reply to it.
Just scoot down to the bottom of the page and start typing in the box where it says "Write your reply".

Of course, if you want to quote and respond to something in particular, this article will show you how:
How to use the quote feature

 

[dadman35]

I am 18 months out and still have swelling and achy when I work it. I dont know what knee I have and go by the montra ignorance is bliss! Lol. Even though the recovery was challenging it was one of the best things for me as I could not walk without being in pain. You got this!

 

[sistersinhim]

On your phone, just go to Bonesmart.org/forum through your browser. The links should work then. I never use the Bonesmart app., just go via the browser.

I hope you can find that happy recovery place in your exercises. Probably, the most important thing to remember is that if it hurts or swells more during or after your PT, your knee isn't ready for that and will rebel and set your recovery back some. Easy does it gives you an easier, less painful recovery!

 

[Celle]

My last physical therapy session was this past Friday and I had a very difficult time explaining to her that I was not going to allow her to force push my swollen leg to give an end result for my therapy thus far. She had a hard time taking no as an answer.

I'm glad you insisted. It doesn't matter if your therapist didn't like it - it's your knee, not hers, and you are the only one with the right to say what happens to it.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[Josephine]

Absolutely right, @Celle !

My knee is still getting super swollen and hot off and on and it’s when I’ve been on my feet or at therapy.

Well, now you know what to do about it!