TKR HELP Two steps forward three steps back

[Juju50]

I am new to this site and need advice. My TKR was June 3 seven weeks ago. I was doing great for seven weeks, ROM was 119. Have been active, off pain meds at 2½ weeks and also driving at 3 weeks. Finished my first 4 weeks of PT and my Dr said I should have another round of PT. I was excited and ready to keep going.​

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That's when I got into trouble. I had a different therapist this Monday and she put me on a machine for forward leg extensions with a 10lb weight. I couldn't lift it so she helped raise it for me with her hand. As the day went on my knee got stiffer and stiffer by the next day my knee was swollen with a hard knot and so stiff. I have lost a great deal of my ROM.​

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I have been elevating, icing and when I'm up I wrap it. I feel like I have lost weeks of my progress and now I'm so scared I may have a hard time getting it back.​

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So I'm sitting and icing and back on the couch. Has anyone had anything like this happen to them. HELP​

 

[gazelle7777]

Wow! So sorry you had to go through that! Did it hurt when you were doing the exercise? Did you say something? I had my surgery about the same time as you and have had my own struggles with doing too much at PT and feeling the discomfort after. I am learning from this site that pain does not always bring gain.

 

[Josephine]

Welcome to BoneSmart. The first thing I want to know is how on earth you were off all pain meds at 2½ weeks? I can't believe that's possible! However, a ROM of 119 is excellent and what's happened to you is that PT. She's pushing you too hard. Either tell her a firm NO or stop going altogether! You really don't need it.

But don't be fearful of having lost your ROM, you haven't. It's still there but being masked by the swelling and pain that PT has caused you. Read this to understand why Swollen and stiff knee: what causes it? and this TKR recovery article compilation.

But first I have some questions to ask you:
1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. how often are you icing your knee and for how long?
4. how high are you elevating your leg, how often and for how long?
5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
6. what kind of PT are you doing? How much and how often?

I'll be back!

 

[Juju50]

The pain meds made me feel so bad. I couldn't keep any food down had to wear patches for that. Made me depressed and cry at the drop of a hat. I felt like myself again when I quit taking them. Started taking Tylenol and was ok with that. I'm not really having any pain just stiffness and sometimes I ache deep in my bones but not bad I guess a 2-3.
I'm icing my knee off and on all day now that I hurt it. I'm keeping it elevated when icing as high as my heart.
I'm cooking, shopping,swimming in our pool I love the sun and water. Not much housework.
The first PT I think was pretty mild rode the bike, did exercises and had some joint mobilization 3 times a week for 4 weeks. I went somewhere new for the second round and got hurt the first day. Bad idea !

 

[skigirl]

Yes, that machine is one that I avoid in the gym--it is not for folks with bad knees. I question your pt's competence to be honest. So, if you want more pt call first and tell the facility that you want another pt to work with you. (it happens all the time). I would make sure they know that you were injured at their pt.

When you go back, they can do some massage and stretching to help you heal. Be firm, do not have that person again.

 

[Juju50]

Gazelle it did hurt alittle but I just want to get better so bad and have been trying my hardest. I told her I couldn't do the leg extensions with just my bad leg so that's when she grabbed the bar and helped me lift it. I know now to never try to do this type of exercise again this soon. I'll know better when I have my other knee done. I just figured they knew the right way to work my knee.

 

[Juju50]

Skigirl I am not going back for sure. I got the bright idea to go somewhere new for the second round of my PT. When this knee heals I'm going back where I went in the beginning. If it ain't broke don't fix it. That's what my mom always said.

 

[Juju50]

Josephine I'm not sure where to ( in mg ) you .

 

[Knee pain]

I had Tkr, 5 weeks ago, I was going great, then had a mishap at rehab, this was 2 weeks ago, now have pain & swelling all the time. Not on many pain killers, 2 Panamax x 4 times a day. I have only a few endones .Night is the worse, it's the worst tooth ache, in the knee. Sheets and clothing touching sends my head in a spin. I'm so over the recovery. I'm sure my husband is sick of my complaining. He has been very patient with me.

 

[Dulcimer Diva]

Is that machine the one where you sit, hook your ankles beneath a bar and try to lift the bar in front of you with your legs? If so, that's NOT appropriate for so soon post-op (or perhaps even ever for a TKR patient--I saw it and asked about it and was told that's for sports injuries or strength training). That doesn't even improve extension--in fact it probably inhibits both extension and flexion. There are gentler and safer ways to improve extension and strengthen quads (most of which don't require equipment). Along about 9 wks post-op last year I was put on the leg press ("shuttle"), as I was for "prehab" this spring, but even that's premature at this stage of the game. Your PT should have known the difference between rehabbing after arthroscopy and after knee replacement. Can you talk to her supervisor?

 

[Juju50]

Knee pain I know what you mean nights are worse and it does feel like a tooth ache. I'm sure my husband is tired of me talking about my knee all the time also but I have to say he's taken very good care of me.

 

[Juju50]

Dulcimer Diva yes you are exactly right that is the machine I'm talking about. They do a lot of sports injuries work there. I'm not going back that's for sure. I think she put me through the same routine she would of someone with arthroscopy surgery. I hope I'm doing the right thing by staying off my knee as much as possible and icing off and on all day. I just feel like I should be doing some exercise but am afraid I will just keep it aggravated. I hope I'm not waisting precious time that I could be improving my ROM.

 

[daughter stalker]

Hi Juju50,

Sounds like you are doing the right thing by letting your knee rest for a while. I would still do some light stretching on my own if I were you along with the rest, ice and elevation. I am sorry to hear that the physical therapist didn't know what they were doing to mess up your progress.

I hear you about the pain medication. I got off my pain medication after 12 days. I do use some when I am in real pain, not for soreness or stiffness. I'm on Celebrex for inflammation and take aspirin. While on the pain medication I worked past what I should have on PT; past the point where I should have been working causing my knee to stay swollen. I learned early on about rest, ice and elevation (35 years ago) and was practicing it religiously. When I stopped the pain medication on a regular basis I found that I had been stretching/pressing myself way too much. I found that I stretched and did the exercises to the proper level when I was not on pain medication which in turn helped the swelling go down. Maybe the combination of not taking the pain medications and the new physical therapist who has worked with TKRs and believes in massage therapy helped. My potty issues were also a factor on stopping the pain medication on a regular basis. I am by no means an expert in this area, but this is what is working for me.

You may first want to ask your OS office for PT references. The OS doesn't want their work messed up. My first OS in 1978 was adamant about which PT worked with his patients because certain PTs had messed up his work before causing the patient more issues. I hope you get with a good PT who will work with you correctly. Ask the new PT how many TKR he/she has worked with before deciding on that person for physical therapy.

I hope you get some relief soon! Good luck to you and keep us updated on your progress!

 

[SFBaySailor]

Juju50,
I agree with Daughter Stalker. Ask your OS for a recommendation for PT. My OS recommended a PT facility that is rather small compared to the rest, and that other patients have had experience with. The treatment was very personalized. They work with many TKR patients, and the regimen is geared as such. A decent PT WILL work with you if you have trouble with any of the exercises. I had trouble with severe muscle pain at about 8 weeks when doing some of the exercises. The PT worked with me and removed those exercises from the regimen. That helped a lot, and I was able to complete the full 6 weeks.
I will also say that my PT facility did not use that particular exercise for extension. They didn't even have that machine. We worked on extension by propping my leg up, and putting weights on the knee. I did most of it at home while sitting around, and it eventually brought me to 0.

Roger

 

[maryo52]

This is how you determine your limits: by exceeding them. You'll continue to experiment and once in a while overdo it. That's how most of us go from ambitious to conservative.

 

[Juju50]

Thanks guys for all the helpful info I don't feel so all alone. It's kind of hard for your friends and family to understand what your going through. It's hard for me to understand sometimes what it takes to get through this process. I had read a lot about the surgery and rehab before I had it. But I guess I thought not me I can heal faster. Well not so much I have found that out. Patience is not my best attribute but having this surgery I am having to learn.

 

[Josephine]

Josephine I'm not sure where to ( in mg ) you .

In mgs is in milligrams - the dose! Meaning don't just say "Vicodin twice a day" of something like that!

 

[RestAssured]

Yes, it is hard for friends and family to understand, because they haven't been through it. We have, and some of us live in PT because of unusual circumstances, so we learn to tell the PT what is and isn't working! They haven't ever tried to make me do the leg extension machine! They know that I would just look at them. Last week since my kneecap kept popping out, I started telling them "no" to split squats, leg press, and regular squats. They said I was dismissed until Dr. Maale decided to do surgery!

Dr. Maale saw the effusion- swelling under the kneecap, told them to get rid of the very exercises I had mentioned and continue. Remember, YOU pay for their services, you are not at their mercy!

 

[Juju50]

So funny Josephine I thought you wanted me to sent you a private message. (In message) HaHa.
I was taking Hydromorphone HCL 2 mg 1 tablet every 3 hours as needed. And of course I thought I needed it most of the time.
OxyContin 10 mg every 12 hours
Everything I read said stay ahead of the pain so that's what I did until I stopped taking it.

 

[Juju50]

Thanks RestAssured when I do go back to PT somewhere else I will speak up. For now I'm back on the couch elevating, icing and board out of my mind. I thought I was past this stage.