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TKR Help with pain meds post op

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I do not have any experience with a quad tear, but I would certainly say that if you have room to up your pain medication than do so! For example if you are not taking the maximum amount prescribed and still are in pain, then certainly feel free to take the full prescription.

Did your OS agree that your quad tear was a result of your aggressive PT? I certainly hope that you take it very easy and strongly consider either finding a new PT or talking to your current one.

I have read and read about taking this slowly and can say that it is working for me as well. In these early stages (week 3) I am just doing the minimal stretching at home as well as moving about to use the restroom and short trips to the kitchen. In PT my therapist is amazing and she has NEVER touched my leg other than tissue massage. She measures my ROM, but I am always in full control of the bend - with either a strap, or my other leg and sure enough it is slowly but surely doing what it needs to do. My family may think I am not doing enough of my exercises, but I have minimal swelling (except after PT) and the ROM is coming on it's own.

I certainly do not mean to hijack your thread with my personal experiences, but I wanted to share that the bonesmart way is working for me in the hopes that it brings you comfort. I'm sure that as my knee heals, I will have to ramp up the strengthening but for now, rest and gentle movements are my plan.
I can only imagine how painful your leg is now - I am sorry to hear you are dealing with this set back!

Best wishes to you, please take care of yourself. :puppysmooze:
 
Injured tissues need time, pain meds and love. That's pretty much the bottom line.

Your tissues were pretty well injured during surgery. I'm guessing you got home from your appointment and some unanswered questions started to weigh on you. I'll tag Josephine regarding your tear.

Listen, patients are superb at knowing how much pain medication to take. You know how often from experience (for my moderate pain it was every 4 hours). The dose is based on how well one pill works. If it doesn't work well enough, take 1.5 pills. If you find a pill works very well plus makes you groggy, try one half pill. I had an alarm clock that woke me in the middle of the night with the sound of a babbling creek, which prompted me to take the dose I'd set out at bedtime. Does that help?
 
Thank you so much for all your responses and help. Unfortunately, it seems that I have a tear in the quadricep tendon and I am waiting to hear from my OS how to treat this. It has been a real battle with doctors from the ER to my own OS to get an MRI but eventually, a week after the initial pain and swelling, they ordered an MRI for me. I should have the results on Tuesday morning.I am in a quandry at the moment because every article about quadricep tears says to keep the leg straight and use crutches but I am so worried that my knee will just lock up and I will never get any flexibility back.Has anyone else dealt with a quadricep tear or can give me any indication as to how to proceed. I am becoming so stiff and sore just lying on the couch and feel there must be some way to keep myself from being one big ache and pain. I am also extremely emotional this week and descend into crying at least three times a day! Could someone tag this message for Josephine, if she is available, as I am unsure of how to send her a copy of this post. (really, really bad on computers). Thank you.
 
Joanne12 said:
every article about quadriceps tear says to keep the leg straight and use crutches but I am so worried that my knee will just lock up and I will never get any flexibility back
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It depends where and how extensive the tear is. If it was that bad, it would have needed surgery to repair it and then it would certainly be a case of not bending. What did your doctor advise you to do?
 
Hi Joanne; you are doing just fine..remember it's YOUR LEG, not theirs.
YOUR. LEG. Your body, your life, your dime and your time!
I too was too trusting at the start of my recovery. Then ,one day at PT, my therapist pushed so hard that I passed out from the pain. They called this a "vaso vegal response",because it sounds nicer than"fainting from torture", but lets get real here..that's what it was.

When I came to, I REALLY came to, and went;"what am I doing???"

I politely discontinued formal therapy, refused MUA ( manipulation under anesthetic) for "adhesions"- aka swelling from being tortured, and doddered off to continue my recovery MY way. (I had adhesions from a previous surgery and worked through those on my own..I can do it this time too, if indeed I even have adhesions to start with.)
Everyone on this forum knows just what you are dealing with. I will tell you that at week 14, I am making slow gentle progress. I even cancelled my final "follow-up appointment" with the surgeon. I'm fine, I'm happy with his job, which I've told him, and my life is not about making him feel better. Why stress myself with his timeline for my recuperation?

Over and over, the nice people on Bonesmart will tell you not to let fear govern your post-op choices. Also REST, way more than you think you need to. Because you need to. Right now, I have good days, but that only means a 4 hour window of energy. If I overdo it triggers my fibromyalgia, forget the knee, and I have no choice but to get prone anyway. I talked to my dental technician friend the other day and by some freak of nature she was back at work in 3 weeks after her TKR, but these people are very, very rare..and if she had her other knee replaced, there would be no guarantee that the second would heal as easily as the first Each knee is different, even on the same patient!
You've come to the right place...take good care of yourself.:puppysmooze:
 
Oh! nearly forgot to add, that by the same token, if you don't feel that your issue has been adequately explained by your Doc, you can always consult with a revision surgeon for her or his feedback;not because you are planning a revision, but because revision specialists are familiar with every complication under the sun.
 
Josephine said:
It depends where and how extensive the tear is. If it was that bad, it would have needed surgery to repair it and then it would certainly be a case of not bending. What did your doctor advise you to do?
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My doctor has not reviewed my MRI yet. I was assessed by OS in ER and he said to try keeping the leg extended and to gently bend it but not to over do it until we knew how big the tear was. I had my MRI on Friday and hopefully my OS will see it on Monday/Tuesday and will be able to give me some direction then. Really hoping it is a minor tear and does not take too long to heal. Some times I feel very optimistic and other times I feel so down that this happened, I really hope it does not stop my new knee from healing and progressing.
 
Ms.fixit said:
Oh! nearly forgot to add, that by the same token, if you don't feel that your issue has been adequately explained by your Doc, you can always consult with a revision surgeon for her or his feedback;not because you are planning a revision, but because revision specialists are familiar with every complication under the sun.
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Thank you so much for your imput, I wish I had read far more on this forum before surgery and before PT. I was blindly doing everything he suggested and I realize now that it was just too much, too soon. I am going to find out about the tear by Monday/Tuesday and then will see how to progress from there. As long as I eventually reach my goals I am no longer in such a hurry.
 
Hi Joanne, so sorry to read about all the problems! Hope you've kicked that PT into touch!
I wouldn't be overly concerned about your RoM right now, if you find out the extent of your tear on Tuesday, you will be able to deal with it then & get some answers fom your OS about the best way to proceed.
As you will read from experiences and the bonesmart library, ROM doesnt have a sell by date, it continues to steadily get better as we heal.
Please know that you will get better!!
Have a restful weekend & we all look forward to your news once you've been to see your OS! :puppysmooze:
 
Hi Joanne, I am so sorry about your tear! Just what you didn't need. I really love MsFixit's comments. I think we have to listen to our own bodies and then convince the "professional" that we are, indeed, individuals; that there is no one size fits all! Keep your head up (or down on the pillow, whichever works for you!). :friends:
 
Just wanted to know I am thinking of you and hoping your quad tear is manageable. I can only imagine how stiff and uncomfortable you are trying to stay in extension all day long - I can barely handle the 20 minutes on ice during PT!!

Let us know how you are doing, when you feel up to it please!
 
Hi, thanks for all the imput, well the tear is slowly healing and I am taking it very easy. Doing gentle PT just to keep from seizing up completely. I feel the tear is healing and I am beginning to get some motion back. I will just take it a day at a time and look forward to being able to really use my new knee. :)
 
Joanne, I tore my quad muscle a few years ago from a fall while hiking. I had to use crutches for the first week or so. 'after that, I mostly had to be careful not to overtax that muscle. Gentle bends, Mostly while sitting in bed or on a table at pt. My pt did a lot of massage that helped me too. it took about four weeks to heal.

You will not lock up in four weeks--so take that worry out of your thinking. Last year, I had to have an open surgery to remove scar tissue and to put in a new spacer. I went three weeks with no pt, so that the leg could heal. Then eight weeks with very gently pt---like you will do for four weeks or so---bending and straightening the leg while on the pt table. Gentle stretching, massage, leg lifts with no weights attached, clam shells, etc.

At the end of eight weeks, I began strengthening in a more serious way. My rom is 148 in that knee--so don't worry about your leg loosing your rom or not getting enough. You have plenty of time to get rom, right now you have to heal that muscle. Relax---find some books to read or learn to knit---this time will pass sooner than you expect.

Ps---read some of the articles from above-- they will help. Kelly
 
I am now four weeks after my quadricep tear and I do feel that it is beginning to heal but very slowly as I was not kept immobile because of the tkr. Last Wednesday I went to my PT and the next day, I could not walk because my leg was so sore from his manipulations. He is very concerned with getting my leg straight and was doing a great deal of painful massage and pushing on my thigh and shin with some weights. He also started to try and bend my leg but I feel so nervous about extending the tear that I felt I was resisting more than helping. I have cancelled my next two sessions as I feel that it is not helpful if after my PT I am unable to move comfortably at all and my leg is stiff. My concern is that my leg will become weaker rather than stronger and I will put myself back to far to recover. I am at 3 degrees straightening and about 80 degrees bending. Are there any excercises that will keep my leg and muscles progressing without the danger of retearing the quadricep?
 
Jo anne, lots of folks do not use a pt for their recovery---In the UK, it is uncommon to use a pt except for some advise in the beginning as to how to do exercises. There are some articles in the Bonesmart library which I am going to post for you. The first few are about early recovery. There is also an article by one of our members who is a pt with a very nice patient progression. When you do any exercises, do them to the point of a little discomfort--but never to the point of pain. You need to begin to exercise gently and gradually increase the level of exercise. Good luck and feel free to ask us any questions as they come up.


Swollen and stiff knee: what causes it?
Progression of activity for TKRs
Elevating your leg to control swelling and pain
Using ice -
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

It's never too late to get more ROM!
It's Worth the Wait for ROM

Exercises for TKRs: do-it-yourself exercises from basic to advanced
 
Oh, my goodness dearheart!! I am so sorry you are having such difficulty. You can thank that terrible PT for helping you tear that quad!!
Too much, too soon on an injured leg! Now your husband and family can see what happens when you try too hard to do things you're not up to.

How long it takes for that tear to heal idea depends on how bad the tear is, and of course your own body. We all heal at a different pace. For now, you need to take it easy, easy, easy!! Don't let ANYONE make you feel badly about not moving. This should not have happened sweetheart, but now you just need time to heal.

If you see that PT again, let him/her know just what their brand of therapy has caused. I would be calling the facility and complaining bitterly. That PT has no business working on TKR patients.
 
Yeah, it sounds like you need a different PT or like Titianlady says, tallk to a supervisor.
 
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