TKR hypersensitive knee

Toyon

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Hi, I'm new to this forum and glad to find it. I had total knee replacement June 16. Have been going to outpatient PT for two weeks. Because of the pandemic, I have two different therapists. They are both stressing the flexion of the knee! I am at 90 degrees and one says that I must work much harder, that it will be extremely painful. She even told me to do my home exercises 5 times a day because 3 times wasn't working.
I've followed directions and am in a lot of pain. I am three weeks post surgery and feel like my pain level is going the wrong direction. I use tylenol every 6 hours and oxycodone 5 mg 3 times daily right before my home therapy. I elevate and ice frequently. Has anyone else encountered this pain level with home physical therapy?
Thanks
 

sistersinhim

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It's quite obvious your pain and swelling are because PT is pushing you too much. You are less than a month out and already have 90 degrees. Most surgeons don't expect that until at least 6 weeks out, so you are ahead of that. Don't let your PT upset you. You are doing great and all they are doing is keeping you depressed, swollen, and painful. Aggressive exercises are setting your recovery back. You don't have to do any exercises. All you have to do is use your knee in your daily activities. Many of us never took formal PT or did exercises. I am one of them. I had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.
 

Pumpkln

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@Toyon,
Welcome to BoneSmart, glad you joined us! :welome:

stressing the flexion of the knee! I am at 90 degrees and one says that I must work much harder, that it will be extremely painful. She even told me to do my home exercises 5 times a day because 3 times wasn't working.
I've followed directions and am in a lot of pain.
90 degrees at 3 weeks is fantastic! No need for you to work on ROM. What is blocking your ROM is swelling, all that pushing and shoving is increasing your pain, inflammation, and swelling, all of which will block your ROM. As your swelling goes down your ROM will reveal itself, as it has been there all along.
Saying no to therapy - am I allowed to?
In the early days less is more, and pain = no gain.
Ask your PT to help you with finding ways to reduce pain with ice, elevation, and TENS, gait training, gentle exercises, balance, and how to pace yourself so you do not cause additional irritation to your knee.
TKR: work “smarter” and not “harder”

Right now all you need is the natural activity you do around your house and some gentle activities you do yourself. We recommend the two following activities.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

What kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access these pages on the website


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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Toyon

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Thank you so much for your responses. I'm spending the day doing icing and elevating 15 minutes out of every hour. Why do physical therapists get so wrapped up in pushing the range of motion so soon after surgery?

I'm also concerned about oxycodone 5 mg. I was scripted 61 tablets 24 days ago. Also, I was given eleven oxycontin (for overnights). I did get a refill of 40 more oxycodone but surgeon said he can "cut me off". I am not a drug addict, but feel like I'm a suspected addict. Is this excessive?
 

Pumpkln

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Why do physical therapists get so wrapped up in pushing the range of motion so soon after surgery?
It is the easiest way to communicate to the insurance company and your surgeon that you are doing better.
What really matters is can you get up and about, walk around your house, up and down the stairs/steps in your house, fix a simple meal, bathe, etc.
It can also be an indicator that your PT is out of date.
I am not a drug addict, but feel like I'm a suspected addict. Is this excessive?
The amount of medication you have been prescribed is not excessive, your surgeon is only responding to the current thoughts about drug abuse.
Sorry to hear you had this experience, it is unnecessary and can cause a loss of confidence in your provider.

I'm spending the day doing icing and elevating 15 minutes out of every hour.
You can ice for 45 minutes, I slept with my ice machine on all night. Just be sure you have a cloth between the ice and your skin.
 

Roy Gardiner

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one says that I must work much harder
A point of view with which BoneSmart fundamentally disagrees.

Imagine working hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Read full details here https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
 
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Toyon

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I took a total rest day from exercises yesterday...did icing on and off throughout the day. I woke up practically pain free... Now I'm planning to rock back and forth on the stationery bike and do some gentle exercises. I'm still afraid because my surgeon ( before surgery) mentioned the idea of manipulation under anesthesia. Tomorrow marks four weeks from total knee replacement surgery.
 

Roy Gardiner

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Now I'm planning to rock back and forth on the stationery bike
If your leg is stiff and swollen then using an exercise bike for training is not a good idea; but you can still use one for mobility exercises - even if you can't make a single rotation!

  • Set the bike to zero resistance
  • Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

Roy Gardiner

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Once you can do a full rotation, using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
 

sistersinhim

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I'm still afraid because my surgeon ( before surgery) mentioned the idea of manipulation under anesthesia.
No one can force you to have a MUA. Besides, it's way too early to even think about that. The swelling keeps your bend down, not lack of exercise. The number one thing you should be working on is healing that knee. You do that by icing, elevating, and gentle movements, not repetitive movements. Just use it in your daily living and it'll rehab its own self!
 

Dimire

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I am so glad to find this site. Today marks 4 1/2 weeks from my knee replacement, and outpatient physical therapy is too aggressive for me as well. They physically manipulate my knee to the point of extreme pain, and put me on the bicycle for 10 minutes, even though I'm not at a full rotation yet. It takes 2 days to recover, then I'm back for another 3x week session. Today I will definitely not push myself as much or let them. At this point, I am at 95%, and they are pushing for 110.

Toyon, it sounds like you are doing really well if they would just let you heal, body, mind and spirit.
Fifteen years ago I had my first TKR and went through 3 physical therapists before I found one I could tolerate and who worked with me, not against me. Best wishes for your days to come and hang in there. It definitely gets better.
 

kneeper

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Once I hit 90 (at 6 weeks, as the swelling came down) my OS was happy--he said more bend would come as I was able to be more active and it did.
I see your PT wants you to exercise 5 times a day. IMHO that's likely overdoing it and aggravating your knee more. I probably did heel slides 5 times a day--BUT--I'd only do a few at a time, not the many repetitions PTs usually recommend.
 
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Toyon

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Thank you for all of your advice...I really need it to offset my PT. I have an appointment today with her and plan to try and switch to a supportive PT for future visits.
 

sistersinhim

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Just remember that it's your knee and your recovery. You are 100% in charge of what will happen to it.
 
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Toyon

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Prior to knee replacement, I used CBD cream regularly for knee pain. I was told by PT not to use any cream or lotion in the knee cap region because it could penetrate. I'm interested if others have used any substance like this, and, if so, when in the recovery. Thanks
 

Dimire

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I was told by the OS to only use Vitamin E oil on the incision. You can break the capsule open and drip it into your knee. It’s thick oil and feels great to gently massage it in. It’s also sold in bottle form, but more pricey and I don’t know the consistency of it.
 

Jaycey

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I agree with your PT - don't use any cream on your incision until it is totally healed. Keep the area clean and dry.
 
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Toyon

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Hi, I've ordered a pill cutter from Amazon because I only have 12 oxycodone 5mg. tablets left and I figure that I need to wean myself off the drug. But I still need the oxycodone for pain. Any other suggestions?
Thanks
 

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