Revision TKR Jolease's knee saga part 3<^

[Josephine]

So your pains are here?

I think both are the same issue - ITB (ilio-tibial band) issues

The IT band is a massive big muscle and tendon as you can see here - it's the white band going all the way down from above the hip to below the knee. An awful lot of exercises cause tendinitis in that structure.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jolease]

@Lindylee @lisabl thank you both. If it’s not one thing its another. Atleast I take comfort in knowing these issues will go in time unlike my previous ones. I do have a roller I’m using but will use more often and I booked a massage for next week!

 

[Jolease]

@Josephine I believe you're right. Never though it could be so painful. Thank-you.

1. at rest 1 moving- 5-7

2. Tramadol as needed, 500 mg Tylenol’s x2 twice a day.

3. moderate

4. 130/0

5. ice a lot 3-4 times a day

6. elevate when icing

7. activity is quite a lot , cook, clean,shop,socialize

8. stationary bike 20 mins - daily
Clamshells 3x week
Step ups 3-4 x week
Hip abductor exercise with band x 3 week
Walking about 10-15 mins daily outside
Stretches- hamstring, calf 5x week

PT- once every 2 weeks with above exercises.

 

[lisabl]

@Jolease your exercise programme sounds much like the one I was on last year after my partial knee replacement. I thought I was doing so well but they triggered a problem with my ITB running from the knee up the leg nearly all the way to my hip. Stopped all exercise. PT just massaged leg for nearly 4 weeks and I used the roller. Afterwards I cut back on most exercise as I just lost confidence and did ADL. Then knee started failing and for last month I feel almost like I did just after leaving hospital. RICE and not much else. Cannot wait till after Mondays op to do it all again.

 

[Jolease]

@lisabl oh no!! I never had these issues at all with my partial. It’s like I got the one issue fixed only to suffer with this. My hip and knee and down side is so tight!

What is ADL?

I’m sorry your partial didn’t work either. I wish I just had the full to start. I’m going for massage and having her work my leg. I must say after I do some of the exercises it loosens up some but right back to pain and tight. Mornings and nights are much worse. You never know if you're making things worse or better. I’m going back off exercises besides bike and see if I notice improvement. I’m sooo over this knee!

 

[lisabl]

Jolease ADL is an acronym on the site for Activities of Daily Living or as I say just going about my normal pottering around the house, garden and not much else.

 

[Jolease]

@lisabl Thanks!!

 

[Josephine]

What is ADL?

Jolease, it you ever come across an acronym like this and don't know what it is, we have this thread you might want to bookmark abbreviations and acronyms


I also need some extra detail please

2. Tramadol as needed, 500 mg Tylenol’s x2 twice a day.

The question asked "how much are you taking (in mg please) and how often?"

5. ice a lot 3-4 times a day

The question asked "how often and for how long?"

7. activity is quite a lot, cook, clean, shop, socialize

Can you be more specific here? What does each one of those actually represent? I really do need detail.

 

[Jolease]

@Josephine
2- Tramadol/acet 37.5/325
2-4 per day when I need them( bad pain days)
Tylenol -500mg x2 twice a day
5- 3-4 x a day for 20 mins
7- I do housework daily, cook meals daily, do pt exercises, run errands, walk for 10-15 mins outside 5x week .
Thank-you.

 

[Jolease]

10 weeks today since the revision. I believe the knee is healing ok, but my IT band has gotten worse! I’m beyond frustrated . The pain can stop me in my tracks sometime I can’t bend my leg to 90 degrees without awful pain from hip to knee. I’ve made a chiropractor apt for next week. Had a deep tissue massage yesterday of the glutes and hip. This just sucks! Tired of pain,tired of these issues. I’ve stopped exercises except for gentle stretches. The smallest tasks upset it. Ugh!!!! If I only knew 18 months ago....

 

[Celle]

I believe the knee is healing ok, but my IT band has gotten worse! I’m beyond frustrated . The pain can stop me in my tracks sometime I can’t bend my leg to 90 degrees without awful pain from hip to knee. I’ve made a chiropractor apt for next week. Had a deep tissue massage yesterday of the glutes and hip. This just sucks! Tired of pain,tired of these issues. I’ve stopped exercises except for gentle stretches.

I'm glad you've stopped most of the exercises. You're doing plenty in your daily living, soyou don't need those exercises as well.

8. stationary bike 20 mins - daily
Clamshells 3x week
Step ups 3-4 x week
Hip abductor exercise with band x 3 week
Walking about 10-15 mins daily outside
Stretches- hamstring, calf 5x week

PT- once every 2 weeks with above exercises.

Josephine is away at the moment, but I'm going to say that at least some of those exercises could have been the cause of your irritated IT band - particularly the clamshells and hip abductor exercises with the band.

The chiropractor sounds like a good idea.

 

[Josephine]

1. at rest 1 moving- 5-7

3. swelling moderate

Moderate swelling adds around 4 points to your pain score which means your score is nearer 10

2- Tramadol/acet 37.5/325
2-4 per day when I need them (bad pain days)
Tylenol -500mg x2 twice a day

So you are approx 10 weeks out. I think you need to be taking your pain meds more regularly. Even twice a day would be better than what you are doing.

4. 130/0

That's excellent! And at 10 weeks? Wow!

5. ice a lot 3-4 times a day 3-4 x a day for 20 mins
6. elevate when icing

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

7- I do housework daily, cook meals daily, run errands, walk for 10-15 mins outside 5x week .

Okay, not bad.


3-4 x a day for 20 mins
stationary bike 20 mins - providing it's only on zero resistance, okay
Clamshells x3 - don't do these. They are inappropriate for knees anyway.
Step ups - same with these, very bad for knees
Hip abductor exercise with band - and these - totally inappropriate for knees
Stretches- hamstring - ONLY if you really have hamstring pain (Hamstring stretches)
Walking about 10-15 mins daily outside - okay

PT- once every 2 weeks with above exercises - I suggest you quit these totally. You ROM is good so you don't need them and they are causing your pain anyway.

 

[Jolease]

@Josephine thanks for your input. I have stopped the exercises and back on regular pain control.

 

[Josephine]

Jolly good!

 

[Irish471]

@Jolease , I am so sorry you’re still dealing with that pesky pain! Hopefully, taking a step back from everything will calm that IT band down so you can feel better!!!

 

[Jolease]

@Irish471 Thank-you , I just can’t seem to catch a break. I had none of this with other two surgeries. But had other issues! Just feel frustrated as I felt I’d be way further along by now. Some days are better than others but some days I suffer so bad. I’ve got a chiropractor appointment tomorrow and there is a sports massage therapist there so I’ll do whatever I can to get this body back in my favour. And this knee feels nothing like a normal knee, not sure it ever will. Currently I’m so swollen and icing. Just feel like a broken record. I wish I never ever had this surgery to start with, I was defiantly better off before it.

 

[Irish471]

@Jolease , I still have days where I think that, too. My knee clicks all the time. I keep thinking, well, it used to crunch and grind with crepitus, so I have traded that for a new noise and sensation I want to feel normal again. Patience has never been my virtue. I must say, I haven’t noticed that pain and spasm-like catching feeling in the back of my knee for about a week now. I am thinking it’s because I have been stretching a lot. I lay on the floor with my rear against a wall and I extend my legs up against the wall and adjust my heel and flex my foot to feel a good stretch. That how I start my day now. Fun times!

 

[Jolease]

@ Irish 471 My patience is pretty much non existent atm. I think the pain and limitations of what I can do has just wore me down. If it’s not the IT band it’s the nerve pain, if it’s not that it’s the medial side pain. Or it’s all at once or other parts of my leg. I keep telling my self it will get better, but after two failed replacements my faith wears as the time does. My knee is still very stiff and swollen. I’m still tender on medial side and knee still warm. I see the surgeon in a couple weeks.
I’m glad the stretches are paying off for you.I do stretches also and roll my it band . I ride my bike but have even backed that off to see if I notice a difference. I was an avid walker and I can’t even go for a walk, just depressing. Anyways thanks for listening, just feeling really bummed out.

 

[Lindylee]

It will get better. You're not even 3 months out yet. At 4 months I still have numbness, swelling, intermittent various aches and pains, but lessening and improving all the time. I can empathise with how you're feeling after the 2 previous surgeries, but hang on in there, listen to your body and remember you're not even a quarter way through recovery. We all get impatient from time to time, but I've realised it doesn't accomplish anything other than make me feel depressed. Mind you I don't always listen to my own advice! I'm looking forward to being able to go for a walk that lasts longer than 30 minutes, but am hanging on to my OS saying I'd have pain and swelling for 6 months. I've been getting my husband to drive me out to some lovely gardens that have plenty of seating areas if I need them. A change of scenery does me the world of good even if it's only a couple of hours.