PKR JusticeRider’s rehab adventure

[sistersinhim]

Unfortunately, most of us don't recover from a setback in just a few days. It usually takes up to a month. That's why we suggest that members try hard to not overdo it. These setbacks are so depressing! Most of us have been through them by just trying to live a normal life too soon. It happens, but you do get over it. Let your knee be the boss until it settles down. Forcing it to do things that hurt will not help you overcome this setback. Treat it very gently like a newborn baby, cause it is!

 

[JusticeRider]

Ok, so my massage therapist and PT have each seen me twice now during this flare up. They both agree that there is a LOT of swelling. My massage therapist did some more lymphatic drainage and I think it has helped a lot because the knee visibly looks less swollen. But it still feels very tight and full and pinches when I walk. My PT looked it over really well and doesn’t feel anything amiss with the way the joint itself is moving. He is a little surprised it has lasted so long but still thinks that it is just the swelling making it hurt and just from overdoing it EIGHT days ago. He had me do some gentle movements, massaged it a bit and put me in the compression icer. He said to just keep taking it easy, icing, elevating, and giving it gentle movement (the Bonesmart way!) and be patient. Easier said than done! Argh. It helps if I don’t think about how much better I was two weeks ago ): I really need to do something fun. Jockette and sistersinhim, I really, really hope this won’t last a month!!

 

[sistersinhim]

I really, really hope this won’t last a month!!

It probably won't be this painful and swollen for a month, but don't be surprised that it takes it a month to get back to where it was before. Your therapist and you and doing the right things!

 

[R2R]

I went and played pickleball yesterday afternoon for a couple hours. I’m in some pain but dont regret it for a second

 

[JusticeRider]

R2R this makes me feel very sad right now ):
Truly happy for you, but really sad for me.

 

[benne68]

Oh, @JusticeRider, please don't compare yourself with anyone else! We all go into surgery in different places, and we each recover in our own time.

I also had a setback, when I was 5 weeks out like you, and I was overwhelmed by frustration and depression. Two weeks later, I was in a good place again.

This week, I marked the one-year anniversary of my surgery. Here's a link to my post about it, if you are interested: https://bonesmart.org/forum/threads/benne68-in-recovery.67226/page-16#post-1564353

Be patient. You will recover. It just takes time.

 

[Dancingqueen]

Hey all, I’m new to this forum although I have been lurking for a while. I had a left patellofemoral replacement on August 10th. I am 44 years old and have had FAI hip labrum repair twice on my left hip, an arthroscopic cleanup on my left knee and now the partial replacement. Really hoping this is it for a good long while! I want my (formerly very active) life back! This is the hardest of all the surgeries I’ve had. Pain levels are good now but I am worried about ROM and it has been stressing me out. I hike, backpack, snowshoe, trail run, and train horses and have a farm. I need 120 degrees of flexion to mount my horse. Right now I’m at about 80. I could use some encouragement (though I already feel somewhat better after reading up on ROM on this forum). My problem is everyone else is telling me I have 3 more weeks or else! I’m tired today.

Hi..
Just read your post and I, too, have felt so pressured (from day 3!) to get the ROM going. I’m still pretty swollen going into 7 weeks (all anti-inflammatories are off the table for me). I was at about 70 and through pretty “rigorous” pt, the number improved. At the clinic, I really pushed, along with now using a leg press with “good” leg to push/control new knee.
I hit 105, along with going upstairs with own body weight.
Did I mention pain 24/7 and little sleep?
After reading many stories and understanding that “pain no gain” story is NOT APPROPRIATE with my newly chopped up knee..I took charge at pt (well, mostly).
Last week, gentle quad work, heel slides-NO touching by pt, no forcing for numbers!

Today, I’m icing, short walk, some stretching, lots of resting.

That’s it for now. ROM will happen (my new mantra!!!‍)

 

[JusticeRider]

benne68 and Dancingqueen, thanks for the encouraging words! So appreciated.

Benne, I have read your recovery thread and it’s amazing to see your journey. I am so glad you are doing so well these days! Happy belated Knee-versary! It gives me hope, especially when I manage to take the long view…!) It is inspiring.

Dancingqueen, I am not far behind you in our timelines, at just over 5 weeks. I totally empathize as far as limited options for pain meds. But so great for us that we found out we don’t have to push our ROM into pain. I think (hope) most PT’s will respect these boundaries if you lay them out Mine has been great about that. I had to laugh at your description, “newly chopped up knee”! Perfect description.

I am trying not to compare myself to others, but it is very hard sometimes. Also trying not to compare myself to what I was like a week and a half ago. Thanks again for the encouragement and support. It is too hard a journey to do it alone.

 

[JusticeRider]

I am still dealing with so much swelling. I am wearing a light compression sleeve all day now because it seems to help. It looks better than it did a week ago but still significantly larger than the other knee. It feels like a water balloon about to burst. It does not appreciate bending, most of all while I am walking. I have taken ibuprofen when it feels especially bad. Would it be helpful to take it on a schedule instead (to help with the swelling)? The pain is almost non existent except that one movement while walking, so I haven’t taken Tylenol for the most part. Otherwise it’s just discomfort due to the pressure from the swelling. I feel like Frankenstein when I walk. Is there anything else that could cause my knee to be so swollen besides having overdone 10 days ago?

 

[Jockette]

I am still dealing with so much swelling.

I have taken ibuprofen when it feels especially bad. Would it be helpful to take it on a schedule instead (to help with the swelling)? The pain is almost non existent except that one movement while walking, so I haven’t taken Tylenol for the most part. Otherwise it’s just discomfort due to the pressure from the swelling.

Here is an article about the different types of pain (swelling qualifies as a type of pain) and taking pain medication:

Pain management: importance of managing pain after a TKR and the pain chart

The process of pain/swelling/healing and all is this In other words, it's not so much that pain causes swelling but that the after effects of surgery is swelling as the after effects of any trauma to the tissues is swelling. So you have a double causative effect (otherwise known as a...

bonesmart.org

If Tylenol agrees with you, the most effective way to take it is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

I did this schedule with Tylenol, and I also took ibuprofen, every 6 hours. I staggered the 2 medications so that I was taking one or the other, every 3 hours. This schedule was very helpful to me.

 

[JusticeRider]

Thank you, Jockette. I don’t completely understand it, but I do see how swelling is inhibiting my motion and that is causing more stiffness, which results in less movement, which causes more swelling. And the pain is wrapped up in there somewhere? And maybe I’m in more pain than I realize because it doesn’t feel like it did before surgery because that pain is gone. So maybe I don’t recognize the type of pain I’m having now? I don’t know. But one thing I haven’t tried yet is going back to a full pain pill schedule. I felt like I didn’t need to, but maybe I do. All I know is I’m spinning out, so I’m going to try that and hopefully it will get me walking better again. Thanks for the advice and support. I’ll let you know how it goes.

 

[sistersinhim]

I don’t completely understand it, but I do see how swelling is inhibiting my motion and that is causing more stiffness, which results in less movement,

Think of filling up a water hose and keeping the nozzle shut off. Now, try to fold it. You can't because the water is in the way. Open up that nozzle and let that water out and the hose will fold up quite easily. Your knee is the same way. The water in your knee is in the way of bending it. Let the water out and the bend improves.

 

[JusticeRider]

That makes sense. I guess the part I can’t figure out is why the swelling won’t go away with rest, elevation, and icing, and why taking pain killers will help? I guess even though it doesn’t hurt unless I do that ONE movement, maybe I NEED to do that one movement that hurts in order to get the swelling to come down…and I can’t do that because it hurts? Omg, you guys, I think my brain is fried from depression and anxiety. I woke up last night about 3 am and just cried. Could not get back to sleep. I have my 6 week follow up this coming Friday and I just keep imagining the sense of failure and humiliation I will have if I have to slowly limp down that hallway with my cane, looking worse than at my 2 week appointment. I’m really spiraling ):

 

[sistersinhim]

What are you doing for activities and PT? If you are doing more than your knee is ready to do, then your knee will swell. Try cutting back your activities and ice, elevate and rest more. What you are doing now isn't working so try to do less PT and exercises and rest more. It's worth a try. But, it'll take more than just a few days, probably more like a few weeks.

Are you elevating correctly? Elevating Dos and Don'ts

 

[JusticeRider]

I have PT 2x a week, the last few appointments all we’ve done is a gentle flexion and extension (heel slides, hanging legs off table, resting ankle on bolster to let knee stretch) and some massage and ice. And he’s watched me walk. I have only done those at home also. I was taking walks around my porch and starting to take walks down the street when this all started, but since then (past 10 days) I’m only walking for adl’s and a little extra through the house. Whenever I’m sitting I’m elevating and usually icing too. I ice probably 5/-6 hrs out of the day. My average steps every day altogether are about a mile. It feels like I couldn’t possibly do less than what I’m doing now. I’m normally an extremely active person, so this is adding to my depression.

 

[JusticeRider]

For elevating I use the pillow stack method either on my bed or in the recliner. Toes above nose.

 

[sistersinhim]

It seems like you're doing everything right. It sounds like your knee just needs time to heal and get over itself temper tantrum!

 

[JusticeRider]

Ok, thanks, sistersinhim. I was starting to worry I was now doing too LITTLE and was making it worse that way. I did start taking Ibuprofen and Tylenol on a schedule like Jockette recommended. I guess I’ll just try to hang in there. I think I’ve reached the anger stage, so pray for my poor husband…

 

[sistersinhim]

Most of our caregivers need prayer during our recoveries!

 

[JusticeRider]

Well it happened. I had my 6 week appointment with my surgeon’s PA yesterday. My swelling and pain has continued, unfortunately, and my ROM and walking have not improved much. At least extension is still great at -1. Flexion is 90 if really pushed. You can guess what he said. They are not happy with my flexion. They want me to push through the pain to get my ROM. He said it might have to be extremely painful for a while. He said they want an update every week and would expect 120 degrees flexion in two weeks and if it’s not at least 110 they will want to do MUA. I was stressed and upset but didn’t want to show it. I listened and nodded very seriously. I asked multiple different ways if it weren’t possible that my ROM would improve with more time and less pain so the swelling could come down. He said it was very unlikely and we had limited time to get it back and I would just have to force myself to endure the pain and/or get MUA. I didn’t say much…but inside I was thinking angrily, “I DON’T WANT TO DO THAT! I don’t HAVE to do that. This is MY body. They can’t make me do that!!!” I had to keep reminding myself of all the people on BoneSmart that have gotten their full ROM over time and without torturing themselves. Those surgeons and PA’s can be so convincing and terrifying. I already knew he was going to say all those things, so it shouldn’t have bothered me. But I drove home wanting to cry and feeling numb and hopeless. It was also 2 hrs of driving, so by the time I got home, my knee was even angrier. That didn’t help my state of mind. Why do they do this to us??