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[TKR] Lindylee's recovery thread<

Discussion in 'Knee Replacement Recovery Area' started by Lindylee, Feb 2, 2019.

  1. Lindylee

    Lindylee graduate
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    Well here we are, exactly one month today. My husband said it couldn't be a month because I had my surgery on a Monday. Errr, yes, but there's more than 28 days in January :rotfl:

    The past 2 days the knee has been quite swollen and uncomfortable, especially behind the knee. It all feels quite tight. My fault really. Prior to surgery I had a morning routine of around 30 mins exercise and stretches for my back and hip (degeneration of the spine, lumbar scoliosis and gluteal tendonopathy) that kind of kept my back going and I felt I really needed to do some.

    Pleased to say I got on and off the floor ok and did the routine I could do on my back. One of my exercises was shoulder bridges, which are also on the list of knee exercises from the hospital, so thought I'd give them a try. It was the highest degree of uncomfortable before I'd classify it as pain, but it didn't take long after for the knee to object, so I've been elevating and icing since and laid off the exercises. The night before last was really uncomfortable in bed and the knee was very stiff when I woke up so last night I thought I'd try the clingfilm wrap.

    I still have a couple of small scabs on my scar so haven't begun to use creams or oils yet so used the kitchen towel instead. I woke a couple of times in the night, but there was no nagging ache behind the knee, which usually bothers me, and this morning the swelling had gone down and knee was far more flexible than it usually is first thing :yay:

    Shortly after I took the wrap off the ache returned, but nowhere near as bad. It still feels very tight behind the knee though. I'm doing some calf and hamstring stretches to try to ease it,but has anyone else got any tips?
     
  2. Steph

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    Ooh @Lindylee, maybe not the back exercises yet then. I normally do a few each day too, I have sacroiliac issues but haven’t felt I can do them right now.

    I might try the cling film trick, sounds like it helps. Night time is the worst time isn’t it?
     
  3. Lindylee

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    It was probably a bit premature, but you never know until you try do you? It's worth trying the clingfilm.
     
  4. Lindylee

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    I've taken it easy the last couple of days, cut right back on exercises, used clingfilm wrap again last night, but the back of my leg from just below the crease of the knee, on the outer edge, down about 4" is so tight and stiff. This morning I'm finding it difficult to lift my heel behind me before pain kicks in. I've been doing calf stretches in an effort to loosen it, but to no avail. Knee hangs seem to make it worse so have been cutting back on those too, but still no improvement, although am I expecting too much too soon?
     
  5. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Okay, I really need to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  7. Lindylee

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    Yes, thank you, fire away.
     
  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  9. Lindylee

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    @Josephine

    1. Overall pain about 3.
    Pain on first moving leg in morning or after sitting with foot on floor for 45 mins plus is 5-6.
    Pain in back of knee/upper calf last 2 days 6. Ache inner knee 3.

    2. Paracetamol 2 x 500g 4 times daily
    co-codamol 8+500 that I take instead of plain paracetamol if I feel I need a little extra. Also use Voltarol Gel on back of knee as needed.

    3. Between slight and moderate. Most swelling is a band of 4" above scar and at back of knee on outer side.

    4. ROM measured on Feb 12, flexion 100, extension 0

    5. Icing at least 4 times daily for 45-60 mins.

    6. Apart from meal times and activities I sit with my leg up. I elevate toes higher than nose on 4 pillows probably twice a day for as long as I can, but it puts pressure on the swelling at the back of the knee and my toes go numb.

    7. Walking between 1400 & 2000 steps round the block (20-30 mins).
    General tidying, dusting, sort washing and ironing (husband does the actual washing and ironing), fold and put away clean clothes etc, make porridge most mornings, wash up breakfast pots/pans, make sandwich for lunch if husband is out, have prepared one meal in slow cooker.

    8. Exercises at home. I only do as many of anything that I am comfortable with or causes a little discomfort but not pain. I know I could leave some as ROM is quite good, but they seem to reduce stiffness in knee.

    2-3 times daily
    Quad sets x 10, hold for count of 10
    Gluteal set x 6, hold for 20 seconds
    Straight leg raises x 10-20 reps as able, 1 set
    Inner range quads x 10 reps, hold for 5-10 seconds
    Heel slide in bed 10+ reps as able (I'll often repeat a few of these throughout the day as it helps to move knee and reduce stiffness)
    Knee hangs up to 5 mins as able, x3 daily (have been really struggling with this and haven't done more than a few seconds the past 2 days)
    Seated assisted heel slides using other foot hold 10 seconds, see if you can move a little further back and hold another 10 seconds x 3
    Knee extension x10, hold for 5 seconds
    Calf raises x10-15 as able, 2-3 reps

    Attempted 10x mini shoulder bridge on Wednesday (only about 1" off floor), which I also do for my back, but think that caused the current problem so haven't done any more. It is a little better today although quite tight walking.
    PT starts March 6

    Thank you for your input Josephine, greatly appreciated.
     
    Last edited: Feb 23, 2019
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Can you describe this to me? I don't think I'm familiar with it
     
  11. Lindylee

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    @Josephine
    It's where you rest heel(s) on a rolled up towel or pillow and let the back of the knee relax down to the bed to get a good stretch and allow the knee to straighten.
     
  12. Lindylee

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    Getting from sitting to standing has been really difficult today. I didn't have a good night, saw every hour and each time I woke any initial movement was painful. We went out for lunch for my brother's birthday and my husband forgot he'd moved the passenger seat forward. Thinking the gap was what I was used to I must have bent an already painful knee back too far, or at least further than it was happy with and now I really can't put any weight on it when it's bent. The loo in the restaurant was so low I wasn't sure I'd get back up, but thankfully just managed it. It's now being rested and iced and, hopefully, will let me sleep tonight.
     
  13. Jockette

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    Those 2 things have upset your knee. It might take more than just today for it to feel better.

    Things come up that are unavoidable and we just have to be extra nice to our upset knee and give it the time it needs.

    I was 4 months post op and visiting friends for a whole weekend and struggled with their low toilet the whole time. I honestly don’t know how I managed. In my case, due to struggling a whole weekend, it took a month for me to improve. Definitely not what one wants to experience at 4 months! I would have thought I was healed enough to handle that. Unfortunately, I wasn’t. :bawl:
     
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  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's high pain scores
    Codeine has never been very good for TKR pain. I suggest you have a word with your GP and see if he will let you have some Tramadol instead. This will be much more effective. I have a chart I made out for myself for both my knees.
    As for the Voltarol gel, there was a scientific experiment done on BBC2 a few months which showed conclusively that this gel never penetrated into the skin more than about 2-3mm and certainly never reached the knee or had any therapeutic effect on knee pain.

    aa Tramadol routine 4.JPG

    Okay - about right for 4 weeks out.
    Excellent!
    Very good
    I think you're probably doing it with your knee straight which is bound to have that effect. If physios have told you to NOT EVER lay with your knee bent, it's not true. In fact, it's harmful. If you had read the articles Jockette left you in the third post of this thread, you would have seen this one Elevation is the key, which clearly explains the do's and don't's of elevating! I suggest you read it again. It's important.
    I suggest you put that Fitbit away in a drawer for the time being and time your walks. 2,000 steps is roughly equivalent to a mile and that's too much. Again, in the Recovery articles, you would have seen this article Activity progression for TKRs. Read it again and note the distances suggested for early in the recovery. At 4 weeks, walks of 20 minutes are more than adequate, being 10 minutes each way! Also note the "additional activities" listed.
    But they are increasing the degree of pain and swelling!

    Exercises at home 2-3 times daily - once a day is plenty and none at all at the weekend
    Quad sets x 10, hold for count of 10 - too much by far!
    Gluteal set x 6, hold for 20 seconds - and here
    Inner range quads x 10 reps, hold for 5-10 seconds - and here
    Straight leg raises x 10-20 reps as able, 1 set - once you can do SLRs, you don't need to do them any more!
    Calf raises x10-15 as able, 2-3 reps- same applies here
    Heel slide in bed 10+ reps as able (I'll often repeat a few of these throughout the day as it helps to move knee and reduce stiffness) - these are unnecessary as your ROM is excellent
    Seated assisted heel slides using other foot hold 10 seconds, see if you can move a little further back and hold another 10 seconds x 3- the same applies here
    Knee hangs up to 5 mins as able, x3 daily (rest heel(s) on a rolled up towel or pillow and let the back of the knee relax down to the bed to get a good stretch and allow the knee to straighten - have been really struggling with this and haven't done more than a few seconds the past 2 days) - never subscribed to extension exercises as they seem to cause more swelling and stiffness than anything. Apart from which your extension is excellent anyway!
    Knee extension x10, hold for 5 seconds - same applies here, they are unnecessary
    Attempted 10x mini shoulder bridge on Wednesday (only about 1" off floor), which I also do for my back, but think that caused the current problem so haven't done any more. It is a little better today although quite tight walking - well as long as you're not doing them for your knee!
    PT starts March 6 - I don't think you need any more exercising AT ALL!! Your ROM is excellent and doing more might easily set you back

    In summary
    Read all your Recovery Articles again, thoroughly. They are in the third post of this thread.
    Adjust your medication as suggested
    Adjust your elevating as suggested
    Quit ALL exercising as your pain scores are actually quite high and all these exercises are the reason for it
    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  15. Lindylee

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    @Josephine Thank you Josephine. I'll lay off the exercises and rest the knees.

    Unfortunately I can't take Tramadol as it makes me so nauseous that I can't face food. It has only been the last few days that the pain level has increased so maybe it will soon reduce again if I lay off the exercises. I do think it was probably the shoulder bridges that caused the problem. I was doing quite well before then.

    The Voltarol gel does seem to have an effect on this ache at the back of the knee - unless it's just the placebo effect.

    When elevating I do bend the leg as shown in the article on elevation.

    I don't have a Fitbit, just a simple pedometer and I'm not walking a mile yet. The pedometer shows a maximum of 0.89km. My stride is probably shorter than usual and I'm a lot slower.

    I thought I was following the walking (20mins or longer if you feel up to it) and activities as detailed in the activity progression. I might have misled you by listing all I have been doing, but I've only been doing a little of some of those activities each day not some of everything listed.

    Thanks again for the info. I do appreciate your help and advice.
     
  16. Jockette

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    This recovery is such a rollercoaster. Any little thing can upset our drama queen knees, as I well know.

    You’ll get back to where you were. Another good way to measure progress is, as we heal and overdo something, progress is recovering from whatever we did quicker than we did earlier.

    You got this! :console2:
     
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  17. Lindylee

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    Thank you Jockette. It's easy to be disheartened when we regress. It's great that we can access such helpful advice and support from the forum instead of sitting at home on our own wondering what to do for the best.
     
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  18. Jockette

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    We are always trying to figure out what we did and how to fix it, I know I did.

    But often, we need to just take a step back and rest and elevate, ice if it needs it, and just jet time do it’s thing. Josephine once told me I couldn’t baby the knee too much.
     
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  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Okay, no problem.

    Obviously I'm wiser than I realised!
     
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  20. Lindylee

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    After a couple of rotten nights, last night was better. Yesterday was pretty miserable; I was so tired, but just couldn't nap, went to bed before 10.00 and slept until 5.00 with a couple of brief episodes of wakefulness. Knee was still quite painful going to standing from sitting, worsened as the day went on in spite of all the rest, ice and elevation, back to finding it difficult to put a shoe on, but felt more comfortable wrapped in clingfilm last night. Trouble with all this resting is that my back is now complaining, but off to the chiropractor this morning for a tweak or two.
     

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