TKR MSuki Recovery Thread - Sleep Issues, Muscle cramping, Walking

[Mamie]

Thank you for replying. I hope you have found the answers you are seeking. I am glad you recognize that it's not beneficial to push so hard. I had a bad experience with my surgeon pushing me, so life was more tolerable after learning in Bone Smart about how much further I could get without the drama. I enjoyed water therapy because it made me weightless and easier to move, but you could still overdo it. The secret to healing is rest, icing your knee, elevating it, and moving around.

Be kind to yourself. My best friend told me to imagine being in a cage wrestling with a gorilla, and I may have some idea of how my leg needed to rest with ice time, especially after physical therapy. Check out the link here on Bone Smart. Therapy makes far more sense here. You sound like a person with the end in sight and lots of focus. Those are wonderful traits.

Please bring your concerns and progress back to your friends at Bone Smart. Or just come to hang out with us sharing what's on your mind! We all care about one another, and you'll find many fine staff members are here to help you.

Good Luck!

Mamie

 

[Mamie]

Hello and Welcome HikigGoal
It seems that four weeks to wean off pain meds is too soon. I'm glad you have more to help you. It was not for me. I ran into complications, and maybe why, but everyone I speak with says it is at the three-month mark.

It would help if you congratulated yourself for such a job well done, having 125 ROM so early. Waking up several times a night is a common complaint I read in here. As for myself, I am up at least four times every night and have developed insomnia where I am here or on my computer around 2 AM. and falling to sleep at 5 or 6 AM and up again by 9. Not what is healthy for sure!

Are you really ready to be free of all walking ads at six weeks? I am still using my walker sometimes, but only when really tired. Right after surgery for my revision, PT was pushing m too hard. When they left), I grabbed my walker and pushed harder but learned a lesson the hard way. My surgeon pressured me to work harder, and I should have ignored him. Well, I put so much weight on my walker for support that I tore my biceps completely off the shoulder! What an idiot and more pain. My advice to everyone working hard is to back off when you are tired and rest. You can always start up again.

Again, congratulations on a great attitude and progress.

 

[MaryCat]

So I had in home PT and watched/ got guidelines from him on massage. He did super light massage first couple of times (10-20 days post surgery) and that felt great! After that a bit more intense. My calf and quads were really sore and it helped to do a few minutes of light massage. But we stayed away from incision and back of knee.

I just started working in the pool and liking that too. So far on my own just walking and leg lifts in all directions. And hopefully do a session with a therapist this week

 

[hawk2go]

I do agree that I am pushing too hard sometimes but it's so hard to know where the line is.

My doctor and Bonesmart said if it hurts while doing it stop. If it hurts a day or 2 after doing it, rest and try again another day. You get to decide. We all have trouble finding our post surgery limit, complicated by the fact that the limits keep changing. Relax in your own knowledge of your body and that this recovery can take up to a year. Regardless of your (excellent) ROM, you're still healing from this significant surgery which cut or disrupted bone, muscle, tendon, ligament and skin tissue. When you think of how long it takes to recover from a stubbed toe, you'll realize why this recovery seems so long. Hang in there, every day is a rollercoaster but it gets better with time.

Sometimes it feels fine while I'm doing it but then later I find out otherwise (like after I got enough flexion to peddle my recumbent bike and then did about 25 minutes - at a slow speed but it turned out it was way too much.)

I'll have to check my thread but I believe I was stretching, slow speed with no resistance and the seat up high to minimize the bend, for 2 minutes at a time at 1 month (though I might have started that at 6 weeks). I use the stationary bike for stretching (still 2 mins) and training (up to 45 mins) now. It helps to keep the seat high and do a few rotations to stretch when I've stood for too long. Here's a great article on training vs. stretching:

Stretching vs. training
Exercises to regain ROM are *stretches*, exercises to make you fit are *training*. Stretching exercises are gentle and do not make you breathe hard, sweat or have an elevated heart rate. Training exercises do this.

You cannot do training until healing is complete because it worsens damage to the ligaments and tendons that were affected by surgery. You can easily tell if this is happening because your knee will get stiff, will hurt, will swell up in the 24 hours afterwards. When this happens, stop.

Here is a longer explanation of the training/healing differences https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/

Here are some ROM and extension stretches (there are loads, these are just examples) https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/

I do sit in the recliner with the feet up but not on a pillow, not sure if that counts.

Many recovering from TKR sleep in their recliner until they can lie down comfortably for long periods of time. I had a Knee Cave in the guest room and slept in that bed so I wouldn't wake my spouse with my moans/screams when I turned and had to move the knee in the middle of the night. Sleep is elusive so just sleep when and where you can.

 

[Jockette]

I do sit in the recliner with the feet up but not on a pillow, not sure if that counts

Yes, this counts. If you don’t have a huge amount of swelling, and this is a comfortable position, then it’s fine. The only time I elevated “toes above the nose” was when I was in bed. Any other time I was resting, my legs were “only” on an ottoman, but it was comfortable, so that worked for me.

 

[MSuki]

@Jockette I'm sorry you had that bad experience. And @Jcx I feel your pain! That's exactly how I felt.

But I plan to continue and just be more careful. I'm the one that asked to go in the water. I didn't take into account the resistance and how weakened my muscles are, and it is so easy in the water to do more than you think you are doing. My therapist tried to start me off easy and like I said I could have turned down the intensity a little. I do think though that the water is going to be great for me as I go along because I need a lot of work on my gait. I have been walking wrong for a long time and it is easier for me to walk correctly in the water where there's less weight and less fear of hurting my knee. This week I am seeing the therapist I have gone to for a long time before my surgery and will tell her how I felt, and I know she will help me adjust the intensity accordingly.

I will try to be careful about overdoing but the thing that makes it hard is that on some exercises, what was too hard last week is not too hard this week, and others I progress more slowly. It is difficult for me to gauge it sometimes. Hopefully I will get better at it as I go along.

At this point I think I am getting a feel for what will irritate my knee itself, but I keep getting surprised by the pains in the other muscles/parts of my leg, hip, and back that are brought on by who knows what!

 

[benne68]

I keep getting surprised by the pains in the other muscles/parts of my leg, hip, and back that are brought on by who knows what!

Isn't it amazing how surgery on the knee seems to affect so many other parts of our bodies? I was so surprised when my LEFT hip started to hurt about a month after my RIGHT knee replacement. I forgot my high school anatomy classes where we learned that everything is connected!

You are early days of recovery, so you likely still also have pain from all that major carpentry work that was performed on you. Muscles were stretched, bones were sawed and things were hammered into them. Your body needs time to recover from all that trauma.

Here's a great chart that helps put recovery into perspective

Take it slow and steady, for now. You'll be feeling better soon.

 

[MSuki]

@MaryCat I definitely want to experiment with light massage on calf and leg. Will try a little and see what happens. I really thought the muscle soreness would improve sooner but I guess I'm retraining them to a degree with new and different activities.

@hawk2go below is the key problem for me. Everyone, here, my husband, and even my PT has told me not to get carried away so I am really starting to work on that. But so hard to know what is too much.

We all have trouble finding our post surgery limit, complicated by the fact that the limits keep changing.

Today I went to PT and told the therapist that I thought standing on my one leg for 30 seconds 3 times was too much. So she said try 15 seconds. Did that 3 times and did not seem to cause any problem. But I was still sore later, but not nearly as sore as normal. Actually I think some of it could have been because I got distracted and was an hour and a half past my pain pill due time. Oh well. I am able to go 6 hours and do well, 7 and I can tolerate it, but over 7 hours I have a problem.

@benne68 thanks for the chart. Love it. Some of the time periods are longer than I'd like but still encouraging in a way. I'm now hoping to get some of my muscles to calm down in the next few weeks like my left calf that has been super tight ever since the surgery, even when I do nothing. (I know it may take longer but I can still hope!

One question I am wondering about in this forum. So I had seen where we should use the same thread for entire recovery, but many of the other threads have specific issue titles on them. Do people change the thread title as they go when they are on a different topic?

 

[Jockette]

Yes, titles can be changed, just let us know if/when you’d like a different one and we’ll change it for you.

I was never told to stand on one leg for an exercise. I would skip it, especially since you feel it might be causing pain later on.

 

[Scaredycat10]

MSuki​

Just make sure when you have your light massage, if your therapist goes anywhere near the new knee, say for lymphatic drainage, it is VERY light and stops if it becomes in any way, uncomfortable, never mind painful.

I have a sports massage [deep and penetrating] on my hamstring twice a week and it's helping but last Saturday, I had lymphatic drainage on my actual joint. I have had drainage around my previously broken ankle and also broken foot as this new joint has done nothing for the swelling there and the lower swelling definitely benefits but

for the actual new knee, it was far too strong and I was in pain after it. I'm still feeling the after effects on the outer part of my knee.

Not worth it and I shall be mentioning it on Thursday.

 

[MSuki]

I just hit 5 weeks and am having hamstring pain also. Mine is dead center back of leg and also running up side of leg. Sometimes I have a sharp pain in a small area on outside of thigh about a third of the way up from the knee to hip. The PT thinks this could also be hamstring related. I am not currently doing any extensions. I have a hamstring stretch in my home list. However, I have recently noticed that when I elevate my leg (including the way I was sleeping at first) it creates a hamstring stretch. (I notice it more because it's sore already). I am wondering if I overstretched it early on. Wonder if that could be part of it?

Edit: Just realized this post was super old. Oh well....

 

[hawk2go]

But I was still sore later, but not nearly as sore as normal.

This is an indication that what you are doing is too much, right now. Those things may be achievable in a day or a week from now. Note that and try again later. When I was super frustrated that it took 3-5 days to recover from each PT session (the reason I went from 3x/week to once), I asked my doctor if needing that kind of time for the post-PT pain to settle was normal. He said no. No equivocation or exceptional circumstance explanation. Just no.

 

[newkneeforme]

You are not alone with these sleeping issues. I had my L knee TKR Jan 4. I have sleep apnea, I am a side sleeper who now had to transition to being a back sleeper because that was the only way I could be without significant pain. I was getting an average of maybe 3 hrs of sleep per night. Then developed recurrence of my chronic lower back pain about 4 weeks post surgery. At 8 weeks post surgery I was getting 7-8 hrs of good sleep and this has continued. I cant say I did anything unique but just persisted with PT everyday , took gabapentin and celebrex or advil, and maintained CPAP therapy. Eventually Back sleeping was less bothersome. Knee pain is minimal walking for me but I have issues with knee shin pain while sitting with knee bent. Not sure if its a tendonitis or peroneal nerve or what but its so uncomfortable i cant sit in a car for more than 5 min without significant aching pain. Sitting with knee extended is fine. I see the surgeon in a couple weeks.
Hope your knee and sleep improves soon.