MUA for me...I'm discouraged...and a strange pain

[referee54]

This feeling down in the dumps is normal--pain meds. loss of mobility, loss of sleep, isolation, and the lack of independence all figure into it---not to mention the invariable slowness of recovery.

While I know that it does not make you feel any better, please understand that it is normal---and at this time of recovery, "don't sweat the small stuff."

Take it slowly and gently and do not worry about progress---it will take care of itself, but it will take longer than all of us realized.

We will be here for you---we will ride that roller coaster ride with you!

 

[maryo52]

Distraction DOES work. If I had taken a hammer to the foot of my opposite leg, I'm pretty sure I would've forgotten about the TKR!!

 

[Josephine]

At best my ROM is 79%..on a good day with pain killers onboard. Then I regress back to 70.

What did you expect at 3 weeks?

on my second 'outing' yesterday to the grocery store with husband while I drove one of those electric carts. Even having my leg down for that time (30-40 min) was terribly painful.

You shouldn't be going to the grocery store yet! You need to read this again Progression of activity for TKRs

Is it still considered 'normal' to have to keep taking pain meds?

Depends what you mean by "so much"!

FWIW, I was taking all my pain meds for 12 weeks! And I needed them!


Some questions:

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 compare this with the bone-on-bone pain you had before surgery!

)

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

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

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

6. 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)

 

[suzzee2000]

It is so nice to read so many great responses to some serious issues here. The support here at Bonesmart amazes me! @need2nees you are going to be just fine....I can see myself in your shoes doing the same thing. I Keep telling myself I will take it easy but it's going to be hard! Just hang in there!!!! As they say take it one day at a time!!!

 

[kneeper]

The first few weeks are tough. Your knee is swollen (whether it looks it or not) and your tissues are angry. As others have said you're doing ok for 3 weeks.

 

[need2nees]

Suzzee thank you for your words if encouragement. Makes me feel less lonely!!
Josephine here are answers to your great questions!


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 compare this with the bone-on-bone pain you had before surgery!

Best (or least) amount of pain is 3...after icing and pain meds on board. Worst, in AM, or right when I put weight on my leg in AM, and that hovers around 7-8.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
hydrocodone 7.5/325 I take one tablet about 3-4 times every 24 hours. Also occasionally when I have very uncomfortable muscle spasms (like an immediate charlie horse sometimes along the sides of my knee, or in the hamstring area) I take flexeril 2.5 mg at most 2 times a day, usually just once.

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?
I have a recovery-wrap electric system for icing which is really terrific. I use it in 30-60 minute increments with leg well elevated on a wedge about 3-4 times a day. I probably don't elevate my leg enough. Sometimes I find I have been puttering around or on a car ride for several hours without elevating and it REALLY hurts, even though there is not a lot of visible swelling (but it sure feels swollen)

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
I think I am guilty here. (btw it is great to ask these questions because it really makes you reflect on reality vs what you think you have done..) Housework, I would have said 'little'...but...I have in fact done things such as washing my bathroom floor (couldn't stand the dust bunnies) by bending over and holding my leg in back of me to keep it straight...oops. Cooking...no dishes, but prepared a few things for dinner/snacks although I did bring a chair in the kitchen so I could do mixing/chopping while sitting down. Went to grocery store once with hubby and used electric cart. A mistake. Leg was down too long. Haven't shopped since. I walk around house (no stairs) unaided. (also perhaps bad) Nap at least once a day. Sleep relatively well but awaken if I turn in an odd position. Went to see my elderly father yesterday (my daughter drove) and used my crutches, but, still, I was up too long (3-4 hours or so) ..this part really seems frustrating too me.

6. 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)

I do heel slides every time I am in bed, for naps or evening sleep, about 10 times repeating once when I get into bed and when I awaken. Husband has been very helpful in daily evening leg massage which really loosens things up. (he is very skilled in anatomy and massage so nothing is overdone or painful).

Gentle stretches (flexion and extension) 3-4 times for 2-3 sets. Up to my max before I feel like I have "hit a wall" of cement in my knee. I have not been able to get past 80 degrees yet, and extension has decreased this week to about 10 degrees.

I sit on floor and use small towel under knee, lay flat and push knee down on towel,5-8 times for 3 sets, around twice a day. At the same time and in same increments I do straight leg lifts on back, and turn to side and do leg lifts slowly and holding for about 5-8 seconds each time.

I also (and this might be too much) lay on my stomach, use my unoperated leg to prop my operated leg so it doesnt fall completely straight then slowly try to remove my 'propping' leg to let gravity straighten my leg out. I can only do 2-3 of these once a day. I also try straight leg lifts towards the ceiling when on my stomach, being careful of position to protect my lower back. I have a very strong back and usually a lot of flexibility...former dancer...

This, plus walking around house, and stopping to do gentle calf stretches at counter by putting leg in back of me while keeping knee bent slightly and pressing on ball of foot to stretch calf muscle.


Any feedback/recommendations/thoughts/insights??? A HUGE thanks to you for taking the time over and over again to respond in so much detail to each of us!

 

[speccybecky]

If it hurts, you need medication......take it!!
I was taking tramadol for at least 3 months. You have a long way to go but you are moving in the right direction

 

[Josephine]

hovers around 7-8.

That is high!

hydrocodone 7.5/325 I take one tablet about 3-4 times every 24 hours

Is that what you are prescribed? It doesn't say '1-2 tablets every 4-6 hours'?

I have a recovery-wrap electric system for icing which is really terrific. I use it in 30-60 minute increments with leg well elevated on a wedge about 3-4 times a day. I probably don't elevate my leg enough.

Ice and elevate more - a LOT more.

Sometimes I find I have been puttering around or on a car ride for several hours without elevating and it REALLY hurts, even though there is not a lot of visible swelling (but it sure feels swollen)

Swelling often isn't visible and that's the kind that hurts the most as it means there is a LOT of pressure inside the leg.

btw it is great to ask these questions because it really makes you reflect on reality vs what you think you have done

That's the point!

washing my bathroom floor (couldn't stand the dust bunnies) by bending over and holding my leg in back of me to keep it straight.
Cooking...no dishes, but prepared a few things for dinner/snacks although I did bring a chair in the kitchen so I could do mixing/chopping while sitting down.
Went to grocery store once with hubby and used electric cart. A mistake. Leg was down too long. Haven't shopped since.

I walk around house (no stairs) unaided (also perhaps bad)
Nap at least once a day.
Sleep relatively well but awaken if I turn in an odd position.
Went to see my elderly father yesterday (my daughter drove) and used my crutches, but, still, I was up too long (3-4 hours or so) ..this part really seems frustrating too me.

Honey, you are three weeks out. You shouldn't be doing any of this AT ALL! Your job right now is just to rest and recover and NOTHING ELSE! Read the mantras and the article on progression of activity below. Tut tut!

As for the exercises - are you training for the Olympics or what? At 3 weeks you should ONLY be doing 5 heels slides every couple of hours and about 5 straight leg raises morning and night on your bed! Increase as per the activity article and save the intense PT for week 8 at the very, very earliest! If you want a guideline, you might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

- heel slides 10 times
- walking around house as needed for bathroom, etc.
- gentle stretches (flexion and extension) 3-4 times for 2-3 sets. Up to my max before I feel like I have "hit a wall" of cement in my knee
- sit on floor and use small towel under knee, lay flat and push knee down on towel 5-8 times for 3 sets x2 a day
- straight leg lifts on back 5-8 times for 3 sets x2 a day
- side and do leg lifts slowly and holding for about 5-8 seconds each time 5-8 times for 3 sets x2 a day

- lay on my stomach, use my unoperated leg to prop my operated leg so it doesn't fall completely straight then slowly try to remove my 'propping' leg to let gravity straighten my leg out - I can only do 2-3 of these once a day.
- I also try straight leg lifts towards the ceiling when on my stomach, being careful of position to protect my lower back
- gentle calf stretches at counter by putting leg in back of me while keeping knee bent slightly and pressing on ball of foot to stretch calf muscle.

have not been able to get past 80 degrees yet and extension has decreased this week to about 10 degrees.

And you want to know the reason why your ROM is so limited at this stage? For one reason and one reason only - you are doing far too much! FAR too much! If you want better ROM, do less, a LOT less.

Now read these articles and make sure you read them all and digest the content.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it (that includes ignoring dust bunnies)
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

And here are some very crucial articles - especially note those in bold
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs
Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[maryo52]

This, plus walking around house, and stopping to do gentle calf stretches at counter by putting leg in back of me while keeping knee bent slightly and pressing on ball of foot to stretch calf muscle.

This is an example of an exercise you don't need to do. I think I posted my thoughts earlier, which sum up three years and scores of people's experiences from this forum (plus my own). When the going gets tough, increase the healing measures: icing, elevating, medication for comfort. AND minimize your leg's acitivities. You only need to do three things each day: (1) extension, (2) flexion (such as heel slides), (3) straight leg lifts for quad strengthening. Scuttle the rest until you're happily progressing. Nothing should be painful. Do 20 a day of each. Space them out over the day. Watch lots of your favorite re-runs and indulge yourself in other simple pleasures for some therapeutic distraction. Remember that Time is the ultimate healer. KEEP YOUR LEG UP. And adjust your expectations. The progress you're probably hoping for in a day might take a week (!!). This can be a very slow process.

 

[need2nees]

Josephine (and all) You are AMAZING!! I kept re-reading your replies because i almost didn't believe it. You are square-on regarding everything you said. Yes my meds say 1-2 q 4-6 hrs prn. What is it about people like me who revert to these childlike behaviors like "less meds is better for you!!" or, "thanks for the praise about how far I walked!! Let me walk another block to show you how really good I am!!" Sick, sick. I am going to turn the dial WAY back here, and do some re-reading too!! Lesson: even though you read all through the suggested readings, read them AGAIN every time anything changes (or doesn't) because I bet there is valuable info in there you forgot about. Consider me rebooted. (didn't sound right, but you get it)

(oops 1-2 tablets every 4-6 hours as needed...non-nurse speak)

 

[need2nees]

maryo52, you are indeed very wise. Thank you..this information is really helpful as well as your other insights. Sometimes some of us need to have this info tossed at us time and time again. I have to give up some old fashioned beliefs...more pain more gain, you'll get weak if you sit around, blah blah. You are a wealth of information

 

[icep707]

I guess a lot depends on your expectations prior to surgery. Having not 1 friend that had a knee replacement I relied almost all my expectations from what I read on bonesmart. Only thing I heard outside of bonesmart was that it will be a terribly painful ordeal. With that said, pain and patience would be the order of the day. And that I should rest ice and elevate. Which I learned were bonesmart's holy grail. Months and months of bonesmart studying I felt 100 percent prepared for my surgery, basically fearing the worst. It's been 10 days and I couldn't be happier and surprised so far with the outcome.

My knee is not very swollen on the outside, it looks great but my ROM has been low. Because its swollen inside the knee. I have been walking, getting up and down often, stairs and PT. Am in relatively low to med pain. Nothing bad enough to start up the oxy again. Toes raises ,heel raises, glute tighteners. Quad lifts leg lifts are easy. But heel slides and bending knee very difficult. Clear sign I'm over doing it because pain is low. I'm gonna rest over the weekend and focus on using the controversial CPM that OS prescribed for 21 days.

I'm doing so well and doing too much that my knees is too swollen inside to bend thus already discouraging my ROM. Lesson learned this early on. Hope this gives you a insight, maybe inside your knee is swollen. Hope this is not a comment that deserves a Booo

 

[Josephine]

 

[referee54]

thanks for the praise about how far I walked!! Let me walk another block to show you how really good I am!!"

This is exactly the attitude that we have to fight---that hard work will help everything move that much faster---you are right ---it is difficult to do, but one has to learn that "less is more" and it is not all about how far we walk or how much work we do---it is all about keeping the knee happy and cutting back when we have to---

"When you feel the urge to do more, do the opposite!"

 

[need2nees]

Icep707 no boo from me!! This concept of 'invisible swelling' is new to me but SO accurate. Sometimes the less my knee looks swollen, the more it hurts...and this concept explains that. Appreciate your thoughts...very helpful.
Tim C. love the quote....I am really changing my thinking about this path of recovery. My knee is thanking me already

 

[maryo52]

Good day Trish, How are you doing? I wonder with the activity restrictions we recommended if you're feeling confined. It is indeed hard to not do things.

 

[need2nees]

Hi maryo52, yes you hit the nail on the head. It IS hard to not do things. But my knee sure tells me when I have overdone it, even if it was something simple or brief. Mornings are still extremely tough, and I have awakened the last 2 nights in pain and up for an hour trying to get back to sleep. Blah. I have been backing off of exercises other than heel slides and leg lifts. I think this is the right thing to do. And i am not being so obsessed with ROM. Hanging in there....thanks for checking in!

 

[need2nees]

Towards the end of my 5th week of recovery. Not 'smooth sailing' by any means, but nonetheless progress in the right direction. ROM still about 85 and 8...and thanks to all of your advice, I have been backing off of the over-exercising and spending more time elevating and icing.

However.....yesterday I decided to wear a different pair of shoes. I went for a short outing. When I got home I took the shoes off, and on my first step out of them had a searing pain shoot through the outside of my knee and deep into my leg. I absolutely froze it hurt so much. Thinking it felt like muscle spasm, I took 5 mg of flexeril ( I haven't taken this in several days), elevated, iced, went to bed. Hubby massaged carefully. Kind of slept. As long as I didn't move it, I could tolerate it. This morning, first step out of bed, same pain. Pain medication followed. More elevating/icing. It really really feels like a setback. Can hardly walk today; by far the most painful move is this...when one takes a step forward on the right (unoperated) leg, my left (tkr) leg of course is behind me. When I lift my tkr left leg to bring it forward, that is what sets off this searing pain. I don't even have to (or can) put weight on it...just the lifting process sets it off. It is so painful I can't even speak when it happens. I haven't had pain like this, and certainly not in this specific location, since surgery.

I compared the shoes I wore yesterday to the slip-on flat, athletic type of walkers I have worn since surgery. The heel of the 'new' shoes was probably 1-1.5 inches taller than my usual shoes since surgery, so my foot was slightly but definitely at more of a slope down from heel to toe in these 'new' shoes. Could this have really caused all of this pain?

Help! Recommendations for treating/nurturing this? I feel so discouraged. Thanks to everyone..

 

[Jaycey]

Have you done anything different other than wear new shoes? New activity or exercise? Shoes usually cause back issues (from my experience). I'll tag a couple of knee experts and see what they recommend @Jamie @referee54

 

[need2nees]

Hi Jaycey, thanks for tagging...and no, not really done anything different that I can think of other than the shoes yesterday. I did go for a brief outing to see my elderly father ( I have done this before, although paid for it then as it was too early for the walk from car to his apt.) but this pain was so specific and sharp that it concerned me.