TKR My knee is tighter and more painful<

[Jockette]

You should let your knee settle down before trying any more exercises.

It sounds like your therapist got carried away with the massage. Tell her/him that you only want gentle massage or none at all. You don’t have to do what they want, they have to do what you want. They don’t pay the painful price, you do.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

 

[sistersinhim]

Should I still do my therapy while the muscles are so flared up or take it easy a few days?

Yes, I think that would be the smart thing to do! You don't want to aggravate an already angry knee. Just gently do your movements.

 

[malkie1953]

Thank you! I’m somewhat of an overachiever which doesn’t always benefit me. I’m so afraid that I will lose motion if I don’t do my therapy at least once a day. I normally do it twice every day.

Thank you again.

 

[Jockette]

Here’s something about Working Smarter, Not Harder:
https://bonesmart.org/forum/threads/tkr-work-“smarter”-and-not-“harder”.11205/

 

[Jockette]

And this article about
“Lose The Work Ethic”:
https://bonesmart.org/forum/threads/lose-the-work-ethic-while-you-are-recovering.20402/

 

[malkie1953]

Wow!! I wish I had read this at the beginning of my recovery. Since this really bad flare up I’ve been resting a whole lot more and Toned down the need to work this knee so much. Thank you for THE best advice of all. I have a totally new perspective and I’m enjoying being relaxed and giving my knee the respect and time it needs to heal. I’m soooo blessed with a husband who is reminding me to rest while he goes to the grocery store, cook, wash dishes, do laundry. Thank you again!!

 

[Josephine]

I'd really like 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?

 

[sistersinhim]

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!

 

[malkie1953]

Yes I would be happy to answer questions.

 

[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.

 

[malkie1953]

1. It ranges from 3 to 5. I’m a bad judge of that. A few days ago after the sharp pain I felt and the massage from the therapist my pain was up to 10-12!

2. Prescribed oxy 5 mg. I stopped taking them 2 weeks after surgery and went to Tylenol and Motrin. I went back on 10 mg oxy to sleep (every 5 hours). 3 Motrin and 2 extra strength Tylenol every 4 hours during the day.

3. Moderate. I ice and elevate allllll day

4. I was never told the number for the straight but I know she said I was over the grade. It’s perfectly straight. My bend was 113 on Thursday.

5 and 6. Ice and elevate pretty much all day. No swelling in my ankles so I don’t go above my heart anymore.

7. I do some laundry. Tonight I washed dishes after dinner. Before this muscle episode, I went to the grocery store and was cooking dinner. Now I don’t do much other than ice and elevate. I did some therapy today because I don’t want things to get all stiff.

8. Was doing exercises 2 times, now only 1 until muscles stop being angry.
Leg lifts 20
Bring toes towards me - 20
Push back of knee into bed and hold 3 sec - 20
Slide foot back to bend knee - 20
Bridges for piriformis muscle - 20
Standing at island: side kick 20, back kick 20, march 20, bend 20, side stepping 10 times.
Sitting on the chair - lift leg out straight - 20, pull my foot back under chair as far as I can go 10. I was walking up and down the steps foot over foot but stopped when the muscles got sore. I want to try it again but I’m afraid to do it yet. Pain while doing exercises 2; afterwards maybe 4. I never was bothered with pain when I did my exercises in fact felt better when I did.

Only thing we’ve done at PT is massage my piriformis and Monday she massaged the muscles around my knee which was what REALLY set my pain level over the top.

She said my ROM and my leg strength is over the grade at this point.

The muscle behind my knee seems to be angry right now. I’ve been messaging it, hope it’s okay to do that.

Thank you so much for what you do! I honestly am having a real hard time convincing myself that this will ever get better.

Blessings
Lynda

 

[Josephine]

Some extra detail required before I get to work!

went to Tylenol and Motrin

malkie, you've not told me the doses! Very important that. Doses and how often you take them.

No swelling in my ankles

You ankles are not the issue - it's the swelling in your knees I want to know about!

I’ve been messaging it

Oh that's clever! How do you do that? By text or email?

 

[malkie1953]

Hmm. I’m sorry if I’m missing something. I take 3 Motrin 200mg and 2 extra strength Tylenol 500mg every 4 hours. 2 oxy 5mg to sleep at night.

New to me now is I have bad muscle pain in the back of my knee. Also some tight spots on top of my leg along with a tight piriformis muscle. The tight muscle behind my knee is making it hard to walk etc. The recovery in this knee is so far worse than my other knee. I was so blessed with that one. Hard to not get discouraged.

Thank you so much for your time!

 

[malkie1953]

I have this pocket of fluid on the front of my knee. Tomorrow is 5 weeks since surgery. Is this normal?

 

[Josephine]

Show where these painful spots are using this chart

 

[Josephine]

1. It ranges from 3 to 5. A few days ago after the sharp pain I felt and the massage from the therapist my pain was up to 10-12!

O-er!

2. Prescribed oxy 5mg. I stopped taking them 2 weeks after surgery and went back on 10mg oxy to sleep (every 5 hours), 3 Motrin 200mg and 2 extra strength Tylenol 500mg every 4 hours. 2 oxy 5mg to sleep at night.

Okay. Sounds good to me

3. Moderate

Okay

4. I was never told the number for the straight but I know she said I was over the grade. It’s perfectly straight. My bend was 113 on Thursday.

okay so 113/0 - not at all bad for 8 weeks out.

5 and 6. Ice and elevate pretty much all day.

Ugh! You never told me how LONG you iced for!

7. I do some laundry. Tonight I washed dishes after dinner. Before this muscle episode, I went to the grocery store and was cooking dinner. Now I don’t do much other than ice and elevate. I did some therapy today because I don’t want things to get all stiff.

The more activity you do (more on that later) the less stiffness you will get but this does NOT include exercises!

Was doing exercises 2 times, now only 1 until muscles stop being angry.
Leg lifts 20 - tip: once you can do leg lifts, you don't need to do them any more!
Bring toes towards me - 20 - I suppose these are a kind of ankle pumps which are now unnecessary and you are adequately mobile
Push back of knee into bed and hold 3 sec - 20 - extension stretches. There is no need to do these because you said your extension is already at zero
Slide foot back to bend knee - 20 - you don't need these as your flexion is 113 which is more tan good enough
Bridges for piriformis muscle - 20 - this is NOT a piriformis exercise! But it is bad for your knee!
Standing at island: side kick 20, back kick 20, march 20, bend 20, side stepping 10 times. - don't do these either - unnecessary
Sitting on the chair - lift leg out straight - 20, pull my foot back under chair as far as I can go 10. - no, don't do these

I was walking up and down the steps foot over foot but stopped when the muscles got sore. I want to try it again but I’m afraid to do it yet.

Don't stress about the stairs. You'll find it happens automatically in time

Only thing we’ve done at PT is massage my piriformis and Monday she massaged the muscles around my knee which was what REALLY set my pain level over the top.

Good

There are many on this forum who did their knee recovery with no exercises (or PT) at all. Yet we all god really good outcomes. Yes, I was one of them! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[sistersinhim]

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there!

 

[malkie1953]

Tomorrow will be 8 weeks post tkr on my right knee. I have fluid on the front of my knee and the pain has gotten worse. Has anyone else experienced this?

 

[traceys]

Yup. Member of the piriformis club here too! I too can handle my knee but when you can’t sit or lay anywhere for longer than 10min it’s so hard to elevate the knee. My pt is doing some heat and ultrasound and I start massage Monday so fingers crossed. Keep us posted and will let you know how it progresses!

 

[skigirl]

I have had piriformis issues myself. I finally got a shot in my SI joint and the pain went away for me, that was the cause of the piriformis pain. In a month or two you might need to research your back issues with another doc. For now, the most obvious cause for increased pain is overdoing the activity of your knee.

Since your quads and hamstrings are not fully functioning yet, your joint has to do some of the work of supporting your leg. The joint does not like doing that and lets you know through pain that you need to rest more. At 8 weeks my doc said I should be lying in bed for one hour for every two hours I was up. Going to the grocery store, cooking, etc are more work than you think.

For now, rest your knee and elevate and ice it.
Elevation is the key to controlling pain and swelling