TKR New Year, New Knee - Jan. 3, 2017<

[Josephine]

Will you answer my questions so I can advise you?

I'd like to ask you some questions if you don't mind, and 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)

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.

 

[jaschembra]

@Josephine
1- 2-3 From tightness and stiffness. (What felt like bone pain Tuesday was a 7)
2- 15 mg Meloxicam 1 x per day; 50 mg Tramadol 2 x per day (9am and 9 pm); 1,000 mg Tylenol 3 x per day (7am, 2pm, 9pm)
3- moderate
4- 116 flex and -4 extension
5- yes, I go to sleep with the ice machine and remove it about 5 hours later. I ice about 60 minutes 4-5 times during the day/evening
6- yes, I'm elevated the same times as icing and I'm elevated whenever I'm not walking at home
7- Small laundry loads, a couple a week. Make my own breakfast and lunch. I make some dinners but I'm usually sitting on a stool for any prep work. Feed the dog a.m. and p.m. Vacuum 1 hour 1x/week (taking a break in the middle). Load, unload dishwasher every other day. If I go to the grocery, it may be 1-4 items, 1x/week (hubby does the shopping right now)
8-
Exercise at home-
-15 min. slow stationary bike, no resistance, rocking back/forth until I go around 2x/per day unless I had PT, then only 1x
-Step ups on stairs to 2nd floor. 3x/day. 8 on left leg, going up leg over leg (come down, sideways)
-Straightening, 10 min, 1x per day with heel prop
-Bend and straighten leg while laying down or watching tv letting gravity hang the leg (knee bent)
-Heel slides 10. 1x/day
-Stretching hamstring 3x, 30 sec. hold
-Calf stretch 3x, 30 sec hold

PT (first 5 weeks was 3x/week and last 2 weeks was 2x/weeek). Sessions ended today -
-Stretching hamstring 5x, 30 sec. hold
-Calf stretch 3x, 30 sec hold
-Straight leg raise 2 sets 15x
-Quad set with heel prop, 10x, 5 sec holds
-Knee extension while sitting in chair with leg outstretched on floor, pressing on thigh, 10 x 10 sec hold
-Balance on 1 leg, standing on rubber mat, 10x, 10 sec each
-Heel slides with strap, 10 x, 10 sec hold
-Knee bending with strap under table, 10 x, 5 sec hold
-Step ups 6 inch, 10x, 3 sets


MRI showed a small Bakers Cyst in the back of my knee which I think is also causing some discomfort back there

Thank you for your input.

 

[Jamie]

That balancing on one leg on a foam mat is a pretty advanced exercise for someone with a new knee! It is a good one for sure, but I'd wait at least 6 months to be on a mat. "Tippy" surfaces like that can really work all the soft tissue around your knee and cause pain when done too early. If you want to work on balance, just do the same thing without the mat. If you get really good at just standing (work up to 5 minutes slowly), then try to reach one hand out in front of you while on one leg.

If it hurts or causes more swelling stop doing it.

Maybe you need to post this on the frig for a reminder! Don't feel bad....we've all overdone things. Sometimes just "knowing" something isn't quite enough....

 

[Grammy211]

@jaschembra, I think you are doing fantastic! My therapist just started me on balancing on the TKR leg and boy was it hard but I made it for 2 minutes but felt like an hour! Tried it at home the other day and didn't make a minute! I'll have to keep working on it since Josephine agrees that it's a good exercise!


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[jaschembra]

@Grammy211 Jamie agrees it is good - but after about 6 months on a mat. My PT has had me doing it on a mat for a few weeks and finally this week I have stopped it. I was getting a specific swelling location from it and it's where my major pain came from on Tuesday. Thank you for the compliment. once I'm really healing and feeling better, I'll start up again

 

[Josephine]

What beautifully listed answers! Thank you so much!

1- 2-3 From tightness and stiffness. (What felt like bone pain Tuesday was a 7)

Oh - nasty!

2- 15 mg Meloxicam 1 x per day; 50 mg Tramadol 2 x per day (9am and 9 pm); 1,000 mg Tylenol 3 x per day (7am, 2pm, 9pm)

You are missing one very important thing in your regimen which is that these meds only stay active in the system for about 4-5 hours. So taking the Tramadol every 12 hours means you go about 7hours with no cover at all! And it's the same for the Tylenol. Every 8 hours leaves you with 3-4 hours with no cover. If you are getting pain at the level of 7 then you need to rethink this a bit

3- moderate swelling

Swelling is one manifestation of pain and swelling also causes pain. Nice double wammy there! Hence why you need to adjust your pain meds. There are other forms of pain such as soreness, burning, stabbing, throbbing, aching and stiffness. All need to be medicated if there is a problem.

116/-4

Pretty darned good for 7 weeks out, actually!

5- yes, I go to sleep with the ice machine and remove it about 5 hours later. I ice about 60 minutes 4-5 times during the day/evening
6- yes, I'm elevated the same times as icing and I'm elevated whenever I'm not walking at home

Excellent!

7- Small laundry loads, a couple a week. Make my own breakfast and lunch. I make some dinners but I'm usually sitting on a stool for any prep work. Feed the dog a.m. and p.m. Vacuum 1 hour 1x/week (taking a break in the middle). Load, unload dishwasher every other day. If I go to the grocery, it may be 1-4 items, 1x/week (hubby does the shopping right now)

Good, good.

My comments in bold
Exercise at home-
-15 min slow stationary bike, no resistance 2x per day unless I had PT, then only 1x
-Stretching hamstring 3x 30 sec hold
-Calf stretch 3x 30 sec hold
these are all okay though I suggest you just do them once daily and none at all at the weekend!

-Step ups on stairs to 2nd floor. 3x day, x8 on left leg, going up leg over leg, come down, sideways
-Heel slides x10 1x day
-Bend and straighten leg while laying down or watching TV letting gravity hang the leg (knee bent)
here you ae doing THREE flexion exercises when your ROM is already really good! So you have no need to do these now - ordinary activity will see to the rest. Plus you no longer need to do straight leg raises if you can do them easily.

-Straightening, x10 min, 1x per day with heel prop - an extension stretch but you already have as near perfect extension as you need. As I said before, ordinary activity will see to the rest.

PT (first 5 weeks was 3x/week and last 2 weeks was 2x week). Sessions ended today -
-Stretching hamstring 5x, 30 sec hold
-Calf stretch 3x 30 sec hold
-Straight leg raise 2 sets 15x
-*Quad set with heel prop, 10x 5 sec holds
-*Knee extension while sitting in chair with leg outstretched on floor pressing on thigh 10 x 10 sec hold
-*Balance on 1 leg, standing on rubber mat, 10x 10 sec each
-*Heel slides with strap 10 x 10 sec hold
-*Knee bending with strap under table 10 x, 5 sec hold
-*Step ups 6 inch 10x 3 sets
I am so pleased you've finished with all of this as many of them, those marked *, are actually injurious to the leg.

Overall, now you've stopped PT and if you stop the ones I have crossed out, then you will find your comfort level improving along with your ROM!

 

[jaschembra]

Thanks bunches @Josephine Typically, my pain level has been tolerable at the 2-3 and that's when I'm walking or standing. It's zero or 1 typically, when I am resting. On the day I had a 7 I did add an additional Tramadol and a few hours later, a Norco as a last resort. Thanks on the compliment for flex and extension but I'm just past 10 weeks out, not 7.

 

[Josephine]

Even for 10 weeks it's still good!

 

[jaschembra]

Dang PT. My last visit and the last minutes before ice they had to do a strength evaluation. Leg straight, they pushed down, my strength was good. Leg at 90 degree, they pulled out, leg gave way after a moment and I said, ouch! Needless to say, I felt new ouches last night and a pinching/pulling behind the knee.

"Hasta La Vista PT"!!!

 

[sistersinhim]

I hate PT! I hope you're feeling much better today.

 

[Grammy211]

Oh no! Hope you're feeling much better today and you enjoy your weekend!


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[jaschembra]

I am better, yes. Thank you. Feeling like I'm getting back to normal too after my ODIC set back

 

[Grammy211]

[emoji7][emoji7][emoji173]


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[sistersinhim]

 

[Josephine]

they had to do a strength evaluation. Leg straight, they pushed down, my strength was good. Leg at 90 degree, they pulled out, leg gave way after a moment and I said, ouch!

I've never heard of this being done on a TKR and certainly not at 11 weeks! You should refuse to let them do this. It has no therapeutic value whatsoever but is the kind of diagnostic manoeuvre surgeons do when testing the integrity of the cruciates. It has no place here.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[Red's Mom]

Hey kneebee how goes the recovery from the ODIC?

Finding the balance is a challenge

 

[jaschembra]

Yes Josephine, I think I was focused on getting my ice and being done with PT and just wasn't thinking of any ramifications from their strength evaluation. Fortunately it's not too bad today and I can continue life without them.

@Red's Mom All is well. My mind is no longer playing tricks on me making me think something was wrong with my bionic knee! You've got that right!
By the way, I was sitting on my back patio this afternoon and my horse saw me from the barn. I whistled to him, he saw me, perked his ears up and the turned around and showed me his butt. Guess he's mad at me or has disowned me.

 

[Celle]

After my first knee replacement, my PT did an evaluation like you had, Julie. She did it on what was my last session and she said that if my muscles hadn't been strong enough she would have recommend a few more sessions. She didn't do anything that hurt, though.

I think she wanted to write a report, to finalize my notes. It was also the only time she actually measured ROM. At all the other sessions, she just did a visual assessment.

 

[L.I.T]

@jaschembra Hope you are feeling better! I don't think I would have done well on the second part of that strength test either! It sounds painful! I probably would have said 'ouch' and accidentally kicked them trying to get my leg away


Sounds like (overall) you are doing well! I kind of wish I had more ODIC.... since I'm parked in front of a computer most of the day, there's not a lot I can 'overdo' except if I walk too far! Instead, Mr Plant has random mood swings. If I didn't know better, I'd think he had a split personality like Dr Jekyll and Mr Hyde!

 

[jaschembra]

Wow, 11 weeks and I am finally starting to feel bone pain leave and just the tightness, stiffness remain. When i'm up walking or standing, I do feel like I constantly have a "grip" on my knee. I guess this is normal. I also have that grip at the back of the knee that many speak of. For 2 days now, I've reduced my Tramadol to 1½ (½ in the a.m. and 1 in the pm.before bed). Still keeping Tylenol in me and Meloxicam.

I know during the first month I had to sleep on my back. Now that things are feeling better, as long as my pillow is between my legs, I sleep on either side. Last night is the first time I felt very comfortable on my left side as well as the right. Are there any issues with sleeping on our sides with legs bent? Nothing that will effect my straightening, correct?