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TKR Night time swelling

snowdog50

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Hello, I am a recipient of a TKR on my right knee back on October 9th only 17days ago. I was bone on bone and have had a history of knee issues. I'm 55yrs old 5'11 190 and was an avid skier for over 30 yrs. My first scope on the knee was back in 89 then again in 98. I'm pretty sure the two previous surgeries contributed to degeneration of my knee forcing me to go with the TKR.

PT (Physical Torture) has been just that. I can get to 95 degrees ROM but the therapist has to push the knee to the point of agonizing pain in order to reach that level. What I notice is happening is that by evening around 7pm my knee just blows up with swelling and pain. I'm working the knee so hard with morning and afternoon PT that by evening I can't do anymore.

Is this common or am I overworking the knee doing PT? I do notice that the swelling subsides overnight but that's a whole other thread my sleeping has been horrible due to the isolated pain in the right knee. Pain meds don't seem to be helping much with sleep.

I totally understand how discouragement and frustration can easily set in.

thanks,
 

Carole4815

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I found that for me, eliminating any agonizing PT pain helped my recovery so much. When I had such an experience at PT, I would end up just sitting and icing and elevating to get the swelling down from the time I got home until two days later when it was time to go to my next PT session. This was not helpful for my recovery and even though I communicated the problem, it kept happening. My last PT session (6 weeks after surgery) was so bad that I had to be wheeled out of there in a wheelchair. That was the last straw for me, so I quit PT. My surgeon is OK with this.

Now I can finally walk every day and engage in more normal daily activities, and this has really improved my rate of recovery in my opinion. Whereas PT refused three times to clear me to switch from my metal hospital walker to my rollator walker... the day after I quit going to PT I switched to the rollator, and now, at 10 and a half weeks I am not even needing the rollator walker any more, well at least most of the time. Also my capabilities have rapidly improved in so many other ways. To me that is great progress.

Pain control is so important for me to sleep. Even minor pain messes that up for me, because I am a light sleeper.
 
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Jaycey

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@snowdog50 Welcome to BoneSmart and the other side of surgery!
PT (Physical Torture) has been just that. I can get to 95 degrees ROM but the therapist has to push the knee to the point of agonizing pain in order to reach that level.
We see so much of this here and it is so counter productive. Yes, you are over working your knee. I suggest you stop all this PT and let that poor knee heal. Icing will address the swelling and is a natural pain killer. Once your knee has recovered from the trauma of surgery, you can work on more mobility. There is no window for gaining range of motion (ROM).

I'll leave you with some reading material. The articles are short and they may help you understand where you are in this recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Jockette

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Hi and Welcome!

Excruciating pain from PT is not necessary for a good outcome, but as the others have said, it is counterproductive. Yes you want to keep mobile, but gentle mobility will take you further than painful PT.
 

Sara61

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Poor you :-( why on earth do some PT instructor use the old outdated motto of "No pain no gain" its barbaric. I was operated 1 day after you I had my 1st PT class last Tuesday ( 10 days after) for just 30 minutes during this time I was put on a gentle cmp machine and no pain whatsoever was involved - my instructor has told me to take it easy and let my knee heal, this I have done and I am now able to walk properly with just one crutch and can even manage without.
I have minimal swelling at night and have been able to reduce my medication- your body especially your new knee needs time to heal the bend will come naturally on its own- read the forums everyone will tell you the same.
Wishing you a better few weeks and enjoy your "me time" xxx
 
OP
OP
S

snowdog50

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Poor you :-( why on earth do some PT instructor use the old outdated motto of "No pain no gain" its barbaric. I was operated 1 day after you I had my 1st PT class last Tuesday ( 10 days after) for just 30 minutes during this time I was put on a gentle cmp machine and no pain whatsoever was involved - my instructor has told me to take it easy and let my knee heal, this I have done and I am now able to walk properly with just one crutch and can even manage without.
I have minimal swelling at night and have been able to reduce my medication- your body especially your new knee needs time to heal the bend will come naturally on its own- read the forums everyone will tell you the same.
Wishing you a better few weeks and enjoy your "me time" xxx
10 days after surgery wow. My first session was 4 days post surgery and they come to my home 5 days a week. So I've already had 10 PT sessions since surgery 17 days ago.
 

Jockette

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I never had in home PT. No, I had to go to an out patient facility 48 painful hours after surgery. (I was discharged from the hospital after one night in).

Little did I know then that I didn’t have to do that. I could have waited until I felt better and done my own movements to maintain mobility at home. I won’t make that mistake next time.
 

Sara61

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Plus I only went to PT as the therapist is a family friend and he suggested it. My surgeon is against any PT till after 1 month he solely recommends walking around house / garden and a doing a few light exercises.
Funny how they all differ xx
 

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