TKR Numbness and kneecap pain<<

[bsassy]

Took the advice and upped my pain meds to 3x today....this morning I felt it kick in and felt pretty good...did my exercises but didn't over do. Rested, iced and read outside in the sun which really helped the spirits in dreary western Pa. since we had snow all last weekend. Took 2 more Norco mid afternoon, tho I still felt pretty good... Didn't do much of anything and felt quite guilty about that but took a "me" day... By 10:30 tonight, without much physical activity, my stabbing pains returned inside my kneecap area...seems like a knife is on the inside trying to get out!band it's mostly in the same area where all my pain was before surg... I did mention the stabbing to my OS on Monday and all he said was " it takes time, it's healing nicely , still some edema inside" , didn't seem concerned at all...Pretty stiff and sore still when I stand up, moving around seems to help that a lot but also seems to bring on the knee stabs...took the 3rd pain dose at 10:00 but it's like I took nothing.... Just wondering if anyone else is experiencing this type of discomfort at 9 weeks ( surg was 9 wks tomorrow)...I've lost 30lbs since surgery, trying so hard to get some weight off the knees...feel much better that way and you'd think it would make it easier...not so much. I have a bad habit of wanting to sit wt my legs bent up or tucked in and it's my most comfy position...still not able to push it back out wtout lifting it but that's a strength thing...the stabbing pain is wearing me out.... I know, patience! Just nice to know we're not alone in our dilemmas...or am I? ;-)

 

[smarttoys]

It still sounds like you are trying to do too much. Instead of doing your exercises at home and PT try doing as little as possible for a week or so and see how you feel. No exercises, no shopping, minimal house work, etc. Take your meds, ice and elevate as much as possible. Do some gentle bends and little walks around the house to stay limber. When I was at your point in recovery if I had extra pain from doing too much I would do nothing but rest for a few days until I was back on track.

It was a shame that you were not prescribed at least a stool softener after surgery and warned about the side affects of pain meds. That was one of the things that the nurse stressed during the joint replacement class. She said "write this down", then gave us a list of over the counter stool softeners that we should have on hand after surgery. I was well stocked before my surgery and I was also prescribed a stool softener before leaving the hospital. My prescription said to take 2-3 a day. I usually took 3. I also had a lot of high fiber foods, prunes, prune juice, etc. on hand and drank a lot of water. I would add miralax occasionally and a laxative once in a while if needed.

 

[referee54]

.Pretty stiff and sore still when I stand up, moving around seems to help that a lot but also seems to bring on the knee stabs.

I returned to the classroom at eight weeks, and you sound just like I felt, as well. I thought that eight weeks was going to be the "magic date" and that I would be good to go---wrong!!!

It sounds like you are doing to much and just need to cut back---listen to the knee---there is nothing, unfortunately, that you can do to speed up recovery, but there is plenty you can do to slow it down and to make it more painful and frustrating---take it from one who knows.

I would get up in the AM and feel pretty good, but, by 11:00 AM, the knees would begin to stiffen up and become sore. By the end of the day I was exhausted. On Sundays, I would do nothing but ice, elevate, and rest the entire day.

Nine weeks seems like a long enough time, but, in the grand scheme of things, you have a ways to go yet. We have to think and to come to terms with the idea of how devastated the knee was during the traumatic surgery, and it will take longer than we would like it to to be fully recovered.

 

[kneeper]

The stabby pains may come and go for a while. There are all different kinds of pain in the recovery, from stiffness to aching, to stabbing. Just to keep things interesting.

 

[KarriB]

It has been a beautiful week in PA! I hope you've been able to rest that knee and relax in the beautiful weather.

 

[bsassy]

@KarriB Thanks ... It has been gorgeous weather for a change. Unfortunately no rest for the wicked...had PT 3x this week, made a condolence call to a close friend, last night dinner wt hubs and another couple...st 5am I was in tears again. I feel so weak and hopeless. Very shaky on my feet... I'm starting into my 10th week and it seems worse now than week 4...certainly no better. I've been icing all morning and plan on spending the rest of the day outside reading...I've got to turn the corner soon, if not I'm going to lose my mind. The harder I work, the worse it seems to be. Pretty down right now...
This week coming is to be every bit as nice...enjoy!!!

 

[KarriB]

You are right, the harder you work the worse you feel. Work harder at resting your damaged knee and I think you'll find it gets better sooner. After my infection surgery my OS said the tissue was so damaged he wanted me to rest it. I was only allowed to walk short distances and was in an imbolizer (may have told you this) but my knee didn't hurt during this time and wasn't swollen either.

 

[Celle]

The harder I work, the worse it seems to be. Pretty down right now...

I'm sorry to hear that you are feeling down.

You really don't have to work hard at this recovery. In fact, working hard could actually be holding you back. For recovery after a knee replacement, it's a case of "Less is More". Less work = More progress.
Since it's now about 2 months since your surgery, can I suggest you cut back your PT to no more than twice a week, or even less? Your everyday activities are enough exercise for your knee.

Have you read these articles?
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!
What You Should Not Expect To Do After a TKR
Life in the slow lane

I'm going to ask @Josephine to advise you about your activity. Do try to answer her questions as fully as possible.

 

[Josephine]

Close to losing your mind, eh? Let's see if we can get it back for you! (9 weeks)

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. 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 ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?

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

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: (enter number) of sessions each day
enter exercise & enter number of reps and sets
enter exercise & enter number of reps and sets
enter exercise & enter number of reps and sets

At PT
enter exercise & enter number of reps and sets
enter exercise & enter number of reps and sets
enter exercise & enter number of reps and sets

 

[Josephine]

Incidentally, I had you answer these earlier in this thread - post #26 to be exact - and these were my recommendations!

My comments in bold
Straight leg raises 10-15 reps 2x per day - a tip: once you can do SLRs you don't need to do them any more!
Heel slides 20 reps 2x per day - there is little to be gained by doing these in two intense sessions. Read this Heel slides and how to do them.
Knee bends 5-10 1x per day - you're already doing a flexion exercise, you don't need two of them!

Tip toes.. 50 of them - a very punishing exercise and so many! I strongly suggest you don't do any more of these

Side slides 15 2xper day, Kick backs 10-15 1xper day/ with band 1xday - for what purpose? These are pointless exercises for a knee and certainly never with a Theraband

Exercise bike 3-5 minutes 1xper day - okay

My assessment (as always) is that you are doing way too much exercise. I am of the opinion that all this frenetic exercising is unnecessary and causes more harm than good. In fact, I think it's much more likely to cause poor progress in ROM than otherwise. I recommend you read my recovery threads to see how much exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[referee54]

You are right, the harder you work the worse you feel.

Exactly---people do not realize that you do not have to work at recovery---recovery is something that just happens.

You can help it along with gentle PT, but overdoing it sets yourself up for a very painful and very frustrating time period.

 

[bsassy]

@Josephine .. I really am ready to lose my mind going into week 10.

My pain levels vary thru the day... The dull ache in my shin and thigh and the stabbing pain in the kneecap area is never relieved , even with the meds ( Norco 10 325mg) at best I can get to a 4 or 5 if I'm resting. I've cut way back on the Norco since it doesn't help all that much. Morning, mid day and before bed ( I tried Percocet same strength and had similar results as in no relief) Yes I stayed on top of the pain in the beginning and had no problems...this is a new and different type of pain.

I'm icing 3x a day about an hour each time.

My knee is moderately swollen , very "hot" to the touch.

I elevate my leg , including sleeping , probably 15 hours a day... I have very little stamina.

Bend is 123, straightness 3 as of 2 days ago.

I have cut back my therapy to 2x a week and cut out the excersises you were against. We did add the treadmill for five minutes.

My pain is a deep deep bone type ache with a stabbing feeling thru the knee cap.

My quads are so weak I'm actually shaking for the first 30 seconds I stand.

I've lost quite a bit of weight and can feel my thighs are a lot thinner, therefore when I start walking , I start out a little hunched over until I can stand tall concentrating on the core. Heel toe as instructed.

I am weaker now than I was at 4 weeks post op, I do not do much thru the day and don't know if I'm hurting myself or helping by mostly sitting and elevating.

As I sit here now typing away my leg is up, I tighten my thigh muscles and my hole upper thigh just shakes.

I had my 2nd post op with my OS this week, he said it will just take time, that it was healing nicely, still have a lot of inflammation tho.

My main concern is the trembling as I walk and the stabbing pain thru the kneecap. The OS didn't seem concerned with that. I suppose if the surgery was successful the rest I'm on my own.

I am in tears (total sobs) every night and at times thru the day as well. The pain is just wearing me out. I feel as tho I've lost everything I started to gain and that I will never be strong and independent again. I'm a very young, quite active 60...although right now I'm feeling like a very fragile little old lady. I am a positive person as well and have done everything by the book to help in my recovery. As I said, I sure expected to move along slow and steady, instead I'm back to the early days.

I appreciate you taking the time to read through this and any suggestions you have so I can start having my life back again.

Thank you so so much.

 

[newlybionic]

I know it seems against what we are told by PT and some OS but have you tried stopping PT altogether for a week? I did that first time around and I felt better. I know when my muscles quiver that is a sign that they have had more exercise than they can stand and need some rest. I know we all want to be back to normal asap but you truly are only 2 months out of a recovery that can take a year. That means you are only one sixth finished. I iced and elevated every time I was sitting as well as all night. It will get better.

 

[Clipless]

I agree with Marian 110%. I don't wish to upset you, but 10 weeks is still "early days". I remember Christmas shopping at 10 weeks post op; started out okay then was suddenly in so much pain I thought I'd never take another step or make it back to my car! That said, I generally felt pretty good most of the time and by that point was not taking anything for discomfort except an occasional Tylenol. During both my recoveries my knees hurt while I was on them, felt much better as soon as I could sit or lie down, continued to ache at night for six months or so. Ice still helps me six months out, though I rarely bother. Six months post RTKR I am still easily fatigued. Anything I do (a hike, a bike ride, the gym) I come home and immediately require a nap. I don't remember needing so many naps before the surgeries. Maybe it's my age, HA!

I didn't read through your entire thread, but have you tried a specific med for nerve pain? Or a muscle relaxant in case it's muscle spasms? Maybe you would benefit from a referral to a pain specialist.

 

[Celle]

With a ROM of 123/3, you don't need PT at all. I did none after my last TKR and my knee works perfectly, with good ROM and strength.

I'm going to suggest that you take a total break from all forms of exercises and just get on with everyday living. I know that sounds counter to what you have probably been hearing from your therapist, but it's pretty obvious that what you are doing isn't working for you, so you have nothing to lose by trying something different.

10 weeks is too early to be worrying about quad strength and it's too early to be doing any strengthening exercises. If you give them a chance, your muscles will strengthen naturally, just with walking around and doing a few household tasks. That's all they need.

So, give yourself and your knee a vacation from exercising and trying to meet deadlines. Your knee will improve all by itself, if you just allow it to. Nature is pretty good at healing, without our intervention, so please give it a try - not just for a week, but for at least a month, because it can take that long. I suspect that your knee is suffering from irritation and inflammation, which needs to settle down before you can move forward.

There really is no need to rush, no need to try to achieve deadlines. Full recovery takes a whole year and your knee's ROM and function can continue to improve for all of that time. There is no magic "window of opportunity", within which time you have to achieve ROM and strength, or all is lost. You can afford to give your knee the time it needs to heal properly.
It's never too late to get more ROM!
Myth busting: the "window of opportunity" in TKR

What has made you so anxious? Has someone been telling you that you are behind, not meeting deadlines, have to work harder? If they have, they're wrong. I think you're going to do OK.
Be kind to your knee and kind to yourself.

 

[KarriB]

Tomorrow is Monday, start the week new with no therapy and see how it you feel. Stamina was the last thing yo return for me, there was nothing I could do that seemed to help gain stamina. I slept every afternoon after working half days and that was 4 months out.
Like Celle said quad strength will return when the knee and surrounding tissues are healed. Relax and don't worry, it'll happen when the knee is ready.

 

[bsassy]

@Celle and @KarriB ... I think I just took a real breath for the first time in the last week... You have given me the encouragement that I needed to back off therapy... I really do think I'm aggravating it more than helping it...and not helping myself by avoiding the day to day living part. Yes, a new week and baby steps instead of the pain and tears. Thank you!

 

[Celle]

I'm so glad you're going to try it!

You sound as if you're tired out and just worn down by worry.
You're going to be OK, but your body has been through a major trauma - this is a big surgery - and you need to treat yourself as if you are the most precious thing on earth, which you are. Spoil yourself, give yourself a stay-at-home holiday. Allow yourself not to be perfect. You're going to do just fine.

 

[bsassy]

@Celle i am going to try it and will keep you posted... I did want to tell you that you were so right in me feeling anxious and worried every minute , every day... When I go to therapy it's always that do and so could do this by week 5, and somebody's grandmother could do something before they left the hosp.... I know they mean well but I does make one feel rather inferior and slow. Yes her exact words were " you're not where you should be and we really need to kick it into high gear if you're ever going to feel normal again.... I'm made to feel so inadequate and such a failure I totally doubt myself. The pain is real! In fact right now it's about an 11 on the scale with having taken the 2 Norco about an hour ago...it just wears me down to the point of distress. Thanks again for the confidence booster

 

[Clipless]

" you're not where you should be and we really need to kick it into high gear if you're ever going to feel normal again...."

That therapist is not a good match for someone who suffers from anxiety. While you are taking your week or two off from PT, why not call around and find someone more gentle and positive? My PT's never said anything remotely like that to me, and I would have dropped them immediately if they had. I'm not a terribly anxious person (sometimes, I guess), but I have a very low baloney tolerance.