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[REVISION TKR] Ouch...CRPS!<<.

Discussion in 'Knee Replacement Recovery Area' started by Jordon6, Dec 12, 2015.

  1. Jordon6

    Jordon6 member
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    I had a right knee MUA 2 days ago. My total knee was sept 29th. I had 70% flex before MUA. The surgeon got full extension and immediately following surgery, I got 100 in PT. I am terribly sore and all of my muscles in that leg are stiff. Because of my soreness, I am not able to stretch much. I can hardly make it to the bathroom on my own. I feel as though I've been run over by a truck. I tried wall slides - so stiff and sore that I couldn't move correctly. I tried heel slides - my quad is so tender that I can't do it! I take norco for pain very 4/5 hours and ice twice a day. I have even taken warm baths to soothe my sore muscles.

    I fear that I'll lose my ROM because I'm so sore. Will I lose the ROM that I gain in the MUA?
     
  2. spinnerdiva

    spinnerdiva junior member

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    After my MUA I was sore and swollen which was normal But also did feel much better ... I think due to the ant inflammatory IV meds during the MUA . Do what you can ,follow the after instructions . I did not lose the range I had and did gain some . Although in my case still not where I want to be . Everything with my recovery seems to be rather slow!
     
  3. Jordon6

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    Thanks spinnerdiva
    It helps talking to someone who has had the same experience. My rehab too, has been slow and frustrating trying to justify why I'm not running marathons by now!
     
  4. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Having an MUA always causes some new damage to your soft tissues, so you need to be gentle with your knee - and with yourself. Until you're feeling more comfortable, only do a very minimum of exercises - certainly don't try wall slides again yet. Just do a few Heel slides and how to do them and practice straightening your leg gently.

    For the remainder of the time, rest, ice, elevate your leg and take your pain medications.

    Since you haven't been here before, I'm going to give you our recovery reading list. The most important ones come first:
    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 (PT) - 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
    - 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 lie down!

    Next is a FAQ (Frequently Asked Questions) thread.

    And here are some very crucial articles
    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 then some 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

    Be kind to yourself and kind to your knee!
     
  5. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Jordon6,
    I echo what Celle said.
    Follow the Bonesmart Mantras, Rest, Ice, Elevate, and Medicate on schedule as prescribed.
    The MUA irritated your soft tissues they are swollen, as the swelling goes down, your ROM will be there.
    Work smarter, not harder.
     
  6. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    You need to gen up on what an MUA IS! MUA (Manipulation under Anaesthetic) and Adhesions

    IF you had adhesions broken down, you certainly will feel like you've been run over a by a truck. And the more work he had to do, the worse it will be.

    If it's too painful to do things, the answer is simple - don't do them! You won't lose the ROM you gained and the adhesions won't magically reoccur. Follow the mantra.
     
  7. tigz

    tigz graduate

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    I took the heavy duty pain meds for about four days after my MUA. Those unused muscles in my thigh overwhelmed any knee pain I had initially. After a couple days of ice I moved to heat on the thigh, ice on the knee. I had daily PT, save weekends, for a couple of weeks, but at home I iced elevated and just did gentle movement.

    Hang in there!

    ~Julie
     
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  8. Jordon6

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    Well...one week after MUA my rom got to 93 after much pushing and tears in PT, but today I only got to 73. Very disappointing! I noticed after getting home today from PT my knee was swollen and that was maybe why I couldn't get more ROM. It's been 13 days since MUA and 8 out of 10 weekdays,I have had PT!!

    I'm exhausted and disappointed!
     
  9. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Well, your answer to the declining ROM is there! Too much pushing and shoving and pain in PT. Your poor knee has just gone through a MUA, which forced bending. That has caused some damage to soft tissues. And now the PT is causing more damage.

    Of course you knee is sore - it's wounded and it is only going to swell still more if you allow this to keep happening.

    You do not have to work hard or do lots of PT to increase your ROM. What your knee needs right now is gentle treatment and lots of Rest, Ice and Elevation. so it can calm down again and the swelling will go down.

    Give your knee a break from PT and just do some very gentle bends and stretches.
     
  10. Jordon6

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    You're correct. I have to remind my therapist this when she turns her nose up at me!:)
     
  11. referee54

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    Please remember that the PT works for you, not the other way around. You draw the line in the sand and let the PT know ahead of time what you will tolerate and what you will not do---and take no exercise past the point of discomfort.
    ai1195.photobucket.com_albums_aa394_referee54_line_in_the_sand_zps66afc62e.jpg

    You are forcing the knee to do way too much, and PT should never, ever push you to tears. Give the knee some time off---rest, ice, elevate, and I bet that the turn---but remember, this is a long process,; you have to be gentle and you have to be patient.
     
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  12. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I agree with referee54!

    It's your knee and only you have the right to say what will happen to it. So, say NO to too much exercise and pain.

    It doesn't matter what your PT thinks, because she works for you. You don't have to please her. She has to please you.
     
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  13. Jordon6

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    I'm now at 6 months post TKA and still having issues with ROM and flexibility. My ROM is around 90 and very painful to walk for extended periods. My OS wants now to do a scope to remove scar tissue to help my flexibility. I teach and by mid day my knee is so swollen and tight. The doc said that the scarring is what causing pain. I take 2 aleve in the morning and then 2 Tylenol around lunchtime and before bed. I have sone questions- how can I keep this from happening again? And what's the recovery like? I had X-rays-can you see scar tissue on X-rays?
    I stopped PT because they were all about the numbers and not me. I then tried to stay active at work, walk on the treadmill twice a week and use my peddler 10/20 min daily depending on how I feel. Help!
     
  14. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Jordon6,
    Sorry to hear you are still having challenges with your TKR and arthrofibrosis. Recommend that you seek a second opinion from an OS that specializes in revisions, they have the experience and training to best determine what is going on with your knee, and why you have developed arthrofibrosis.
    After surgery to remove the scar tissue in your knee, you will need to rest for a few weeks to let your knee heal. Anything that causes inflammation in the early days will cause the reoccurrence of the scar tissue.
    If the treadmill or peddler cause increased pain, swelling, or tightness, you will need to cut back, or stop those activities, to reduce inflammation.
     
  15. Jordon6

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    Thanks pumpkin! I really appreciate this forum!
     
  16. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Let me ask you some questions so I can advise you

    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! :no-fin:)

    2. are you icing your knee - if so how often 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?
    ai63.tinypic.com_eta39s.jpg

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

    8. what kind of exercising are you doing at home:

    how many times a 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
    etc., etc.
     
  17. Jordon6

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    Josephine
    1- pain is about 4 early in the day but about 5 after work
    2-I ice one a day in the evening about 2 hours
    4- I elevate once a day about 15 minutes
    5-I can get 90 on my own, PT can push it to about 95/100- but in pain, extension is minus 5
    6-I have moderate swelling, my knee looks big and sits higher probably cause it's not flat yet
    7-I teach first grade in a large school. Lots of fast walking! I track my steps and I get around 3500/4000 a day. I do light grocery shopping and cook 3/4 times a week. I walk on the treadmill 1 time a week for 10/15 minutes and use my peddler every night about 20 minutes while watching tv.
    8- no other exercises except the treadmill and the peddler. I'm exhausted after work! Walking on this knee feels like a workout! It's tight and heavy! I take warm baths every night and stretch it while in the bath and afterwards I sit at the edge of my bed and stretch it by sliding my bottom out to work on ROM

    I appreciate any thought you have Jo!
     
  18. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    That's a very high pain score.
    That's not enough. Can you not ice during the day in breaks? You must get breaks. If you have nowhere to keep ice packs, use the crushable ones that coaches use on the field and track. You can see an example in here Ice to control pain and swelling
    You accomplish little or nothing in 20 minutes. It's not worth the effort! Elevate and ice for at least 40-60mins and as often as you can. 4-6 times a day on days off.
    On NO account allow your PT to push on your knee much less cause you pain. It undoes any good you have done before by making more swelling.
    No - it looks big because it is!
    That's about 2 miles a day which is pretty extensive. And hard work!
    Quit all I have crossed out plus the PT sessions. You don't need any exercising when you're that active at work. Your knee feeling tight and heavy is the reason for your poor ROM. Did you not read this article in the collection Celle left you in post #4? Swollen and stiff knee: what causes it?

    If I had £1 for every member on this forum that was anxious about poor ROM while doing all this exercising, I'd be a wealthy woman! Please try to understand the direct correlation between this boot camp approach and poor ROM. Exercising makes your leg swell. Swelling blocks your ROM, both flexion and extension. For some reason surgeons and PTs seem to think the answer is to go at it more aggressively but it is NOT! Your only answer is to get your swelling down and thereby allow your ROM to be revealed. It's the only way.

    I know this is a scary story but you really must read this to see how bad too much exercising can be. PT: the seriously grave consequences of doing too much of it You're nowhere near this man's state yet so please stop now before it does get that bad.
     
  19. Jordon6

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    Jo
    I read that thread! Terrible!

    I get a 30 min break during the day. I'll have to buy some of those disposable ice packs, cause Otherwise I have a leg ice wrap that has to stay frozen.

    I'll elevate more! You're right about being anxious! I'm ready to feel better and I'm tired of people looking at me with the "pitiful" faces and questions like " Are you still having trouble?"

    Should this scope and rest help? I'm leaning toward getting it done when school gets out in May.
     
  20. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    To be honest, I'd ask for it to be postponed for a while as I doubt you really have a great deal of 'scar tissue' in there. My opinion is that your problem is mostly (probably entirely) activity related swelling.
     

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