TKR Take Two

[Jewlz1]

sistersinhim-thanks for your emoji post. I'm really more frustrated then sad. Today I'm going to start taking Gabapentin to manage the nerve pain. And this blog is helping me understand that aggressive PT will never really allow my knee to heal. So this is a minor blip on the journey. Support from family, friends and Bone Smart really help me from becoming down in the dumps. Today is a new day and I'm excited!

 

[Jewlz1]

The Gabapentin allowed me to sleep 8 straight hours on Monday night! Woohoo! Tonight not so much. Drowsy but couldn't sleep, so got up and watched some TV. Off to bed again!

 

[LD of Michigan]

Good for you on the sleep tip. I am settling into bed extra early tonight sans laptops and TV's etc. to hope to get some sleep. Awesome that you are getting relief from the nerve pain!

 

[Helizabug]

Sleep, like everything else on this journey, seems to get better then slip back then get better again. My sleep has mostly been good, but last night I was up every hour. Then I remembered that would happen before the surgery too. For decades before the surgery, So, maybe I’m learning some sleep skills from this part of my life.

I hope the gabapentin continues to help. I found it helpful that first month and have been thinking of asking for it again.

 

[Celle]

I hope the gabapentin continues to help. I found it helpful that first month and have been thinking of asking for it again.

Gabapentin is a serious drug that should only be used for nerve pain, not as a regular pain reliever. It is used to control seizures in people with epilepsy.

You need to start taking it gradually, and you should decrease doses gradually when you come off it.

 

[Jockette]

I think at this point the pain you are feeling is still from the aggressive PT you have done in the past weeks. It can take a while to settle down. I suggest you stop doing formal exercises and just walk around, and do the normal day activities. You have been through a very major surgery that has disrupted all your soft tissues in that area and it takes a lot of time to recover.

Right now walking around, though not to excess, is all the mobility your knee needs. It will not freeze up if you stop the formal list of exercises.

You have not done irreparable damage to your knee with the aggressive formal PT, but if you don’t step back and let things recover you could be at risk of causing chronic pain.

 

[Jewlz1]

Celle-I was very reluctant about using Gabapentin, mainly because of the taper down when nerve pain has been resolved. I did reach my limit with nerve pain this past weekend and asked for the script. I felt like I was throwin' in the towel.

Jockette-I did end up doing some exercises at home today and rode the stationary bike for 10 minutes, zero resistance and very slow. I find myself sitting alot, or lounging on the couch. I've read (can't remember where) that I should get up and walk every hour for 5 minutes. I feel restless sitting and lounging which is probably why I got up and exercised. I felt okay afterward, but it was hard to stand and prepare dinner and clean the kitchen. I'm icing every couple of hours and usually keep the ice pack on until it's no longer cold. I make sure to protect my skin to avoid a freezing burn. I am scheduled to see the clinic director where I have PT done. I will be reassessed and will make sure it's understood no strengthening, but gentle stretches. I sure don't want to run the risk of chronic pain.

Thanks for the support.

 

[Jewlz1]

Reassessment with PT is on 2/17

 

[Jewlz1]

Well tomorrow is the reassessment with my PT. This past week I've done alot of resting and icing, some elevation. I did some mild exercises mid week and no more the rest of the week other than ADL's. I have a short flight of steps (6 steps) to get to the bathroom and bedroom , and another short flight down to the garage where the washer and dryer are located. I'm going to be sure and let the pt know only stretching, no strengthening until 12 weeks (the week of 3/9) out and only if I'm ready and not experiencing pain. I'm going to see how sleeping goes without taking Gabapentin tonight. I've only been taking it at bedtime for 7 days.

 

[Helizabug]

Good luck with the reassessment!

 

[Jewlz1]

Thanks Helizabug! It went well. I made it clear just gentle stretching exercises which is what we did and I was in full control of when I'd reached my threshold. I didn't discuss my strengthening plan yet. I want to see how the rest of this week goes.

 

[Jewlz1]

Update: last night after trusting my PT, I began to experience the same pain I did after leg pressing 80lbs and was miserable and had very little sleep. I contacted my OS's office this afternoon and received a call back within an hour. I shared what was going on with the nurse and she wanted to check with the Dr. She called me back within 5 minutes and the doctor wanted me to get to his office right away, if possible. Of course I went! X-rays were taken and my new knee is all good. Bad news is those 80lb leg presses were way too aggressive, just as was thought This caused vastus lateralis tendon & lateral retinaculum strain! OMG! And yesterday at PT I was told I should walk fast to help improve my gait and to work on stairs. Both of those could have made things worse. Soooo....my PT is fired! My OS was visibly upset. I'm going to consult with the PT he uses for his TKRs. I will have to drive quite a distance but it will be worth it. My first appt with the new PT is Thursday.

 

[Jewlz1]

Note: the 80lb leg press was done.on 2/6, not at yesterday's PT.

 

[Jewlz1]

First appointment with new PT seems to have gone well. I'm shy to put faith in this field. But my ROM measurements were better than I thought, but that's never been an issue. I'll see how things go. Something new is taping over an area on my inside calf that's been puffy. I'll see how that goes too. No PT appts until Monday, although I do have home exercises to do. A little nervous about watching my 2 grandkids this weekend. They are coming over early Saturday afternoon and spending the night. They are very aware of my circumstance as they've been over with their mom (my daughter) since just a few days after surgery. And they're good kids 6 & 8 so it should be all good!

 

[LD of Michigan]

80 seems high especially if you did not do them before surgery. I am pressing 60 lb about two sets of 10. Very slowly. But that's gym work I enjoyed/ did before and only started in my 8th week post TKR. I would not do that early on in the PT context. If you're miserable after it's too much/ too early!

Good you moved on to a new PT. It is your health, your TKR investment. We must speak up as needed!

Update: last night after trusting my PT, I began to experience the same pain I did after leg pressing 80lbs and was miserable and had very little sleep.

 

[Helizabug]

Turn your recovery area into a pirate ship or a space ship! Pretend that every foray off the ship requires special preparation and equipment!

I want to come play with you!

I hope their time with you is wonderful for them and you.

 

[Julia1911]

Feel good when I go to PT, but then after massage (he says tissue manipulation) and exercises, have pain/swelling about 6 hours out then through-out night.

Now have 4 days until next session. At home, just tried my old elliptical machine. Can just now make 1 revolution with the minimal ROM I have stationary bicycle, but it is still way too much given my ROM. Did 30 elliptical revolutions of those (about a minute)--know it is baby step but gentle stretching and motion that will help me with stairs. Also have short (5.5 inch, 11 inch) small exercise platforms (2). Go "up" the 2 small stairs pusing off with surgery knee, then down with my good knee, which requires major stretching/bending (just make it) of surgery knee. Will eventually need to work up to full 8 inches of stairs, but on my own timetable.

These give me discomfort, but no real pain like in PT. So, it is my way of doing gentle stretching that does not result in major pain/swelling. Also, these are movements I will need to go up and down the stairs in my house 2 footed, so it seems like exercises for real life, not just PT gym.

 

[Jewlz1]

I need another head to help me think in my latest TKR recovery decision.
It's all documented in my recovery thread. Quick summary: aggressive PT on 2/6 led to me taking a week off beginning 2/10. I didn't want to return, but the therapist said come back in a week (2/17) and we'll reassess, which ended up being more exercises. It seemed okay at the time, but I ended up in pain later that day and contacted my OS on Tuesday 2/18 and was asked to come in for x-rays which showed vastus lateralis tendon and lateral retinaculum strain. The OS referred me to a physical therapist that he works with and I saw them on Thursday, 2/20. PT was more low key with sit to stands 15 x 2 reps, sidekicks 15-20 x 2 reps and step-ups with my left leg stationary on the step and the right leg taking the step up and down 10-15 steps x 2 reps.
My question now is with the lateral quad tendon and lateral retinaculum strain, shouldn't any PT be focused on healing that strain rather than post TKR rehab? I'm always trying to lean toward the bonesmart train of thought with physical therapy. My ROM is optimal, so is formal therapy post TKR even a necessity right now? The strain will take time to heal so I'm not sure if physical therapy is appropriate for that either. I'm not concerned about losing ROM. I am concerned about the strain and also concerned about losing quad and/or hamstring strength if I stop physical therapy all together. Any input will be helpful.

 

[Jewlz1]

@Helizabug The overnight visit with the grandkids went well and was lots of fun! We made Perler bead bowls and played some Yahtzee. I took about a 2 hour nap earlier this afternoon.

 

[Jockette]

I agree with you, I wouldn’t do the things either of these PTs are having you do, with that strain. If you’re not careful with that you could have a bigger problem.

I'm not concerned about losing ROM. I am concerned about the strain and also concerned about losing quad and/or hamstring strength if I stop physical therapy all together. Any input will be helpful.

I’m glad you’re not concerned with losing ROM. It’s not so much “losing” it, but it will naturally fluctuate depending on any overdoing that you might do.

Your quad and/or hamstring strength may also vary at this stage, for the same reason. As you heal, all will strengthen naturally over time.


Regaining our ROM/Strength is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion and strength is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.