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[TKR] Post surgery knee stiffness?<

Discussion in 'Knee Replacement Recovery Area' started by bad0351, Jan 7, 2019.

  1. bad0351

    bad0351 new member
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    Hi everyone,
    I'm new to the forum and wanted to ask a question, my first total knee replacement was done on December 11th 2018 and I'm still having stiffness in the knee at 4 weeks and wondered if this is normal? Makes it quite difficult to do my exercises but struggling through them.
    My second knee is scheduled for January 22nd (getting close) and was hoping for a little less stiffness and pain by then.....by pain I mean during and after my exercise.
    Thank you so much for any help you may give....
    Dale.
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!

    One of the first things Bonesmart says is, if it hurts, don’t do it. Pain indicates than your new knee is not yet ready for that activity.

    I am going to tag @Josephine
    our forum administrator and nurse director to address your concerns.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    Knee Recovery: 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
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    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. Here is a week-by-week guide for

    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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
     
  3. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    The stiffness is normal for your stage, as long as you are being more than 90 degrees. You can't progress faster by working more at PT. That's a myth that seems to be widely proliferated.
     
  4. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @bad0351, not only is it normal, but expect to experience some level of stiffness for several more weeks! Until your knee is fully healed and swelling completely gone, your knee will feel stiff. In fact, the tight band feeling across the front of your knee can last several months. I’m just under 9 months from my PKR and I still have remnants of the tight band feeling. Slowly getting better, but still there. The following article explains why:
    https://bonesmart.org/forum/threads/tight-band-feeling-across-the-front-of-my-knee.11734/

    As noted by others already, when it comes to pt and other “exercises”, if it hurts stop doing it! It’s okay for pt to be uncomfortable, but at no time should it be painful. If it is and your pt tells you to work through it, tell them “NO”.

    The following may also be of interest:
    https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/
     
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  5. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  6. bad0351

    bad0351 new member
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    I would love you to ask.....thank you for helping.
     
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  7. bowhunter8

    bowhunter8 junior member

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    @bad0351

    I agree with @NavyGunns. That stiffness will be your sidekick for quite a while and is normal for the healing process. I’m at 4 1/2 months post op and I just said to my wife last night how nice it will be when I’m not as sorr when I get up in the morning and go to bed.

    At 4 weeks, for me, it didn’t take much to make the knee swell. I didn’t do formal PT but walking down the lane and back up to get the mail was enough to make me want to ice and rest. At first I was a little concerned that OS said no PT but hind sight, I don’t know how I would have done it without being in a lot of pain. If it causes pain, don’t do it. Walking, daily tasks, etc... really is all I needed to heal.

    I was hunting at 4 weeks, hiking through lower elevation mountains at 8 weeks back to a laborious job at 10 weeks, back at gym now doing upper body weightlifting and bicycle and I still do have soreness every day and expect it for a while longer. Soreness not pain.

    I wish you the best on your upcoming surgery.
     
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  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go then!

    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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  9. bad0351

    bad0351 new member
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    1 5

    2 oxycodone 5 mg as needed, usually after PT about once sometimes twice daily some days none.

    3 moderate

    4 today was first time at 115 according to therapist.

    5 maybe 3 times a day or as needed.

    6 on a foot stool on my chair about even with my hip?

    7 my activity level is fairly good, a lot of walking outdoors with small chores so far.

    8 1 full session each day with different ones at times throughout the day.
    Foot slide x10 times as far as possible and hold for 10 seconds each
    Lunges x15
    Marching x15 times
    Balance x30 seconds
    Kick my knee back x15
    Stretch as far as I can leaning into the first step on staircase x15 hold 10 seconds.
    Step up x15 times

    I think that is about it. It's hard to remember them all but I try to walk as much as possible. The weather in NH doesn't cooperate sometimes in winter.
     
  10. hopalong61

    hopalong61 member

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    Hi @bad0351
    Just thought i'd let you know that stiffness in the knee is pretty common. It will be 12 months on Jan 20th since I had my TKR. My knee is still sore and stiff most days but gradually getting better. I did have an MUA in March 2018 which sort of set things back a little I suppose but I don't think it's unusual for the stiffness to last for many months. You seem to be doing a lot of exercise which may not help but i'm sure you'll get better advice from @Josephine soon.
     
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  11. bad0351

    bad0351 new member
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    Thank you so much for all the replies.....I can't tell you how much I appreciate them.
    Nice to get help right from the horses mouth so to speak!
    It means a lot to have support in this situation!
    Dale

    Hello @hopalong61
    Since you mentioned it, I may cut back a little on the PT.....it really does cause a lot of discomfort on a daily basis and sometimes I would just like to rest it for a day.
    Thank you so much!
    Dale
     
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  12. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

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

    Our range of motion 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
     
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  13. Celle

    Celle FORUM ADVISOR Forum Advisor

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    @bad0351 - Just to let you know that Josephine is taking a few days off, as she isn't very well.
    She'll respond to your answers to her questions when she returns.
     
  14. bad0351

    bad0351 new member
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    @Celle
    Thank you no rush, I hope she feels better soon....☹️
     
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  15. dmichael21

    dmichael21 junior member

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    Hey neighbor, I’m in Mass. over by Foxboro stadium and we both had. Our surgeries on the same date, I know how you feel and it’s no fun, I just keep doing my homework 3 times a day and the pain is aggravating and the swelling is depressing because it gives you that feeling that all your homework is for nothing but you sound active and will be fine, try this exercise I learned to day and you lay on your back and put both feet on the wall and get as close to the wall with your butt and lower your operated foot against the wall till it slightly hurts and hold it for 30 seconds and then slide it up with your strong leg and rest it, do that 6 times, been my favorite exercise.

    Here’s an illustration
     
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  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Thanks bad0351 - that was kind of you.

    That does not gel with the pain score and the swelling you have declared. You should NOT be taking 'as needed' because your pain score is higher than that. Take it as it is prescribed which is 3-4 times a day regularly. Untreated pain will result in stiffness!
    That's the flexion. ROM if flexion AND extension and I need to know both. However that's a pretty good flexion for 5 weeks out.
    How do you define 'as needed'! You need to ice for at least 40-60mins and more than 4 times a day.
    That is NOT elevating! This is how to elevate and you need to do it as your swelling is moderate. The rule is 'toes above nose"!

    elevate 2-horz-horz.jpg

    Good.


    1 full session each day with different ones at times throughout the day - no 'others' during the day!
    Foot slide x10 times - that's a heel slide and you're doing them incorrectly. This article was give you in the Guidelines in the second post of this thread Heel slides and how to do them properly
    Lunges x15 - not a good exercise. It stresses the muscles
    lean into the first step on staircase x15 hold 10 seconds - this is a lunge and the same applies
    Marching x15 times - don't recommend these either. Walking is much better
    Balance x30 seconds - also not recommended
    Kick my knee back x15 - nor these
    Step up x15 times - nor these


    This article was also left you in the Guidelines BoneSmart philosophy for sensible post op therapy
    You did read the Guidelines, didn't you? If not, I suggest you go back and read them all now.

    I would also suggest that you don't do any of these exercises because all they do is cause you pain. Quite a number of our members went through their recovery doing no exercise at all and came through their recovery with excellent results. I was one of them! I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  17. bad0351

    bad0351 new member
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    @dmichael21 thank you for the tip! I'm going to tone down my trying to stretch my knee muscles till it becomes painful. Try and walk more with gentle PT and see how that works. I do feel like I'm getting better!

    Go Pats!!!!


    @Josephine Thank you for taking the time to help me,
    I believe I will take your advice and tone down my painful PT a little.
    I have another TKR coming up in about a week and believe I will try and use your method from the start and see what difference there is between the two.
     
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  18. bowhunter8

    bowhunter8 junior member

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    @bad0351 josephine has given you some good advice. I cringed when I read some of your exercises. Stay on top of icing, elevating and pain meds and I think you will be good my man. That was my best form of pain meds and still is.

    I consistently iced up to 3 months, even in my work van between jobs, and now I do it as needed. I still take 3 Tylenol a day however if I had a sit down job I think I wouldn’t need too. Especially with another TKR coming up you will want that leg as good as it can be. I’m 4 1/2 months and last night hiked 1 mile each way to a tree stand I have not been able to hunt since before surgery because of terrain. It was such a confidence builder and a reminder that I did the right thing by getting the replacement.

    As a Steelers fan I will be rooting for the chiefs...ha...
     
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  19. bad0351

    bad0351 new member
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    My second knee is now in the books......I'm a little depressed about going through this again and just want it done.
    The first 72 hrs have been really painful and just trying to wish time away...LOL.
    I just didn't feel up to starting pt on the day I got home but there was a message on my phone they wanted to come that day, just too painfull....that was Thursday and I asked to start on Monday, do you guys feel this is acceptable?
    I just didn't feel up to it.
    Thank you for your support.

    Dale
     
  20. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Many of us didn't do any PT at all and we did just fine, so don't worry about a couple of days without. You can go forever without PT. Just do your daily activities and you're get plenty of exercises and PT.
     
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