Ask the Expert Webinar

Bilateral TKR Pre-op Pain

Status
Not open for further replies.

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
Maybe others have experienced this and can help. I got my booklet to prepare for surgery. It had a list of exercises to do to strengthen before surgery. Since this will be bilateral, I also added pushups (modified) to the mix. I also added exercises I found on the internet to further stretch and strengthen hamstrings and quads.

I was going along for a few weeks and feeling pretty strong, then started having more pain. This pain was up and down the backs of my legs; mostly right leg. The muscles are spasming like a charley horse. Sometimes it is intense. I struggle to find a position to make it stop. It comes and goes in all positions and activities. I'm having trouble sleeping. Needless to say, my exercises have stopped and I can barely walk. Bending my right knee is very painful, and I have to lift my leg to get in and out of my car.

Have others had this happen? I'm suspicious that I overdid the exercises and have stirred things up. I mentioned it to a nurse and she said I will experience this type of pain after the TKR. She said it was probably from too much exercise.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,207
Age
64
Location
Delaware
Gender
Female
Country
United States United States
The best intentions don’t always yield the results we want. Yes, I think you overdid it.

The good thing about this is that even though you are in worse pain right now, you are not in post op recovery mode. This is a heads up for you to think about how you are going to do your recovery. And yes, you have a choice.

Many PTs and surgeons encourage us to rehab at a more intense level than is necessary. Going into this surgery many of us think, “PT is going to hurt, but that’s how it has to be.”

Well, that’s not how it has to be. When you add painful PT on top of recovering from a traumatic surgery that can cause a lot of post op pain, you are just in a lot of extra pain.

Painful post op PT is not in your new knee’s best interest. Keep this in mind. Treat your knee gently so it can heal. Gentle bends and short walks will be all your knee needs for a while. You can add other things later as you heal more.


Regaining our ROM 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 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.

Also keep in mind:
Saying no to therapy - am I allowed to?
 
OP
OP
bikinglynn

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
This is interesting. I've been led to believe that scar tissue will form and I will lose ROM without painful PT. I started reading Roy's posts (since he is a bicyclist), and notice this very discussion.
 

kneeper

FORUM ADVISOR
Forum Advisor
Joined
Dec 11, 2010
Messages
12,773
Gender
Female
Country
United States United States
Yes, it sounds like you overdid it and pulled muscles or something. I have found you don't have to do intense stretching to get good effects. (I'm thinking the problem was that you got over enthusiastic :oyvey:and looked up exercises on the internet instead of sticking to the pre-op ones.)

This close to the surgery, I'd say just do your arm exercises and let your legs recover. Post op your PT can show you some gentle stretches if you want.
And as others have said, don't let them force your leg. A good PT can be helpful but some get too aggressive. The key is to listen to your knee.
I always say you need to move the leg during recovery but not go too aggressive. What that balance is will change as you recover.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,207
Age
64
Location
Delaware
Gender
Female
Country
United States United States
Scar tissue gets wrongly blamed for a lot of things.

The best way to form scar tissue is to overdo the exercises. That creates more inflammation making the tissues hot and dry, which encourages them to stick together, which is what an adhesion is.

Usually, what PTs and surgeons call scar tissue is usually just plain swelling. I don’t understand why they mislead their patients. You need some scar tissue, it’s what knits things back together after this surgery. Eventually this normal scar tissue blends in and all is well.

This surgery creates a lot of swelling from all the trauma inflicted on your leg. This swelling is what prevents your leg from bending. It needs time and gently treatment to settle down. Icing, elevating, and taking your prescribed pain medication will help the swelling go down.

As Celle likes to say, adhesions are not just waiting to pounce on you if you don’t exercise enough. And yet most of us are warned that they will, just like you were.

Yes you need movement for your new knee. We are not saying to lay in bed and do nothing all day. But use common sense. Try to avoid doing extra things that increase your pain and swelling. Do gentle bends that cause no extra pain, and take walks, but not to excess. As you heal you’ll be able to do more.

If you give your knee reasonable time to recover you will have a good outcome, and will be back to cycling. Just don’t rush it.
 
OP
OP
bikinglynn

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
Thank you for your thoughtful responses. If I mostly stay off my feet, the spasms are not happening as much. I'll listen to my body.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
39,765
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Not only is scar tissue (adhesions) not just waiting to pounce if you don't exercise enough - over-exercising to the point of pain is actually likely to increase the risk of developing adhesions.

Why is this? Because over-exercising after a knee replacement causes your wounded soft tissues to remain hot and inflamed. Hot soft tissues are drier than normal and dry tissues tend to stick together easily and form adhesions.

Exercise is good, but it should be gentle and never cause actual pain. There will be discomfort, but pain is a warning sign that you are trying to do more than your knee is ready for at that stage of recovery.

Remember that your knees will not be lazy or unfit, needing lots of exercise. They will be wounded, from major surgery, and they will need gentle treatment, so they can heal. Initially, you can give them all the exercise they need, just by walking around your house, from bedroom to bathroom and kitchen. As they heal, you can gradually increase the amount of walking you do.
 
OP
OP
bikinglynn

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
Tomorrow is the day. The pain in my legs got somewhat better with rest, but I am almost house-bound now. Going off the Celebrex brought on an additional set of pains.

The only good thing about this pain is that I am not having doubts about the surgery. It's time to get back into the things I like. I can't wait (of course I will) until I am able to take short walks and ride my bicycle.
 

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
7,145
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
This is interesting. I've been led to believe that scar tissue will form and I will lose ROM without painful PT. I started reading Roy's posts (since he is a bicyclist), and notice this very discussion.
You will know, then, that the statement is pretty much the opposite of the truth; too much painful PT will cause inflammation, which may cause adhesions, which result in loss of ROM. Gentle, pain-free mobility stretching is what you want.

Good luck tomorrow. By the time the warm weather gets here, you'll be riding. No bother.
 
OP
OP
bikinglynn

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
Roy Gardiner, I have read so many of your posts and take heart from them. My neighbor had both knees replaced (at different times) and told me she took control of what she let PT do to her. After one of her surgeries, the doctor came in and said he was going to see how much he could bend her knee. She told him no. She agrees with the Bonesmart philosophy. I watch her walk her 2 little dogs twice a day at a very brisk pace. She is doing great.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
18,207
Age
64
Location
Delaware
Gender
Female
Country
United States United States
After one of her surgeries, the doctor came in and said he was going to see how much he could bend her knee. She told him no.
It took me 7 months to stop allowing my surgeon to push my knee into the bend to measure. He was the surgeon, after all. That sure won’t happen next time around!
 
Joined
Nov 1, 2019
Messages
377
Location
Southeast Michigan
Gender
Female
Country
United States United States
Yes. YES! I've had day of too little activity and too much. There must be balance.

Remember that your knees will not be lazy or unfit, needing lots of exercise. They will be wounded, from major surgery, and they will need gentle treatment, so they can heal. Initially, you can give them all the exercise they need, just by walking around your house, from bedroom to bathroom and kitchen. As they heal, you can gradually increase the amount of walking you do.
 
Joined
Nov 1, 2019
Messages
377
Location
Southeast Michigan
Gender
Female
Country
United States United States
Righto. My first at-home PT sessions were a bit dumb. A bit of forced contraction (forcing the leg a bit). Which was ok, as contraction was always pretty good. But 'real' numbers would come later during on sight PT when I was more in control, beyond the numbers game!

After one of her surgeries, the doctor came in and said he was going to see how much he could bend her knee. She told him no.
It took me 7 months to stop allowing my surgeon to push my knee into the bend to measure. He was the surgeon, after all. That sure won’t happen next time around!
 
OP
OP
bikinglynn

bikinglynn

member
Joined
Jan 2, 2020
Messages
144
Age
66
Gender
Female
Country
United States United States
Surgery went well on Wednesday. I just got home and am lying in bed with ice on both knees. Day 2 was rough, but once we got the dosage adjusted on the pain meds, things smoothed out. I'm looking forward to a quiet, dark room tonight, although the hospital really was very comfortable. I'm supposed to go for my initial PT evaluation on Monday. We'll see if I feel like leaving the house!
 
Status
Not open for further replies.

New

Active Antibacterial

BoneSmart #1 Best Blog

Forum statistics

Threads
51,911
Messages
1,389,305
BoneSmarties
32,439
Latest member
Lyndsie1996
Recent bookmarks
0

Top Bottom