TKR Quads and ROM

[MSPS]

@Bfan I quit PT yesterday during my 4th week. Even 'kinder' people seem to have an agenda and make snarky comments, like "for someone in pain you're..." whatever, not crying hard enough? Enough! I was at 0 extension from the start and can bend, when swelling low, beyond 90. I just went through the seeing stars thing @Bfan noted, getting up off the loo hands free and onto my surgery leg...knee did not feel good all day after, but it does tell me I've made progress, I never could have done that a few weeks ago! So a small victory!! Can I ask your pain regimen @Bfan? You're going through my life just a little ahead of me and I just tried to stop tramadol last night after tapering down to a few at night only and woke up with knee on fire...but slept more than I had since surgery 2/5! Tylenol and Celebrex not quite enough right now, ice helps but tired of being tethered...growing roots and flab feels so unhealthy, but drat, it works.

 

[mendogal]

@Bfan I have had those painful knots.

First I want to reassure you they are not adhesions; sometimes they are an accumulation of scar tissue and sometimes they are muscle "trigger points" (areas of stuck, tense muscle fibers).

For both the treatment is the same, as @benne68 wrote: massage, massage, massage, plus some light stretching.

My earlier, 13 month old knee developed them quickly, they never actually interfered with my ROM, and with a steady massage regimen they softened and diminished and went away.

My newer 8 month old knee has more problematic knots. My ROM is fine but the adjacent quad is shortened, still aches every evening, and has trigger points. I have just resumed PT and we are addressing these issues.

 

[mendogal]

@MSPS Great post! I would love to also read this post on your own thread so we can comment there!

 

[Bfan]

As far as pain, I've tried to keep it to Tylenol and Advil. If I wake up in agony, I will sometimes take a Tramadol which is more effective.

 

[Bfan]

Today is my two month anniversary LTKR. Doing better now that I'm trying to think in terms of months, not weeks. This forum has been a great source of information and camaraderie. True story: My son wandered into a church in L.A today just to soak in some good vibes. The priest was giving a talk about prayers not answered. He said (tongue in cheek) that he'd had a TKR and the pain was so horrible he was starting to question his faith . He went on to say with time the pain eased and his faith was restored. We're in good company if a Catholic priest could joke about his faith and prayers tested over a TKR.

 

[Layla]

Happy Two Month Anniversary!
Glad you're doing better since you've lowered your expectations in regard to weekly progress. We're happy you're enjoying the camaraderie here. I did too! I look back with fond memories of those I recovered with here. Cute story about your son and the priests sermon. I hope you have a good week, Bfan.
@Bfan

 

[benne68]

Doing better now that I'm trying to think in terms of months, not weeks.

This is so true! Our perspective changes, doesn't it?

Since you are now into the "multiple month" category, would you like to change your thread title to something that more broadly reflects your recovery journey? Just let us know!

 

[Bfan]

Yes, how would I change my thread title to something like LTKR MONTH THREE

 

[benne68]

@Bfan, I've updated your thread title as requested.

 

[Bfan]

thank you

 

[Bfan]

I'm roughly at week 9 and have a question about pain at this point. I exercise on my own... stationary bike, swimming stretching and anything to help ROM that isn't extreme. After sitting I need to wait 15 or 30 seconds before walking. Pain upon waking at 4 am is really bad and I need to lean against a wall for a bit before I get going. I am beginning to see small improvements... like a more natural gait but the pain that has hung around in intensity is worrying.

 

[mendogal]

You are not alone! One of two replies...
On my first TKA over a year ago, I gained ROM and lost swelling very quickly. Yet starting right around 8 weeks I had this problem after going to bed at night.
If I had to get up to use the bathroom and again every morning: my left knee would hurt so badly that I had to use both hands and my right foot to ease my left leg up and over the edge of the bed. The first few steps bearing weight on it were breathtakingly excruciatingly painful. By the time I had walked to and from the adjacent bathroom it was fine. At 12 weeks suddenly I woke up one morning and it was fine. I assume, in hindsight having joined BoneSmart 6 months later, I had really overdone something that needed tincture of time.

 

[mendogal]

And with my second, R TKA... again my ROM was good...
I never once had that problem. However, the very painful stiffness after sitting, oh my yes indeed! Initially I couldn't tolerate sitting up in a chair more than five minutes. And the stiffness was with that briefly excruciating pain.

Over a few months I could sit longer periods without experiencing that, and increased my sitting time to 20-30 minutes, with the horrible pain and stiffness present but going away more quickly. I took soooo many five minute walks in addition to my daily walking.

By four or five months it had transformed into stiffness and quad aching. The stiffness with sitting remains; I stop the evening movie once or twice to get up and walk around the house.

From reading many member's threads here, what you're experiencing isn't unusual. Is it possible you're cutting back on icing and elevating, 45-60 minutes at a time a few x daily? You're right at the time where folks start to let that part of the regimen go, when in fact with increasing activity it remains an important part of recovery.

 

[Bfan]

I'll keep on top of icing. For the past two weeks it's been one step forward, two steps back. It seems like I'm forever trying to get up for the day with not many victories, but what choice is there? The physical pain can be a lot, but the mental part of this recovery is a real challenge.

 

[mendogal]

Yes, I 100% agree - and the mental part is what they don't warn us about.
You might try slightly reducing a part of each day's activity and see if that makes things easier.

 

[Layla]

As tiring as the ups and downs become, you're only two months into a year long journey, on average. Taking one step forward and two back, which discouraging, is normal. Give yourself time and grace, slowly but surely you will get there. I hope you have a good week, Bfan!
@Bfan

 

[Bfan]

Thank you. Because everything is all over the place and recovery is far from a straight line I guess I'm wondering what are red flags to be concerned about 3 to 6 months out... for instance not only knee pain but bad shin or thigh pain, stiffness, that wasn't there two days ago etc. I know the Bone Smart philosophy is patience. Your knee/body heals on its own timeline. Are there some markers at different months that should be aspirational? I'm seeing my surgeon tomorrow at week 9 and I know he'll just admire my scar and say good luck.

 

[benne68]

not only knee pain but bad shin or thigh pain, stiffness, that wasn't there two days ago etc.

This is quite normal. In addition to recovering from the surgery itself, all of the muscles and soft tissues now need to adapt to your body's new alignment.

Remember that, before surgery, as our knees deteriorated, our bodies made adjustments to ease the pain. These changes can be subtle and occur slowly, so we don't even notice that we are favoring the leg or limping or splaying our foot out to the side. We live with that bad alignment for so long that, when the knee is fixed and our alignment is corrected, all the surrounding tissue has to "relearn" what to do.

I am a couple of weeks ahead of you in recovery and I still develop new aches and pains up and down the leg -- in my back, in my hip, in my calf, in my groin, in my ankle -- it seems each week there's a different spot that is adjusting to this new knee.

I can tell you from my previous surgery that it does get better. It just takes time.

 

[Bfan]

Thank you for always offering good advice. It really helps. Good luck to you.

 

[Bfan]

LTKR was Jan. 3... guess I'm 10 weeks out. I struck a good balance with my PT who goes easier on the pushing/pain. I seem to have hit a plateau the last few weeks. No new ROM. Pain in other knee probably because of compensation. Had some pretty good days with painless walking, but that was short lived. Was hoping I would see a positive bump at 3 months but we'll see. Trying to look further out... sometimes it's hard to keep the faith but there's no other choice. Feel bad for my wife. Probably more frustrating for her than me.