PKR Raffs' Recovery Thread<'

[tigz]

Nice to hear from you.

I second what Karri said. That settling down business sure seems to take a while!

I think I too baby my knee at times without thinking about it. It's an unconscious habit that's hard to break.

 

[Josephine]

How 'normal' is it to still be experiencing quite severe tightness and soreness at 6 months? How concerned should I be?

Very normal! 6 months is merely a short period post-op. did you not read so many people saying that it can take a full year to be completely recovered?

Should I be asking if anything can be done to help ie MUA or surgery to remove scar tissue? I assume that the tight band feeling is caused by scar tissue as per everything I've read on here

Then you assume incorrectly! Read this "Tight band" feeling across the front of my knee

Any thoughts on whether this could be CRPD?

Absolutely not!

I'd like to ask you some questions if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery! ) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what prescription or over the counter pain medications are you using, how much (in mg please) and how often?

3. are you icing your knee, if so how oftenand for how long?

4. is your leg still swollen at all?

5. are you still doing any exercises? if so what kind, how much and how often?

Can you describe them like these examples ....

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[PolarBear60]

I'm at eight months and still have some residual tightness. I wouldn't call it severe. I can't tell how much my limitation is my TKR knee and my very arthritic non-operative knee, but for now, I choose to blame my non-operative knee for nearly everything. Despite that, I began experiencing severe sciatic pain on the left (TKR) side a little over two weeks ago, which has converted from the sharp pain to soreness in my hamstrings and calf and numbness in my left foot. So the waters on the left knee are a little muddy for me right now. Offering that for comparison purposes, which may not be very valuable to you.

I don't think you should be too concerned, but continue to monitor your status and ask questions as appropriate of your PT, OS, and GP. You have tremendous ROM, so I don't believe an MUA would be appropriate. I can't speak to the likelihood of scar tissue causing the tight band feeling. My tight band feeling is gradually diminishing, but it is still there. The intermittent shooting/tingling pains are probably normal nerve regeneration. I'm not seeing much improvement e

No idea from me on CRPD. I see Josephine has better information.

 

[Celle]

Hi Lynn, @Raffs
That's a pretty good report for six months after a TKR!

I think the tightness and soreness are still normal at 6 months, so I don't think you need to be concerned at this stage. Remember that we always tell people complete recovery takes at least a full year - so, by that estimation you are half way. I think you'll see a gradual improvement over the next six months - and I think it's unlikely that you have CRPS.

I don't think there's any way that you need either a MUA or more surgery. With a bend of 135, you don't have any significant adhesions and most surgeons won't do a MUA once you're past 90 degrees anyway.
The minor adhesions that cause the tight band feeling will gradually disperse over time. They're not the sort that would be helped by a MUA.

Your surgeon seems to be keeping a good eye on you and I think his letter is pretty close to the mark.

Continue with PT by all means, but cut down on exercises, because you're exercising your knee plenty in your everyday life now.
Rather than exercises, ask your therapist to concentrate on measures that reduce inflammation and tenderness - because I think that some of your discomfort could be caused by inflamed soft tissue, especially tendons. I expect Josephine will ask her usual questions about the type and amount of exercise you're doing.

As it seems to be helping, continue with the elastic support.

I don't think you have any need to be concerned at this stage.
For what it's worth, my latest TKR is nearly 16 months old and it still niggles a bit from time to time if I do a bit too much for it, but it's gradually becoming less and less "touchy". when I think bck on that awful bone-on-bone pain I used to have, I'll take those little reminders every time!

Best wishes.

 

[hawk2go]

Hey Raffs! I was wondering if I'd hear from my surgery "sisters". Where's @tigwy11? Out living loud, I bet. That ROM is fantastic and it sounds as if the pain is slowly (too slowly for your tastes) dissipating. Hang in there!

I think I too baby my knee at times without thinking about it. It's an unconscious habit that's hard to break.

Right! I find myself going downstairs one at a time then I remind myself, "hey! you've got this". I even find myself waiting for that stiffness I used to get when I stood after sitting a while. I wait but it ain't there. It will be a very happy day when we just move without thinking about our knees, don't you think?

when I think back on that awful bone-on-bone pain I used to have, I'll take those little reminders every time!

exactly.

 

[Slainte]

I hear what you say about learning to trust your knee. I have to consciously take a decent stride and not mince along.

 

[Majic]

Hi Lynn,
I have some of the same problems. Knee painless, tissues under knee are a different matter, they sting, burn, and sometimes just hurt. I had LTKR 13 months ago, but when R was about 4/5 weeks old, left came out in sympathy, and wherever right hurts so does left. I can't work this out, but OS wasn't surprised and I think @Clipless had the same problem but hers has resolved. Mine hasn't and sometimes left is more painful than right.
However I am living fairly normally, cooked Christmas Dinner and for small Dinner last night with husbands help and have gone back to ballroom dancing, and some Latin but not all yet. Like you I can't stand for long, queuing is a nightmare, soreness under knee seems to start to spread down shin. The tingling/shooting pains I put down as a good sign that nerves etc are knitting together and finding each other as they heal.
Like you I seem to have got better then worse etc. I put this down to the terrific winds we have been experiencing certainly here in the Cotswolds - up to 50mph gales, and the fact that we live on a hill, and I seem to remember that you do too. I still use a stick in wind, and two if it is very strong.
I don't think you should worry too much, I would give anything for your ROM and I also have very tight muscles and am seeing a pt next week for massage. We will probably heal together. Have a happy, healing and pain free New Year.

 

[Raffs]

Thank you, everyone. I will reply to you all over the next couple of days. Your support really does mean a lot.

@Josephine here are my answers to your questions:

1 - pain levels are pretty much zero when lying down (my knee doesn't keep me awake at night). Anything from a 1-4 when sitting (depending on what I have been doing) and from 3-8 when walking or standing (again, depending on how much I have walked or stood). My pain is mainly tightness (tight band feeling), a bit of stiffness in the patella tendon area and soreness around the fat pad. I also get little zingers in the fat pad area (the numb area) but these don't cause pain, I can just feel them zinging.

2 - no meds at all - haven't taken any since the end around the beginning of October.

3 - I do still ice some evenings - probably averages out at 2 evenings a week and for about an hour each time.

4 - very little visible swelling if any. If I do get any swelling it is in the fat pad area.

5 - my PT routine (as set by my PT) is:

Short range quads (with rolled up towel under knee) - 3 sets of 15 reps

Straight leg raises - 3 sets of 15 reps

Hamstring curls (lying on stomach on bed, using good leg to give a bit of resistance) - 3 sets of 15 reps

Sit to stand onto a dining chair or the bed - 3 sets of 15 reps

Sit on dining chair with resistance band around ankle and around chair leg, straighten leg from 90 degrees to full extension - 3 sets of 15 reps

My quads and hamstrings are still weak hence the above routine. I do these exercises probably 5 or 6 days per week. If my knee feels sore or especially tight then I tend not to do the sit to stands.

I am also going about my daily life - getting ready in the morning, commuting by tube to work, spending 8 hours in the office, commuting home, preparing meals, housework, ironing, grocery shopping, socialising etc. I do tend to wear my elasticated support a fair amount of the time - always when I am outside - I try not to wear it in the office or at home unless I am doing housework or ironing etc.

Thank you very much.

 

[Josephine]

1 - pain levels are pretty much zero when lying down (my knee doesn't keep me awake at night). Anything from a 1-4 when sitting (depending on what I have been doing) and from 3-8 when walking or standing (again, depending on how much I have walked or stood). My pain is mainly tightness (tight band feeling), a bit of stiffness in the patella tendon area and soreness around the fat pad. I also get little zingers in the fat pad area (the numb area) but these don't cause pain, I can just feel them zinging.

That's a lot of pain for 6 months out!

2 - no meds at all - haven't taken any since the end around the beginning of October.

Why not? With pain levels up in the 8s, you need something. Seems daft to me to declare that much pain and not take anything for it. How about 1,000mg Tylenol 3-4 times a day?

3 - I do still ice some evenings - probably averages out at 2 evenings a week and for about an hour each time.

Okay

I am also going about my daily life - getting ready in the morning, commuting by tube to work, spending 8 hours in the office, commuting home, preparing meals, housework, ironing, grocery shopping, socialising etc.

Okay

4 - very little visible swelling if any. If I do get any swelling it is in the fat pad area.

Okay

I forgot to ask you what your ROM is but since you never mentioned it any way, I'm assuming it's okay.

PT routine (as set by my PT) is:
Short range quads (with rolled up towel under knee) - 3 sets of 15 reps
Straight leg raises - 3 sets of 15 reps
Hamstring curls (lying on stomach on bed, using good leg to give a bit of resistance) - 3 sets of 15 reps
Sit to stand onto a dining chair or the bed - 3 sets of 15 reps
Sit on dining chair with resistance band around ankle and around chair leg, straighten leg from 90 degrees to full extension - 3 sets of 15 reps

at home I do these exercises probably 5 or 6 days per week

I think these are your problem. You shouldn't BE doing exercises at 6 months out. Besides which, you have enough activity in your daily life not to need them anyway. Every exercise you listed is responsible for the pains you complain of. I strongly suggest you quit all this permanently and and let everything else be your PT. That's what people generally do.

 

[Raffs]

@Josephine - thank you very much for your response.

I agree that I have a lot of pain for 6 months out - this is why I am worried and why I asked for advice from you and also to see if other members have experienced anything similar.

To be honest, I didn't think that paracetamol (Tylenol) or ibuprofen would help with the kind of pain I have (tight band feeling, stiffness and soreness) which is why I haven't taken any for months. I will give it a try.

My ROM is 135/0 so no concerns at all there!

I am confused about PT versus no PT. Both my OS and PT say that the exercises will help to strengthen the muscles around my knee which will help to stabilise it and function correctly and therefore ease my symptoms. There is no doubt that the quads in my operated leg are atrophied - the difference is visible. However, everything you say makes sense too - I honestly don't know what to do - continue with the exercises, give them up completely or modify them?? Hmm.

I have a couple of other questions, please:

1. Is there anything I can do to lessen the tight band feeling? I read the article you posted to me and understand that it is caused by scar tissue - is there anything I can do to encourage the scar tissue to disappear more quickly?
2. Why does wearing a knee support help with my pain and with the tight band feeling? Is it due to compression or stabilising or a combination or something else? I am keen to understand why the support helps so much.

Once again, thank you for your time.

 

[Raffs]

@CATSMUM - I was born to worry!!! LOL !!

@Swish - Sorry to hear that you are experiencing similar issues - let's hope that 2016 brings us both some progress and happy times.

@Clipless - That is all very reassuring to hear - thank you. Hope the right knee is behaving - I will pop over to read your thread soon.

@KarriB - I was excited to see your reply to my post - thanks! I am going to try to be more active on here again - whenever I post I realise how much I have missed it and how wonderful everybody is. Yes, very good ROM - my PT says that my flex is probably slightly better than my non-operated knee now - yay!

@tigz - Good to hear from you too! Hope you are doing well. PT says we are going to work on my gait next time so that I stop underusing my new knee. How long was it before you stopped wearing the elasticated support?

@PolarBear60 - very useful as always, thank you. Sorry to hear about your sciatia issues, sounds very painful. Your point about the other knee is a very good one - mine is complaining and I am sure I am not helping either at the moment with the way I walk or how much pressure I am sure I am still putting on my non-op knee. Thanks for your advice and comments.

@Celle - thank you for taking the time to reply. Your comments are very reassuring indeed and much appreciated. Your comments re PT are especially helpful - I will speak to him when I see him next week - thanks again.

@hawk2go - hello! Hope you're doing well. I do indeed think it will be a fantastic day when we can just move around again without thinking knee, knee, knee!

@Slainte - I'm going to check up on your thread soon to see how you're getting on. Never had you down as a mincer, always seen you as a strider! Thanks for stopping by.

@Majic - yes, that is how the tissues under my knee feel too. It's horrid isn't it? Yes, we've had lots of windy days here that have tested my balance and your memory is correct - I have to go up and down a hill to get to the station. But as long as I am wearing my knee support I can manage it no problem - not like those early days of Hillgate! Happy New Year to you, too.

 

[Swish]

Lynn, I understand that exercise or not exercise conundrum. I did 30 minutes on the bike yesterday....first time in a couple weeks. Everything around my knee is sore this morning. Since OS told me to do this, I'm going to keep it up. I definitely need to build up strength in my quads. So happy your OS is working so well with you. I keep reading of others that have had problems with their OS taking their problems seriously. Again, wishing you a happy and healthy new year.

 

[KarriB]

@Swish i believe biking and walking are two exercises that are good for a new knee. I found biking really helps to loosen up the knee.

 

[Josephine]

Both my OS and PT say that the exercises will help to strengthen the muscles around my knee which will help to stabilise it and function correctly and therefore ease my symptoms.]I honestly don't know what to do - continue with the exercises, give them up completely or modify them??

Did you miss this comment of mine?

Every exercise you listed is responsible for the pains you complain of.

And I do mean EVERY exercise.

Is there anything I can do to lessen the tight band feeling? I read the article you posted to me and understand that it is caused by scar tissue - is there anything I can do to encourage the scar tissue to disappear more quickly?

See now you're doing it - mixing up scar with adhesions. Scarring is a very necessary part of would healing. It joins together tissues that have been cut by the surgeon's knife. If you didn't have this normal scarring, your wound would just fall open and get infected! I think I explained this quite clearly in the article. This is not something you want to make disappear and you can't anyway - it's there for the rest of your life. But I did also say "It will gradually reduce in size and thickness over the following months"

Why does wearing a knee support help with my pain and with the tight band feeling? Is it due to compression or stabilising or a combination or something else?

Because part of this is also swelling and compression hose will keep that down. It's also comforting and warm.

But I will repeat, basically your problem is all the exercises you've been doing. In the wrong time and place, they will cause tendinitis in spades!

I'm also going to have you tell me the exact site of your pain using this charts.

Please note the instructions in the smaller image

I believe biking and walking are two exercises that are good for a new knee.

I do agree with you, Karri, but Raff's knee is not new, it's almost 6 months old!

 

[tigz]

I stopped wearing the sleeve totally end of October I think. I was only wearing it to work to help with the swelling and not on my days off and managed to forget it two mornings in a row, wasn't any worse off in the afternoon, and just did away with it.

 

[Majic]

Just a thought backed by no medical knowledge at all. Could your knee support mean that you don't need to use your muscles as much and that is why they are not as strong as you need them to be. Why not try going without the support and leaving off the exercises, the lack of support could build up the muscles as you use them.

 

[Raffs]

@Josephine

Thanks for the clarification re the exercises. I am going to take your advice and stop exercising until I see my PT next Tuesday.

Apologies - I haven't been clear. I am not concerned about the vertical scar tissue caused by the incision - this is absolutely fine. My concern is with the "tight band feeling" that I have across the front of my knee horizontally just below the knee cap (the band feels like it runs pretty much across the front of my knee).

Do you agree with what @Majic has suggested about trying to do without the knee support?

I do have tendonitis in the patella tendon. What would you recommend as possible treatment for this, please?

I think you have posted the charts for hip patients rather than knee patients?

Thanks again for your help and advice.

 

[Josephine]

I am going to take your advice and stop exercising until I see my PT next Tuesday.

Is that the 12th you're talking about. I can tell you now that your PT will recoil in horror and preach about 'the window of opportunity' and all that guff. She certainly won't be in favour of my radical ideas - most likely because she will be losing a client rather than out of concern for you. If you're going to quit, quit and make it your own decision.

I haven't been clear. I am not concerned about the vertical scar tissue caused by the incision - this is absolutely fine. My concern is with the "tight band feeling" that I have across the front of my knee

Yes I fully understood what you meant. But you clearly didn't read the article either as I explained how come there is an incisional scar at that point. Go back and read it again.

I think you have posted the charts for hip patients rather than knee patients?

oops!

Can you tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

 

[Braunzie]

@Raffs - just catching up on your thread. Good to hear from you! And Happy New Year!

So sorry you are struggling with your recovery right now. I can relate to much of what you're saying.. except the pain side of it. I've got the tight band feeling, and still not doing stairs too much like a "normal" person (although going up is getting pretty good.. ) .. Standing in one position can cause some degree of pain, so I try to keep moving when possible, or at least flexing my knee if I have to stand in one place. I have to say.. the one difference I see is that I stopped "PT" when I went back to work, figuring I would be "exercising enough" with that. I haven't done any additional "exercise".. even haven't been doing my stationary bike, because my OTHER knee started talking to me. (And yes, I've felt a little guilty about it, because we are always drilled with how "exercise" is so good for us!)

Like you, I do things like cooking, cleaning, errands, .....the "living" kind of stuff we must do. I can walk more extended durations, - and have actually been pleased (and surprised), though have not "pushed" myself, either. I haven't iced in quite a long time - but that's because I haven't had the pain or swelling to control.. I have little if any real "pain" beyond the tight band feeling (with the very occasional jolt if I twist it in a way it doesn't like, normally when tossing in bed.. but again, VERY rare.) I don't want it to sound like everything is all roses, because there is still a lot I can't do.. It's just that what I CAN do, is without the pain you're experiencing.

Really, my message/ experience is in alignment with what Josephine is saying. I think (and HOPE) that is you stop the exercising, hopefully you will have less pain and feel more progress .. Keep us posted!!!!

 

[Raffs]

@Josephine

Yes, the 12th. I am giving some serious thought about what to do and will definitely take your advice on board.

Got it! I have re-read the article and now understand fully, thanks.

DRF1 and DRF2 - tight band feeling, often feels like a piece of wire across the front of my knee.

ERF1 and ERF2 - tightness, stiffness and 'pulling' feeling across the patella tendon.

DRF1 - soreness and tenderness in the fat pad

Thank you.