TKR Recovery Gone Wrong?

[GrrrrTKR]

I am eight weeks out from my surgery. I had home PT for about six weeks, which in hindsight may have been too gentle. Now that I can drive, I’m going to outside PT and the second session nearly killed me. I was laying on the table crying while the PT was pressing on my knee to try and straighten my leg. My leg swelled up and the pain got worse. Fortunately, for me we had bad weather and I didn’t go to PT for another week. I told PT that I could not repeat that type of manipulation; that it sent me back weeks in my recovery.

My surgeon tells me I have a short IT band and tight hamstrings. I also have severe pain in my lower back, and when I move my knee, my femur rubs against the sciatic nerve which sends pain from my lower back to my toes. I also have some numbness and tingling in my leg.

At this point, I’m very discouraged and certainly regretting my decision to have TKR. Before TKR I walked or swam daily and had no back problems. I have trusted the professionals with my care and I’m not sure how we got off-track.

I’m going to PT three days a week and a chiropractor twice a week for the back pain. I am doing lots of stretches and keeping my hammies under a heating pad. Exercise is just too painful right now. I don’t know whether I should rest or work my muscles. I know that irritated nerves and swelling require RICE, but my recovery requires a quick turnaround lest I have to go back into surgery for manipulation.

 

[Jaycey]

@GrrrrTKR Welcome to BoneSmart!

I had home PT for about six weeks, which in hindsight may have been too gentle

No such thing as "too gentle" PT. PT should never hurt! Please do not let anyone force your knee. As you found that approach is totally counterproductive.

my recovery requires a quick turnaround lest I have to go back into surgery for manipulation.

No you don't! The choice of whether you have MUA is totally your own. And there is no timeframe when this must happen. Sounds like that knee just needs a break! I would stop all that PT and just do gentle stretches at home. Ice and elevate and let that knee settle.

Here are your recovery guidelines:

Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

​

5. Here is a very general week-by-week guide. Activity progression for TKRs

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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 a 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 history before providing advice.

 

[Flashlight]

I wonder why PT isn't working on your IT band and hamstrings. It would make more sense to get those working right before trying to straighten your knee. My sister-in-law wasn't able to straighten her knee until 6-months in. Does your doctor have any suggestions on how to move forward? Can you go to another PT?

 

[GrrrrTKR]

PT told me at evaluation that they could not work on my sciatica because it was not on the order. They have since come around somewhat and are working on a little more stretching but still working that knee straightening. I should consider a change but don’t want to be a “quitter.” Doctor has finally acknowledged sciatica after eight weeks, but doesn’t have any good suggestions other than to reduce swelling by wearing compression stocking, seeing chiropractor and continuing PT. I am further hampered because I am unable to take NSAIDs for swelling and pain. Good suggestions all. Thanks

 

[Flashlight]

I think you are very brave and never would be a quitter. Half of these people have never had surgery and really can't relate. Lots of time PT will contact the doctor and let them know there is an issue, and their client might benefit from another treatment, xray, etc. Saying it isn't in the order is not an answer that is acceptable. Thinking of you and wishing you the best.

 

[Zanza]

PT told me at evaluation that they could not work on my sciatica because it was not on the order. They have since come around somewhat and are working on a little more stretching but still working that knee straightening. I should consider a change but don’t want to be a “quitter.”

They can't work on your sciatica because it's not on the order? This is why I sometimes hate the medical profession. You go in with a problem, and they ignore it because it doesn't fit their narrative. It's just lame that they expect you to straighten your leg when you have things that are too tight. As to being a quitter, clearly you're not a quitter. You might be trying too hard to please the PT and the doctor when the one you should be pleasing is your new knee.

Seriously, you need to rest and ice and elevate and give your knee time to calm down. One thing that I found very helpful was walking backwards. It stretches all the muscles in a different way and it helps your leg to straighten. Just be careful you don't tip over! I do that by the couch so I have something to grab, and I try to take 100 backward steps a day.

 

[GrrrrTKR]

Thank you for your compassionate comments and suggestions.

 

[Jaycey]

@GrrrrTKR I have chronic sciatic pain. Can you get yourself a TENs machine? Whenever my sciatic pain flares I use a TENs. No medication and it calms things down fairly quickly. TENS machines for pain management
You might ask your chiropractor for a recommendation on what is available there.

BTW - you can see in the article, TENs can be used on a recovering knee as well.

 

[Odieodell]

I try to take 100 backward steps a day.

My chiropractor has also encouraged this when I was having trouble straightening my leg and I do believe it helps.

 

[Flashlight]

Also, it might help to go to your PCP instead of ortho for this problem. I found they don't want to talk about anything, but your knee. They might think this is out of their scope or it might have to do with insurance.

 

[ski_bum]

I am eight weeks out from my surgery. I had home PT for about six weeks, which in hindsight may have been too gentle. Now that I can drive, I’m going to outside PT and the second session nearly killed me. I was laying on the table crying while the PT was pressing on my knee to try and straighten my leg. My leg swelled up and the pain got worse. Fortunately, for me we had bad weather and I didn’t go to PT for another week. I told PT that I could not repeat that type of manipulation; that it sent me back weeks in my recovery.

My surgeon tells me I have a short IT band and tight hamstrings. I also have severe pain in my lower back, and when I move my knee, my femur rubs against the sciatic nerve which sends pain from my lower back to my toes. I also have some numbness and tingling in my leg.

At this point, I’m very discouraged and certainly regretting my decision to have TKR. Before TKR I walked or swam daily and had no back problems. I have trusted the professionals with my care and I’m not sure how we got off-track.

I’m going to PT three days a week and a chiropractor twice a week for the back pain. I am doing lots of stretches and keeping my hammies under a heating pad. Exercise is just too painful right now. I don’t know whether I should rest or work my muscles. I know that irritated nerves and swelling require RICE, but my recovery requires a quick turnaround lest I have to go back into surgery for manipulation.

Search Bonesmart for IT Band.
I have serious IT Band issues, both knees.
Quit PT!
Get a roller, with leg up roll the from just below the knee up to the hip.
I also have back pain after second surgery and my only meds now is muscle & back Pain pills.
My IT Band pops when I walk. First knee worse than second knee. 16 months and now it clicks more in my Quad than popping at knee.
Good Luck with recovery.
Don

 

[ski_bum]

PT told me at evaluation that they could not work on my sciatica because it was not on the order. They have since come around somewhat and are working on a little more stretching but still working that knee straightening. I should consider a change but don’t want to be a “quitter.”

They can't work on your sciatica because it's not on the order? This is why I sometimes hate the medical profession. You go in with a problem, and they ignore it because it doesn't fit their narrative. It's just lame that they expect you to straighten your leg when you have things that are too tight. As to being a quitter, clearly you're not a quitter. You might be trying too hard to please the PT and the doctor when the one you should be pleasing is your new knee.

Seriously, you need to rest and ice and elevate and give your knee time to calm down. One thing that I found very helpful was walking backwards. It stretches all the muscles in a different way and it helps your leg to straighten. Just be careful you don't tip over! I do that by the couch so I have something to grab, and I try to take 100 backward steps a day.

Backwards down the steps and a raised seat on a stationary bike helps straighten leg.
Neither of my knees are straight but that gives me good stance for skiing.

 

[Dancingqueen]

I am 9 weeks into TKR..allergic to all anti-inflammatories, ice and rest have been my friend. About week 4 I talked with PT about extreme pain and swelling following too aggressive of exercise. We have gone to a more gentle approach though he still expresses concern that my ROM is around 95-100.
Pain in hamstring and IT (and top of foot!) is like “whack a mole”. I’ve started easy stretching my back (done against any wall) throughout the day and things are loosening up. Also, started “walking” in a warm wellness pool at public facility.
This recovery stuff is a long journey.
Today, noticed a strange “clicking” when I bend my knee. I just gotta throw my hands up, breathe and accept.
I, too, (sometimes) wish I hadn’t done surgery. But, here’s where acceptance comes in.
And, a bit of faith that I’ll look back a year from now and things will be ok☺️

 

[Scaredycat10]

GrrrrTKR​

May I put my two pennyworth in?

I have history of tight hamstring due to an accident years ago and basically, the only way to loosen it, for me, is stretching.
But
It was quite some time before I managed a stretch stretchy enough to make a difference. IT band and I are also well acquainted but the unoperated leg is the beggar now.

I'm often to be found cocking my leg [bent] up on the kitchen table, bending into the stretch and reading the morning paper when it feels a bit tight, the band, not the paper! I doubt you'll be up to that yet. All I will say is, it works.' I'm also a fan of the ad/abductor machines in the gym for the glutes etc.

I still push the car seat back to get in and out and I think that will be my forever problem but cycling, which hurt like mad for ages, is OK as is rowing [indoor machine].

Don't panic. I was the world's worst at worrying. I am a year into the op in two weeks time and it's the best thing I could have done.

 

[LaJudes]

l too , had sciatica nerve pain after revision knee replacement . It was so bad , all l could think of day and night ! l complain to my orthopedic doctors and was ignored . When my OT came back myself house , l offered her a bunch of $ to fixed my sciatica nerve pain . She showed me where and how to message the muscle where the sciatic is , lower back , mid butt side , she had me feel a lump in the area that she said was a nerve enraged ! lt was in an areas that did not even hurt ! She helped me message it and how to do it myself . My sciatica pain was behind my knee and went to the bottom of the foot . lt totally disappeared!

 

[GrrrrTKR]

it might help to go to your PCP instead of ortho for this problem.

You got that right. My surgeon did not want to talk about anything but the perfect outcome.

My IT Band pops when I walk.

Yikes! Everybody says popping will stop when swelling goes down. Not sure I could stand it for 16 months!

 

[ski_bum]

l too , had sciatica nerve pain after revision knee replacement . It was so bad , all l could think of day and night ! l complain to my orthopedic doctors and was ignored . When my OT came back myself house , l offered her a bunch of $ to fixed my sciatica nerve pain . She showed me where and how to message the muscle where the sciatic is , lower back , mid butt side , she had me feel a lump in the area that she said was a nerve enraged ! lt was in an areas that did not even hurt ! She helped me message it and how to do it myself . My sciatica pain was behind my knee and went to the bottom of the foot . lt totally disappeared!

Did you pay her a bunch of money for fixing it?

 

[Zanza]

I'm so jealous of everyone who could fix their sciatica without surgery! lol I had to have surgery. Here's my tip of the day. If you get an MRI for your lower back pain, also insist on a dynamic X-ray. I had a clean MRI, and the back pain got worse and worse. Then I got a terrible pain in the left buttocks that would shoot down the leg. I argued and argued with the doctor, who said my MRI was okay. He sent me for another MRI when my left leg started dragging when I walked. Turns out I had a stenosis, which showed on the MRI, but it was compressing my spinal cord when I moved certain ways. I had a laminectomy (no fusion) and there was immediate improvement. I still have back pain from the arthritis, but with a lot of work I could walk normally again.

 

[Jockette]

I had home PT for about six weeks, which in hindsight may have been too gentle.

As Jaycey said, there is no such thing as PT that is too gentle.

I have trusted the professionals with my care and I’m not sure how we got off-track.

I was laying on the table crying while the PT was pressing on my knee to try and straighten my leg. My leg swelled up and the pain got worse.

This is how you got so off track.

Regaining our ROM (both bend and straight) does not require forceful bending or painful exercises.
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.

 

[Jockette]

My surgeon tells me I have a short IT band and tight hamstrings.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed is healing...and full healing takes a full year or more.

but my recovery requires a quick turnaround lest I have to go back into surgery for manipulation.

This recovery does not require a quick turn around. This is totally a misconception. In reality, this recovery is long and slow, with many ups and downs. It takes a year for complete healing. We often refer it to a roller coaster. There is no “window of opportunity” My ROM continued to improve well into my second, and even my third, years post op!

Stop letting your PT cause you pain, doing so means they are using outdated information for their rehab approach.

As one of our staff members likes to say, this recovery is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers.