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Discussion in 'Knee Replacement Recovery Area' started by Rockgirl4, May 23, 2019.
@Pumpkln She’s 3 weeks post op, is a tens unit ok at this point? Is there a time it’s too early?
TENS should be fine, just be sure it is not over the incision. Here is an article with a photo of how to position the electrodes. TENS machines for pain management
Call and ask your MD if you can use the TENS.
Hi everyone---I took a break from the Internet yesterday. I'm just updating after my first Outpatient PT appointment.
Let's get the emotional junk out of the way-
I was worried for nothing. I'd worked with this PT in Feb/March for an ankle problem and liked her. I "interviewed" her for my TKR recovery and loved her PT philosophy. She's not a "cranker," she completely understands my "PT PTSD" from the ACI recovery, and she never did anything to make me distrust her. Twice, she commented on how guarded/tense I was, just sitting there. She wasn't offended but made a point to get me to relax my leg/hip as much as I could. She was very empathetic and understanding of the weirdness known as "Lisa's knee."
Now for the physical...
1) As soon as I walked in, she said "Whoa--that's one angry knee!" Lots of swelling, lots of peeling skin from the fracture blisters. She agreed major swelling is my biggest problem right now.
2) In her 15+ years of practice and as a certified Ortho PT specialist, she'd never seen a fracture blister from joint replacement---only from broken bones due to traumatic injury. After the eval and discussion of my "severe inflammatory reaction" to the surgery, she asked if I'd had a valid inflammatory arthritis diagnosis (as that would help explain things) and what the surgeon thought when he saw the knee post-op. I told her I hadn't seen him yet---she was surprised. I then explained my last 6 yrs of bi-yearly exams with a Rheumatologist, no definitive diagnosis, some random joint swelling of the wrist, a "tennis elbow" flare with no direct cause/repetitive trauma---she suggested I discuss the knee recovery in gross detail at my next Rheumatology appointment, as this TKR recovery seems to be a another puzzle piece. My Rheumatologist still suspects Psoriatic Arthritis, as I get very small, thin plaques on my hips/torso/scalp.....my Dermatologist says it's not enough to biopsy though, so that's that--no concrete answers yet. Just lots of suspicion.....
3) Flexion was 60 when I got there, 78 when I left. Lots of soft tissue massage. Calf and thigh were hard as rock. IT Band super tight----no surprises from any of this.
4) At the top point of my last heel slide, as she was measuring, she saw "blanching" of the skin----she reiterated swelling is impeding this bend. The knee is just FULL!!!! She's asking me to do 10-15 heel slides every waking hour, and once a day to try and force the bend "a little bit" further. Not to the point of pain, just reasonable discomfort and trying to maintain each daily gain (or to just not go backwards either!). I think today is better than yesterday morning.
5) Best part of the visit----my extension was +3 when I walked in the door. She was impressed. After the massage and light stretching, it was +1. As she had me move to a different part of the clinic, one of the other PTs said "Wow---that's some magical extension!!!" They both complimented my heel-toe walking and my speed with the walker (not on purpose). She said I should take heart we have no need to worry about extension.
6) She said don't bother buying a cane as I'd only need it a day or two. By the end of the 2 hrs, I was walking slowly/carefully without the walker. I had to wake up a few balancing muscles first, as I'd been shifting all of my weight to the left knee for 3 wks. It was much easier than expected. We walked a short loop around the clinic with my hands hovering above hers, in case I lost my balance. I'm to go without it at home unless I need it in the night/morning after sleeping and am extra stiff/tired. I'm to use it for outside the home and around people until my balance improves. The walking adds to my soreness though, so it's going to be awhile before I want to walk a lot or do too much around the house. I don't know how some of you walk so much this early on. I am in awe!!! My knee would look like a watermelon and hurt like .
7. In a nutshell, I'm glad I went and KNOW I need what this PT can offer me. I'm glad I set the tone though and was my own biggest advocate. I still worry at times, wondering is she's going to do a 180 on me and start pushing me to achieve numbers, but I need to give her the benefit of the doubt for now and not punish her prematurely for the PTs of my past.
8) My mood was much improved today. I didn't feel as trapped and immobile once I knew the walker wasn't a 24/7 necessity, and I know I might be driving in 2-3 wks. I may not WANT to go anywhere, but knowing I CAN is huge!
I celebrated with french fries, a Dr. Pepper, and a 3 hr nap. I was mentally and physically exhausted.
I note you seem to think your knee is getting better with this routine - is it really? Is your swelling less? And your pain? Must admit, I went "oooooh noooo"! when I read that part of your post. To me it seems like piling bad on top of bad!
Wow, your PT sounds wonderful! Sounds like it was a healing experience! Good luck!
@Josephine My bend was better this morning. I was able to easily maintain what I had yesterday, and there was no pain or forcing. Keep in mind I'm using no straps/belts, just my own muscles, and she wasn't touching me. I'm actually walking better today too. The hourly heel slides are not grimacing, forceful heel slides--just moving it through whatever existing range of motion I have.
Also keep in mind for 3 wks post-op, I hadn't been doing any home exercises except a few (7-8) straight leg raises and a Quad set each day. I was doing no heel slides at all since that first week when the surgeon had me stop for a few days. My bend with the home PT 8 days ago was 78--it was 60 yesterday. I have been doing lots of sitting/elevating, no walking except bathroom trips and an occasional trip to the kitchen.
At some point I had to get moving, and if it takes some trial and error, I'm good with that. Swelling is not worse, pain is not worse, so we shall see.
I'm glad your PT session went so well and your therapist was kind and gentle. The only thing I have an issue with is this:
While your knee is so swollen, there's no point at all in trying to do heel slides and you certainly shouldn't be trying to force the bend. Doing those things is going to increase the knee swelling.
The most important thing you can do is try to reduce the swelling. Instead of those exercises, spend as much time as you can resting, icing and elevating your knee.
At the moment, your knee is like a garden hose that's stiff because it's full of water. If you get rid of some of that water, the hose (and your knee) will become more flexible and it will start to bend more easily. Right now, it's a physical impossibility for your knee to bend more.
It's only 3+ weeks since you had your TKR, so it's far too early to worry about range of Motion (ROM).
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
And it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
Beware of giving up the walker or the cane too soon. Until your knee is less swollen, trying to walk without them is putting too much strain on that new knee. Right now, it needs the support, or you will be working it too hard.
That sounds good, but it will depend on how your knee is getting along. While it's so swollen, driving is out of the question. Being your right knee, it's the one you'll use most while driving, so don't try to rush back into driving.
For anyone interested, this is my 3 wk & 3 day post-op update. I decided to concentrate on all the things I CAN do now, and not focus on anything negative.....
1) PT has been great for gettind out and having normal conversation.
2) Ditched the walker today, keeping it close by at night for stiff, middle-of-the-night bathroom breaks.
3) Bending has improved a tiny amount...almost made a backward revolution on the stationary bike today after 6 minutes of gentle rocking.
4) Extension improves a little each day. Walking is slowly beginning to feel more normal.
5) My leg strength is awesome!!!! So many people told me to get strong before the surgery, but yrs of strength training took care of that for me.
6) Able to do a load of dishes every day, plus load/unload dishwasher, 1-2 loads of laundry. Not trying anything else yet except helping to get a simple supper for the guys. The extra walking around the house is improving each day and is plenty. We're trying to get rid of some swelling instead of just adding more to it.
7) Can occasionally get by with 1 Ocycodone-5 for 4-5 hrs. I'm not one of those to just drop the narcotics. My swelling is still moderate, and the pain is real. I'm in no hurry yet and would rather stay on them 2-3 more wks than slow my recovery with loads of pain and no sleep.
8) My bruising is FINALLY almost gone. The back of my calf doesn't want to return to normal yet though and still has some sore spots.
Now if I could just get my son well----he had strep last week and is going back to the Dr tomorrow for a suspected sinus infection. It stinks to not be able to just run him to the Dr when needed. Hubby was stuck at work today, mother-in-law had a medical procedure, and father-in-law was my PT chauffeur. I'm counting the weeks until I can drive.
You're doing so well!
@Benay--Thank you, but I still have my meltdowns on occasion. I'm not one for patience and wish my leg bent more easily. Plus. I just haven't felt good today. I decided I need to think positive and focus on the positive.
Good to hear that your recovery is moving along and that your PT went well.
I have now joined you over in recovery, which is going well thanks to reading BoneSmart!
Sounds like you are doing really well. I had the same difficulty re the loo until I stopped codeine. Then I went to the opposite end of the scale#!! Are you sleeping ok?
@BCSAnna I started reading your recovery thread yesterday but haven't been online as much. I'm glad things are going ok so far and looking forward to seeing you progress. Hang in there.
@dogwalker2 I finally started sleeping better this week and spent last night in the bedroom. Granted, I had to get up and go watch TV until my eyes were drooping, as laying there with an achy knee wasn't fun. Once I was tired enough, I slept like a baby for 6 hrs. I do take a muscle relaxer every night though, as I'm the anxious type and struggle to turn my brain off.
Tomorrow is 4 wks!! The last week has brought a lot of change....
1) Less narcotics, though I can't get through the night on the lower dose. I'm hoping this week brings more improvement there.
2) More time on my feet--doing more laundry, dishes, cooking. Still very limited, but more is better than less.
3) No more moments of unbearable pain when I can't concentrate. I've entered the phase of "yeah, this hurts, but I can get through it." Even 2 wks ago, I wasn't sure when I'd see those days again, and it thankfully crept up on me over the last 3-4 days.
4) Better sleep and a few hours in my own bed. I still move back and forth to the living room couch some nights, but it's when the aching keeps me up. I need TV to take my mind off of it.
5) I'm more hopeful for the future. My bending (or lack of) is driving me crazy, but I know I'll need a lot of patience, considering my history. My PT says she can tell swelling is part of problem, but another part is severe muscle guarding. We were interrupted and didn't get back to that topic today, but I can't help but think it's my body's defense mechanism based on my horrid ACI recovery (AKA torturous PT). When someone grabs my leg, my first thought is to protect it from being forced, so I bet I'm always tense and on guard for it. She said we're making progress and any progress is good.
6) I see my surgeon Thursday afternoon. I could care less what my range of motion numbers are. It is what it is, and I will progress accordingly. I can't do any more than I already am.
7) Walking/standing----I still don't see how Bonesmart and other people recommend walking as a way to improve/recover. It swells me up more and makes the pain worse, leading to more medication. Maybe I'm just an anomaly. Those of you walking 10-15 minutes at 3-4 wks post-op blow my mind.
@Rockgirl4, the walking to get out and stay sane at this point. Thank goodness we choose this nice time of year to do this. But the walking is tough, want to get right under ice afterwards.
For me it's good to be off the narcotics. After awhile 1 or even 2 didn't do that much. Anymore and I'm over their dosing limit and who knows at what level you can overdose.
As a friend told me, better days are ahead.
Sounds like you are doing really well to me. I love your "can do" attitude!! I find it hard to be chilled out and not get frustrated as well, I want to be back to doing everything and I just cant. My hubby is back at work now (self employed, so if you don't work you don't get paid!!) and I get so frustrated just sitting there. So I do one thing, that leads to another and before I know it I've done too much!!!!!
@Rockgirl4 - the walking isn't great for me either. I can walk, but in order for me to walk correctly, I have to go soooo slow - like it would take me a minute to walk across the room slow!! One of the hardest things for me to do is bend my knee behind me while standing, which is a part of the walking motion. Since my leg doesn't want to bend in that position, I find myself walking really stiff/ limping and compensating with my hip and/or ankle and then they end up getting sore.... just add them to the list lol!! My PT agreed, and suggested getting on the treadmill at the slowest speed. I did that today and I think it went well - at that speed, I had plenty of time to think about and execute the right form. After a bit, I was able to increase the speed and keep the form, so maybe this will help.
Because they straightened my leg quite a bit, my gate changed completely. By the end of week 2, I noticed my knees were touching when I walked, wow first time in years. I’m going into, week 9 and my new gate is almost natural , except when I’m tired
@Woodpusher I totally understand wanting to be outside and having something to do. I still have so much swelling that I'm wobbly when I walk because I'm not bending enough or straightening fully yet, so I'm having the same problem as @klinkmcbear with it bothering my hip/glute/ankle etc after doing too much. Thus I tend to walk in spurts around the house doing chores. As for the narcotics, I'm thankful they DO help me tremendously. I still dislike that I'm not cutting down faster, but I also know not to compare this recovery to any of my others. Even my ACI surgery was different because by the time I could toe-touch at 7 wks, all of the surgical pain was gone. I see my surgeon Thursday and plan to get his take on things pain-wise. He's an easy-going guy though and doesn't rush things, so I doubt he'll care.
@klinkmcbear You and I could be twins right now. I also have to walk slow in order to walk correctly, and even then I have trouble getting the knee to bend enough. I can do it at certain times, just not ALL of the time. My PT has been detailing the last 8 days (since I began outpatient PT) with more notes than usual, so my surgeon is well aware of how angry and swollen/stiff the knee was at the 3 wk mark. She wants him to see the wonderful progress we've made in 8 days, even if my flexion just got to 90 today, and my extension is +3 (on my own, can get to 0 with no pain when warmed up a lot). I'm ready to walk normally though because it's doing a number on my lower back and glutes. I've been down this road enough to know things will improve in time, and it won't last forever. I hope you see some progress soon too. My PT told me I'm "right there" with the extension, so it should be getting better soon.
@dogwalker2 My "can do" attitude completely comes from a fear of missing out on things, like I have for the last 2 yrs. I am not the most patient person, and I've been down this road before after my ACI surgery in 2015, so I know it won't be as depressing as that experience, and things will be better sooner rather than later. I also keep thinking this is NOTHING compared to my mom dying last Christmas. If I can get through that, I can do anything and have no excuse not to put my best foot forward. I had a similar talk with my PT today though--she makes sure I'm not obsessing over the number and that I'm recognizing the progress we've made in 8 days.....knowing future gains won't come as quickly (most likely), but to just be in "the here and now." I also have the recovery experiences of my 11 other surgeries to remind me how badly I rebound swell after doing too much. The blessing of all that mess is I know my body super well and know what NOT to do right now! For example, my PT had me do more stretching/movement today while standing. It fatigued my legs severely, so I'm purposely doing less of everything tonight. I DO NOT want any setbacks.
@winemama I still find it amazing how much straighter some people end up after surgery. I can only imagine how that would affect your gait---seems like one would almost have to adjust everything!!! I'm glad it's going well for you though.