MUA RTKR issues with pain and stiffness

[itsallgood21900]

Had my right knee replaced, Been up and moving as often as i can. Just a tad bit impatient and worried this pain will never go away. I have been going to PT now for two weeks, didnt have the in home. They say my bend is getting better but i just feel hopeless at times. I know im only 2 weeks out but it will just be amazing when im mobile again and dont feel down about it all

 

[Layla]

Hello and Welcome to BoneSmart! Thanks for joining us. Please share which knee was replaced so we can add the information to your signature.

I’m sorry you’re struggling with pain and feeling hopeless at times. Please try to be more patient. You will need to lower your expectations since you’re not even two weeks post op from major surgery. Recovery takes time, a full year for some, and you can expect some ups and downs. Don’t worry about your bend right now. It's not exercise that increases your range of motion, it's time. As the swelling dissipates and tissues begin to heal, you will notice your range of motion increase.

If the meds you were prescribed aren’t allowing you to feel comfortably mobile, consider calling your surgeon’s office so they can adjust your meds. If you’re not icing, that will help also. Read the article on ICE in the Recovery Guidelines below. Hang in there, all is temporary. Brighter days are on the way!

 

[Layla]

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.

 

[itsallgood21900]

Thank you very much

 

[itsallgood21900]

I had knee replacement on May 18 2022 and thought i was doing well with PT but i saw my surgeon for the first time since today and he not only said im way too stiff but without notice, he just grabbed my leg and forced it into an almost complete bend, i have been in pain ever since. I'm worried now because he says when i come back in a month if it's no better he's going to really have to bend it forcefully. I am being told so many different things im torn on what to think now, my wife thinks I'm doing fine but he thinks otherwise. He wants me to increase to 3x a week for PT so that's what i will do but i get a pain in front of my kneecap at times when i lift it so its diff sometimes to stay hopeful, im discouraged at this point

 

[Jockette]

I am so sorry your surgeon treated you like this, at only 3 weeks post op! This was uncalled for. My surgeon also hurt me during follow up appointments until I finally, at the 7 month follow up, refused to get up on the table, which would give him easy access to my leg. I stayed sitting in a chair in the room. You can do the same. Now that you know what he’s like, be on guard and protect your leg from him.

I'm worried now because he says when i come back in a month if it's no better he's going to really have to bend it forcefully.

You have every right to worry, but you also have every right to take charge of your recovery. He is talking about a Manipulation Under Anesthesia (MUA) and he can’t do that without your consent. And, it is way too early to even think about an MUA, even a month from now.

Saying no to therapy - am I allowed to?

You don’t need to increase to PT 3 times a week, especially if PT is causing increased pain and swelling. What you need is time and gentle treatment, so can heal from this surgery.

 

[Jockette]

By the way, I merged your newest thread with your original recovery thread, as we prefer that members in recovery have only one thread.

This benefits you because all your information is in one place, easy to find, and maintains a nice journal for you.

This also benefits our staff, as your information is all in one place, and we often go back through your thread for previous details, so we know what you‘ve been through which helps us advise you better.

So, please keep all your posts in this thread. If you’d like a new title, let us know what you want, and we’ll change it for you.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

Best wishes on your continuing recovery!

 

[Jockette]

Here is an example of a member who went so far as to stop seeing her surgeon, until she was much more recovered.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[itsallgood21900]

Thank you for this, it gives me more hope

 

[Jamie]

I'm sorry to hear your surgeon is pushing you so hard. I would caution you about increasing your physical activity or therapy when you are experiencing significant pain or swelling. More exercise under these conditions does not make your knee better. It just ensures that it will stay inflamed.

Obviously, you need to move your knee frequently throughout each day, but painful exercises are counterproductive. It's normally better to engage in gentle bends and stretches or other exercises that bring you to the point of mild discomfort, but not real pain. Listen to your body. It will let you know when it's ready to step up the pace.

The goal in these early weeks is to make steady progress from week to week. Recovery is not a straight path and you will have good days and not-so-good days. Those not-so-good days are the ones where your body is letting you know that it's not quite ready for whatever level of exercise or activity you've attempted. Take it easy for a couple of days and then you can try again. Hang in there.....you've got this.

 

[itsallgood21900]

I'm sorry to hear your surgeon is pushing you so hard. I would caution you about increasing your physical activity or therapy when you are experiencing significant pain or swelling. More exercise under these conditions does not make your knee better. It just ensures that it will stay inflamed.

Obviously, you need to move your knee frequently throughout each day, but painful exercises are counterproductive. It's normally better to engage in gentle bends and stretches or other exercises that bring you to the point of mild discomfort, but not real pain. Listen to your body. It will let you know when it's ready to step up the pace.

The goal in these early weeks is to make steady progress from week to week. Recovery is not a straight path and you will have good days and not-so-good days. Those not-so-good days are the ones where your body is letting you know that it's not quite ready for whatever level of exercise or activity you've attempted. Take it easy for a couple of days and then you can try again. Hang in there.....you've got this.

thank you i had PT today and looks like I've gone from a 78 down to a 74 somehow but man did she push. Im super stressed even thinking about my surgeon saying hes going to take other measures if i come back in a month and its stiff

 

[Jockette]

You didn‘t really “lose” 4 degrees, you have more swelling, which affects the number, due to your surgeon forcing your knee to bend way too far, and the PT also pushing your knee.

If you want to improve, you must not allow the PT to do this. Though most of them seem to have this protocol, that doesn’t make it the correct thing to do, and not all PTs push like this.

Stop going to PT for a couple of weeks, spend your time icing, elevating, and resting, and just do gentle bends and short walks around the house. If you really are that worried about your next month’s appointment with your surgeon, postpone it a few weeks and give yourself more time to heal and improve. You will improve if you stop allowing all this forcing of your knee every other day. It’s obviously not helping, so what have you got to lose by trying a different recovery method.

 

[sistersinhim]

i had PT today and looks like I've gone from a 78 down to a 74 somehow but man did she push. Im super stressed even thinking about my surgeon saying hes going to take other measures if i come back in a month and its stiff

As Jockette said, it's swelling that affects your bend, and all you are doing is adding to that swelling. Forced bending causes inflammation which causes swelling. Swelling makes it impossible to bend well. Stop all that PT and exercising and just let your daily activities be your PT. It works! I know, that's all I did. I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

All this forced bending you've been going through is not working so it's time to try something different. Give it a month and you will see an improvement. You will not lose any bend, you'll gain more!

 

[kneeper]

In the first weeks I was so swollen I couldn't have bent much no matter how much I tried. I did do my heel slides just to keep the knee moving, but the main priority was icing and elevating. Just walking to the bathroom, having a shower and so on counts as activity in the first couple of weeks. Neither my OS nor my PT would have cranked on my leg like yours did to you.

As the days and weeks go on, you typically do a bit more exercise, but still keep up that icing and elevating. For me what worked was to move the knee several times a day. I did heel slides mostly. I did short walks (at first just in the house with the walker) and had to get my own (easy) meals. I did PT but no one cranked on my leg. Bending won't be comfortable, and that's ok, but you shouldn't push to the point where you're crying or anything.

 

[Odieodell]

i saw my surgeon for the first time since today and he not only said im way too stiff but without notice, he just grabbed my leg and forced it into an almost complete bend, i have been in pain ever since.

I would have kicked him with my good leg and asked him what the world do you think you are doing? It’s one thing if you agreed to a MUA, but him doing that was wrong on so many levels. Clearly, he has never experienced knee replacement himself. Just because some people who may have less tissue surrounding their knees gain flexion quicker doesn’t mean you aren’t healing properly. No two knees or patients are the same and shouldn’t be compared. Swelling will affect your ROM and I agree with others here that you can have swelling and fluid in your knee which is inhibiting your bend. Someone here once explained it is like comparing a hose filled with water under pressure versus one that is not. It’s common sense.

 

[sistersinhim]

Someone here once explained it is like comparing a hose filled with water under pressure versus one that is not. It’s common sense.

That was me. If you fill up a water hose with the nozzle closed off, you can't fold or roll the water hose up. Open up that nozzle and let the water out and the hose can be bent, folded up, or rolled up. Your knee is the same way. Get that swelling out, which is fluid, and it will automatically bend better.

 

[itsallgood21900]

Good news for me, my bend is getting better with physical therapy, i feel like its not as stiff. Just keeping the faith and taking it day by day

 

[sistersinhim]

Wow, it sounds like you are doing well, especially so early in your recovery!

 

[kneeper]

Yep, day by day is the way to go.

 

[Jockette]

had mine on may 18 and am only at 85 bend, tomorrow we are measuring again but ive had a lot of pain and swelling as well, i keep telling myself that my stiffness won't go away but trying to remain positive the best i can

Your bend will improve when your swelling goes down, and that takes time. Stiffness is par for the course.

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 is healing...and full healing takes a full year or more.

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

I've been depressed and sad several times since surgery but I'm keeping the faith that ill get through this

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

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