MUA RTKR

[mendogal]

Hang in there! It sounds like you're on the way to recovery.

 

[Birdie23]

( TKR Oct 31, 2023)
Update from MUA April 2/2024:
My ROM is almost at 130. However, that is with a lot of pain when I'm in PT. Outside of PT, I have been able to move more and bend my knee more in general.
But, I'm still experiencing the same level of pain I had after the MUA on April 2nd. There has been no change whatsoever.
I've started going to the gym to build strength in my leg. I still take Tylenol, Naproxen, Gabapentin,and Lidocaine, icing my knee, etc.
I have decided to get a second opinion from another Orthopedist from a different hospital to look at the MRI & X-rays.
I'm also going to schedule a pain management/ neurologist doctor. I really don't want to go down the rabbit hole of pain management.
I just think something isn't right--I shouldn't be experiencing this much pain for so long a period of time.
I don't know what's worse: One doctor telling me that the TKR wasn't done properly and I need a revision;
or A Pain/Neurologist telling me the pain is neurological nerve-related pain that signals from my brain to my knee (so it's all in my head, and no pain meds will help anyway).
Or, if there's nothing physiologically wrong with the TKR , according to the second opinion doctor, where does that leave me with the pain issue?
So, basically, the MUA gave me almost full ROM, but left me with very bad pain.
Orthopedist 2nd opinions, Pain Management doctors, Physical therapists, Neurologists! It's just too much!

 

[Jockette]

My ROM is almost at 130. However, that is with a lot of pain when I'm in PT.

But, I'm still experiencing the same level of pain I had after the MUA on April 2nd.

I've started going to the gym to build strength in my leg.

Your leg suffered trauma (“damage”) to the soft tissues with the MUA. Healing takes time. Painful PT does not enhance healing. It is probably too soon after the MUA to be at the gym, you can’t strengthen damaged tissue, it has to heal first.

 

[Jamie]

Birdie.....I suggest that you give Jockette's suggestion that you may be trying to push your knee too hard right now some consideration. You really have nothing to lose by taking a couple of weeks off from all but just the most basic exercises (gentle bends and stretches are all you need.....your ROM is fine). Try resting more each day and just let your activities of daily living be your "workout" for this time. If you try this, you may find your knee is a lot happier and you won't have to see a bunch of doctors. If it doesn't work and you still are experiencing these same levels of pain, then it would make sense to try and find out the cause.

 

[mendogal]

You cannot build muscle when muscle is still damaged.
Please. Just let your leg heal.

 

[Birdie23]

Maybe you are all right. Maybe I just need a break from intense PT.
I feel pressure from my PT when I tell them I want to take a rest day in between PT. They want me to exercise every day. They told me to fo the leg press and leg extension machines at the gym. I did that today including leg curls, Elliptical & stationary bike + upper body work. I was at the gym for about 1-1/2 hrs. When I got home, I could barely walk. Had to take Dilaudid, Tylenol and Lidocaine patches.
It's been 7 weeks since the MUA.
Now that I have a good ROM, I guess I can just limit myself to gentle stretching flexion & extension exercises at home as you recommended.
I guess I'm afraid that if I stop PT, I'll lose the ROM I've gained.
I do feel comfortable riding the stationary bicycle, and the leg curl machine at the minimum weight also feels fine.
When I walk too far, I do need to stop and rest and find a bench to sit down.
When I get home, I always ice my knee.
Thanks for your input.

 

[sistersinhim]

Now that I have a good ROM, I guess I can just limit myself to gentle stretching flexion & extension exercises at home as you recommended.

There is no reason to keep on exercising. You have great ROM. Why don't you just stop these excessive exercises and just enjoy your new knee? Those traumatized soft tissues from the MUA need time to settle down and heal. You can just relax and do your ADL!

 

[Layla]

Maybe you are all right. Maybe I just need a break from intense PT.

Yes! Yes!! Only joining the chorus with the hope you understand how many are viewing your situation.

They told me to fo the leg press and leg extension machines at the gym. I did that today including leg curls, Elliptical & stationary bike + upper body work. I was at the gym for about 1-1/2 hrs

Your body is trying to heal, what they're pushing you through sounds like you're in training mode.

When I got home, I could barely walk. Had to take Dilaudid, Tylenol and Lidocaine patches.

This should help you understand that there is no value in the drills they / you are putting yourself through, you're likely doing yourself more harm than good, stalling the healing process and ultimately your recovery.

Keep this in mind -> Pain Is Your Body Asking For Change. Please respect yourself through lots of TLC and gentle stretches, easy walks and the activities of daily living. You will not lose anything, but instead heal without the constant assault on your healing soft tissue / body. Please take our pleas to heart.

Wishing you comfort, Birdie

 

[Layla]

It’s been two months since the MUA, Birdie. How is it going? Please let us know when you have time.
Hope to hear from you soon. Take good care!
@Birdie23

 

[Rockgirl4]

I was where you are back in 2016. The 3 hours of PT, 3X a week, for MONTHS kept my knee swollen and inflamed. It prolonged my recovery and caused massive rebound swelling. I took a different approach in 2018 following a microfracture surgery on the left knee, then again with my TKR on the right knee in 2019. When I stopped the heavy PT, the rebound swelling was much less, and I regained my range of motion quicker. My TKR surgeon said too many people are beating their knees up post-op from a TKR, and it simply isn't necessary.

 

[Jockette]

My TKR surgeon said too many people are beating their knees up post-op from a TKR, and it simply isn't necessary.

So true!!

 

[Birdie23]

I'm back here after finishing my PT. Have knee flexion 125 degrees post MUA in April 2024. Knee extension almost there-- need about 5 more degrees.
Now, I developed IT band pain and sharp pain on outside of my knee from the IT band muscle pain. My gait is all off.
PT and doctor recommended targeted IT band stretches and strengthening exercises as well as foam rollers.
Today, I went to a sports medicine doctor referred by my orthopedist. He gave me a cortisone injection just to relieve my knee pain.
I hope it helps.

 

[mendogal]

Join the IT band club!
You can't really strengthen an IT band - it's super tough fibers that give good support, kind of like strapping tape.
Lots of us do really well with stretches and with deep massage of the ITB, and that's essentially what the foam roller does.
Here's an article about the IT band.

 

[Layla]

Three months to date since your MUA...how are you doing, Birdie?
Hopefully your gait and balance have improved. Let us know about your progress when you have time.
Have a great Summer 2024!
@Birdie23

 

[Birdie23]

My new doctor, who is a sports medicine & pain management, gave me a list of stretching exercises for the ITBand. I also have to buy a foam roller. He told me to use it on my hip area.
He gave me a cortisone injection on the side of my R knee where he saw bursitis on the sonogram. It feels better. But, I developed acute pain on the top of my knee and still have " cracking." I don't know if exercises a d stretching will help.
As always, I take Tylenol, now my other doctor recommended Gabapentin ( my new sports medicine doc said no harm in taking it), ice, Lidocaine patches at night, sometimes Voltaren.
I don't know how to get rid of the "cracking " and pain on the top of my knee. I can't flex and straighten in a smooth motion.

 

[Birdie23]

Update July 2024. My new Sports Medicine/ Pain Mgmt doctor gave me a knee brace to stabilize my knee. It hasn't really made much difference.
I've been massaging and stretching my ITband as best as I can but to no avail. My own strength is just not enough. I have a foam roller for my hip, and electric massager for my leg. But my knee pain has gotten worse. I can't walk properly. I feel the pain in my outer thigh and quad when I walk. My gait is all twisty. I wish I could afford a professional masseuse to really work on my IT band.
I'm in constant pain.

 

[Jockette]

My new doctor, who is a sports medicine & pain management, gave me a list of stretching exercises for the ITBand. I also have to buy a foam roller. He told me to use it on my hip area.

My new Sports Medicine/ Pain Mgmt doctor gave me a knee brace to stabilize my knee. It hasn't really made much difference.
I've been massaging and stretching my ITband as best as I can but to no avail.

You are in constant pain because all these things you are doing are constantly irritating your soft tissues.

but to no avail

But my knee pain has gotten worse. I can't walk properly. I feel the pain in my outer thigh and quad when I walk. My gait is all twisty.

Stop doing all these things and let your body just “be.” Your body has not has a chance to relax and recover with all the “therapy” options you are using. Since none of these things have helped it might be worth it to try nothing for a while. Stop stretching, stop foam rolling, and just do regular life things. Rest a lot. Do things you enjoy. Just getting through the day will give your body the movement it needs for mobility. At this point you have nothing to lose by stopping all the “therapy” you are doing and I bet your body will thank you. It won’t happen over night though, it could take quite a while, but I really think it’s in your best interest.

 

[Jamie]

I wouldn’t be surprised after all this “work” on your leg that your soft tissues are out of balance. If you notice that your gait is off, that’s a good sign you may need a treatment like pressure point release and some manual manipulation to help get things back to where they should be. Do you have the ability to seek out an opinion from a physical therapist who is trained in these techniques. Be sure any therapist you see has “DPT” after their name AND they are experienced in working with soft tissue and gait problems. You don’t need more exercises at all. But if you have muscle imbalance from one side to the other or tight, knotted muscles this type of therapy can help.

I do agree that it would be of benefit to give the knee a real rest of several weeks (at least 3 weeks) from any formal exercise. If you are hurting after 1 1/2 hours at the gym, then that’s your body saying it’s not ready for all that at this point. Please stop doing this to yourself and let things settle.

 

[Birdie23]

Thanks. I will take your advice and stop all of the stretching and other exercises recommendations by my sports medicine doctor.
I'm also not sure if the knee brace is helping. My doctor said it should keep my knee and leg stabilzed. But, it feels so awkward.
I do like to ice my knee. It also feels good to lightly massage my knee with vitamin E oil.
Unfortunately, I cannot afford any therapy right now for pressure point release or manual manipulation.
The only thing is that I'm in a lot of pain all the time.
I have to go back to the doctor and maybe get a cortisone shot or something.

 

[Birdie23]

Update: TKR Oct 31st 2023; MUA, April 4, 2024. I am under the care of a new physiatrist ( pain management & rehabilitation specialist).
I am going to have a radiofrequency ablation procedure. I have gone through two successful
" test blocks. " Now, I'm waiting to get medical insurance approval and an appointment for the final stage of the RFA injections.
I'm very optimistic about this, since the two test blocks went very well. I was pain free for several hours both times. What an amazing feeling.
My physiatrist also recommended that I get a herl lift for one leg as the other leg is slightly shorter. He said this will help improve my gait, balance and potential hip or lower back pain.
I do feel that I forgot how to walk, though. I noticed this when I was free of the knee pain.
Once I'm pain-free, I'll be able to go to physical or occupational therapy. I need to re- learn how to walk and to re- build strength and flexibility.
I feel I'm on the right path now.