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TKR Runner, Rx meds, ROM, strength

TBITKR

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TKR July 10, 2020
I’m 5 weeks out and wondering about Rx pain medication. My prescription is for Oxycodone 5 mg. These days I take 1 every 4 hours, except on PT days I take 2 an hour before. I am also taking 4 Advil every 4 hours + 2 Tylenol every 6 hours. I haven’t been able to find anywhere what is the expected length of time, dose, and frequency of taking Rx pain meds?
 

Jaycey

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@TBITKR Welcome to BoneSmart! You can't find any timeline for taking medication because there isn't one. This is very individual. Some people can stop just days out of surgery and some are still taking meds months out.

Two things you said concern me. You are taking a double dose of medication before PT. Please don't do this. PT should not hurt. But if you are masking the pain you can do damage.

Second you say you are taking 4 Advil every 4 hours. What strength is the Advil you are taking? Advil can cause major issue with your stomach and intestines.

I'll leave your recovery guidelines here for you.
Knee Recovery: The Guidelines
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 

Abbylayla

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I have to wonder why mostly all of pur Doctors, it seems, tell us to take Advil and/or Tylenol which are not strong drugs for major surgery & have well known serious side effects on the liver & kidneys, rather than prescribing a prescription opioid that, yes can be addictive but will not blow out your organs. Why is there an across the board insinuation we will all become addicts so better to chance ruining out organs. "First, do no harm".
And WHY is it almost everyone of us is pushed into aggressive PT so quickly after surgery? When I read the Bonesmart method of rest, ice, elevation with "PT" being normal daily activities, and gentle movements, that makes absolute sense to me!!
Why, why, why is the medical profession & Bonesmart so 180 on this? I do not understand
 
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TBITKR

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Thank you for your reply Jaycey. And for you and Abbylayla to know— I am taking the Advil & Tylenol on my own — doc doesn’t even know. As far as PT, I am also the one intentionally pushing it (possibly overdoing it, but who knows). My PT & surgeon keep trying to reign me in. Being a seriously competitive runner, it is paramount that I lose as little muscle strength as possible because I do intend to race again.. with the goal to win!! At my 2 week checkup, the surgeon said “get your flexion, not strength” and “no running for a month”
 

LynetteCly

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Wow, no running for a month? Was that said seriously?
 

Jockette

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It is too early to try to regain strength. First, you need to heal. You feel weak right now because you’ve just had a very major surgery that caused a lot of trauma to your leg. The energy drain you get from your body trying to heal from this onslaught is very intense.

Trying too hard to do things your body is not yet ready for will set back your recovery, which will extend it’s length, so take a deep breath and allow your knee the privilege of sorting itself out.

As you heal, your body will regain strength on its own, and down the line you’ll be able to do more strength training. But not yet. This is a slow recovery and you need to respect that.
 
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TBITKR

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Wow, no running for a month? Was that said seriously?
Yes .. So that would be a total of 6 weeks from
Surgery. I’ll see him and get the details of how he believes I can start up
 
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TBITKR

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As you heal, your body will regain strength on its own, and down the line you’ll be able to do more strength training. But not yet. This is a slow recovery and you need to respect that.
I’m pushing so hard for ROM, not strength. I got to 120* early on, but have hardly improved from there. That is what is so painful. I don’t get why I’m not progressing with the all the bending & holding I do.
A running friend is a PT said “if you don’t get your ROM right away there will be no running ever”
 

Jockette

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Your ROM is not progressing because you are pushing more than your knee can handle, which is causing and maintaining swelling, and it’s hard to bend a swollen knee.
 

sistersinhim

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Yes .. So that would be a total of 6 weeks from
Surgery.
That's awfully early to be thinking about running. That will put way too much stress on your baby joint. You can not speed up its healing, but you can slow it down by doing too much too soon.
I don’t get why I’m not progressing with all the bending & holding I do.
A running friend is a PT said “if you don’t get your ROM right away there will be no running ever”
How does this friend know that? All of us have heard the rumors, that if we don't get to so and so by so and so time the knee will never improve. Well, that is just wrong! We have had tens of thousands of knee replacement patients come through Bonesmart during their healing. These experiences and proven that there is no time limit at all on achieving ROM. You aren't seeing any progress now because you are doing too much, keeping your knee inflamed. That means more swelling and pain. A swollen knee won't bend as well as an unswollen one will. Quit trying so hard to force it to do something it's not ready to do and you'll get some of that swelling down and improve that bend.
 

Roy Gardiner

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The BoneSmart view is very different from yours - but our primary message is "What works for you is better than all advice." As what you're doing isn't working, here's our view:
except on PT days I take 2 an hour before
Please don't take painkillers before PT. Masking the pain enables you to do too much, to worsen the existing damage, and delay/halt/reverse your recovery.
As far as PT, I am also the one intentionally pushing it (possibly overdoing it, but who knows).
You are overdoing it if it causes you pain.
My PT & surgeon keep trying to reign me in
They are right.
Being a seriously competitive runner, it is paramount that I lose as little muscle strength as possible because I do intend to race again.. with the goal to win!!
You have some serious thinking to do.
Wow, no running for a month? Was that said seriously?
Yes .. So that would be a total of 6 weeks from
Surgery. I’ll see him and get the details of how he believes I can start up
Yes it's serious, six weeks is incredibly early.
I’m pushing so hard for ROM, not strength. I got to 120* early on, but have hardly improved from there. That is what is so painful. I don’t get why I’m not progressing with the all the bending & holding I do.
Asked and answered. You are overdoing it.
A running friend is a PT said “if you don’t get your ROM right away there will be no running ever”
It's nonsense. Soft tissue can continue to improve forever, there is no time limit, trying too hard will worsen, not improve, your recovery.

Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

See also our article Healing and training are different http://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463.

Running is quite strongly contra-indicated for TKR people, because the impact every stride is thought greatly to elevate the danger of loosening the implant. Plenty of people do run, quite successfully. The decision is yours.

But the BoneSmart view is that you're currently scuppering your recovery by doing too much.
 
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Pumpkln

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I got to 120* early on
120 is fantastic at a month out from surgery. Probably all you will need when your first start running, unlikely you will be at full speed ahead, the first time out.
All that pushing and shoving is probably irritating your poor knee, causing inflammation and swelling, limiting your ROM. Suggest you start focusing on letting your knee heal, allowing the inflammation and swelling to go down, you will find your ROM is there as it has been all along.
Suggest you start working on balance, so during single limb stance you will be stable on your knee.
 
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TBITKR

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hmmmm

Firstly, I’d like to express my deep gratitude fo
Bones for all the attention and support. I accept your words as a gift.

I’ve been hanging onto this person’s experience as the one to emulate

Ok, so I will slow the go for now, I can do that, but I will get going as soon as it feels right

Thank you so much!
 
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Celle

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@TBITKR
Complete recovery from a TKR takes a full year,no matter how young and fit you were before your surgery. Whether you are 18 or 80, it takes just as long for all your soft tissues to heal.

Your knee isn't lazy or unfit - it's wounded, having been through a major surgery that caused a lot of trauma. Your knee needs gentle treatment so it can heal, not pushing to recover faster than it is able to.

Your friend who told you there was a limited time in which to regain ROM is misinformed. There's no such thing as a deadline you have to meet. That's an old myth that should have died long ago.
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.
Myth busting: the "window of opportunity" in TKR

In any case, 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 knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain.
By over-working your knee now, you risk prolonging the swelling and tissue inflammation that retards ROM.
 

Roy Gardiner

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Ok, so I will slow the go for now, I can do that, but I will get going as soon as it feels right
:thumb: It's what works for you that counts.

Do a little more every day; if you get pain at the time, or after, or swelling, back off to a previous level where you don't.

If you have a static bike you can use that to gain ROM:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix
 

newlybionic

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I’m happy to hear your ROM has gotten better. Make sure you ice and elevate after PT to keep the swelling down.

I want to bring up one point that you didn’t answer which is how much Advil (ibuprofen) you are taking. If you are taking 400mg of Advil every four hours that’s a level that can cause stomach problems and a possible gastrointestinal bleed. In addition Tylenol can cause liver problems. If you are taking Tylenol extra strength every 6 hours, that's the maximum (4,000mg a day) that you can take safely. Depending upon your other pain medication, it too can contain some Tylenol (acetaminophen). Acetaminophen (the active ingredient in Tylenol) can also be found in cold, sinus and allergy medications and should be counted in your daily total.
 
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TBITKR

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@newlybionic Thanks. I needed that reminder. Never would I have thought there’d be this much pain for this long (or longer). I’ll cut down on OTC pain meds as well as Rx
 

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