TKR Suggestions needed for “tight band” feeling

[Stiff knee NC]

I had left knee surgery in early August as a last resort to pain and arthritis. (I tried cortisone and gel shots, PT, and even had a meniscus surgery, to no avail). I am 14 weeks and 1 day out and it has been a VERY difficult recovery. What I’m struggling with the most is “tight band syndrome” from one side of my knee, across the front of my knee, to the other side. I can’t stand more than 30 minutes without pain...and my knee gets tighter and tighter the longer I stand. ROM is 115 (120 w/a push from my OT). My OS told me to do the stationary bike, elliptical, and use the hip abduction machine. I have been icing, elevating, and resting every day. In the gym 5 days/week. Got a deep-tissue massage, which didn’t help much but I have a few more scheduled. I’ve read the BS info on my tight band problem. Went to PT 3x/wk initially but am nearly done (my 40 insurance-approved sessions are almost done). May try water therapy. I am NOT getting better and am beyond discouraged. My surgeon says it just “takes time.” My experience seems very reminiscent of patient 99’s (Carol)....how I would love to hear how she’s doing all these years later. Please, if you have any suggestions, I’d be grateful if you could share them!

 

[Jockette]

Hi and Welcome!

Your surgeon is right, most of this recovery just takes time. This is a year long (52 weeks) on average recovery and you are at week 14. You still have a way to go.

I can’t stand more than 30 minutes without pain...and my knee gets tighter and tighter the longer I stand.

This is pretty common, unfortunately. It was months before I could stand for longer periods of time.

We all deal with that tight band, it is swelling, even if you can’t see it. Actually I think you are overdoing your rehab and I think you should cut back quite a bit and let your knee and the swelling settle down.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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​

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 to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Please also tell us the exact date of your surgery and a moderator will put it in a signature for you.

 

[Stiff knee NC]

Thank you for your response! My surgery was Aug. 2. Can you pls point me to info on this site w/info on the nuts and bolts of posting, responding to others, etc. Tks!!

 

[Celle]

Can you pls point me to info on this site w/info on the nuts and bolts of posting, responding to others, etc. Tks!!

@Stiff knee NC - At the moment, all our articles on how to do things are being revised. However, most of what to do is common sense.

If you want to reply to someone, just scoot down to the bottom of the page and start typing, as you did, above.

If you want to tag someone, just put the @ sign in front of their username, as I did when I tagged you.

 

[Tykey]

I agree with Jockette, you are just trying too hard with the exercise. I would just cut out 90% of the exercise and just get on with the normal things of life. Your poor knee is living in a constant state of aggravation, the swelling, tight feeling and pain is its way of saying, gimee a rest!

 

[Stiff knee NC]

@Tykey: Thanks for your response. My dr wants me at the gym, doing the things I mentioned! It’s hard to know WHAT to do and to figure the balance between “resting, elevating and icing” in my recliner many times per day VS exercising. Sigh...

 

[Tykey]

Ask yourself if your doctors approach is working. Just because he wears a white coat doesn't make him perfect.
What is it he wants you to do at the gym?
Resting icing and elevating versus exercising aren't the only alternatives. What I would consider is something in the middle, such as just doing normal things in life. Are you resting icing and elevating BECAUSE you might be overdoing it at the gym. I can't judge it, because I'm not you.

 

[Jockette]

There is a balance. You need movement, but I think you are overdoing the activity.

 

[Stiff knee NC]

@Tykey and @Jockette: I hear you re the dr. He wants me doing the stationary bike, elliptical and hip abduction machines (inner and out thighs). He did not specify the amount of time or level. I’ve been doing 20 mins on bike at lowest setting (slightly uncomfortable), 20 mins on this “pedal-type” machine (doesn’t hurt at all but I’m not sure if it’s helping at all) that the gym trainer recommends instead of the elliptical (the elliptical is too hard for me) and 15 reps on each type of hip abduction. I also do a bunch of other things that I do at PT (and this may be what is getting me in trouble): 20 squats on TRX (this feels good and I’m able to get close to floor), leg press (180 lbs both legs, 80 lbs operated on knee), and knee extension (leg over padded thing and pushing down). I’m at 120 ROM and don’t want to lose that. Does this all sound excessive? (Writing it...it DOES). Tks in advance for ALL your advice/help!

 

[Celle]

He wants me doing the stationary bike, elliptical and hip abduction machines (inner and out thighs). He did not specify the amount of time or level. I’ve been doing 20 mins on bike at lowest setting (slightly uncomfortable), 20 mins on this “pedal-type” machine (doesn’t hurt at all but I’m not sure if it’s helping at all) that the gym trainer recommends instead of the elliptical (the elliptical is too hard for me) and 15 reps on each type of hip abduction. I also do a bunch of other things that I do at PT (and this may be what is getting me in trouble): 20 squats on TRX (this feels good and I’m able to get close to floor), leg press (180 lbs both legs, 80 lbs operated on knee), and knee extension (leg over padded thing and pushing down). I’m at 120 ROM and don’t want to lose that. Does this all sound excessive

Yes, it does all sound excessive - in the extreme. Your knee isn't lazy or unfit - it's wounded and it needs time and gentle treatment, so it can heal.

At only just over 3 months since your surgery, your knee is only a quarter of the way to full recovery.
I suggest you limit time on each machine to 5 minutes and only build up this time slowly.
Cut our the weights and the squats. They're both bad for new knees.
You're not in athletic training. You're helping your wounded knee to recover from major surgery.

This article may help you:
TKR recovery and an analogy to athletic training

 

[Carole4815]

You never said so (or I missed it?) but was your surgery a Total Knee Replacement (TKR)? If so, then I agree with others here that it just takes time and that your exercise routine seems awfully rigorous and may be part of the problem.

It's hard to be patient but surely you have noticed fairly frequent improvements in what you can do, as time passes. For me it helps to focus on the improvements as they happen, instead of focusing on improvements that are yet to come.

 

[judgar]

I had my surgery aug 20th. I have the tight brand feeling.it drives me nuts.my dr. Said what you are at 6 months is usually where you will be. I have to ice and sit in the chair for awhile too. I had this tight band feeling on my other knee too it took about 4 months to go away. It was like I went to bed with it and woke this next morning and it was gone. I hope it happens again that way

 

[Starsfan22]

@stiffkneeNC, my surgery was a couple of days before yours and I'm right where you are. I stopped formal PT at 7 wks. It sounds like our pt was similar but no gym for me. I'm just as frustrated as you and have no idea if or when I'll get better. Some days I get angry, some days I become more accepting that this may as good as it gets. I've seen very small gains but don't feel I'm any better off than at 8 or 9 wks. I was thinking just this morning I guess I'll just adjust, makes short trips out, do things at home I can accomplish in 10 or 15 min. increments. Everyone here says it will get better and I've counted on that hope. Today is a negative day for me.

 

[Tykey]

You will not lose ROM by not forcing your knee lots of times. It's great as it is, unless you are a part time limbo dancer

Very excessive regime!! I'm horrified at the thoughts of weights, and double horrified at the thought of so many squats.
You are doing extremely well, be happy and just get on with the good things TKRs bring to our lives

 

[Jockette]

.my dr. Said what you are at 6 months is usually where you will be.

I don’t believe this at all. Healing takes at least a year and sometimes 2 years. My whole leg continues to improve and I’m 2.5 years post op. I am waaaay better than I was at 6 months.

 

[judgar]

Well I don’t know. Iam just stating what he said.

 

[Rockgirl4]

@Stiff knee NC This is just my 2 cents, but I'm only 47 and was super athletic/in shape before my TKR (and for years before the TKR). There's no way I could do what you are, and I'm already 6 months post-op right TKR.

With that said, your post-op exercise regimen at 3 months sounds like a sure-fire guarantee towards chronic swelling/inflammation. My surgeon was adamant not to do any strength-training until the 12 week mark, then to slowly increase things as the knee allowed. If the swelling and right-band feeling increased, back off! If range of motion dropped and was hard to regain, back off!

I could see doing what you're doing if you're in training and have to get back to a certain level of fitness....but even then, there will be that trade-off: a tight-band feeling WILL stick around, and your swelling will NOT go away! It's just the way it is and nothing will likely change it. If you don't have to have such a strict training regimen, don't.

I have been there and done that with a former surgeon who thought I should continue being an athletic beast after a different knee surgery in 2016. All it got me was scar tissue from chronic inflammation, caused by overaggressive exercise and bending to extreme (yes, that happens too, though most surgeons won't admit it!!). That procedure failed, hurling me a towards a TKR 8 yrs sooner than it was supposed to---and the reason it failed was because I continued to rehab like an athlete. My new surgeon (the one who did the TKR) says TKR recoveries are NOT athletic injury recoveries. It's traumatic, invasive, and needs lots of time for the average person to recover and not have pain/swelling. You cannot treat it like an athletic injury/surgery. The worst thing one can do is "doing too much." When I asked him how I'd know, he said it's not rocket science---the knee will tell you with swelling, tightness, possibly pain, and definitely limited range of motion. It truly is a balancing act.

One last thing.....remember I'm 6 months post-op TKR. Standing for more than 10-15 minutes guarantees me a limited flexion day tomorrow---every time!!! It's my biggest challenge and one I was told is super common. My knee is much happier walking than standing....though too much of THAT causes issues too. The balancing act continues, and for most of us, it's a 12 month ordeal.

Best of luck to you.

--Lisa

 

[Stiff knee NC]

@Starsfan22: I so appreciate your response (sorry for my delay in getting back to you). I was literally JUST thinking abt doing things in 15 minute increments, like you mentioned! Very hard to do, especially this time of yr. Do you still have warmth in the knee? (I did a very light workout today and now my knee is warm). I feel very “alone” in my struggles w/the tightness...I have 2 friends who also had TKR...one in May is doing fantastic; the other 5 days after me says she only had tightness in the am! Lucky them! I want to recommend something that a massage therapist suggested to me...a knee sleeve. I should be getting it this week but in the interim I am using this elastic sort of compression socks...it has made a BIG difference! If you’re interested I will give my knee sleeve a few days and let you know if it helps and give you the brand name. Take care...hope today is a better day!

 

[Stiff knee NC]

Rockgirl14, judgar, Jockette, Tykey, and Carole4815: I hear ya’ll abt my exercising and have drastically cut back on what I’m doing! Tks for ALL the comments and encouragement ❤