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TKR Suggestions needed for “tight band” feeling

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Stiff knee NC

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@Jockette: I had a very light workout today and now my knee is warm...is this normal 14 weeks out? I’m resting, icing and elevating now...
 

Jockette

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Yes, it’s normal. You’ve been doing a lot of exercising for all this time and you won’t see a major difference in just a few days of cutting back. It’s that Time thing again. Everything in this recovery takes a lot of Time, except overdoing. You can feel the negative effects of overdoing real quick!
 

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@stiffkneeNC I too get the tightness. I have it every morning and I put a lot of effort each day trying to get rid of it. I ice, elevate and use my floor pedal before I can function at all. After I'm loose enough I go for a walk outside,no more than 1/4 Of a mile. More walking causes more pain and stiffness for the rest of the day. Yesterday was a good day, very good. I can usually tell walking down the hall first thing in the morning how the day will be.
Yes, I still get the warm knee, when I feel it I ice.
There seems to be a fine line on doing enough to stay loose and doing too much and having pain and stiffness. Surely this will get better. Mentally I'm in a much better place then 2 wks. ago so something is getting better!
 

sistersinhim

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Watching your knee's reaction to different activities is a learning experience. If you obey your knee, your recovery will go much better. Warmth is not only a sign of doing too much, it is a sign that your knee is healing. Mine stayed warmer than my other knee for at least a year.
 

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Add me to the warm knee list. My knee is still warm most of the day, even at 6 months post-op.
 

Celle

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A warm knee is a sign that healing is still going on beneath the surface. It can sometimes take as long as a year post-op before that warm feeling goes away.
 
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@Jockette: I hope you don’t mind an update and another question. Since I posted 2 wks ago I have cut exercise to 8 mins on bike and similar time on “pedal” type elliptical, 20 toe touches, and 15 reps on inner/outer thigh machines. Nothing else—no more leg press, leg extension and squats. Its early but I can’t see ANY improvement in the tightness. (Tightness gets worse after exercise but no pain). My PT measured me today—120 ROM and great extension. VERY good strength. Even measured circumference of both knees (thinking post-op knee might be swollen). Measured the same. Said if it weren’t for tightness, he’d discharge me w/no reservations. Dr says to “keep working the knee.” Other doctors won’t see me because it is too soon since my aug. 2 surgery. I’m icing/elevating/resting, getting therapeutic massages, wearing a knee sleeve (or being taped w/Spider tape). I’ve been told tightness is normal but I feel that I have EXTREME tightness. I’m at a loss as to what to do. I want some sort of test (any recs?) to determine what, exactly, is causing the extreme tightness, and what can be done to alleviate. I suspect excessive scarring. (X rays, btw, look fine). I’m at my wit’s end...Tks in advance for any help...
 

Jockette

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Tightness is par for the course in this recovery, we all have it to some degree.


I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. 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.”

The amount of exercising you were doing has kept your knee inflamed and upset, increasing that tightness. It can take a lot more than 2 weeks to settle down. To be honest, with the extreme tightness you have, you are still doing enough rehab to keep the knee upset.

Your ROM and strength are great. Because your knee is still so tight and uncomfortable I suggest you stop doing the all the gym exercises you are still doing. Right now giving your knee time to rest, relax and recover is more important than doing even these few exercises. Give this a try for at least a month.

When it feels better gradually add these things back in if you want. Have you always been this active in a gym, or is this just the rehab you have been told to do?

What does a normal day look like for you in terms of activity? Do you work, are you out and about a lot, shopping? All the movements you do in these activities are enough exercise for a tight, healing knee

This recovery takes a very long time, a full year on average.
 
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@Jockette: Tks for your response. To answer your questions, I don’t work right now. And yes, I’ve been pretty active for the past 3 yrs (I lost 40 lbs bc my blood sugar was getting too high). Better for my knees! My exercise routine back then (2015-2018) was 30 mins on bike and 30 mins on treadmill, or an hr on treadmill, abt 3x/wk. Plus knee press. My knees could tolerate that pretty well, until they couldn’t. Then I water walked 3x/wk for a yr, hoping it would help my left knee. It didn’t, so surgery in August. I will gladly take a break from the gym for the next month and will keep icing etc. I’m pretty much out and abt for 2 hrs or so per day, running errands (this is a tough time of yr to be resting!).
 

Jockette

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I’m pretty much out and abt for 2 hrs or so per day, running errands (this is a tough time of yr to be resting!).
This will give your knee all the exercise you need. Try to put your feet up any time you are home and sitting down resting.
@Jockette: do you think ANY tests (MRI, Cat scan, etc) would be helpful?
Let’s ask @Jamie about that.
 
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@Jamie: Jockette recommended asking you abt whether I should seek out any tests (MRI, Cat scan etc) to help w/my extremely stiff knee (pls see my comments, above). Tks in advance for any recs...
 

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Knee tightness is normal at your stage of recovery, @Stiff knee NC . Nothing is wrong and nothing is going to make it go away completely until your knee is ready for it to do that. It will just fade away gradually, but I'm afraid it is a normal part of this year-long recovery.

An MRI or CAT scan won't show anything that needs to be dealt with.
 
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@Celle: Tks for responding. Sigh. I was sure you were going to say it’s scar tissue and that my dr could do X, Y and Z. This may be the longest yr of my life!
 

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I’m pretty much out and abt for 2 hrs or so per day, running errands (this is a tough time of yr to be resting!).
This is exercise. This is what normal life and using your knee is all about. You don't need to add anything to these things. Using your knee normally is why we have this surgery.

That stiffness is swelling inside your knee. You can't see it, but it's there and exercising more keeps your tissues inflamed and they react by producing fluid, thus you have inner swelling. The best way to get rid of that stiffness is to rest, elevate and ice that knee. Getting the fluid out is the key, not exercising.
 

judgar

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Tightness can last a long time. I hate telling you this. I had one knee done in 2013 and once in a great while that knee will get tight. My other one is 13 weeks I still have tightness hope it don’t do what my other knees does keeping my fingers cross.
 
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@sistersinhim: so the tightness is swelling and NOT scar tissue? It sure feels like scar tissue! (When I stretch I can feel whatever it is stretching). I’m going to ask my dr abt taking an anti inflammatory. What abt cortisone shots? Can the fluid be drained?
 

sistersinhim

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Your body flushes it out. That why you need to rest, ice and elevate. I doubt it is adhesions. They are very rare. Yes, the number-obsessed PTs and OSs will rattle on about it as if the big. bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

What you are feeling that you think is a tearing is more than likely fluid being pushed around inside that knee.
 

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@Stiff knee NC I'm just jumping in to say I know where you're at and it IS frustrating:tantrum:----but it's all part of the normal recovery process. I was lucky in a way----my previous history just about guaranteed a 12-18 month TKR recovery (and I'm only 6 months along!), so I know I have a ways to go. I was one of the EXTRA lucky ones because my surgeon was very forthcoming about how long this recovery could take.

Mostly, I wanted to say I agree scar tissue is not your problem. With a flexion of 120, there's no way!!!:loll: I'm stuck at 110 most days after riding my bike for 5 minutes. I'm 6 months post-op and usually only have 104-105 degrees at wake-up on a good day---all because I STILL have loads of tightness/inflammation. Take it from one who DOES make adhesions easily though and has dealt with Arthrofibrosis in the past:headbang: .....Stiffness/Tightness from swelling feels much different than true adhesions.

When I had true adhesions back in 2016, the knee hit a hard stop at the same point every time, and no PT or bike could get more bend. :shrug:This time around, I had a new surgeon for my TKR. He was super strict with me how I rehabbed. My previous knee surgeries had aggressive rehabs and kept the knee chronically inflamed. I made loads of adhesions in 2016 because of that, needing a scar tissue removal surgery AND an MUA. I did more aggressive rehab after those procedures and made MORE adhesions.:headbang: So this time around, my rehab was much gentler and more subdued.

My range of motion definitely varies day to day, depending on my activity/exercise/amount of standing, but I agree time is your best friend here. The frustration is real, but we just have to walk through it. I saw my surgeon 2 days ago for my 6 month post-op. I said how was surprised I was that I was still having THIS much swelling/inflammation with some days struggling to bend past 100 degrees. I knew some swelling would linger for a year, but THIS MUCH????!!!!!!:gaah::gaah::gaah::gaah:

He smiled and said some of us just need longer, and it often takes the full year. If we try to speed things along and keep exercising too much/inflaming the knee, we're actually slowing down the healing process and it WILL take longer for the swelling to dissipate. He was just reminding me what I already knew. I didn't like it, but I knew this going in, so I'm working on more patience.

Just know you're not alone, and many of us here get exactly where you're coming from. Even knowing the "whys" doesn't always make us feel better though.:console2:

--Lisa
 
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