TKR Terrible muscle spasms<<

[Ajmdd6]

Thank you for responding.. I posted when I started this journey last month (July) and am still trying to get use to the posting rules meaning where/how! LOL Anyway, I was hoping my DR would help me out with a muscle relaxer by calling back today. He didn't and now I have to wade through the weekend .. I feel overwhelmed by the PT and wonder if I could do just the same on my own since I have access to a pool and a gym!?

 

[Pk4tmjsd]

Hi Ajmdd6:

Oddly, no muscle spasms with the right knee replacement, but am experiencing them with the left..... They mostly occur during the overnight when trying to sleep. Occasionally, they make their involuntary appearance (s) during the day, while seated, much to the delight of those around me?!?!?

Surgeon told me it may be nine months post-op before they resolve. He did not prescribe me any meds; they have not been too bothersome. Good luck in your journey. I see we have similar surgical dates.... ~ Pat

 

[newlybionic]

Welcome to Bonesmart. We are glad you found us. You can have spasms as part of your healing. Your OS can prescribe a muscle relaxer to help with them.

Here is your own copy of our guidelines.
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. Here is a week-by-week guide for https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

Activity progression for TKRs​

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.

 

[JMB]

My two cents. I had the same terrible spasms at night. Someone told me about drinking tonic water throughout the day as it contains quinine. Also I started taking magnesium supplements. For me it did the trick. I quit this routine last month and now after a manipulation the painful night spasms are back. I will begin again and hope for the same result. Good Luck.

 

[Pheebs52]

Here's something you can try that I found helpful: A rolling pin! It really did help me, but I wasn't getting spasms post PT and am not sure if that matters. I'd get them from driving or sitting with legs down for more than 20 minutes. My PT said they came from a too tight quad which exerts too much pressure on the hamstrings. At any rate, it's worth a try even if your OS orders some muscle relaxers for you.

 

[Polkadot]

I am not a doctor and don't want you to take this as medical advice. However, a swallow or two of tonic water relieves muscle cramping for me. The science isn't conclusive on it, and there are cautions about taking too much quinine--most doctors no longer prescribe it in large doses for spasms due to extreme side effects and danger to some people. However, I'm talking about an amount of tonic water that is equal to or less than what is in a mixed drink. My leg cramps respond within 5-10 minutes to a couple of ounces of tonic water. (Gin is optional!) (Some people swear by apple-cider vinegar. A new line of investigation hypothesizes that something very bitter somehow may trigger receptors in your body that help calm spasms.)

Once I had to leave the theater in the middle of a movie due to severe leg spasms. Luckily, I had just bought some groceries, among which was a bottle of tonic water. After a couple of swallows, I was able to go back and finish the movie. It might be worth a try. Ask your doctor if you are worried that you are in a high-risk group and should not drink tonic water.

Dehydration is also something to watch, as are your salt and potassium levels. I take extra potassium to help with muscle cramping, as my low thyroid messes with my body's ability to take in and use potassium. My mom was on a low-sodium diet for years due to my dad's heart problems. A severe period of stress and poor eating precipitated a series of debilitating muscle spasms and cramping. She was found to have extremely low sodium levels, which can be dangerous. This could also be something to discuss with your doctor; however, I suggest that you take a look at whether or not your diet has changed since the surgeries. The TKR surgery and aftereffects, including medications, made me lose my appetite. My diet changed quite a bit afterwards. Has yours? Perhaps increasing fluids and salt intake(moderately), as well as eating potassium-rich foods, might help.

 

[Pumpkin]

I started PT this week... (hard wrk) ROM 107 so far HOWEVER , shortly after the first session Monday the muscle spasms kicked in and have become unbearable, especially at night. Told PT Thursday who said We'll go easy and that didn't happen!

IMO, the aggressive PT contributed to your muscle spasms. Your ROM is fantastic at 3 weeks, let your knee heal and ROM will continue to increase as your pain and swelling go down.

I feel overwhelmed by the PT and wonder if I could do just the same on my own since I have access to a pool and a gym!

Yes, you can recover on your own. Right now all you need is to follow our guidelines, and do these two gentle activities.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

At your gym and pool everything you do should be very gentle, and not cause any increased pain, swelling, or muscle cramping.

You are still in the very, very early days of recovery, as your knee heals, you can increase your activity and exercise. Most find this happens around 3 months, in this year long or more recovery. As always you will need to listen to your knee, and give it a break when it talks to you, with pain, stiffness, swelling, and muscle cramping.

 

[kmak81230]

I knew there was a good reason to have a vodka tonic now and then .

 

[Celle]

Hi @Ajmdd6
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated.
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on. Perhaps you could do that?

Did you see Josephine's offer to help, in Post #17? It looks as if, by not coming back to your original thread, you missed it, as you also missed some of the other advice.

 

[Celle]

I posted when I started this journey last month (July) and am still trying to get use to the posting rules meaning where/how! LOL Anyway, I was hoping my DR would help me out with a muscle relaxer by calling back today. He didn't and now I have to wade through the weekend

You can have spasms as part of your healing. Your OS can prescribe a muscle relaxer to help with them.

Don't give up on this. Keep phoning until you get a response, either from your surgeon or your own doctor.

I feel overwhelmed by the PT and wonder if I could do just the same on my own since I have access to a pool and a gym!?

At this early stage, PT isn't even necessary and I'm sure it is contributing to your muscles spasms. Cut PT right back, or stop it altogether. You can follow the exercise suggestions given to you here:
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

Your knee really gets all the exercise it needs by just doing your activities of daily living, because what your knee needs most is gentle treatment and time to heal. As your knee heals, the swelling will go down and your ROM (Range of Motion) will increase naturally.
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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.

I knew there was a good reason to have a vodka tonic now and then

Yes, there is a time to have a drink, but it's not when you are still taking pain medications.

 

[Josephine]

@Ajmdd6, a few posts back I posted this question but you never responded ...

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

If your not answering meant you didn't want to answer my questions, that's okay but please just tell me so I know. Thanks

 

[Red's Mom]

The experts will be here soon but in the meantime go to the library tab and start reading. Many of us have had terrible muscle knots and spasms post operatively. Rest, ice, elevate, medicate and very gentle stretching is the key. Keep us posted on how your doing.

 

[NewKneeMe]

I also had horrible muscle spasms in my quad a couple of weeks after TKR. It took me a couple of days to figure out what it was because it didn't so much spasm as tighten up and stay that way. My entire quad was as hard as a rock! My Dr phoned in muscle relaxers and they did the trick.

I am somewhat prone to leg cramps in the summer because I sweat a lot (but not so much this year bc I'm indoors mostly) and I drink a lot of water. I started having a banana smoothie in the mornings and those have really helped once I got the initial cramping after surgery under control.

I hope you get relief from the spasms quickly. Those are miserable!

 

[Ajmdd6]

Sorry for the late response.. Thank you all for helping me out and Nurse Director Josephine I would love your advice. I am not much tech savvy and will do my best!

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Ajmdd6]

1. 6
2. Oxycodone 5mg I've been spacing 6 to 7yrs apart during the day. About 5hrs at night.
3. I say moderate to huge
4. ROM 107 with PT pushing my leg back. Straightness: PT said it was good when I asked but focused more on flexion.
5. Icing in mornings and evening
6. Elevating when icing and after cramps/spasms
7. Mornings I get my self and daughter breakfast and do some dishes/cleaning if my knee allows. Otherwise I get up to walk around apartment to keep moving, however I have a problem trying to stand up without my leg giving out on me or after a couple of steps.?.
8. Heel slides ( don't like them) 12 x1 per day in the evening before bed... I get better results from sitting in my chair and doing it there with the aid of my scarf 20 x3 per day.
I do side and front lifts 25 x3 per day. Often I get cramping in my muscles in the beginning of exercises!
PT.. First thing is measuring by force.
Bike 10 min.
Leg pushing press 10min.
Marching with poles about 30min

 

[Josephine]

1. 6

That's high even for 5 weeks out.

2. Oxycodone 5mg I've been spacing 6 to 7hrs apart during the day. About 5hrs at night.

Hmm you could do with more than that. Aren't you prescribed 1-2 tablets 4-6 hours apart?

3. I say moderate to huge

You are aware that swelling is a form of pain? So is that included in your pain score?

4. ROM 107 with PT pushing my leg back. Straightness: PT said it was good when I asked but focused more on flexion.

1. you should never ever allow anyone to push on your leg. Very bad.

5. Icing in mornings and evening
6. Elevating when icing and after cramps/spasms

I did ask how long you iced/elevated for and how often?

7. Mornings I get my self and daughter breakfast and do some dishes/cleaning if my knee allows. Otherwise I get up to walk around apartment to keep moving, however I have a problem trying to stand up without my leg giving out on me or after a couple of steps.

Don't overdo the walking around. You are still only 5 weeks out.


Heel slides (don't like them) 12 x1 per day in the evening before bed... I get better results from sitting in my chair and doing it there with the aid of my scarf 20 x3 per day - then don't do them! They're not necessary anyway.
I do side and front lifts 25 x3 per day. Often I get cramping in my muscles in the beginning of exercises!- front lifts - also known as straight leg raises - good thing is, once you can do them you don't need to do them any more. As for the side lifts, they are not appropriate for a knee! Anyway, there are far too many reps


PT.. First thing is measuring by force - on no account allow your PT to apply force to your leg. The only measurement that counts is that which you can do on your own strength. So you flexion is most likely 100.
Bike 10 min - and is this fairly comfortable for you? If not, cut it back to 5 mins
Leg pushing press 10min - same here - NO pushing
Marching with poles about 30min - also NO marching!

In summary, you are doing far too much over all and I suspect you have been since day one! One thing many of us on here have discovered is that you don't need all this exercising to get a decent outcome. It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal.

One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

Did read the recovery articles left for you in post #23? If not, you should go now and read them. I suspect you haven't read them as the answers you gave me all tell me that. Two of the most important are these BoneSmart philosophy for sensible post op therapy and Activity progression for TKRs.

Another thing I suggest you do is to quit all the PT sessions. They are not good for you, in fact causing you far more harm than good. So here's another article Saying no to therapy - am I allowed to? All the best!

 

[Ajmdd6]

Thank you for sharing your expertise/advice!!
I canceled my PT last Thursday and was going to call tomorrow/Monday to set up this coming week's schedule, however after reading your post aloud to my husband while he was iron his wrk clothes, he and I (both) agree that I will be doing my recovery on my OWN..... It's funny, I have an appointment with my primary care physician tomorrow PM to get referal to see my OS regarding possible TKR on right knee from taking SO much stress. So happy I found you guys Bonesmart.org!!!!! Life changing and saving advice.

 

[Ajmdd6]

The back of my knee has been having an issue regarding it sticking with accompanying pain when going from either sitting to standing or walking position. I don't know how or why this has been happening and thought it would be temporary but it seems to be happening day and night!! Any one else going through this? 5wks Post-op TKR tomorrow Aug 15th

 

[Josephine]

@Ajmdd6, this post was in someone else's recovery thread which means if we gave you answers there, we would derail that other member's thread.

You can see this is your thread because your post is grey and you have a "Thread Starter" label under your name. So please post all your own recovery comments and questions here, okay?