TKR Thegoose2 on the go<

[thegoose2]

Good morning.
Today’s concern is swelling. I feel that my ability to bend my knee (flexion?) has been hugely reduced by swelling. I am being the model patient about elevation and icing, but how am I supposed to work on flexing when trying to bend the knee is more difficult (and painful) after having it straight and swollen.
I am finding the pain level surprising but doable. Finding everything else about this REALLY confusing.

 

[Jockette]

You are correct, the swelling is making it difficult to bend your knee. You are just days out of surgery. The swelling is going to take a while to settle down, probably weeks, if not more. This is normal. The surgery caused a lot of trauma and it will take your body a while to recover.

Treat your knee gently. Just bend slightly and gently. Short walks throughout the day is all your knee needs right now. It does not need “ X amounts of reps of exercises” this early.

Work on reducing the swelling by resting, elevating your leg, and icing (always putting a cloth beteeen the ice/gel pack and your skin)

Keep in mind it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for 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.

 

[sistersinhim]

I feel that my ability to bend my knee (flexion?) has been hugely reduced by swelling.

Swelling most definitely affects the amount of bend and extension your knee can have. There's no room inside it and you can't squish all that fluid out of the way. The only way to do that is to get that fluid out of there!

how am I supposed to work on flexing when trying to bend the knee is more difficult (and painful) after having it straight and swollen.

You don't. That bend will come naturally after the swelling goes down. Concentrate on that. Just walking around doing your daily activities is enough for now. When the swelling goes way down, then you can gently work on the ROM. Your main goal is to get the swelling down!

 

[Josephine]

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?

 

[thegoose2]

Of course. Thanks for your help.

 

[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.

 

[thegoose2]

1. Around 6

2. hydrocodone/acetaminophen 10/325mg 1 every 6 hours
Tramadol 50mg 1 every 6 hours as needed
Methocarbam 500mg 1x4 times a day as needed
I have taken the hydrocodone faithfully every 6 hours. Overlapped the Tramadol with it 3 times for better pain control. Took the muscle relaxant 3 times yesterday, once today.

3. Not quite huge but worse than moderate.

4. Guessing based on PT yesterday extension around 0-2, flexion was between 80-90 yesterday but I would be surprised if it was more than 45-ish today.

5. and 6. Constantly when I’m not up and around.

7. Activity level is low. I make 3 loops of the house every 90 minutes or so. I make my own coffee - that kind of chore. So mostly gentle walking.

8. All done once a day
hamstring stretch with strap, 3 times, hold 30 seconds, one set
sitting heel slides with strap, 20 times, hold 5 seconds, one set
quad sets, 15 times, hold 10 seconds, one set
straight leg raise, 10 times, hold 1 second, 2 sets
hip abduction, 10 times, hold 1 second, 2 sets
exercise ball floor bridge, 10 times, hold 2 seconds, 2 sets - I did not do this one
I do what I can without pushing it
While sitting I do ankle stretches and quad stretches.

First PT was yesterday. She taught me the above and had me run through my sets so I would know what to do at home. Felt good to move but sore later. Will be doing 3 sessions a week (Mon, Wed, Fri) but not sure what it will consist of yet.

Hope I covered what you need?!!
I sure do appreciate it.

 

[thegoose2]

More pt this morning. Leg remains quite swollen so I went from a flexion of 78 down to 70, but extension is 0. Not sure why I am having so much pain and swelling but my instructions for the afternoon are elevate and ice.
This is definitely not for the feint of heart!

 

[Josephine]

1. Around 6

That's about right for the first week out.

2. hydrocodone/acetaminophen 10/325mg 1 every 6 hours
Tramadol 50mg 1 every 6 hours as needed
Methocarbam 500mg 1x4 times a day as needed
I have taken the hydrocodone faithfully every 6 hours. Overlapped the Tramadol with it 3 times for better pain control. Took the muscle relaxant 3 times yesterday, once today.

I think you should be careful of using a muscle relaxant as a adjunct to pain medication.
I'm not quite sure how you mix the hydrocodone and Tramadol but it appears to work for you.

3. Not quite huge but worse than moderate.

Again, pretty standard for the first week.

4. Guessing based on PT yesterday extension around 0-2, flexion was between 80-90 yesterday but I would be surprised if it was more than 45-ish today.

All normal for the first week out. Don't get panicked about it. It might even get worse before it starts getting better!

5. and 6. Constantly when I’m not up and around.

Good but here's a good schedule to stick to: Ice and elevate for at least 40-60mins and more than 4 times a day.

7. Activity level is low. I make 3 loops of the house every 90 minutes or so. I make my own coffee - that kind of chore. So mostly gentle walking.

You're probably doing a bit too much. You could do those little walks even less, say just for bathroom and kitchen trips. No need to make a passion for it!

Exercises all done once a day
hamstring stretch with strap, 3 times, hold 30 seconds, one set - do not use straps, weights or anything similar. Leave that until at least 6 months time
sitting heel slides with strap, 20 times, hold 5 seconds, one set - again, no straps and rather follow this method (this was in your "Knee Recovery: Guidelines" in post #4 of this thread)
quad sets, 15 times, hold 10 seconds, one set - much too much. I suggest you stop doing these
straight leg raise, 10 times, hold 1 second, 2 sets - SLRs: once you can do them, you don't need to do them any more!
hip abduction, 10 times, hold 1 second, 2 sets - hip abductions are unnecessary for knees!
exercise ball floor bridge, 10 times, hold 2 seconds, 2 sets - I did not do this one - I'm glad because bridges are not necessary for knees!
While sitting I do ankle stretches and quad stretches - these are only necessary for when you are almost immobile in the first 2-3 days after surgery. Since you are clearly more active, there is no need to do them now.

First PT was yesterday. She taught me the above and had me run through my sets so I would know what to do at home. Felt good to move but sore later. Will be doing 3 sessions a week (Mon, Wed, Fri) but not sure what it will consist of yet - I suggest you quit your PT sessions completely. This kind of exercising is totally unnecessary for knees and often causes far more problems than it resolves.

More pt this morning. Leg remains quite swollen so I went from a flexion of 78 down to 70, but extension is 0. Not sure why I am having so much pain and swelling but my instructions for the afternoon are elevate and ice.

This proves 100% what I said before. Exercises will cause your leg to swell (more) and will therefore cause your ROM to lessen tremendously. I've seen it happen here far too many times.

You see, 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.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

BTW, I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

 

[thegoose2]

One week out and I feel I have finally made some forward movement.
Took the compression socks off and showered. Too ridiculous how exhausting it was. Put on knee high compression socks and am much more comfy.
Switched to a tramadol/XX Tylenol regimen. Will see if that works for me.
Feel like I have a bit more control over my muscles and that they actually will work one day! Was able to walk a very short distance without the walker. Will not make it a habit, but good to know.
Top part of dressing comes off today. Sounded easy when he told me but now that I look at it I have no idea which part is which. Will have the pt help me.
Not a good sleeping night but I am still feeling pretty upbeat. Not quite ready to do this again, but at least willing to consider it...

 

[thegoose2]

Just to let me know who is actually in charge, my knee has been on a rampage all morning.
Back to square one. But at least I know square two is out there and I will reach it.

 

[Jockette]

Knees that are upset can be very bossy!

 

[sistersinhim]

As long as we obey the knees, life will be easier!

 

[thegoose2]

Great progress in terms of movement and strength but have had a few bummer days. Stopped all meds (except blood thinner) and suffered/suffering GI issues. Have gone to Tylenol 4 once at night if I need it, and I do.
I have an annoying pain in the LF3 C and D area. Don’t know what it is but it’s wearing. Still low energy as well—showering is more than I can deal with.
I am scheduled for my right knee in a couple of weeks and right now the thought makes me sick. It has to be done but the idea of starting over and going through all of this again is more than I can deal with.
As I said, a few bummer days...

 

[Jockette]

You are in the dark, angry tissue stage. It will improve, try to hang in there.

I think the advantage of having both done close together is that once you are past this stage with the second, you’re done. As compared to doing them a year or more apart, you have really improved from the first one, then you are back to square one with the second.

I don’t know that first hand, but I think that’s how it might be.

 

[thegoose2]

@Jockette
Thank you for your reply. Having someone offer support makes such a big difference. I had hoped to get a few more responses that would give me a sense of been there, understand, it’s worth it... But I am grateful for any support!

 

[gecko]

Hi there @thegoose2 , I had my knees done two weeks apart and I know how you are feeling, I feared that I wouldn't have a leg to stand on as my first knee was still so new and oh so painful, I persevered and I am so glad I did, I did only 3 pt sessions in total I just accomplished what I was able to do and elevated and iced for most of the day.
I am not saying it was easy, it wasn't but with the help of all these wonderful dedicated bonesmartie friends, and all their advice and encouragement, I made it, still stiff and sore at times but no more bone on bone pain and no pain from my original injury, and looking forward to starting back at work next month
It seems an amazingly up hill battle you have to face but you know what just take tiny baby steps at a time and listen to your knee's , we are all here for you

 

[thegoose2]

@gecko
Thank you! Intellectually I agree and want to get this over and done with but emotionally I can’t seem to get there! I think I do pain fairly well and definitely am on the quicker side of recovery, but this whole experience is so much MORE than I anticipated.
I will be having a nerve block with knee 2 which I did not have with the first one, so I am hoping that helps. And I am determined to get my pain meds sorted out so that this time that all goes more smoothly. But right now I feel like a scaredy-cat.
Thanks for the reassurance. I will read this many times over the next two weeks!

 

[gecko]

@thegoose2 I was petrified, you are allowed to be a scaredy cat, theseTotal Knee Replacements are no walk in the park as you have already found out, I can see from your post that you are doing things a bit different for your next one and that is great, plus you know now some of what you can expect having had one already, but please know that no two knee's are the same, and they each have their own way of healing, crazy I know but it is true, but in the end no matter how it works out you will be recovered from them both and wont have to think about the pain any more, you are never alone on this journey we are here for you, and best of all we all GET IT!! we have all been there
Oh by the way there is NEVER a silly Question someone here some where will know exactly what you are talking about

 

[thegoose2]

@gecko Thank you!