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[PARTIAL KR] Tightness to extreme!<

Highridge

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Hi. This is the first time I am posting. I had a partial knee replacement on my left knee on April
3 of this year while staying in Florida. I am into week 5 and still have swelling and lots of tightness. Started with physical therapy while in Florida a week after surgery. It was brutal with them telling me no pain no gain. Many times I had to tell her to let off her pushing on injured knee. It got so bad that I quit going and was doing exercise at home. I returned to my home in PA three weeks after surgery.

Started going to physical therapist here. He has the same frame of mind. No pain no gain. Today I had to really scream at him because I couldn’t take the pain. I don’t know what to do. I have all the tools and exercise to do at my home. But my knee is so tight it hardly bends after 5 weeks. I really have no pain unless doing exercise to extreme. I am worried there is something wrong.
 

sistersinhim

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What is wrong is that you've inflamed an already traumatized knee with all those painful exercises. We have found that recovery from this surgery is much better is the knee is treated very gently. Your knee isn't out of shape, it is injured. It needs time to heal from all the trauma it has gone through. The following are our basic guidelines and should help get you started. As you read more on other members recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

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
5. Here is a week-by-week guide for 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.
 

Celle

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Hello @Highridge - and :welome:

First of all, "No pain, no gain" is the completely wrong approach to recovery from a knee replacement. It irritates and upsets all your knee tissues, making them hot and inflamed, which causes more pain, swelling and tightness.
We prefer, "No pain, more gain."
Myth busting: no pain, no gain

Your knee is wounded not lazy or unfit, and it doesn't need PT boot camp. So my first advice is to quit PT and give your poor knee a chance to calm down and start to heal. Aggressive PT therapy is bad PT therapy. It does more harm than good.

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.

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. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Instead of spending time at PT, spend it resting, icing, and elevating your knee, to try to help it calm down and reduce the swelling. Your knee will get all the exercise it needs at this early stage, just with your normal activities of daily living. Just walking is the best exercise of all,and you'll be doing that.

Don't even worry about ROM. It will come, as your knee settles down. Since it can improve for a yer or more, you have all the time in the world to achieve good flexion and extension.

sistersinhim has left some post-op reading for you, with lots of useful and informative articles. Be sure to read the ones about icing, elevation, and activity progression.
 

Josephine

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And I'll give you another link to look into Saying no to therapy - am I allowed to?

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?
 
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Highridge

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Yes. Sorry it took so long. I’m new to this posting. It’s been a week since I quit going to pt. Do exercise at home. But even with normal workout and walking knee is still swelling up. Feels better in morning after having leg elavated all night. But as soon as I start normal routine I can feel it getting tight. Would compression socks help. Thanks for all the help. This is really getting me depressed.
 

bill 3/20

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I had a partial 2 years ago. Like you, I had swelling and pain at 5 weeks. My physical therapist gave me light exercise and light massage to reduce the swelling. I think the exercise and massage helped. I don't think physical therapy is a bad idea, but like everyone here says, stressing inflamed tissue won't make the inflammation go away. My new knee isn't perfect, but it works pretty well. I'm glad I did it. Hang in there.
 
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Highridge

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Thanks,
At this point I need some good news.
 

Celle

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It’s been a week since I quit going to pt. Do exercise at home. But even with normal workout and walking knee is still swelling up. Feels better in morning after having leg elevated all night. But as soon as I start normal routine I can feel it getting tight.
The good news is that, given time, everything is going to work out all right.

This early in recovery, it's perfectly normal for your knee to swell up. You'll probably find that it swells after activity for several months yet.

It takes a full year for complete recovery after a knee replacement and you're only just over 6 weeks into that recovery. It's not just your bones that have to heal, but all the soft tissues around your knee joint as well. They all had a pretty rough time during the surgery.

I think you're expecting too much, too soon of your knee. This isn't the sort of recovery you can bounce back from in 6 weeks or so. It's a long, slow recovery period.
Where are you in recovery?? (TKR)
Maybe you were told that recovery from a partial is quicker than recovery from a total knee replacement? Unfortunately, that's usually not the case. Most people find that the recoveries are very similar.

I see that, although you've taken a week off PT, you're still doing exercises at home. That's really not necessary. Just let walking around and your normal activities of daily living be your exercise.

Have you checked your normal routine against what we suggest you should be doing in this article?
Activity progression for TKRs
It's still important to not do too much in your normal activities.
 
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Highridge

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Thank you for all your kind words and insight. I have never been through anything like this. And everything I’ve been told before about easy recovery sure isn’t true. I am just glad I found this forum.
 

sistersinhim

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We women say that this recovery is worse than giving birth. I know you can't relate to that, but just know that it hurts!
 
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Highridge

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I have been reading a lot of the post. Just to see how they pertain to me. I have quit pt but just normal walking and my knee still swells. I can’t seem to get rid of the ugly zipper feeling across my knee that restricts my rom. Is this scar tissue? I’m worried to death about having to have a manipulation. I’ve read so many nitemare stories about scar tissue. And that’s exactly what mine feels like. When I try to get more movement it feels like Velcro that won’t pull apart. Am I right?? I’m still icing and elevating every day 4-5 times. Tuesday will be 8 weeks. I’m thinking about calling my dr in Florida.
 

Jockette

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It is very common to swell with even just normal walkkng, at 8 weeks post op. This surgery is rough and causes a lot of trauma to the knee/leg, which is why it takes an average of a full year (52 weeks) for complete healing.

There are 3 stages to healing in this recovery:
first stage: 1-3 months
second stage: 4-6 months
third stage: 6-12 months

At 2 months you are still in the first stage.

You also had quite a bit of very aggressive PT, plus travel from Florida to Pennsylvania at only 3 weeks post op.

I really think your knee is just still very upset from all it’s been through and you need to cut back your activity and any exercises that you are doing, and just do your normal daily activities and give your knee a chance to settle down.

However, you can always check with your doctor to be sure there isn’t a problem.
I can’t seem to get rid of the ugly zipper feeling across my knee that restricts my rom. Is this scar tissue? I’m worried to death about having to have a manipulation.
My knee felt just like this at 8 weeks and no one ever mentioned MUA to me.
Yes. Sorry it took so long. I’m new to this posting
I think this is your answer to @Josephine when she asked you if she could give you her questions to answer, so she could advise you, is that correct?
 

Josephine

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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?
ai63.tinypic.com_eta39s.jpg


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.
 
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Highridge

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1. Pain 1-5 some throbbing at night

2. oxy cod/acetaminophen 5-325 mg twice a day

3. Moderate

4. 90-92

5. icing 4-5 times a day 30 min

6. elevating all night 3-4 times through day
All evening watching TV.

7. help with housework, cooking, Shopping , walking Driving

8. have stopped all PT
foot slides x20
quad sets x20
hamstring sets x20
Hamstring stretch x20
also sitting on my desk and letting gravity straighten my knee. Some once a day some twice.
 

Josephine

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I need some extra detail please

Ha! you fell into the usual trap here in thinking that ROM applies only to flexion. It doesn't. Range of Motion means BOTH flexion AND extension which I explained in the question. And the extension number is equally as important as the flexion.

QUOTE="Highridge, post: 1306793, member: 33272"]7. help with housework[/QUOTE]
What does that mean exactly?
 
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Highridge

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If I’m reading my gauge right it’s 170-10
 

Josephine

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1. Pain 1-5 some throbbing at night
Okay
3. Moderate swelling
Moderate swelling adds about 4 points to your pain score which makes it 9!
2. oxy cod/acetaminophen 5-325 mg twice a day
As I thought - under-medicated. If you are getting pain at night then you need to take the pain meds as prescribed. After all, you are only 8 weeks out. I also suggest that you add in extra Tylenol to the rate of 1,000mg 3 times a day at 6hrly intervals.

I know the FDA has ruled that 3,000mg acetaminophen is a safe maximum but that would be assuming that the patient is taking another medication that also contained it and thereby inadvertently take an overdose. Assuming that this is not the case, the maximum safe dosage per 24hrs 4,000mgs.
4. 170-10
That 10 confuses me. It's unusual for a person to have -10 degrees of extension and would be worrying if you had +10 degrees as that is not a flat knee! Which is it?
5. icing 4-5 times a day 30 min
You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
6. elevating all night 3-4 times through day
Are you elevating according to the guidelines in here Elevation: the do's and dont's
7. help with housework, cooking, Shopping , walking Driving
Okay


have stopped all PT - but you are still doing exercises and to me, that and PT are one and the same
foot slides x20 - your flexion is already excellent so you don't need to do these
quad sets x20 - or these
hamstring sets x20 - or these
Hamstring stretch x20 - or these
also sitting on my desk and letting gravity straighten my knee - and certainly not this! If this is for extension, this is not the way to improve it. Just time and walking (moderately) will deal with that.
 
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Highridge

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Must be 170. Yes I’m elevating with the guidelines. And you think my rom at 90 92 at 8 weeks is ok?I was doing the desk thing because it’s the only way I can get flexion of 90 easily.
 

kneeper

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My OS' opinion seemed to be that once I hit 90 it would just continue to improve naturally. 90 seems to be the "holy grail" ;) And actually it did continue to improve over the next month--mostly as the swelling came down. I did lots of ice and elevation and limited exercise.
 

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