TKR Tried rest and elevation but knee gets stiffer with inactivity

[mytrose43]

Hi Pattycake65 I am a few days after you I had mine done on 6/17/15 I have been dealing with pain issues since the beggining but i finally got that taken care of on 7/16 I have only had home pt so far they made my first in house pt almost 2 weeks after the Dr ordered it so between pain and no pt I have been doing as much as i can on my own I was very lucky my leg was straight and flat from the beggining but my bending has been a issue so i have worked on that I have no ideas what the measurements are I was at 96 on the cpm machine when they came and got that I can sit on a chair r couch and bend my leg almost all the way back to touch it but it hurts I bought a big ball and have been using that laying down and rolling it with my knee and get pretty good bend from that I also keep ice on it as often as possible and elevate i did notice that if i did to much the next day is quite painful and stiff.Sleep is a luxury lol I tried melitonan and it seems to help a bit as far as falling asleep staying asleep is another story...I wish you the best of luck

 

[referee54]

i did notice that if i did to much the next day is quite painful and stiff

yep---we all have learned that what we do to become members of the ODIC.

There were times that I knew that I would pay for it the next day---but those days slowly, but surely, come to an end.

Sleep is a luxury lol I tried melitonan and it seems to help a bit as far as falling asleep staying asleep is another story

I tried benadryl, melatonin, Tylenol PM---and nothing worked. I finally gave in to my OS, and he wrote me a script for Ambien, and that I took for only ten nights, and it got my sleep pattern back on track.

 

[Josephine]

I also have to do all the housecleaning,laundry and cooking

Yes, we have a mantra here - and I'll leave you the recovery articles again while I'm at it!

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Josephine]

To save you searching, here are the questions again

I'm going to ask you some questions and it would be very helpful if you would answer EVERY 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 compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you detail it like this
At physio or PT
First description - 5 reps x 2 sets
Second description - 10 reps x 2 sets

At home
First description - 5 reps x 2 sets 3 session a day
Second description - 10 reps x 2 sets 3 sessions a day

 

[pattycake65]

You are all so helpful. I never thought of freezing coolwhip containers and bottles of water. Excellent idea. I don't have much of a support system,so having someone help me,has been a bit limited. I have a "friend" that will help me clean but she charges me 20.00 an hour and just don't have extra right now. Sometimes I feel very sad and alone,but it's my own fault,as I have isolated myself,due to depression. I had a neighbor just watch me,as I struggled to drag the garbage out.I would help someone in need in a heartbeat. Just don't get it.Anyhow,my question today,is when I sit to rest and ice and elevate for more than 20 minutes,my leg gets so stiff,I can barely walk. Is it normal for a knee to get stiff that fast? Brian,I asked my pt therapist about pushing down on my quad to stretch it and she told me not to do that. Anyway,I will leave on a positive note. I was out of water and couldn't carry the heavy gallons and just had a man from the grocery store bring it to me and didn't charge the delivery fee or 10% of the order. Yeah!!Have a great day,Susan.

 

[pattycake65]

1.Pain level-Varies,Stays between a 4 and 10. 10 when I have been on my feet too long and first thing in morning and end of day,it is a 10 and when I sit more than 20 minutes without ice,a 10 when getting up to walk.
2.Pain meds-Roxicodone 10 mg.every 4 hours,usually 3 x a day and ibuprophen. I was taking norco,but went back to roxicodone due to more pain
3.Icing-1-2x a day. 45 minutes with ice machine
4.Elevation-Just started elevation with icing,as my dr didn't tell me to do this,only put a thin pillow under calf
5.ROM-Not sure. My therapist told me I was at a 16 on extension and I am at a 95 on my cpm machine.
6. Activity level-I have been vacumning,mopping,going up and down stairs(one legged) making bed,minimal cooking,as it hurts to stand unattended for long.Feeding cat,and scooping out liter pan every day.
7.PT home-Ankle pumps-10 reps x 1-2 sessions per day
Quad sets-10 reps x 1 session
Hamstring sets-10 reps x 2 sessions per day
Heel slide-whenever I am sitting in a chair
Short ARC quads-10 reps x 2 sessions per day
Straight leg raise-10 reps x 2 sessions per day
Chair exercises, Long ARC quad- 10 reps x 2 sessions per day
Active assisitive knee flexion-10 reps x 1 session per day(this one hurts)
Towel used to pull up on toes and hold,tightening calf.
CPM machine- 1 -2 hours a day.
Counter exercise-mild squats,side leg extension and kick back(i have a very hard time with this as it is painful)

 

[kneeper]

Josephine will answer, but I would just chime in to say you can ice a lot more than you have been. If you get really stiff quickly while icing it's ok to move your leg in between. I was never totally still for the whole time I was icing.

Also I'd lay off the vacuuming. I found that one of the toughest things early on.

 

[Josephine]

1. Pain level Varies. Stays between a 4 and 10. When I have been on my feet too long and first thing in morning and end of day, it is a 10 and when I sit more than 20 minutes without ice, a 10 when getting up to walk.

hmmm ...

2. Pain meds - Roxicodone 10 mg. every 4 hours, usually 3 x a day and ibuprofen. I was taking norco, but went back to roxicodone due to more pain

That's not what you are prescribed. What is actually written on the label? It most likely says something like 1-2 tablets every 4-6 hours.

3. Icing 1-2x a day, 45 minutes with ice machine

Ice more!

4. Elevation Just started elevation with icing,as my dr didn't tell me to do this,only put a thin pillow under calf

You haven't said how long for and how often

5.ROM Not sure. My therapist told me I was at a 16 on extension and I am at a 95 on my cpm machine.

You're being held back by all teh exercising you are doing. It's causing pain and swelling which is stopping your knee from bending and going straight. More about that later.

6. Activity level I have been vacuuming, mopping, going up and down stairs (one legged) making bed, minimal cooking as it hurts to stand unattended for long. Feeding cat,and scooping out litter pan every day.

Stop the vacuuming and the bed making - just pull the sheets straight, that will do for now.

My comments in bold
PT home
Ankle pumps 10 reps x 1-2 sessions per day - you don't really need to do these any more, they're only for anti-clot
Quad sets 10 reps x 1 session - these are very hard on your knee. I suggest you stop them
Hamstring sets 10 reps x 2 sessions per day - these are very hard on your knee. I suggest you stop them
Heel slide whenever I am sitting in a chair - read this article Heel slides and how to do them
Short ARC quads 10 reps x 2 sessions per day - these are very hard on your knee. I suggest you stop them
Straight leg raise 10 reps x 2 sessions per day - these are very hard on your knee. I suggest you stop them

Chair exercises
Long ARC quad 10 reps x 2 sessions per day - these are very hard on your knee. I suggest you stop them
Active assistive knee flexion 10 reps x 1 session per day (this one hurts) - then don't do them! They are very hard on your knee anyway. I suggest you stop them
Towel used to pull up on toes and hold, tightening calf - these are very hard on your knee. I suggest you stop them
CPM machine 1-2 hours a day - CPM is not really useful at 7 weeks - no point in using it
Counter exercise mild squats - these are very hard on your knee. I suggest you stop them
side leg extension - these are very hard on your knee. I suggest you stop them
kick back (I have a very hard time with this as it is painful) - then don't do them! They are very hard on your knee anyway. I suggest you stop them

So in essence, stop all your exercises. They are doing you more harm than good. Just take walks around the house, strictly on an 'as needed' basis - bathroom, kitchen, all that sort of thing. Maybe plus a short walk around the block once a day.

If you want reassurance about this, just read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

Hate to ask this but - you do know how to access an article using the links don't you? Just want to make sure as so many of my posts carry links to articles. And you have read all the articles I left you earlier, haven't you?

 

[MidwestTKR]

Hi Pattycake,

How are you feeling?? I hope better. Please post an update when you can.

 

[pattycake65]

It is hard sitting at the computer. I called the dr and he said the sharp pain I was getting was normal and could last up to a year! I told him I know my own body and something isn't right on the side of my knee and reminded him how hard I hit the side of my knee on the cpm machine in the hospital.I asked for an mri and he said the picture would look scattered. He then said he could order a ct but I don't think it would show if I had any kind of tear,just bone. I feel as if the surgeon is not validating my pain. I said I didn't expect at 7 weeks to still need pain meds every 4 hours! I said"Is that normal? He said MOST folks are taking tylenol by now but each recovery is different and I need to be patient.Jo,I did read your story and am so confused as they have me so scared about losing motion in my leg. I wish I could sit here longer to read. I am also dealing with springtails in my house,so I have to change my linens and wash quite a bit.I am trying to be strong but pain,bugs,and frustration are getting to me. Also,depression.p.s. My meds say to take one every 6 hours as needed but I have been taking one every 4 hours because I am in too much pain. My dr won't adjust them. I usually ice and elevate once a day. Carrying that heavy ice machine is hard and that is why I only use it once a day.I am still using my walker,as I limp without it and walking around the block,would hurt too much. The pt told me I am walking wrong as I wing my left leg out and keep it too stiff. He thinks it has become a habit,but it is due to stiffening and pain.Wish I could post more positive things. Just worn out.

 

[Pumpkin]

Carrying that heavy ice machine is hard and that is why I only use it once a day.

I left my ice machine next to my bed, and went to it when I wanted ice. I also had cold packs in the freezer that I used in other areas of the house, you can purchase them on Amazon, so you won't need to go to the store.
For ROM try these, Heel slides and how to do them , Extension: exercises for improvement
Can you ask your OS for break through pain medications, my OS gave me Tramadol. You can also check with your GP.
Keep using your walker until your gait is normal, keeps you from developing bad habits.
I injured my TKR at 6 weeks and understand your frustration with out having any answers about what is going on. I suspect you badly bruised your knee, it will take awhile to heal. The OS should be checking your ligament stability. When reporting your pain levels, add 2 to your number, eq 5 = 7, because if you say a 5, for the OS or PT a 5 is a 3.

 

[pattycake65]

Dear Jo,I have done a lot of reading in the library and am happy to learn about my tkr. I tried doing the heel slides that are shown,but my knee hurts way too much when I bend my knee to that extent. I am so miserable and pain is wearing me down. I almost think my knee doesn't look straight.My leg(knee) turns in when I try to walk. I am 7 weeks post op this Monday. What would cause sharp pain on the outside of my knee? I feel random sharp pain there,sometimes just sitting. I ask the dr about getting an mri but he said it would look scattered. He said he would order a ct.Will that show a ligament tear or other problems? What about an ultrasound? He said they are only used for blood clots.He told me sharp pains are normal.NORMAL? I can't even stand very long without terrible pain. Please advise. My daughter and granddaughter are both getting married in October,so it means 2 long trips,one in CA,the other in OH. Sure hope I will be able to make it.

 

[Pumpkin]

pattycake65,
I will tag @Josephine for you so she will see your posts.

 

[Josephine]

My meds say to take one every 6 hours as needed but I have been taking one every 4 hours because I am in too much pain. My dr won't adjust them. I said I didn't expect at 7 weeks to still need pain meds every 4 hours! I said "Is that normal? He said MOST folks are taking Tylenol by now but each recovery is different and I need to be patient.

If your surgeon won't help you, see if your primary care doctor will oblige. Some will, some won't but it's always worth asking. But your surgeon is totally wrong about "most folk" being only on Tylenol at 7 weeks - I know of NO member here that was so.

Jo,I did read your story and am so confused as they have me so scared about losing motion in my leg

That's another myth. You will be much more likely to lose ROM if you do so much exercising than if you don't. Trust me, I've proved it twice. And much of your pain is purely and simply due to doing too much - exercising, house work, whatever. That's what will rob you of your range of movement.

I usually ice and elevate once a day. Carrying that heavy ice machine is hard and that is why I only use it once a day

Why do you need to carry it around? I don't understand that. Better that you get some gel packs for the freezer and use them than not ice more than once a day. It's absolutely essential that you do so at least 5 times a day for at least an hour. If you're being deprived of adequate pain meds, ice is the next best thing to control pain.

I tried doing the heel slides that are shown,but my knee hurts way too much when I bend my knee to that extent

Then don't do them! CErtianly don't do them to the extent that they cause any pain at all. That's not the intention.

What would cause sharp pain on the outside of my knee?

Doing too much - exercising, house work, whatever. If you want the pain to subside and you're not getting enough pain meds, ice and elevate more and do less. There's no other answer.

He told me sharp pains are normal.NORMAL?

Thye are when you're doing too much!

 

[kneeper]

Yes, overdoing can cause sharp pains in a variety of places. Also random sharp pains are fairly normal.
"electrical" sharp pains can also be normal as the nerves start healing.

 

[PolarBear60]

Those "electrical" sharp pains can be surprising. The prickly electric aka are interesting as well. Such an adventure TKR has been!


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[pattycake65]

I had a CT done to see if something is wrong with my knee and the only thing it showed was quad calsification,whatever that means. My primary dr changed my pain meds and gave me valium for spasms but I still hurt. I broke down at pt the other day,as I was struggling,with pain,and a woman around my age,still had steri strips on her knee,and was walking only with a cane,doing deep knee bends and saying she has no pain.I was happy for her,but made me sad,as I think this operation is making me disabled.He asked if the pain was better then before the surgery,and it is 10x worse. I think I am one of the few that has stiff leg and I feel as if I am stuck with this. The pain is disabling.The xray tech said something about getting a bone scan with dye. My surgeon doesn't care. am I stuck? I have to travel out of state for 2 weddings(my daughter and grand-daughter) in 2 months and I am scared I won't be able to travel. I drove 20 miles and I hurt so bad afterwards it wasn't worth it. Please advise.

 

[pattycake65]

I have read over the many post and threads about recovery and I think I overdo it but have no choice. I live alone with a cat and do not have a very big social circle and the friend I have is disabled herself. Also,I can't afford homecare. I have to take out garbage,do laundry,change my linens,scoop liter box,etc. I can only do these in small increments,as my knee is way too painful and have to sit,elevate and ice. I tried to sit all weekend .ice and elevate,and by Monday,I could barely walk,my leg was so stiff and painful. I can understand your theory about exercise,but also see the other side. I don't know what to do anymore,as the severe pain is still strong and stiffness. Guess live with it,but pain has a way of depleating any energy one might have and sure has affected my mood.

 

[Pumpkin]

My question would be are you still taking any pain medication? Stiffness is also pain, and needs to be medicated.
Ask your PT about lymphatic massage for your swelling, or you can look in the yellow pages.
Sounds like you need to find the right balance between activity and Rest, Ice, Elevate, and Medicate on schedule as prescribed.

 

[kneeper]

Small increments is good. Also good is thinking about what can wait. Scooping litter is fairly essential, but can you stretch out the changing of the sheets a bit? How can you minimize trips up and down stairs? Don't do more than one housekeeping activity a day and have a day "off" in between.
When you do laundry, you can fold it sitting down then rest. Then put it away later. Or even leave some things sitting out. Who's to care if it's just you at home?
Use paper plates so no dishes to wash.

Gentle motions for to keep the knee moving are fine to combat stiffness but doing all your housekeeping and being on your feet a lot will add to it.

I also second the question/suggestion about pain meds. they greatly helped my stiffness.