MUA Well, I am confused<

[zab]

How are you doing overall @9 of 11 ? You are a day behind me however I had a PKR, in my 2nd week back at work just feel a bit frustrated with progress and sleep has suddenly started to avoid me.

 

[Lindylee]

Sorry to hear about your recent bereavement. Take it easy and be kind to yourself

 

[Celle]

I'm sorry to read that a loved relative died, @9 of 11 .

 

[9 of 11]

1) pain goes from a 1 up to 6 depending on what my activities are

2)Tylenol 1000mg / 3 to 4 x /day

3) Moderate mostly but certainly can increase after activity

4)105 flex and 9 extension

5) icing for an hour or more-4 to 5x/day

6) it’s always elevated when I am sitting , probably 8 hours daily

7)walk around the house, do small chores such as dishes, wipe down bathroom surfaces , pick up, do some laundry if my family brings it downstairs

8)home
Heel slides x 10x 5/day
Leg lifts x10 x3
Quad strengthening x10x 5
Heel raises x 10x 2
Knee flexion 10x 2
Hip-knee adduction x 10 x 2 (using a pillow between knees

Out pt PT
Bike 7 min increasing resistance
Quad strengthening machine with wts. 25
Heel to toe lifts 20
Leg lift 10
Usually 10 the first 4 I do at home as well

PT does mix it up at times but this the basic plan

 

[Josephine]

1) pain goes from a 1 up to 6 depending on what my activities are

3) Moderate mostly but certainly can increase after activity

If you have moderate swelling, that adds about 4 points to your pain score. Therefore raising it to 5-10!

2) Tylenol 1000mg 3 4x a day

With your pain score (remember 5-10, not 1-6) you first need to take Tylenol 4 times a day. However, since you are only 4 weeks out, you really need to be taking something else as well. Do you have any prescription meds you can take?

(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)105 flex and 9 extension

I assume the 9 extension means you cannot completely straighten your knee? So that would make your ROM 105/+9. But no need to fret about this. It will ease out over time. Could take another 6-8 weeks to get your extension put right and your flexion will improve during this time as well.

5) icing for an hour or more-4 to 5x/day

Good

6) it’s always elevated when I am sitting , probably 8 hours daily

Good

7)walk around the house, do small chores such as dishes, wipe down bathroom surfaces , pick up, do some laundry if my family brings it downstairs

Okay


home - did you read the Recovery Guidelines in second post of this thread? All the articles I suggest in here are in there too
Heel slides x 10x x5 - that's too much. read this Heel slides and how to do them properly
Leg lifts x10 x3 - tip: once you can do these you don't need to do them any more!
Quad strengthening x10 x5 - not necessary at this stage
Heel raises x10 x2 - a pointless exercise!
Knee flexion x10 x2 - your flexion is fine, you don't need to do these
Hip-knee adduction x 10 x 2 using a pillow between knees - this isn't a knee exercise, it's for hips!

PT
Bike 7 min increasing resistance - okay
Quad strengthening machine with weights x25 - never ever use a) a machine or b) weights. Both can cause muscle strain and pain
Heel to toe lifts x20 - as above, a pointless exercise!
Leg lift x10 Usually x10 the first 4 I do at home as well - same as above, you don't need these!

PT does mix it up at times but this the basic plan

In summary:
1. adjust your pain meds as suggested
2. note exercises (all of them!) that have been crossed out. This is because they are unnecessary and likely to cause you harm, pain and stiffness.
3. read this (was in your Recovery Guidelines) BoneSmart philosophy for sensible post op therapy
4. For your advice, there are many, many members here who did their TKR recovery very well but did NO exercises at all. I was one of them. You can read my recovery thread from the link in my signature. We all had excellent outcomes. I suggest you do the same.
5. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[9 of 11]

Thank you for the reply, I would love a pain med to take before bed but in the states, our docs are uber sensitive about scripts, my hope is that I can get some Tramadol at my OS visit coming up. I think my desire to return to work makes me want to push things. Since I do home prenatal -postpartum-well baby visits in the home and I carry all my equipment and go up multiple steps in a day, OS is not ready to release me. I also do supervise other staff, so some in office time is required. Not very patient person and the lack of control does drive me batty.

 

[Celle]

Complete recovery from a knee replacement takes a full year. Of course, you'll be able to do most things by about 3 months, but no matter how much you want to, you can't make recovery go faster. Doing too much, too soon, will have a negative impact that could slow down your recovery.

Your knee is in charge. It knows what it's doing. Try to work with it, not dictate how you think it should be.
Where are you in recovery?? (TKR)

Your surgeon is right. It's much too soon to be going back to a job that is physically demanding.

 

[9 of 11]

Well, I do believe 4 weeks is some kind of turning point. Sleeping at night well, only using a cane when I am going to be walking long distances and certainly not at home. Found a ankle support amazing help for the ankle tendon giving me fits with activity. Still walk with a limp but that’s lessening each day. I may get back to work by tax day! ( April 15th)

 

[Lindylee]

I found 4 weeks a turning point too, but then overdid it, so be careful and don't do the same, but you'll probably be much more sensible. Great to hear things are improving for you.

 

[9 of 11]

Spent the morning with my two nieces, both are OTs and they are identical twins. They did some magic manipulating on my knee, back and lower leg, increased my flexion and extension in an hour, painlessly. Unfortunately the only PT in my area that does the same treatment is their sister. They are heading back to their own homes after supporting their mom through the funeral and follow up. Things continue the same , crossing my fingers that things continue steady on

 

[9 of 11]

Well saw the OS today, thrilled with flexion but concerned about extension which is active ROM at 9, so am getting a JAZ (? Spelling) splint fitted and started next week. Not using a cane anymore but still have bit of a limp. Did renew pain meds so that should help using splint. Allowed to drive and work in the office up to 2 days a week so going forward mostly

 

[Celle]

It's still only just over a month since you had your TKR.
Much too early to be worrying about your extension. It often takes longer to achieve good extension than it does to achieve flexion, but you will get there.

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

Try the JAS splint by all means, but don't use it to the point of pain. It will take time and gentle treatment to stretch those big muscles and tendons at the back of your knee. Don't torture yourself.

 

[9 of 11]

Thanks for the response Celle. So had the most pleasant PT session today, not sure if it was me physically getting back to normal, opening day for my city’s baseball team, or just not having the levels of pain that I did. Was educated more about the JAS splint and am actually rather excited about using it, my flexion is almost 115 at 5 weeks so I am thinking things are improving. I go back to work in the office next week and believe it or not we have a recliner and a comfy overstuffed chair and ottoman in our offices (my nurses do visits in some pretty intense homes and need to relax ) so I am set and won’t be overdoing at work as only am approved to do up to two days a week.

 

[9 of 11]

I had a concern not seen here before. I am on blood thinners related to an artificial valve and monitor my own INRs with a home machine. I have lost 25 lbs since surgery on February 26. Between the increase exercise and the decrease appetite, it’s been quite easy. Anyway, my INR is quite high. Unfortunately I didn’t know this before a rather eager new PT went to town on my knee, she was stopped when it was painful. But the damage was done, my knee is bruised and sore. Told the OS that I am done with this aggressive passive ROM and now have to contend with this mess during Holy Week. Am working at the office but literally don’t do much but elevate and ice while doing things from my chair or my office recliner. Just a warning

 

[jboles]

I’m sorry you’re having to deal with this. An aggressive PT can hurt you before you are able to stop them. Been there... hopefully you can rest and ice your knee and give it a chance to heal.

 

[FCBayern]

Unfortunately I didn’t know this before a rather eager new PT went to town on my knee, she was stopped when it was painful.

If we could just take a base ball bat to PT's that do this to us. When I didn't have an ACL and tore my meniscus that was shoved up behind my knee cap the ER doctor grabbed my leg and tried to straiten in out. I screamed and kicked him with my good leg, something I relish to this day. He sent me home saying I might have sprained my knee. When I went to my primary physician the next day he said ER doctors are there because they aren't good enough for regular practice.

 

[9 of 11]

Seriously, if I hear again that I may have to experience some discomfort in PT to gain my extension, I swear I am going to blow a fuse. No, pushing my knee down while you have some one measure and counting to 30 is pain, you know pain, no discomfort pain. And don’t threaten me with a MUA, because at least I wouldn’t feel it while they are doing the same thing that you do. I love my PT but hate the training here in the US. It’s like they don’t think I am bummed out that I can’t return to work with my babies and moms, walk around the grocery without wondering how long until I just get what’s in the cart, freaking clean my bathroom like I really want to. Sorry for the whiny post but truly am tired of being treated like I sit at home and eat bonbons all day instead of “working hard”.

 

[Jockette]

I agree with everything you said.

Do not let them push down on your knee. It is the wrong thing to do. Not only is that practice out of date, it was never appropriate.

Extension can take a while to return, just plain walking (but not to excess) is very good for encouraging it.

 

[Celle]

No, pushing my knee down while you have some one measure and counting to 30 is pain, you know pain, no discomfort pain. And don’t threaten me with a MUA, because at least I wouldn’t feel it while they are doing the same thing that you do.

For what it's worth, an MUA is almost never done to help with extension. Your flexion is OK, so you can tell that PT that she's talking rubbish.

Can I suggest that you stop going to PT for a while? You've been going for long enough to know which exercises you need to do and which you can forget, because your activities of daily living will be sufficient.
All this emphasis on ROM is unnecessary. ROM can continue to improve for at least a year post-op. It's only the PTs that treat it like a race. You don't need to.

You can help to increase your extension by lengthening your stride as you walk. That will stretch the muscles and tendons at the back of your leg:

Extension: how to estimate it and ways to improve it

 

[traceys]

Seriously, if I hear again that I may have to experience some discomfort in PT to gain my extension, I swear I am going to blow a fuse.”

And that is the quote that makes up 90% of all posts on here.

My journey started that way by going at it hard but quickly became one where my Diva-Knee made her opinions very well known and I am now make more gains the more passive we go.
Discomfort is one thing. Pain is totally different. Sadly few people in the field get that.


You got a long journey ahead of you. You didn’t get here over night and you won’t be over it overnight. Celebrate the victories. They keep you going