MUA Well, I am confused<

[9 of 11]

I am so confused. I am just under 3 weeks post TKR. My understanding is to push through uncomfortable exercises and PT to optimize end outcome but that’s not consistent with what is on this forum.

I am currently at -15 extension and 95 flexion. The later was actually with my outpatient PT giving it quite a painful nudge that may have taken my breath away.

Definitely have been encouraged to wean off pain meds, I can’t take Motrin or anything but Tylenol related to blood thinners. I do pretty well on a dose before bed and late in the afternoon supplementing with a couple of doses of Tylenol.

I literally live with ice on most of the day. I started Magnesium supplement related to muscle spasms (appears to be the problem). I did have blood loss and was given 2 blood infusions while in the hospital.

The only other thing was both the surgeon and his PA remarking on how tight my ligament was and how I was going to battle that during rehab.

I do use a walker if out but fly on my own at home, I do have to go up and down steps a few times a day as I live in a 2 story house.

So, am I pushing things or is this an acceptable pace. I would love to get back to work ASAP but not sure if that’s going to happen

 

[Jockette]

Hi and Welcome to Bonesmart!

You are not the only one who is confused when first finding Bonesmart, but I can assure you that Bonesmart’s gentle approach to recovery does work and achieves a great outcome.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Celle]

Hello @9 of 11 - and

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.

It's easy to get confused by differing advice, but don't be concerned about it. Even the surgeons often don't agree. You'll get one that tells you to exercise like crazy and another who says that just gentle movement is enough.
Just do what feels best for your knee. It's your knee after all, and you have a right to choose.

If you feel that exercise helps, then exercise by all means. Just remember that PT should never hurt. You don't want to re-injure a knee that is already wounded by the surgery it's been through.

We know that the gentle approach does work, and that it makes no sense to stress a knee that is already wounded by major surgery.
We know that there's no deadline by which you have to achieve a certain knee bend and straightening, because we've had people whose range of motion (ROM) continued to improve for many months, sometimes even a year or two.

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

It's really 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.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
It's a very different policy from that of many surgeons, but it does work.

 

[eaglemom]

You are correct it can be confusing navigating through all of the information your given. I will say I've had numerous knee surgeries and this last one I'm doing it the BoneSmart way (almost). I think what's important is that no one ever ever push down on your knee - that's a no no. You know your body and need to listen to it. Too much movement /exercises equals swelling then you can't bend properly. Time, ice and elevation are your friends.

 

[Roy Gardiner]

I would love to get back to work ASAP

We reckon 12 weeks is about right, on average, away from work.

My understanding is to push through uncomfortable exercises and PT to optimize end outcome but that’s not consistent with what is on this forum

Pain is counterproductive, we believe. Stretching will cause discomfort, but shouldn't cause pain. Little and often for stretching exercises.

 

[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?

 

[Celle]

My understanding is to push through uncomfortable exercises and PT to optimize end outcome but that’s not consistent with what is on this forum.

PT should never hurt. Your knee is already wounded by the surgery. What would be the good in hurting it still more? That would just upset and inflame those painful tissues, which then increases swelling and inflammation. "No pain, no gain" is the wrong approach to recovery from a knee replacement.
Myth busting: no pain, no gain

This article was included in your recovery reading. It's worth a second read:
BoneSmart philosophy for sensible post op therapy

 

[9 of 11]

I can answer any questions you may have, my surgery was done on February 26, 2019, it was my right knee that was repaired. I suppose my aggressive push through philosophy may be why my knee remains pretty swollen. I do keep it up and iced all day when I am not doing small, light chores around the house. It’s usually up and iced for at least an hour or more, 7 or 8 x per day.
I am a nurse as well but orthopedic things are way beyond my specific wheelhouse. Thought I did my research but I was so very wrong

 

[Jockette]

Thought I did my research but I was so very wrong

Most of us feel this way, I sure do!

 

[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.

 

[kneeper]

You won't be without discomfort during this recovery, but pushing to the point of bad pain is not good. For me it was a "slowly but surely" approach that worked.

 

[9 of 11]

I am 3 almost 4 weeks post rtkr, and did almost the exact PT in an out patient facility. Today I am iced and have heating pad on my leg from my ankle to past my quad. No sleep last night. The PTs are generally nice but in the USA, they are definitely trained to ignore and pacify. Once again I was told a little discomfort was expected and ice should be all that was needed to feel better. Seriously everyone is numbered driven.

 

[Pumpkin]

@9 of 11
Hope your knee is starting to settle down with some rest. Josephine has posted her questions for you in post #10. The answers will help her directly address your concerns.

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.

 

[Celle]

The PTs are generally nice but in the USA, they are definitely trained to ignore and pacify.

Once again I was told a little discomfort was expected and ice should be all that was needed to feel better. Seriously everyone is numbered driven.

@9 of 11 - It is your body and your knee. You are the only one who has the right to say what will happen to it.

Don't feel that you have to do everything the PTS say, because you don't. They can advise you, but you have the right to choose whether or not to accept that advice. In your case, they are giving you the wrong advice.
It is never right to push through the pain. Doing that does more harm than good to your knee.
Myth busting: no pain, no gain

Tale control of your recovery and speak up when your knee is unhappy.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

Try not to buy into the PTs' obsession with numbers. Good numbers just make the PTs look good, but really 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

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.

 

[9 of 11]

I am actually not doing anything today except a few “soft “ exercises, and heel slides. I am doing the usual self care and house care as well. My PA did order Cyclobenzaprine as it’s been well documented through both the hospital and PTs that I am having spasms especially after some more intense quad work. The med does work well and I can sleep well today.

The knee swelling is actually not too compromised and I actually have nothing but some aches that Tylenol does well with. Pain is all soft tissue. The spasms are being blamed on my pre-op extension or lack of complete extension. The theory is that all my soft tissue is adjusting to the new function of my knee and since my lateral ligament was so tense prior I am battling to get more functionality. It made sense to me.

 

[Celle]

I am having spasms especially after some more intense quad work.

IT's still too early in recovery to be doing any sort of intense exercises. Your knee is wounded, not lazy or unfit.

The theory is that all my soft tissue is adjusting to the new function of my knee and since my lateral ligament was so tense prior I am battling to get more functionality.

Your soft tissues are wounded, not just adjusting. They're bruised, upset and irritated.

Your knee has been through one of the most major surgeries it could have. During this surgery, many of your soft tissues were handled, pulled aside, placed for a while in positions that are unusual, and then put back in their normal positions.
Have you seen this article, or any of the photos and videos?
TKR surgery - WARNING: real life photos

There's no need to battle to get more functionality. It will come, given time, as your knee recovers.
Recovery from a knee replacement is a year-long journey and there are no deadlines you have to meet.
Try to treat it as a marathon, not a sprint.

There's no need to rush to get ROM (Range of Motion) or functionality, because they 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

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.

Your knee is on its own schedule for recovery - not your schedule, not your PTs' schedule, and not your surgeon's schedule. It knows what it's doing and it will serve you well when it has recovered fully.
Where are you in recovery?? (TKR)

If you will answer Josephine's questions more fully, she will be able to give you appropriate advice.

 

[Josephine]

have heating pad on my leg from my ankle to past my quad.

Do NOT ever use heat on your post-op leg. You are only 4 weeks out.

a few “soft “ exercises, and heel slides

Please answer my questions above

 

[kneeper]

If your exercises are causing muscle spasms that's probably a sign that you're going too intensely. You may have them anyway (I had a short run of a mild muscle relaxer after my first tkr). I think when they bent my leg around during surgery they were testing much more range than I had had on my own for years.

But I know during my recovery when I tried to bend too far my hamstring muscles would spasm. (This was primarily the lie on your stomach and bend your leg toward your butt exercise). My pt told me that was because I was trying to go too far too quickly. When I took it slow and easy and gradually increased the bend I didn't have that problem.

 

[sistersinhim]

Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control . This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.

 

[9 of 11]

Well it’s been quite a few days, very loved and close family member passed and much of the weekend was spent on bereavement activities.

The Flexeril was a God-send, between that and Tylenol, I was fully an active participant.

Thought I would have a wicked night but actually slept well with the occasional get up for a bit of ice, repositioning or sip of water. I will see what today brings but, my family consist of MDs, OTs and a PT, all who made me their projects.

Don’t have Outpatient PT until tomorrow late afternoon so have today to rest, ice and elevate. May do a few simple exercises but nothing heavy. Hopefully, the muscle relaxant has gotten to the root of the problems and that 4 week is my turn for the better