TKR Where did my energy go?<

[Third joint]

I was very careful about my activity level until I finished my PT and didn't really get rolling on activities like painting and cleaning until about October/November. I just drove all the way back from Florida to Ohio last week and that went very well. I find the knee lets me know when it has had enough and I go sit down. This other pain is just so annoying because it affects me every time I want to move positions or go to the bathroom.

 

[sleepilu]

Wow I feel exhausted just reading about your level of activity!



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[Third joint]

I have really studied the pain today and it is both knees when I stand. Just hurts worse on my new knee side. So now I really wondering if it from my weak thigh muscles and that when my butt is lower than my knees I am unable to use them to get up?

 

[Third joint]

@sleepilu , I see you are very new to your knee. Believe me I was not doing anything close to my activity level at less at a month post surgery. I was lucky to even get up the stairs to bed and shower and dress myself.

 

[Josephine]

Pain level is about a 2-5. The most pain is when I rise from sitting and have to hobble to get going (there are times that I don't think I can actually get up sometimes and have to help with my arms) that is a 5, a bit when I turn over in bed (2)and when I come down the stairs. That is more of a tight feeling. I swell if I am on it for more than 30 minutes, but that is a tight feeling that goes away as soon as I sit down for a few minutes.

That's a lot of pain for 6 months out!

I was prescribed oxycodone, but have been off of that since September. I occasionally take two ibuprofen if I am having a painful day.

I don't understand - you have pain sometimes as high as 5 and yet you take nothing? Didn't you know that pain and swelling are a vicious circle? Pain causes swelling and swelling creates pain. You must medicated this level. Not with oxycodone but simple Tylenol. I suggest 1,000mg 4 times a day being every 6 hrs.

Don't ice regularly. Swelling is pretty rare and usually if I put it up for about 10 minutes it goes away.

That I have emboldened above is all swelling. A tight feeling is swelling. Perhaps you don't see it but we get a lot of internal swelling which is just as much of a problem. Ice it.

At the end of PT back in October my ROM was a little over 100 and my extension was 0.

That's not bad

I clean, shop, do laundry, paint walls, cook, ride an exercise bike and climb ladders. We live in a three story house and I do spend most of my time on the ground floor, but that is because our stairs (particularly to the basement) are old and need the treads replaced. Lately I have been doing some dancing just for fun to get my flexibility back.

My comments in bold
Straight leg raises x20 with weight every other day - a tip about SLRs - once you can do them, you don't need to do them any more. Doing them excessively with a weight does no good and causes pain
Standing leg raises 30 x every other day with weight - same here
Squats 20 x every other day - squats are very harmful to the knee and cause pain

Side leg raises (each side) x20 with weight every other day - same as before
This causes an extreme feeling of downward pressure on my knee, but that feeling has been present long before my knee replacement - no matter, persisting on doing them at this point is harmful and very likely the cause of all your problems

In summary your exercises are not only excessive and harmful but unnecessary because you have quite enough activity in your life already. So stop these and give your knee a chance to recuperate. I would suggest that it is these exercises that is causing swelling, tightness and pain and as long as you go on doing them, these symptoms will never dissipate and thus your ROM will never improve.

I don't want to scare you exactly but in this article is a cautionary tale about doing too much PT for too long.
PT: the seriously grave consequences of doing too much of it

 

[Third joint]

Hi Josephine
I started doing the exercises when the pain upon getting up began - at the advice of my doctor, so I do not understand how the exercise can be causing it?

I know my thigh muscles are too weak to lift me up. How do I strengthen them without exercise?

 

[Josephine]

Because it's a popular misconception by almost everyone - including doctors and PTs - that if you have a pain, exercise is the thing to do. This is true up to a point but it should be one exercise done very lightly, certainly not using weights! But really, stretches are the correct and much safer thing to do. That and chiropractic treatment which is a form of deep pressure massage but someone who is properly trained in body mechanics. I've certainly seen more cases where an originally mild-moderate pain was escalated to a serious issue that then became chronic.

Some superficial and easy to get at pains can be self-treated with Acupressure massage but exercises such as you have been doing are pretty much designed to make a moderate pain worse and longer lasting.

As for your 'weak muscles' this is most likely a side issue from the pain meaning it's going to be difficult/almost impossible to be active with painful muscles. That's just common sense. But once you allow this pain to abate, you can strengthen your muscles with just sensible walks which means starting small and slowly working up to a good hike over a period of weeks.

You could also start off with some chair exercises which are commonly given to the elderly and are very good at strengthening muscles without overdoing it. I'll see if I can find a website with them for you.

 

[Third joint]

Hi Josephine, Thanks for the explanation. It makes very good sense and last night I took a decongestant that had tylenol in it and I did feel much better in my knee. I took more this morning and was able to get up the stairs at work like a real person. Not sure why I have been so reluctant to take more pain meds....but I will reform.

I have been seeing a Chiro for my neck. I will ask him about my knee as well.

My last question is why Tylenol and not Ibuprofen? I know that the Tylenol kills pain, but is not used for inflamation and I always worry about my liver with Tylenol (it gets a pretty good workout already). I will follow whichever you believe is best, but just wanted to understand the "why" behind it.

Thanks so much!

 

[Josephine]

I made an article! Exercises - for gentle strengthening

 

[Josephine]

I will ask him about my knee as well.

Well just make sure he looks at your entire leg from waist down.I've often been surprised when my chiro finds a trigger point or pain source which is far away from the place I am complaining about.

My last question is why Tylenol and not Ibuprofen?

The explanation is in the Library Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

However, it should also be borne in mind that, gram for gram, ibuprofen has about only 40% of the pain killing power that acetaminophen does. Mostly it works by reducing the inflammation/swelling which has a knock-on effect of reducing pain. Remember the vicious circle that swelling causes pain which causes swelling and so on. The most effective way of dealing with this is to treat the pain rather than just the swelling. However, you can get an even better effect by taking them both Medications: Tylenol/ibuprofen cocktail

 

[Third joint]

Interesting article about the painkillers and the exercises are what I was already doing, but more reps than recommended and the weight. Also these give a better explanation as to how to do them. The chair raise is my trouble spot already so I will be anxious to try this one in a few weeks when I am less sore.

My previous chiro could not adjust my back without putting excessive pressure downward on my hips causing them to be pushed far past the center point. This terrified me and even though I asked many times for him to do adjustment another way; he stubbornly insisted he was not harming my hip. My Ortho had a fit and said the man was a menace. I found another chiro who has worked on my neck and upper back, but we have not explored my lower back or knee. I will see what he thinks as he is more able to think outside the box about how to get things adjusted in my comfort zone.

Again, thanks for all your assistance. I am going to try my best to keep to the painkiller regimine and icing.

 

[kneeper]

The thing for me with the quads & getting up and down from chairs was to just take a gradual approach. Exercising like a demon makes you more sore (like Josephine) has said and sort of gets you into a bad cycle. It's annoying that it takes time, but time and doing daily activities (and the great exercises (in moderation) in Josephine's post) should get you there.

Stairs and getting up and down from chairs took a long time for me. They key seemed for me to be slow, but consistent practice.
Just yesterday I was marveling that I did at least 10 trips up and down stairs with no problem. (Putting away Christmas decorations and figured it was good exercise.) While my knee was recovering in the first months that was only a dream.

 

[hawk2go]

The chair raise is my trouble spot

I feel you! I had to concentrate on executing moves (even walking and stair climbing) correctly after years of compensating for painful bone on bone joints. For me, it was like driving. I had to concentrate very hard on every aspect while I was (re)learning each move and eventually the correct sequence became automatic again. I still have to concentrate on descending stairs properly.

 

[Third joint]

@kneeper, @hawk2go, I hear you. I think after three previous joint replacements I thought I could make the recovery adhere to my schedule and just force my knee to cooperate. It already feels better after three doses of tylenol than it has in weeks. I appreciate the feedback.

 

[sistersinhim]

@Third joint: I have certainly enjoyed and learned much from your thread and will continue to follow you and others like you that have shared such an important part of your lives! I am praying for you!

 

[referee54]

Stairs

For many people, myself included, stairs were the very last checkpoint in getting everything back together.

I thought I could make the recovery adhere to my schedule and just force my knee to cooperate.

We have to remember that the knee is in charge---we have to understand that recovery is on the knee's schedule, not ours.

 

[Joyfull61]

I went in for my six-week visit today. I asked the PA how long it generally takes before sitting and rising from a low surface can be done without pain. His answer was that it's one of the last things that happens. Your soft tissues take a long time to heal and you generally are putting a lot of stress on them when you sit and rise from a low surface. He also said to make sure your posture is good and use your arms to help push up.

I'm going to have PT start working with me on this to make sure my body is positioned.

 

[Third joint]

Hey Joyfull61, that is very helpful to know. I went back to Tylenol and Ibuprofen - switching off depending on where I am and what I need and it has made a big difference. I am also icing in the evenings when it is swollen and am adjusting the way I go up and down the stairs. I think that after so many years of doing it wrong I still don't have the hang of doing it properly. I find if I come down on my heel more than the ball of my foot (even in walking) I get a more pain free experience. I spent almost the entire day on Saturday out of the house and on my leg and it was tired at the end of the day, but a little ice and some ibuprofen and it felt just fine the next morning.

 

[newlybionic]

 

[Third joint]

I have given it a month of no exercises and resting, icing, elevating and the pain has not lessened. When I try to stand from a couch, chair, any seated position I feel almost a ripping sensation accross the top of my knee and down the inside. I feel it less on the left (original equipment) than the right, but definitiely on both sides. The tylenol/ibuprofen lessen, but don't fully relieve the pain and some days it is almost as bad as before the surgery. Without using my arms, there is no way that I could even get up from a seated position. I try leaning forward as far as possible to let gravity help, but it is a challenge.

Stairs (coming down) are still a challenge as well - feeling a tightness/pinch in the knee as I descend and just a vague weakness as I go up. Any thoughts on this? I am making an appointment with my surgeon as well because I definitely think something bad must be happening.