Category: Exercises

Pain In Knee After Knee Replacement Surgery

Yes, it’s normal to have pain in your knee after having knee replacement surgery. But, the questions that many people have are similar to “How much pain is normal?” and “How long does it last?”

To answer the first question, take a look at this knee replacement video and it sort of gives you a good idea of what takes place and why you have as much pain as you do.

Having your knee joint removed and then replaced with “after market parts” is a major and traumatic procedure!

So, yes it’s normal to have pain. But some say that the pain, although intense, is different than the arthritis pain that they had prior to surgery. Whereas the pain from an arthritic joint is “sharp and intense” (and will just get worse over time), the pain after having a joint replacement is more “tight and throbbing” and usually subsides over time.

“But I have pain in my knee replacement a year after my surgery. Why doesn’t it go away?”

If you’re still having pain months after you’ve had joint replacement surgery there could be a couple (or more) things that may be going on.

If you fit into the above category, then you’ve probably already been to see the surgeon (and any other doctor you can) to have the knee checked out. Many times the doctor will take an xray or a CT scan to see if everything looks good at the joint level. Depending on what your knee replacement is made of your doctor may (emphasis on may) order an MRI.

In many cases the knee components are in alignment and their doctor may say “everything looks good. Give it more time”. This may frustrate people that are in pain because they think the doctor believes their making things up or just complaining.

In all honesty, it’s not that the doctor doesn’t believe you. It’s just that when they look at the x-ray, there is no obvious problem that jumps out at them and there’s no clear indication of what can be done to relieve the pain. They don’t want to open you up and then not find anything to do with you.

What Could Be Causing Pain After Knee Replacement Surgery?

One of the most common problems with pain after knee replacement surgery is plain old muscle pain. You can get muscle pain from having a combination of weak and tight muscles.

In a lot of cases, patients who’ve had knee replacements go thru the initial basic range of motion exercises right after surgery. But, after they have their range of motion back and find that they can get up and move around without much debility, they get on with everyday life and cut the rehab exercising short.

Because of this their quads are generally still relatively weak (along with their hip abductors) and the knee flexor hamstrings and calf muscles are relatively tight.

Having weak quads and tight knee flexors (not to mention a tight ITB – iliotibial band) can lead to over use syndromes and continued knee pain.

It’s important to have your therapist set you up on an independent rehab program for advanced knee replacement exercises. This program should be complete with goals and time frames once you’re discharged from physical therapy services. This is especially true if you’re going back to a relatively sedentary lifestyle at work behind a desk or sitting in a car (or anywhere) for long periods of time.

I’m Pretty Active And I Still Have Pain A Year After Surgery

If you’re one of those that have really been diligent with your exercises and have honestly tried to get back into an active lifestyle but you can’t because of your knee pain, you may need to have your doctor think outside the box about your case.

In some cases, people are allergic to or develop allergies to some of the materials that the knee replacement is made of. Your doctor should be able to test for this. And, you can also do some online research about your particular prosthesis.

The hospital should be able to provide you with a copy of your operative report which indicates what type of “knee” you received. Once you have the name of the model and manufacturer, you can do some research online to see if others have had any similar problems.

Another thing that some people run into is that their knee ligaments may be too tight or too loose and this can cause pain too. If this is the case, it generally requires a knee replacement revision surgery. Yep, it’s another surgery, but, in general, the rehab after a revision is a lot easier than the initial surgery.

Recovery From Knee Replacement Surgery Takes Time

Remember, this is a big surgery that’s mostly done on people that typically aren’t that young. The older you get, the longer it takes you to bounce back.

It’s not uncommon for it to take up to a year for you to fully recover from having a knee replacement. So, just because you’re able to get around without using a walker, it doesn’t necessarily mean that your muscles and tissues don’t need further rehab.

It’s very important for you to keep working on your range of motion. Make sure you’re able to extend you knee to it’s fullest limit. Make sure you’re stretching your hamstrings and calf muscles. Not to mention your quads or the muscles that stretch when you’re bending or flexing your knee.

In addition to stretching make sure that all muscles involved are toned and in good condition. You don’t have to do any aggressive weight lifting. But, remember that a weak muscle that’s chronically overused will be painful also.

Work out a plan with your physical therapist. Do some research about the type of knee prosthesis that was used. Cover all your bases. This way, if you aren’t able to get things working right for yourself, you’ll be honestly able to tell your doctor that you’ve tried everything and that you need them to take a closer look at your problem.

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Knee Replacement Exercises: Standing Calf Stretch

standing-calf-stretch

Increasing knee extension (being able to straighten the knee) and knee flexion are the primary goals of the physical therapist after someone has a knee replacement.

While it may seem complicated to some (even some physical therapists make it harder than it needs to be), it’s really a simple matter.

That’s because there are only a couple of things that could be going on that stops the knee from bending and straightening.

The primary reason that people run into problems with not being able to straighten the knee out is due to tight muscles. Most people focus on the hamstring muscles. In fact, most of the protocols that doctors give their patients call for passive extension that is thought to stretch these muscles.

However, even though their patients are faithful in enduring the passive extension (it tends to be the most painful of the post operative exercises) many people can’t really get their leg all the way straight.

Gastrocnemius Stretch – Knee Replacement Exercise

The reason for this is because there is another muscle that they also need to work on. This muscle is in the calf. And it’s called the Gastrocnemius muscle.

The way to stretch the gastroc is to do a standing calf stretch. It looks like one of the stretches the joggers do in the park before they start on their run.

If you add this knee replacement exercise to the set of exercises that you’re already doing you should start to see some good results.

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Knee Replacement and IT Band Pain

NOTE: The information contained in this post is for those who may be several months out from their surgery. This information is not for someone who has had a knee replacement in the last 2-3 months.

The combination of having a total knee replacement and IT band syndrome is not uncommon. It’s basically an overuse injury caused by walking with poor mechanics at the knee and hip after surgery.

What Is The Ilio-Tibial Band?

IT Band - credits Medicinenet.comThe ilio-tibial (IT for short) band is actually a tendon of the Tensor Fascia Lata (TFL) muscle that stretches from the hip, down the side of the leg, and into the tissues at the side of the knee.

A tight IT band can limit how much you can bend your knee, cause poo patellar tracking, and it’s hallmark is intense knee pain when you’re descending stairs or a hill.

In most cases, stretching the tissues will give relief. But, it’s also important to understand what may be causing the shortening in the first place.

Sitting down for long periods, especially with the knees apart, puts the TFL/ITB complex in it’s shortest position. If you’re job keeps you in the car or at a desk for most of your day, then your ITB will probably get short.

After a knee replacement, as matter of convalescence you’re going to be sitting down more often than not.

And it’s easy to overwork the TFL after knee surgery because it has the job of lifting your leg and helping you walk while the other muscles are recovering from the surgical incision.

How To Stretch The IT Band

So, how do you stretch your IT band? There are several ways. But, most of what you’ll see online are techniques that seemed to be geared more toward extreme athletes, yogis, and 20 somethings that are still invincible.

The following are a couple of different ways you can try to get some relief from nagging IT band syndrome.

  1. Side-lying IT band Stretch

sidelying iliotibial band stretchThis stretch, as you can see, will stretch all the tissues on the side of the leg. There is nothing you have to do with this particular stretch except for lay down and go limp.

As long as your knee (and the rest of your body) is comfortable, gravity should do the work of stretching the tissues.

2. The supine IT/Quad stretch

Iliotibial band stretchThis stretch is designed to target the muscles and tissues at the junction of the thigh and hip, as well as the tissues right above the knee.

Once you get into this position, you will feel the tightness over the top of the thigh. Again, just get into the position and allow the tissues to stretch and lengthen.

The pull on either of these positions should be gentle and I would encourage anyone who tries them to resist the temptation to be aggressive with your stretching.

Consistency is more important that intensity.

As you can see in either of these stretches, you’re putting your body in a position that is somewhat opposite of the typical sitting position to counter act the effects of sitting for prolonged periods.

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Straight Leg Raise After Total Knee Replacement

Straight Leg Raise“Hey, that’s pretty easy and it doesn’t hurt near as much. I’ll start doing the exercise this way now”.

This is what one of my patients told me a couple of days ago when I was helping him figure out how to do a straight leg raise after his total knee replacement.

According to him, his surgeon was a little disappointed that 3 weeks out from surgery he wasn’t able to do a straight leg raise. My patient told me that his doctor used raising the leg straight as a way to see progress rather than range of motion, like most doctors.

I thought that it was a little strange too because the doctor hadn’t included the straight leg raise in the knee replacement protocol that he sent home with the patient after the operation. But, what can you say? Each doctor is different.

Why It’s Hard To Do The Straight Leg Raise

Lifting the operated leg is actually one of the most difficult exercises that you can try right after a knee replacement. There’s a couple of reasons for this.

Number 1) As I pointed out here and here, the surgery cuts right through the “lifting” muscles of the leg. This makes raising the leg straight near impossible right after surgery because the muscles are weak. And, 2). With your leg in the straight position, it’s actually heavier (it’s a physics thing), and therefore requires the weak muscles to actually work harder to raise it.

But if you’ve had a knee replacement, you have probably already figured out how much you need to be able to lift your leg straight. For most people it’s the getting into and out of bed that is the biggest obstacle.

You probably hate the fact that you have to call family members or friends every time you need to go to the toilet or get out of bed for anything. Then, when you’re ready to go lay down, (let’s face it, it’s a days work just dealing with your knee replacement for 15 minutes at a time), someone has to be able to bend down and raise up your heavy legs to help you get back in bed.

It has to be a pain in the neck for most people.

Well, I want to help relieve you of that particular burden. I am going to tell you a way that you can actually learn to do the straight leg raise and then use it to get your leg stronger. That way, you will be able to get into and out of bed anytime you want. And, that way, you won’t have to bug anybody anymore. At least not to help you get into and out of bed that is…

To recap, doing the straight leg raise is hard after a knee replacement because the muscles that raise the leg have been cut through and also, when the leg is straight, it’s actually heavier to raise.

But, in spite of those 2 limitations, there’s a way that you can learn to do a straight leg raise fairly easily. The trick is that it is a matter of putting your body and your leg is the best position to use your muscles.

The Trick To Doing The Straight Leg Raise After Knee Replacement

The first thing you should do to learn how to do a leg raise the right way is to lay as flat as possible on your bed. Don’t try to do a leg raise while you’re in the sitting position. If you’re sitting, you’re not able to take advantage of the muscle called the “Rectus Femoris“.

The Rectus is one of the four quadriceps muscles. But, it’s the only one that affects the hip and the knee joint both. The other three only straighten the knee.

When you’re sitting the Rectus is actually shorter and can’t actually contract as hard as when you’re body is straight.

The next thing to do is learn to “lock” your knee straight, while at the same time “locking” your ankle so that your toes are pointed back towards your face. I tell people to imagine that their leg is a “piece of iron”.

When you’ve gotten yourself into these two positions, then and only then is it time to try to raise your leg. But!,… don’t try to raise your leg to the ceiling. Just try to raise your heel or calf off the bed or whatever you’re lying on.

By imagining raising your foot or calf, you’re actually mentally raising a smaller object and subconsciously, this is a lot easier than raising a big, fat, swollen leg.

Keep all this in mind while watching this video

 

 

Conquering the straight leg raise is one of the milestones of knee replacement recovery. Try these tips and see if they work for you.

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Heel Slide Exercise

Heel-SlideOne of the two primary goals after a knee replacement is to get your knee to bend, or flex, further. This is one thing that you really have to work at everyday. If you don’t, then your new knee may get stuck at some point and you’ll not be able to bend it any further.

One of the basic exercises that your doctor has (or will) give you is called the “heel slide“. Basically, all you do is flex and straighten your knee. Think about it like working a rusty door hinge loose or, for some people, when you’re trying to break an unwanted credit card in half. In either case you’re moving the object back and forth to one extreme or the other in an effort to get it to bend further.

This is what you want to do to your leg after knee replacement surgery. Your goal should be to get your operated leg to do what the other leg does (assuming, of course that it works fairly normal).

Most people start out doing this exercise when they first get out of surgery or the next day. In this case, you’re lying in your hospital bed and working with the physical therapist. Some therapists may put a plastic bag under your heel. This will make doing heel slides after knee surgery easier because it helps to reduce the friction or “drag” between your sock and the bed linen.

It’s Called A Heel Slide, Not A Knee Bend

When your foot is in the right position, you slip a towel or pillow case behind your knee and hold onto either side of it with your hands. After the replacement the quad and hamstring muscles aren’t going to be strong.

When you’re in position, start bending your knee by pulling up with your hands and sliding your heel toward your hip at the same time. But, try not to flex the knee too far until you actually get the hang of the motion and have an idea of how much it may hurt.

A heel slide is actually pretty simple and can do a lot to relieve some of the achiness following a knee replacement surgery. But, you’ll want to slide your foot in the right way using the best technique to get the most out of it. Some people actually end up doing the heel slide all wrong and wonder why their knee is hurting so much. Remember you want to minimize discomfort so it shouldn’t be too painful.

One of the biggest mistakes that you could make when you’re trying to do a heel slide is trying to lift the leg using leg muscles, rather than trying to slide the foot. Its called a “heel slide” for a reason. I know that that may sound a bit confusing, but what generally happens is that people try to lift the knee and foot off the bed and then try bending the knee while at the same time lifting the whole extremity.

You’re not going to be able to do this because during replacement surgery, the doctor had to cut through the main muscles that lift your leg. You’re going to have to help lift your legs with your hands.

The reason that you use the towel is to actually “unweight” the thigh and calf so that you can slide the heel as far as possible. The hip and majority of the lower body muscles are actually limp when you’re doing the heel slide. Your arms are doing all the heavy work by using the towel.

Doing The Heel Slide In A Chair

You don’t have to stay in the bed to do the heel slides. In fact, once your swelling and pain are under control, it may be a better idea to start doing heel slides from a straight back chair. Preferably one with arms because after a knee replacement, you won’t be able to use the sore leg to get into or out of the chair.

When you’re doing a heel slide in a chair, you can actually get a little better leverage and get your knee to bend further than you can when you’re in the bed.

The heel slide in the chair is basically the same as the heel slide in the bed. If your leg still feels kind of heavy or swollen, you can place a towel under the thigh and, using your arms, lift your thigh slightly when you slide your heel back.

You can also put a plastic bag under your foot to make it slide easier. This technique works great if you’re doing the exercise on carpet. The plastic bag works the best on floor surfaces that aren’t slippery in and of themselves. Or, if you’re one prone to go barefoot.

 

 

One thing to keep in mind after a knee replacement and when you’re doing the heel slide is that you “are not trying to get there today”. Don’t get too aggressive or ambitious. If your knee replacement surgery was less than a month ago, you are still healing and are prone to swelling and inflammation. And, the more swollen your knee is, the less it’s going to bend.

And, if you have had a knee surgery, it’s best to do the heel slide exercise after you have finished elevating the leg to get some of the swelling down. When your knee is more of a normal size, it’s going to be a lot more comfortable to exercise with it and you’ll get a lot more range in bending it when you do the heel slide.

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