Total Knee Replacement 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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Limited ROM Even After MUA (manipulation under anesthesia)

The following is a response to an email question received from a reader. It is strictly for the purpose of education and information. However, it may be beneficial to some of the other readers of our website.


 

Disclaimer: The content of this email should be considered educational information and is NOT to be considered medical advice in any way. Only your personal medical professional can give you qualified medical advice after a thorough evaluation.

Hello,

I am just writing to let you know that I did get your question regarding your total knee.

While each person is different, the stiffness related to knee replacements in typically due to the condition of what’s called soft tissue, i.e the muscles, tendons, skin, and etc.

For the most part, the components of the knee replacement are in their appropriate place and allow for full range of motion (which the MD checks with you still under anesthesia).

Since that’s the case, getting your ROM back is all a matter of stretching the soft tissue to allow for bending.

There are several things that could be stopping your progress.
1. Scar Tissue. You may be more susceptible to developing scar tissue. This condition is called “arthrofibrosis”. Many people have it. There may be some help for this and I will address it below.

2. “Muscle Guarding”. This is a psychological phenomena where you unconsciously “guard” the knee against bending in anticipation of the pain that will come with activity.

3. Swelling or edema. This stops the knee from bending all the way.

And there could be other issues involved.

Possible things to explore:

I wrote a blog post here – http://www.totalkneereplacementexercises.com/scar-tissue-stopping-range-of-motion/ that addressed this question and there are a couple of physical therapist techniques that may help you if a therapist in your area practices them

Joint mobilization is another approach which your therapist may have tried. Some therapists are better than others and use different techniques. It may be worth exploring other therapists in the area that may have a different approach.

In addition, it may be worth exploring stretching the hip and ankle of the same leg you had the surgery on. Because they indirectly influence knee ROM you may have a breakthrough there.

Specifically the tensor fascia lata muscle, the gastrocnemius muscle and the group of hip “flexor muscles”.

One more thing that may help stretch soft tissue is massage therapy. Specifically techniques like “hellerwork” “Rolfing” and “myofascial release”.

In any case, speak with your Doctor about seeking any of these approaches as you may have other conditions that may need to be considered before you have clinicians apply any approach different than what you’re currently doing.

Best of luck to you.

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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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When Can I Drive After A Total Knee Replacement?

vintage car photo

Let’s face it, most people don’t like sitting around rehabing after having a total knee replacement. People get bored just sitting around the house and start going stir crazy.

One thing is for sure, you have plenty of time to think about all the stuff that you really want to be doing (or that needs to be done). And most are anxious to get going.

When Is It Okay To Drive After A Knee Replacement?

Because of this a lot of knee patients have questions about driving after total knee replacement surgery. “Can I drive?”, “When can I start driving?”, “When will I be ready to drive after my knee replacement?”.

The bottom line is that your doctor will let you know when you’re safe to drive because it’s basically his/her doctor’s license on the line if something bad would happen.

Here are a few things that you should think about when the question of driving a care after having a total knee comes up.

  1. A car or truck can become a 2000 pound lethal weapon for the driver if they are not fully capable of controlling it. You can do a lot of damage to yourself and others if you lose control of it.
  2. If you had your right knee repaired, then it really goes without saying that you need to have full control of your right leg (both legs really) to drive.
  3. If you’re still taking narcotic meds for pain relief you’re basically “under the influence” still. Narcotics affect your mental ability and also affect your reaction time.
  4. After any major surgery, your body needs time to recover. Let it recover and let someone else run errands.

The Doctor Will Tell You When Its Safe To Drive

It’s normal to be anxious and want to be independent. However, it may be safer just to have someone else do the driving until your doctor has released you from his/her care and given you the green light to start driving again.

I know that’s probably not what you wanted to hear but it’s the truth of the matter.

Patience is a virtue.

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Recovery From Knee Replacement: A Routine. Not A Job.

Recovery from any type of surgery, especially something like a total knee replacement, is a matter of consistent effort to improve your overall function. Is it a “routine” or a “job”?

The Difference Between A Routine And A Job

Doing both a routine and a job takes effort. One you don’t really have to think about to do it and the other, you hate thinking about and you probably hate having to do it.

There are a lot of misconceptions of what life will be like after you get your new knee (skip to the bottom if you had a TKR awhile back). Right after surgery, some think that “resting” is the best approach to recovery. “Waiting until the pain goes away” to get moving is one of the most common misconceptions.

And this is understandable. Only the uninitiated cannot fully understand how painful having a knee replacement can be. And with that much pain, you want to make sure that you’re doing the “right” thing because you don’t want to make matters worse!

On the other side, some have the misconception that a “boot camp mentality” is needed. Here the notion of “No Pain, No Gain” rules. People think that they need to do as much as their body will let them before losing consciousness is how they’ll get “better”.

In order to avoid these two traps in your knee replacement recovery, it’s a good idea to take a step back and consider what is really going on.

Recovering from a knee surgery is really like recovering from any physical injury, like stubbing your toe or even breaking one your fingers in an accident. It’s a matter of 1) avoiding anything that makes it hurt worse, and 2) allowing nature to do the healing.

After stubbing your toe, you don’t stop walking do you? However, you’re careful not to stub your toe again. And, you’re not going to go on a 100 mile trek either. You basically nurse your injury with moderate movement and wait until it feels better to do more demanding activities.

And even if you have broken a finger or even your arm, there is an unconscious understanding that “I won’t be able to use this thing the way I want to until it’s healed”. The doctor may put a cast on it for several weeks so it will heal in a normal alignment. But, you basically have an understanding that “nothing is really wrong with it and it’ll heal in a matter of time”.

The same can be said in your recovery or rehabilitation period of your knee replacement. Healing will take place over time. All you have to do is not injure it again.

So What Should I Be Doing While Recovering From A Knee Replacement?

Having a good outcome from your knee surgery is a matter of developing a consistent daily routine of working on your range of motion with and managing any swelling that may be going on.

You want to look at your recovery and rehabilitation as a “routine and not a job”.  A routine is something that you do without much thought. You just go about it and move on to the next thing in your day. A routine usually is a matter of habit and is done at relatively fixed times.

Typical daily routines are things like brushing your teeth, washing your face, eating your meals. Routines like these are important to healthy living. And, they all take effort and you want to do a good job at it. But, you don’t really have to put much thought into doing them.

All the routines mentioned above generally take place at regular times. And, indeed, they usually need to take place before you head to your “job”.

So a good routine for your knee recovery should take place at regular times. And the routine needs to take place before you do any “work”.

A job on the other hand is something that takes some determination to do and is more likely a “burden”. It’s something that you do, but, to be honest, you’d probably like to be doing something else. You put up with it. But, it’s not something you live to do.

What Is The Recovery Routine?

In short, exercising and elevating at fixed times everyday.

If you’re like most people, the whole point of having your knee joint replaced is to get rid of the arthritis pain so you can move normally and enjoy your life again, right? The real objective is to “be and walk normal again”.

So, you need a recovery routine that helps you do this.

Generally, the two things that stop people from walking normally after a total knee surgery is pain and stiffness (and also, not having a good understanding of what to expect).

A routine that addresses decreasing your pain and stiffness is what you need to work into daily life. And, it’s a lot simpler than you may think.

Pick 3-4 specific times of the day to do it and get it done. Keep doing this routine until you don’t have to do it anymore (that is until the pain and stiffness is gone – it could be 2 months or longer. How long have you had the routine of brushing your teeth?)

Most pain and stiffness people have right after surgery has to do with inflammation and swelling. So, if your routine emphasizes keeping the inflammation and swelling down, you’re going to get rid of  a lot of pain. So pain will be less of a factor to walking normal.

Inactivity also plays a big role in the area of stiffness and swelling. This is because moving your muscles actually helps to decrease swelling. And the effect that movement has on “stiffness” should be pretty obvious.

So your daily recovery routine should include elevation above the heart level (as much as possible) and “movement”. The movement we’re talking about is simply “bending and straightening” the knee and doing your ankle pumps.

But What If I’m Still Stiff A Year After Surgery?

Some people still have problems with ROM and stiffness long after they’ve had surgery. This stiffness may be due to scar tissue build up or simply tight muscles. Have a physical therapist evaluate your restriction and get you on a program.

If it’s scar tissue you may need a more specialized treatment.

However, if you’re still dealing with tight and stiff muscles, then getting on a daily routine that targets the specific muscles that are restricting normal motion is needed.

If you’ve been hampered for a while after your surgery, then it’s probably not just your knee that is stiff. Over time, your stiff knee will affect your hip and your ankle. So having a physical therapist develop a range of motion routine for your hip and ankle will also help your stiff knee.

In either case, whether your knee replacement is within 6 mos or has been over a year, a regular daily routine needs to be adopted to “get back to normal”.

For most people, a routine that manages any swelling or inflammation, and works at stretching tight muscles and soft tissue is the best approach to get normal motion back in a stiff knee.

 

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