This blog post is about one of the action items you can do to try to optimize your healing after having a Total Knee Arthroplasty (TKA) aka Total Knee Replacement (TKR).
This is one of the most challenging aspects of recovery post TKA. After your knee replacement, you are going to have pain. It is not uncommon for me to hear, a client say something along the lines of "it was the most painful thing that has ever happened to me". The pain can be very significant, if you do not know why, you should watch a video of a Total Knee Replacement, in our earlier blog post. I have seen clients coming into the local hospital when I was working in outpatients, with total hip and total knee replacement clients and being able to tell that they are not sleeping ro not sleeping very long or soundly. The clients physically do not look good and their scars are not healing as fast as they could.
Why is sleeping important? Sleeping is where 90-95% of your healing takes place. Think about when you get sick, what do you want to do? Sleep! What do you want to do after a hard physical excertion? Sleep! Sleeping is where the body comes to rebuild itself. It is actually quite magical of what the body will do when it is given the chance to recuperate.
One of the things that happens during sleep is the muscle and bone healing. When we were younger and would do a hard workout, we would wake up the next morning and be sore and stiff. Depending on the intensity of the workout you might be more sore the second day and then over another 1-2 days the stiffness/soreness goes away. When we are awake we are stressing our bodies, muscles, joints. When we sleep those areas amongst other areas of the body, rebuild themselves. Here is a cool little fact (and not related to TKA recovery) we have a cleaning system in the brain that becomes very active when we sleep, it is called the Glymphatic system. It is upto 10 times more active when we sleep vs. when we are awake. This is system cleans up the our brains, including the break down of amyloid plaques. Amyloid plaques are thought to be one of the defining features of Alzheimer's disease aka Type III diabetes. Maybe having good sleep on a consistent basis can be preventative for Alzhiemer's disease? Something to think about.
Sorry for the diversion, let's get back to talking about helping you recover from your TKA surgery. Here is a list of actionable steps that I think are very important to get the sleep that you " kneed" (lol)
1) Take your pain medication on time and as directed. That being said, you want to try to time your pain medication close to bed time. It usually takes about 30-45 minutes to become effective after you swallow the pills. Set taking your pain medication at the beginning of your night time routine, i.e. before brushing your teeth and changing into your PJ's.
The pain medications will usually lat for 3-4 hours. You will have to get up and take the pain medications again during the night, 1 or 2 times. Or your partner/spouse can get up and help you with the getting the pain medication in the middle of the night.
2) Use the cold pack with compression, for pain control. There are many different devices now that add compression and deliver cold water to the knee. They have a sleeve that goes around the knee and attaches to a "cooler" you fill with ice and water. Plug the "cooler" into the wall and it will pump ice cold water around the knee. From personal experience, after having a knee surgery, it feels fantastic! What I tell my clients is that using this for pain is wonderful but you do not want to use it all day, everyday.
There is more and more research coming out about effects of cryotherapy on the body. One of the study's looked at injurying mouse leg ligaments. Half the mice got little cryotherapy packs on their knees and the other half did not. What it showed was the mice that got the cryotherapy packs had delayed healing of their knee ligaments. Now we are not mice and I cannot tell you how long they kept the cryptherapy packs on the mouse knees. However we are mammels and heal by similar mechanisms. Using ice/cold is a more 'natural' way than pharmaceutical drugs to manage pain and can be a very helpful adjunct.
After you have taken your pain medication and are ready to go to bed. Put the cold water sleeve on your knee and turn on the cooler to get the water circulating. Wait until the knee feels "numb" then shut the machine off and head to bed.
When you wake up in 3-4 hours time to take you next dose of pain medication, turn your machine back on to get the cold water circulating and cooling down that knee until it is "numb" again. then turn the machine off and you can hopefully fall back asleep.
I have been told by numerous clients that they leave the knee sleeve running all night. I do not recommend this for numerous reasons. Once the knee is numb, does it do any good? Potentially puts the knee area at risk of frost bite from the cold water circulating and you cannot feel it for two reasons. One, that area is numb, and number two, you are asleep and number three with the sleeve around the knee you are cutting off some of the circulatory and lymphatic systems for a prolonged period of time. This may help your knee stay swollen for long. More about this last point in a future blog post about TKA's and swelling.
3) Limit your activity during the day. This may sound like it is straight forward but the number of people that come in and are more sore after doing "nothing" all day is interesting. When you ask a few more questions, then they realize that they should not have been helping out with the yard, or carrying even the light groceries into the house... While all of these are done with good intentions, the person with the TKA will pay a pain price, sometimes for 1-2 days after. When we are injured, the area of the injury becomes very sensitized, i.e. it takes very little to aggravate the area. Think of a bad ankle sprain, even 3-4 days after the ankle sprain it does not take too much walking around to make the swelling worse, the pain start to return. You need movement in your day for many positive benefits including but not limited to muscle contractions, helping your circulation to get the swelling out of the leg, helping you coutneract the constipation effects of the pain medication and eliminate waste from your body, i.e.bowel movement, taking weight on the surgical leg, putting sensory input in through the bottom of the foot...
When is it safe to start to return to regular activity? Day one after surgery! Then increase the amount you do on a daily basis, slowly. After 2-3 weeks, you might be good enough to go to the grocery store as long as you are the one holding onto the shopping cart to help you along.
If you are doing the exercises and following the protocols of a TKA, you can expect to be reasonably well and able to move well at about 6 months post op. You will be moving sooner than that but it takes time to heal, to strengthen and get rid of your pain.
Moving too much, too soon, after a TKA can send you into a pain crisis! Please limit your movement but stay moving for the first 1-2 weeks post surgery. Most commonly, I hear from the clients it takes about 10 - 14 days for the pain to settle down post surgery. This does not mean that the pain goes away after 10 days, it just means that is when people start to notice the pain is decreasing on a consistent basis.
4) Pain crisis. This is when your pain cannot be controlled by pain medication and/or knee cold sleeves. It is best to go back to the hospital, emergency department and see a doctor there. A pain crisis can happen for many different reasons. One of the most common reasons, I hear is that the client getting the knee replacement did not think that that pain medication was doing anything, so they skip a dose or two and/or then start to ramp up their activity. The combination of those two things can definitely be a recipe for disaster. A pain crisis must be addressed by a doctor and even with adequate pain management, the pain might last for 1-2 days.
That is the end of the this blog post/topic. Please if you have anything to add, stories to share please put them in the comments. Next topic on the TKA Survival kit, Part 3 is swelling!
If you are getting ready to have a knee or a hip replacement, have a plan in place and call New Leaf Physiotherapy for your at home physiotherapy needs. 250-826-7300 to talk with Lyndsey, a certified Rehabiliation Assistant, to help you book your assessment.
New Leaf Physiotherapy is a mobile physiotherapy service that sees clients in West Kelowna, Kelowna and Lake Country.
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