A Cyclists Survival Guide to a Total Knee Replacement – Post Surgery (P-5)
I arrived home and everything seemed to be going great. My home was set up for ease of access, my knee felt fine, and I was optimistic and happy. The drugs I was on created a feeling of well being and a bit of euphoria. Feeling good, I laid in bed and went down like a newborn. Like a newborn, I was up 3 hours later with a full bladder. Drinking lots of water is mandatory, and to be honest, I was always feeling thirsty. That and I needed water to take down my medication. I sat up, and placed both feet on the floor and slowly stood up. A rush of warm blood drained from my core and into my legs and, a heated sensation enveloped my knee, then, pain and then, excruciating pain. “Oh, holy mother of…!” I sat back down. My knee felt like it was going to explode. My calf muscle felt like it was in a post ride cramp. My entire leg was in terror. I grabbed my crutch and made my way gingerly to the commode.
Knee surgery and pain is simply a part of the deal. There’s really no fair way around it. It’s just one of those things that life throws at you and you need to tolerate. I was cautioned upon my discharge about blood clotting and how it specifically generates pain in the calf. This was one of my concerns, of course. From no pain to hellish pain in a matter of hours worried me. Might I have developed a blood clot? I looked at my leg and it seemed to look the same as before, lots of bruising, shriveled, wrinkly, ugly. But, I didn’t see any signs of clotting (big new veins foreign to my leg). That and when I put my leg up, the pain flowed out of my leg. Simply, my nerve block wore off and now I could feel everything. So, to caution you, dear reader, if you go home from surgery feeling good, don’t overdo it. Don’t walk on it except to perform the bare minimum functions. Keep it rested and iced and compressed. I found it very helpful and secure feeling to wear and embolism stocking. That good feeling you had from your 2 night hospital stay is probably temporary. And, like I said before, a 3rd night would have been very helpful because the medication that I was given was negated by the nerve block and I really had no way to determine the effectiveness of my pain treatments.
From this point on, pain management is going to be your top concern. Finding a combination of exercise, and medication to minimize pain is paramount. What I believed, and I’m sure most others believe, is that they’ll be able to tough out the pain without medication. I thought that I could do what I always do during painful situations, dig deep and fight through it. As a cyclist I have encountered many painful situations where I was able to psychologically detach myself from its burden. Let me tell ya folks, this is different. Every day. 24 / 7, you will have pain. It’s with you when you sleep, it’s with you when you’re resting and watching TV, it’s there when you go to the bathroom, it there when you get dressed, get food, get water. It never goes away. You and your pain will develop a relationship, but, to make things worse, you must not only deal with your pain, you must also push it at high as you can go in order to begin your slow recovery.
By the 3rd morning, my physical therapist came over to work with me. She scoped out my home and made sure that I was safe to move about it. Then, she began testing my range of motion. While pain management is your top priority, your number one goal for the next 8 weeks is to recover your mobility and, this includes, your range of motion and muscular strength. Now, I had myself a real hardass for home therapy. Yup! My ex-wife, who happens to be a physical therapist. It was Christmass day.
One of the biggest issues with a total knee replacement is to make sure that you recover your full range of motion. This means that you can hug your leg with the knee fully bent and straighten it to the same extension as your original, this is roughly 3-4 degrees into hyperextension. The most difficult to recover is extension, but, the most painful is flexion. Don’t get me wrong, both hurt like Hell. She asked me to flatten my leg. I straightened it and then she asked me to use my muscles to straighten it as much as I could. I tensed up my quads and fire reigned down! I spoke in some demonic language as my voice lowered 10 octaves. “Er ay Ved, es reygal!” I was 7 degrees shy of zero. She pushed down, I gritted my teeth. I had to tell her to stop. It was incredibly painful. Then, I demonstrated how far I could bend it. 90 degrees. Not bad. Then, she pushed on my foot and my knee exploded in pain. “Stop! Oh my God, please stop!” I never felt anything like it. She pushed my food a mere 10 degrees and I thought I was going to lose my sanity.
I was left with a simple message. “Paul, you need to be able to manage your pain.” She explained to me that outpatient physical therapy would be much more difficult and left me with a few basic exercises that I could work on prior to her next visit. “Manage your pain..” What does this mean. Two things.
1. learn to deal with your pain. Raise your pain threshold, buckle in and dig deeper than any bike ride has ever prepared you for.
2. Get on the right drugs. Maintain a schedule. I want to address this exclusively in the drugs section of this article.
After a couple of visits and nightmareish workouts, she graduated me to outpatient. Basically, this meant that I could drive myself to a clinic, walk through the front door and proceed with rehab. As I am writing this, I am still in outpatient care. I have improved my range to a point where I am actually comfortable with what I have, but, I’m not quite done. My leg will still not completely lie flat and I am burdened with muscle atrophy. Simply, my leg is about half the size it once was.
Muscle atrophy is a complicated process of nerve and muscle function. Muscle, as a result of disuse, “waste away”. “Wastes away” is a poor description, however, this is what the medical journals refer to in describing the shrinkage of muscle tissue. The reality, however, is that you do not lose muscle tissue. Simply, the muscle tissue that you have, becomes inactive. The muscle that you have is still there, but, it goes to a hibernated state. That is, the muscle is not supplied with the nerves required to bring it back into the fold. This is due to, 1. disuse, and 2. trauma. Like I said, knee surgery is a serious operation and the leg undergoes quite a bit of trauma. The other contributing factor to atrophy is swelling. Muscle does not respond well to electrical commands when it is buffered by fluids from swelling. Returning your muscles to their original size is painful, time consuming and demotivating. Yet, you must maintain motivation to work harder than ever before and get that leg up to par with the other. This involves intense exercise, isolation of the muscle you want to build, minimizing swelling, and, perhaps external electrical stimulation through electronic devices such as a tens unit, or, through needling.
I wasn’t fully prepared to feel as helpless as I was. It was a terrible thing. I was able to get around a little, but, after about 30 seconds, the pain starts to manifest itself and you’re desperate to get back to your couch and pillow. At about 2 weeks out I panicked. My kids were coming home and school was starting. I had no one to help me out. My ex-wife had to work, my mom lived too far away, and my dad can’t drive. I was not sure how I would be able to mobilize myself at 6AM, make breakfast, pack lunches and drive the kids 45 minutes to school. I could barely survive the trip to the bathroom! So, I stayed at my moms for 2 nights, let her bring me tea and cookies, sat by the warm fire and just slept most of the time. Thanks mom! When the kids came home, I prepared them. They would have to do everything on their own. I bought Lunchables (instead of healthy turkey on whole wheat). And, once they were dressed, I took off my slippers, put on my shoes and in my jammies drove to McDonalds for hotcakes and browns. After 3 days of this, I was exhausted. But, the kids learned a valuable lesson, dad is a good cook and doing it all alone is hard work. I survived, but, I wouldn’t recommend it.
As a conditioned athlete, being helpless really sucks. It messes with your head and your body. I woke up time and time again from dreams of independence and athleticism. I was running, jumping over fences, flying down staircases and had energy and vigor. Perhaps the dreams were slightly skewed from the drugs, but, when I woke up, my knee was still my knee. My leg was in pain and still shrunken like a apple head. This is extremely demotivating. Loss of independence and vigor and the loss looking forward to obtaining and passing goals, is really tough to deal with. Each day feels like the last and the life I had, riding around the city and into the mountains seemed lost forever, as though that life was now just a fading dream itself. However, despite these negative feelings, I forced myself to feel good about achieving different goals. Goal setting after a total knee is mandatory. You must find a way to measure your progress and look forward to it. What goals motivate you? Losing the crutches? Ascending / descending stairs? My first big goal was to be able to pedal my bike. Upon first trying, I could not get my legs all the way around. My knee locked up in pain and as hard as I tried, I could not get it to rotate over the top. I screamed. It seemed a far off goal. So, I set smaller ones. I needed about 110 degrees of knee bend to get the pedals turned over. So, everyday I worked my knee into flexion as far as I could stand it. I wrapped my belt around my ankle and pulled until I had no more to give. Then, a week later I tried again.
My latest accomplishment was riding my bike on my indoor bike trainer for 1 full hour. I succeeded. I’m paying for it now with increased swelling and stiffness, but, I know I can do it and I’ll do it again, and again. My next goal is to take the steed outside and actually go for a ride.