In general, the first week after the knee surgery is the critical period that sets the tone for the coming weeks and months of recovery. This is the stage where you must let your knee know, in a firm but gentle fashion, that you expect it to come back stronger and healthier than it was before. In these pre-ops days, you must take care of your knee carefully by managing the pain, limiting swelling, hydrating, stretching and strengthening.
Need To Know #1: Take Care Of Your Incision
In the first few days after the knee surgery, drainage from the wound is normal. In fact, it is better to have the fluid come out of the knee than to stay in and slow your rehab. Most of the fluid is saline solution that was pumped into the knee during the surgery. With that in mind, make your bed with old but clean linens.
If the bandage gets too wet or bloody, you may change them by following this steps:
- Wash your hands thoroughly and pull down the stocking or Ace
- Remove the old gauze and dab the wounds with some alcohol, witch hazel or peroxide on a clean paper towel
- Leave alone any tapes or pieces of gauze that are stuck
- Re-dress with clean gauze bandages and replace the stocking or Ace
- Remember, if you are using Ace bandage, start from the toes and wrap evenly toward the knee
- When come to bathing, place an old stool in the shower stall or tub so that you can sit for the first few weeks after surgery. Once you are cleared to shower, cover your knee in plastic wrap and then wipe down the wound with an alcohol-soaked paper towel.
Most arthroscopy knees can get wet in the shower after 2 to 3 days, but they should not soak until the portals are completely healed, usually about a week. For ACL and TKR knees, wait until the stitches come out at 7 to 14 days before taking an unwrapped shower or bath. Another option is to take a shallow bath ( 6 to 8 inches) and keep your knees bent up, out of the water which offers a chance to work on your flexion.
Need To Know #2: Manage Your Pain Medications
A prescription for a narcotic pain reliever will be given to you before your discharge from the hospital. Take enough of the narcotic to decrease pain so you can do your rehab and get some sleep. Do take note that driving a car or operating machinery is not allowed under any circumstances when taking such medicines.
Always take the medication with food and plenty of fluids. If you experience an upset stomach or other undesirable side effects from the medicine prescribed, stop taking it and call your doctor. Since narcotic medication can cause constipation and other problems, it is advisable to switch to a treatment program of over-the-counter pain medicines such as naproxen, ibuprofen or acetaminophen 1 or 2 days after the knee surgery.
Patients who undergo total knee replacement are usually required to take narcotic medicines abit longer. The over-the-counter protocol assumes you have normal functioning kidneys and liver with no stomach problems. If you have any questions, check with your doctor. Though you hate to be in severe pain, but the sooner you can get off the narcotics is the better.
Just as with the narcotics, if you have stomach upset or any other bothersome side effects from OTC medications, discontinue use immediately. If you have previous ulcer or other gastrointestinal problems, stick to Tylenol. You should not take any other anti-inflammatory medicines at the same time as ibuprofen or naproxen.
To build up the drug level to where it is most effective, try not to skip a dose. Usually, by 4 or 5 days after surgery, you can stop taking all medicines except your vitamins. Consider taking a multi-vitamin with iron for a month after most knee surgeries and 6 months after a total knee replacement. Although arthroscopy patients do not lose a huge amount of blood, replenishing your vitamin and mineral after the surgery is a good idea.
Need To Know #3: Reduce Swelling
Your main priority after surgery is to get rid of the swelling you have and prevent any more from occurring. In arthroscopic procedure, much of the swelling is due to the saline that was pumped into the knee during the surgery.
With total knee replacement, the swelling is usually the result of your knee being inflamed from the bone cuts. In such situation, you should practice post-op RICE (Rest, ice, compression and elevation).
R stands for REST. In the initial stage after the knee surgery, your body has been through significant trauma from both surgery and anesthesia. Therefore, you should let your body rest well and promote recuperation. This is especially after rehabilitation as it helps your muscles to repair themselves before the next work-out.
I stands for ICE. An ice bag or other icing methods should be adopted regularly in the first few days after your knee surgery. It is recommended to ice your knees for 20 minutes in every 2 hours and repeat the process throughout the day. Cold therapy helps to reduce both pain and swelling.
C stands for COMPRESSION And Massage. The stocklings or Ace bandages not only hold on the bandages but also helps control swelling. Ideally, you should wear them for the first 2 weeks. Besides, you can massage your knee comfortably right over the dressings.
E stands for ELEVATION. It is essential to keep your leg elevated above your heart as much as possible to allow the excess fluid and blood to exit the knee. At least 15 minutes of every waking hour, you should combine elevation with passive extension.
When sleeping, try to stay on your back with pillows elevating your leg. If you are a side sleeper, place a pillow between your knees with the surgery knee on top. Do spend some time to arrange the posture yourself as a good night sleep is essential for healing.
How To Recover Your Knee’s Range Of Motion
Tips #1: Continuous Passive Motion (CPM) Machine
The CPM machine is used in many hospitals to elevate your leg while moving it through a designated range of motion. The leg is usually placed into the CPM soon after surgery. And the machine moves your knee from straight to as much bend as you can tolerate. Unfortunately, you will not get your knee entirely better by being passive. Knee rehabilitation is a predominantly active not passsive proces.
Tips #2: ROM Stretches
Once you leave the hospital, range of motion becomes your responsibility and you need to view it very seriously. The goal is full passive extension for at least 15 minutes every hour in addition to the other ROM stretches.
In most ligament surgeries, flexion (bending) tends to be easier to get back than extension (straightening), but it still needs attention. Conversely, patients who have had a total knee replacement usually have to work harder on flexion (bending) since their knees were often stiff for years before the surgery. Getting and maintaining full extension and 110 degrees of flexion may be uncomfortable, but it is crucial that you seek to achieve this in the first week after the knee surgery.
Tips #3: Patella Mobilization
Mobilization as well as massage of the patella should be done at least 3 times a day for 5 minutes. In the beginning, massage right through the dressings. First, relax all of your leg muscles. Hold the patella (knee cap) between your thumb and forefinger and try moving it up and down as well as back and forth. Do this both with the leg fully straight and slightly bent.
Once a lighter dressing is put on the knee, you will be able to feel your knee cap better. Patella massage is especially important after total knee replacement and ACL surgeries where a patella tendon graft was used. Moving your patella should not actually hurt, but might feel a bit stnge at first.
Tips #4: Muscle Massage
Massaging your muscle helps to reduce swelling, relieve soreness and promote healing. With your foot propped up, massage from the toes all the way to the groin, in an effort to push the fluid toward your heart.
Use a squeezing motion to mobilize swelling and a deeper, kneading-type stroke to relax the muscles of your leg and thigh. Do all 4 sides of your thigh which is the top (quads), bottom (hams) and sides. Spend extra time on any particularly sore areas, such as the hamstrings if your ACL graft was harvested from here.
You can massage your own legs, but having someone else massage them for you is definitely better. If you cannot get anyone to help you and your hands get tired, try moving your thigh over a foam roller or padded rolling pain.
As with patella massage, you should massage your muscles at least 3 times a day in the first week. Hiring a massage therapist is a worthwhile investment, even if you just learn a few techniques which you can adopt at home.
Tips #5: Maintaining Your Movement Patterns
Movement patterns should begin right after surgery during knee rehabilitation. Re-creating some of the same movement patterns immediately after surgery that you make prior surgery whether they are gardening, loading a truck, dancing or other activities that will help keep your muscle memory alive and a speedy recovery.
If you are an athlete, you will need to perform sport-specific movement patterns that help re-create aspects of your sport. For example, if you are a tennis player, keep a racket nearby both as visual inspiration to stay on track with your post-op rehab and to literally practice your forehand or backhand.
Making small, slow and deliberate steps that mimic tennis footwork will not harm your knee and will help retain your muscle memory. If you are a gardener, get potting soil for some indoor planting. Always remember that this is not just a physical therapy but mental therapy as well.
Assuming you have established proper movement patterns at a safe speed, the question is “how much is enough?”In fact, the concept is very simple, just perform the movements with the pain level which you can take it. If there is a need, you can repeat the sets several times a day.
Adhering to such technique is easy at home but once you are back at work or to your sports, there are some tough adjustments which you may make. As such, you should try to establish some parameters with your boss or coach before getting back to your full time job or sports.
Tips #6: Follow A Set Schedule
Keeping a rehab routine in place gives you focus, and focused people tend to accomplish their goals in life. Ultimately, there is no difference in the way you rehabilitate from knee surgery and how an Olympic athlete rehabilitates. In addition, there is little difference in how an arthroscopy patient rehabilitates compared to an ACL reconstruction compared to a total knee replacement.