The Bee's Knees

The Bee's Knees

Knee Replacement Pain Management (Part One)

May 21, 2020

Knee Replacement Pain Management
Mary Elliott interviews PT, Amy Bodway

Below are highlights from Amy and Mary's conversation about knee replacement pain management. To listen to the interview click the Play button above.
Pain and Knee Surgery Recovery
Pain and recovery go hand-in-hand. When we're talking about a surgical situation, there's no way around the fact that there is going to be some degree of pain. Expecting that helps you to be prepared. It's a daily changing entity, and you have to constantly be adapting and changing and listening to what your body is telling you, based on a change in your activity. If you don't have good pain control, good pain management, your recovery is going to be more difficult.

No one wants to hurt and that's one reason we want good pain management. When you hurt to the degree that you can't participate in your rehab, if you can't participate and in your physical therapy, you're not getting the most out of your recovery. That will impact your long-term outcome.

The Importance of Range of Motion
The biggest challenge in rehabbing a knee is to increase range of motion. It doesn't come back spontaneously. You have to put in time and work to get it going. Pain will cause you to tense up and guard and resist the efforts to increase your range of motion. There are a lot of different things that we can do to help manage that pain. It's not just one individual strategy.

Solving the Pain
Here are the basic tools:
A combination of oral medications that your physician may have ordered, whether it be over the counter or narcotics and stronger medications.
Icing your knee regularly and elevating it above the level of the heart.
Balancing your activity (having periods of rest with periods of activity)

* Too much rest is not good. You're going to get stiff and have trouble bending
* Too much activity is also not good because you're going to aggravate your pain after knee replacement. There's, there's a significant surface area of bone that's removed and that bone is trying to heal.
* If you even stand for too long at one time or if you walk for too long, you're going to have more pain. That pain can translate into additional swelling because the pain is a reaction to that. Excessive activity and the swelling will increase as well and in turn that can set your ROM back.

In a nutshell:
It's finding the balance between the timing of your pain medication, icing and elevating, and finding the balance of periods of rest and activity to control the pain.

There will be Pain
In the immediate days after surgery it's unrealistic to not expect some degree of pain. We want to control it and manage it and stay ahead of it. Those are terms that you'll hear. To ‘stay ahead of your pain,’ just means not waiting until the pain is an eight out of 10 to take the pain medication. It's taking it when it's creeping up to a three or a four, taking it in advance of your home or outpatient therapy visits to prepare you to tolerate the rehab.

Los Angeles