Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

158 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Undergone bilateral knee replacement, had prior spinal fusions and gastric bypass. Suggest exercises to release stiffness

Answered by
Dr.
Dr. K. Naga Ravi Prasad

Orthopaedic Surgeon, Joint Replacement

Practicing since :1996

Answered : 2148 Questions

default
Posted on Sat, 16 Nov 2013 in Bones, Muscles and Joints
Question: I am a 58 yr old woman, two weeks post op bilateral knee replacement. I have had 2 prior spinal fusions as well. Despite the amazing amount of drugs which include oxy codone slow release and immediate release, I am in constant extreme plain 8 - 9 on scale. I've always consered high pain threshold but this is insane pain. I'm doing pt, as well as trying to talk hourly to prevenet additioal stiffness, but its still crazy pain that cannot be releaved. Are there any exercises you could relay to me that may offer some additional releaf. The other concern is I'm a 8 year post op gastric bypass pt and realize that I do not digest some things as most. It was a Fobi pouch, similar to a roux n y. Could this have any part to play as to why the meds don't seem to work very well? Thanks you.
doctor
Answered by Dr. K. Naga Ravi Prasad 21 minutes later
Brief Answer:
It takes a bit of time for the pain to resolve.

Detailed Answer:
Hi, thanks for writing to us.

As you are only 2 weeks post op BILATERAL TKR case, naturally pain tends to be on the higher scale than a person undergoing single side TKR.

Generally, the intensity of the pain will go on decreasing as the time passes off and by the end of 8 weeks after a TKR procedure, virtually every patient should be pain free. This is the normal course of pain after TKR procedure.

Excessive (Over vigorous) Physiotherapy is also to be blamed as the cause of severe pain in a few cases after TKR. As the soft tissues are still in the phase of healing within 2 weeks after TKR, Physiotherapy exercises should be done within the pain limits.

The clinical dictum is that whenever there is pain & inflammation in soft tissues, they should be rested.

Apply ice to the painful area after physiotherapy exercises. Ice will help calm the inflammatory response and stimulate blood flow to the area.

Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the painful area prior to stretching or exercising. As a general rule of thumb, remember to heat before an activity and ice afterwards.

As most of the medicines that are consumed gets absorbed into the systemic circulation either in the stomach or the first part of duodenum, I suspect that the roux-en-Y gastric bypass might have been contributing to the malabsorption of the medicines that are being taken so as to reduce their efficacy resulting in lesser therapeutic response.

So, I feel in your case, injectable analgesic preparations may be a better choice. Approach your treating physician and discuss the issues.

Hope I have addressed your query. Happy to help further.

Regards,
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Treatment/Therapy
Medical Procedures ,   ,  
Medical Topics

Recent questions on  Physiotherapy

doctor1 MD

hello sir,

this is Hina ,from Punjab...Actually my father had brain injury due to accident,i want to seek your suggestions regarding this case..hope it would be fine with you.....

My father met from an accident on 22nd aug,2007..he had brain injury..bone from right side of brain was taken out..as it was fully damaged..case was very serious as per doctors..according to doctors he

had no chances of survival...he was in icu for 5 months.brain was operated..the bone taken out was central portion of brain..it controls intelligence,memory etc as doctors said..he spoke by end of november..

memory was nt fine that time..but now it is fully fine..he remebers almost everything...during first year of accident he was not able to eat himself,but now it is fine..also had urine and stool problem..he

couldnt know ...physiotherapy is almost continuous from then...his right leg is affected,which doesnt hold body weight...he cannot stand on his own,cannot sit without back support..using two persons

support,we make him to sit on a chair having side and back support...for 1 year he had memory problem,irritation from family,short tempered..used to say many things to us ,if we do for pap's benefit..

but til two years stool and urine problem remained...but by some manual efforts(not exactly physiotherapy) he was able to sit without back support holding sides of bed..we used to make him walk,in which right feet was moved by us..means some activity was seen. he had some fit (not exactly fit,doctors said that brain injured patients have it because of weak nerves) in dec 2008..no -ve impact was seen as such..because of no +ve results for another 1 year we consulted doctors.

doctors told that their is fluid in brain,for that shunt(dnt knw exactly:shunt,but some pipe to drain the fluid) was put in brain ,so another operation in may 2009..after that some positive results were seen

like,he came to know before passing stool..but not urine..irritation was reduced(one medicine was given by doctor)..but the activity shown in two years that i have mentioned was no more...but we found brain more relaxed..no irritation.. sometimes he used to say 'i will die nd al,u r not caring for me etc'..from then we have seen no much +ve results.physiotherapy is continuous..but he is still not on his own.cannot stand,sit without back support,walk etc..voice is also not much clear..

I think he prefers sleeping..he has become so lazy..no efforts from his side.physiotherapy is not working...we say all day to try to get up,try to move ur right feet..but he thinks that we are doing wrong to him.

and doctors have said :in this case u can only wait..there is no other option,had checkup in pgi.said the same.no solution to this case..such patients can be well all of a sudden,u never know..is this really happens??

can we hope for this magic??sir,we couldnot understand what to do..3 years have passed..and we have no positive results...

now the status is like this:he can only eat himself,memory is fine..but sometimes he talk strange as'where are we sitting'(becoz he hasnt gone anywhere from three years,this question shouldnot arise,and in his own home he asks where are we?i want to go home etc..but he talks so intelligently,that listening to it u can not say that he has brain injury...

but he cannot sit without back support,cannot sit on bed cross leg..cannot stand on his own (2 persons to support) which he used to before 2nd operation atleast for 5 mins..can speak..but sometimes not properly..



physiotherapy is continuous...but no improvements as i said u before..sometimes when we ask 'why havnt u gone to office?'he says 'i will go tomorrow'..he shouldnot say this as he must know that he had accident..



i think his will has died..he never make efforts to get up..want to lay on the bed whole time...we say him everytime to get up,try to do something..but he never listens...there is no cooperation from his side during physiotherapy...it is done forcibly..one physiotherapist said'if u gather all world doctors then also he cannot improve,until and unless he has will to get up'....he asks for our help for even a small work which he can do himself...



sir,wat to do???is there any option??till now we have heard,just to wait in these case...is this really??can nothing be done??how can we make him try,make efforts as his brain is not fine..everyone has tried to make him understand that he has to do proper exercise for standing,walking..but he prefers sleeping...



i really need help,need suggestions...it has been 3 years..and we want papa to get well soon..atleast to be on his own...what are the chances in such cases??sir,be frank to reply,eventhough it is negative ..but please do reply on this mail( YYYY@YYYY this is only till 20th july) and( hina.watts@ WWW.WWWW.WW also.i really want help..please reply whenever u get time







thanx



hina watts



                                                                 

doctor1 MD

I had a discectomy and I woke up in excruciating pain. A week later a laminectomy to stop the pain. Epidural injection,Morhine, Dilaudid , nothing helps. Something does not seem right. My Dr. has released me and says it will take a year to get...

doctor1 MD

My entire right arm keeps falling asleep whenever I sleep, regardless of my position. This has been happening for over a week. I have a history of both stroke and neuropathy. I am a 54 yr old woman.

doctor1 MD

Since yesterday, I have a sharp pain in my right leg at the knee, and above, and the right buttock. It s sharp, stabbing pain in the knee and buttock. Nothing seems to help it (e.g. Ibuprofen , changing position (standing, sitting, laying,...

doctor1 MD

My daughter is suffering from Erb s palsy at the right hand ... Thats due to prolonged labour and critical (normal) delivery - Doctors said. But my Child was suffering, i was crying .. she was not able to use her hand .. but there was grip in the fingers .. We took her to Vellore CMC Hospital- Hand surgery department, Dr Anderson suggested physiotherapy and there was improvement ... On her third month she was lifting her hand to an extend ... she turns 3 next October ... Now she is recovered around 80-85% ... Can someone tell me ... can this be completely cured?? Is there any advanced technology which can help the baby escape from a muscular surgery that making the muscle around C5-C8 nerves rigid / stiff ??? A million thanks for the suggestions .... -Kavitha (Bangalore) YYYY@YYYY

doctor1 MD

Hi, My son is suffering from cerebral palsy. He is 4 years old. He is not able to sit and speak. Though he is able to smile and he understands all activities. His MRI brain is normal. But Spasticity is very high in hands and legs. He is under continuous physiotherapy but sign of improvement is very very slow. Dr s at AIIMS last yeay gave him BOTOX dose also Please advice

doctor1 MD

I hurt my tailbone almost a yr ago.i'vehad SI joints steriod injections also caudall epidural injection in tailbone. Have constant tingling pain across buttocks. Can't sit. Barely walk or stand. Going to aquatic & regular physical therapy. Would it help if physical therapist rectally aligned tailbone. She's trained. Neurosurgeon referring me to a physiotherapy dr. Help,