swelling again....saw PT, can I vent please

[Sore knee]

First off I am sorry, I need somewhere to vent as I felt like crying at PT today, actually I almost did and I did cry in the car sitting in the car park afterwards. I know for many this must seem trivial compared to the more serious complications. SO long vent below, apologies in advance, I think only here at this site may some people understand my frustrations.

I had a LR in May, kept swelling, had steroid injections, ended up in surgery again Aug as they all swore there must have been mischief going on in my knee. As I had a reaction to the steroids that the OS didn't think was allergic just the highly inflammed state of my knee. Well there wasn't much to find during the op, I had a chondroplasty, a few very rough areas under the knee cap which the first surgeon had left during the LR so the second one sorted and then washed out the knee and they said the knee was just inflamed.

Now almost 4 weeks after the washout my knee is swelling again with pain....lots of it. They have told me my muscles get inhibited when it gets too swollen, they keep telling me I must work those muscles to re-gain control of the knee as its clicks, grinds at times, catches and clicks. Don't know if that means the patella is maltracking or what.  I have pain underneath the knee cap and they say the patella femoral area is inflammed.

Well today at physio I went in and he said how is it and I said its swelling again and sorer unfortunately. We did static quads and I kept feeling the need to bend my leg prior to doing another one. He kept saying don't do that, I said I am trying but it feels like a reflex action, I am not consciously thinking do it, it just feels as if I need to bend it to loosen the knee as it feels stuck  before I try to contract quads again. He physically restrained my lower leg and made me do it and kept saying you are trying to bend it. I wasn't trying to, it just kept wanting to release and I was then consciously willing it not to.

Anyway he said move through the pain barrier , why are you consciously doing that, forget the pain and irritation, do it faster get in a rhythm, move through it.  I said I am not cobscioulsy doing it, I am not afraid of pain. I got a lecture on how people pull away from pain. I said look I have lived my whole life with knee pain, why would I be afraid now ? I am not afraid, I do push through it, I am workling so hard with my exercises and obviously we are not making huge progress but its not me conscioulsy thinking knee do something you shouldn't. He got quite adamant that I need to work these muscles ( I am trying SO hard) and I said well if this isn't good enough why won't you sign me off to go to the gym. So he said well usually we needed stability first, but as this wasn't working perhaps we should go straight to the deep end, try complex exercise and work back to easy.

So he sat on a machine where you push away with your feet and it obvioulsy has weights to give resistance. He put it on 10lbs and I really struggled with my bad knee...he said see your knee is struggling to cope, but go on try it push through the pain, give me 10. I did I was so determined no matter how sore it was to do it. Then he got me to sit on the side of a bed with my legs hanging down and lift lower leg straight, I struggle so much it quivers and shakes as it approaches straight the muscle is just so weak and the pain below the knee is so sore. He got hold of my heel and bent it up and down to straighten it and lower it so fast with his hand and said look mechanically there is nothing wrong with your knee it moves, take the strain and you do it, ignore the pain,  feel the grind, ignore it move through it. The tears welled up in my eyes, it was so sore and I have tried so hard, it gets sore as it approached straight under the left side of the knee cap. Eventually I said to him look I am trying, tell me how to get this knee to do what you want and I will do it, I am trying and I can assure you I am consciously willing this knee to work. He said I don't know how to get your knee to work, it must be me and part of my brain consciously or subconsciously. I got quite adamant this time and said, well I can assure you its not conscioulsy, I am not sitting here telling my knee not to work, why would i ?
 He then told me subconscioulsy then, we have to find the part of your brain that obvioulsy is holding you back. He made me feel as if it was all my fault and I was doing something wrong. I felt so dejected I could hardly speak.
My knee is very swollen tonight and in pain. I understand what he is trying to say is that my muscle has perhaps forgotten how to work as its has been so long, approaching 6 months now and we need to stimulate the nerve pathways again....but there are ways and means of saying that without making me feel like an idiot.

I think he knew he upset me, as I was leaving he left another patient and came over and said I am not blaming you you know (thats not what it sounded like to me, I have been going for 5 months now and he was the one that referred me to the OS and said to the OS how hard I had worked to no avail in August). I couldn't even face going back next week so I made the next apt for 2 weeks but right now feel like just doing the work at home and at the gym. It sucks that I am trying and making little progress, but it dents you and frustrates you more when you face that.

Tonight I am so sore, dejected and frustrated. How do I get muscle control if they get inhibited with swelling and how do you avoid swelling and attempt exercise. Vicious circle so far.

Anyhow sorry to vent, I know many have more worries than this but I used to be so active and I can't even chase my 3 year old just now. Thanks

[trainwreck]

Joanne,

i am so sorry you are still struggling with this.  You must be at your wits end.  I wish I could fix this for you.  Maybe another pt would be better for you.  i am sorry but i find it hard to believe you are subconciously holding back.  it seems to me that you are trying everything in your power to get better.  pt should not be so bad you literally cry and then have a  mini meltdown in the parking lot after.  there is somone out there who can help you  that you can relate to.  pm me anytime you need to vent.  i worry about you.

Allison

[TIBBAR]

JOANNE
I SURE DON'T HAVE ANY ANSWERS FOR YOU BUT YOUR STORY IS SO SIMULAR TO MINE THAT IS ALMOST MADE ME CRY!!! MY PT HAD ME DOING THE SAME STEP DOWNS AND SQUATS FOR SO LONG AND I COULD NOT DO THEM. I JUST DIDN'T UNDERSTAND WHY SHE DIDN'T TRY SOMETHING ELSE. I TOO WAS MADE TO FEEL LIKE I WAS GOOFING OFF BUT WITH ALL MY SOUL I WANTED TO BE ABLE TO DO THOSE THINGS. I GUESS SOMETIMES THOSE PT FEEL LIKE THEY ARE FAILING IF WE DON'T PROGRESS ON A CERTAIN TIMELINE. PLEASE DON'T DO WHAT I DID. I JUST TOLD THE PT THAT SINCE MY ROM HASN'T CHANGED IN 3 MOS. AND I STILL CAN'T DO THOSE THINGS I WAS STOPPING PT. I FELT JUST LIKE YOU. I FELT LIKE SUCH A CLUTZ AND A FAILURE.  I JOINED A YMCA AND AM SWIMMING SEVERAL TIMES A WEEK.  DON'T YOU THINK IF THE PT WOULD  JUST SEE HOW HARD WE TRY AND CAN'T GET IT THEY WOULD GO BACK A STEP AND TRY SOMETHING ELSE. THEY JUST SOMETIMES DON'T THINK OUTSIDE THE BOX(THEIR PROTOCAL). I TOO HAVE THAT CATCH 22 THING WITH SWELLING AND GAINING MUSCLE CONTROLL. THE MORE I DO THE WORSE SWELLING BUT IF I REST TO BE ABLE TO DO IT THE SWELLIN GOES DOWN AND SO DO THE MUSCLES
 PLEASE KNOW THAT THERE IS SOMEONE WHO KNOWS EXACTLY WHAT YOU ARE GOING THROUGH. IT IS TRULEY NOT YOUR FALT[/size] BUT THEIRS FOR NOT KNOWING WHAT TO DO TO HELP YOU. GO AHEAD AND VENT ALL YOU WANT. IT IS GOOD FOR THE SOUL AND MIND.                                       CAROL

[Sore knee]

Thank you so much your kind words are appreciated and lifted my spirits.

You have both been through so much more than me, I feel as if why am I still there and in pain as everything should surely be ok now. I don't want to waste their time or my money and like you feel so near to quitting.

Thanks so much, you have made a huge difference just by understanding.

[cassieoz]

Hi Joanne,

Gosh i really feel sorry and for you too Carol, from and outsiders view and i say this because im recovering well after 1 month ACLr, that it just sounds like Joanne that your PT does this all to often and it's their patience that is making them frustrated with you. To test your knee and say their is nothing wrong and then implying your not trying is such a load of bull! Although i do think regaining muscle is the key and this is why im think im doing well. But i can totally see where it is a vicious cycle and i can imagine the pain with the swelling.....then trying to build muscle on top being so frustrated. I kind of had the same thought as Allison with maybe seeing another PT and see what they think.

Have you tried Acupuncture it helps with swelling along with the nerves and it doesn't hurt? I like it but can be expensive although it could be worth a try.

Good luck,

Cassie xx

[Sore knee]

Thanks so much

Last night my knee was swollen and very hot, usually it goes down a little overnight but it didn't. I think the heat is decreasing slightly today......you lose perspective sometimes don't you.

Anyhow onwards and upwards and just try and ignore the pain. I have 2 weeks to think about if I am going to go back and I am going to try and go back to the gym....although after yesterday I worry about the repercussions (sp ? )

Anyway, tell me how you all are, I am so pleased your recovery is going well Cassie, was it a sporting injury ?

[tanyap]

H Joanne,
I totally empathise with you - I absolutely hate the way my PT speaks to me and makes me feel like she is 'blaming' me for lack of improvement. I tend to take it personally and Im always crying in the carpark afterwards too.

The thing about you consciously/subsconsciously not working your leg. This is not your fault at all. My VMO will not budge by itself - it takes major force of will on my behalf to get it contracting. I harped on about this to my OS and he explained to me that your brain does 'muscle guarding' when you have an injury and prevents you from using a muscle to prevent further injury. Its not your fault at all - its a totally normal reaction, you absolutely cannot prevent it from happening. If it atrophies to a certain point the messages from the brain will not get through to the muscle cos the nerve fibres die!! These neuro muscular pathways can be rebuilt but it needs to be done gently. What you gotta is to use the muscle (with physio) but NOT while hurting yourself!!! Trying to work through pain in rehab actually switches the muscles off!!! I think you need a physio who understands this!! This is not the gym and trying to build a big muscle around a healthy joint - people will work through that kind of pain because its 'healthy' pain. But rehab is not supposed to be further hurting an injured joint!!! Its ok for the muscles to get sore/tired, but not the joint itself!!! I had one physio who used to say to me to do my exercises then ice immediately otherwise the swelling would cause the muscle guarding and bring on more problems.

My boyfriend (who is always the one who has to deal with me when I come home crying from physio) says to think of the physio as a tool - dont take personally anything they say. Treat them as a computer giving you instructrions and dont be afraid to be hard and say 'I cannot do what you are asking me to do'. If I say NO to my physio she does say ok. But she always gives out to me for not getting better at the exercises faster than I am.

What about an e-stim machine Joanne? I use one now and I think it has helped - its good for stimulating the growth of those nerve fibres and helping re-open the neuromuscular pathways.
Tanya

[Leentje]

I am pro agressive PT, but PTs should ALWAYS listen to their patients!

Over time, when you have an injury, other muscles and tendons take over and make it unable to do things the "right" way. Have seen it with my knee, now with my ankle too. I really have to concentrate to do my exercises the right way and not let my body take over. Fe walking is so much easier and less painfull when i don't flex/extend the foot, but I just HAVE to roll over my foot and bite through the pain, otherwise it will take me AGES to do it!

I think a good talk with your PT is in order, if not consider switching PTs. My PT listens, goes further one more time and if I say "no I can't do it right now" she switches exercises and tell me to try again at home, wich i do. This is how PT should work. Maybe yours's burned out? Anyway, undertake action!

Helena (off to PT in a minute )

[lilrosie06]

Awwww....Joanne, this is not your fault. I have been where you are. Its tough to hear someone say do this or do that...push through the pain, etc., when in fact, you just cannot do it. I had that problem after my TKR when everyone would tell me to walk heel to toe, and I couldnt because my leg would not go straight. Everyone was convinced that I couldnt handle the pain, so all I heard was you have to work through the pain. Its gonna hurt. Blah,blah, blah. I would cry because I could not do it. Now, when the OS confirms that there is indeed an internal problem, which prohibited me from walking normally, those who continually nagged at me, arent saying much at all. So, Ive been there. I know how frustrating this must be for you. I had weak quads that just would not respond. After my LR, I got nowhere. Nothing worked. Every kind of exercise, stim, whatever we did at  PT....failed. And, like you, I think that even in that situation with me, people thought that I was just wimping out and afraid of pain. And that wasnt the case. So, as I said before, you are not alone. Ive been there....more than once. And it hurts. It hurts alot. Not just physically, but in every way. Just burns you out.

 All I can say is, if this does not improve, you may want to seek out the advice of yet another OS. Thats what I had to do. And, despite everything I am going through right now, I am glad that I did. At least I got to the bottom of things.

You hang in there. You know I am here for you any time. You can PM me if you want. Ill answer any questions, help you in any way I can, or just listen to you vent. I know it helps to get it all out once in awhile, and to people who truly understand what you are going through.

Why not go do something special for you?? Maybe get your hair done? A new outfit? Lunch with a friend? Those things seem to help me when I am at my lowest point.

Again...I am here. Let me know what I can do to help....

Bug hug.....DONNA

[Sore knee]

Donna 

To  you and all of you, you make me feel embarrassed actually that you have taken the time and trouble to reply. I see your signatures and think to myself how 'lucky' I am to only have this when you each have your own struggles. Thanks, words fail me right now but I am so touched.

I am chasing.....ha ha ha  (chance would be a nice thing) after my 3 year old so will try and do something nice, would love to buy you all a coffee and a big bity of cake and make each of us laugh. That would be great !

Thanks again

[tanyap]

To  you and all of you, you make me feel embarrassed actually that you have taken the time and trouble to reply. I see your signatures and think to myself how 'lucky' I am to only have this when you each have your own struggles. Thanks, words fail me right now but I am so touched.

Hey Joanne,
Dont ever feel that your problems are less important than anyone elses - no matter what the physical issue is, if you feel low and you need some support youre in the right place. A positive attitude is half the battle, I dislocated again only yesterday and my boyfriend said to me last night 'you dont seem as down about it as usual' - and you know what? Because mentally I dont feel as down - my knee doesnt feel as bad as it usually does after a dislocation. So keep on smiling - dont mind the physio being mean, my one is gonna probably be mean to me when I see her next Monday - just keep thinking to yourself 'Im doing the best I can do and I cant be expected to do more than that!'
xx
Tanya

[Nettan]

Joanne, first of all I want to say to you, maybe your PT didn't mean to be rude to you. Like we all are, they are also human beings and I know out from own experiences that it's not always easy for them to motivate and keep persons going. He can't feel your pain, but he might be able to know if your leg should be working or not. You are only 4 weeks out of surgery and had one surgery right before Summer too.
I think all that you need is time to let this knee heal. Some can have swelling months after surgery and if you had problems for a longer while the rehab to come back usually takes longer. An idea would be to cut back a bit on the exercises and start off with the easiest ones that you do right after surgery. Also be sure to ice often and elevate above heart as much as possible. I would suggest that you take a look at the rehab site of Kneeguru. They are very good.
Giving up and searching for new surgeries so early after surgery is not really the first you should do. That can only make your problem worse.
Doing surgery on a aggravated knee is to look for more pain and problems only. Just some words from a Oldie at this site. Good Luck !!

[Sore knee]

Thanks Nettan, I didn't really want the 2nd surgery but they all thought there must be mischief as they put it in the knee so I followed a very well respcted OS advice who said the wash out at the minimum would be good for it to clean any debris.

We have been doing the basic exercises they give you after surgery since May and then again in Aug and have never been able to progress from them. I think my PT is just lost as where to go next and thus decided to try these more complex ones this time. I have flollowed all their respective advice to date and do what they tell me. I have only started to learn all about this knee stuff so have been doing what they say to date.

So thats where its come to now really, I have never felt educated enough or confident enough to question their judgement about what I should be doing. Maybe one day though

[Nettan]

To be honest sometimes this take time. And if your knee is inflammed and sore, this could be a cycle going on for a while.
Very important to try get the muscles back but in a way that not aggravates the knee too much.
Also a simple thing like doing ROM exercises of any kind can aggravate a knee. Have you tried to only stick to SLR  ?
I am asking this because I have had this situation 2 times myself and with right exercises and not overdo the knee you can get over this.
Ice frequently during the day and elevate also mixed with stronger NSAIDS. If you can't take the NSAIDS, have you tried any of antiinflammatory creams that can be used to apply on inflammed joints ?
Patience is the key and only 4 weeks of PT after a surgery where the knee is inflammed is nothing. Sorry to say this. But just speaking out of years of own experiences.

[Sore knee]

Thanks ......I can wait, frustrated but happy to keep persevering. Its my PT that seems to be throwing a wobbly right now and not me. I feel I need to have a chat with him to say Look we need to have a positive working relationship and I am trying really hard and will continue to do so, but last time the language used made me feel as if this is my fault and demoralised me. It made me feel I can't go in and say to him I've had a bad week or its sore - and if I can't say that to him then what working relationship do we have. The problem is I am not a confident person, hate confrontation and feel intimidated by people so as much as I want to say something I don't know if I will find the words.

I feel my situation is very trivial to him now ( and only now that the 2nd OS has scoped the knee and seen inside) prior to that he was different and beacuse mechanically the knee should be fine now (although he says the patella is probably still maltracking) I should be able to move on. Noone wants it to move on more than me but trivial or not, fixed or not its still sore and still me that has to live with it. They haven't prescribed any meds I asked my GP and she gave me voltarol which I think is diclorophenic (sp ?) an antiinflammatory but  it doesn't seem to do much.

He gets me to do the following, don;t know if I have terminology right so I have described what I do :
 static quads, tighten the thigh pulling the knee down into the bed, and ROM..bend your leg as far as you can. I got 122 a few weeks ago after surgery when the knee was less swollen....it was great then, they cleaned it and drained it and it was good, but as the swelling comes up I am down to 110. He gets me to attempt straight leg lifts but I have a lag of up to 50 degrees which he says is terrible, on a good day maybe drops to 30 or 40 degrees but the muscles have just wasted. He gets me to sit over the bed , legs bent hanging down and raise my lower leg to try and straighten it...this is a nightmare for me just now. My leg becomes a quivering wreck and wobbles and I don;t ever get it straight. I can have a straight leg on the bed, I just can't do it when it requires the muscles to support it.

So don't know what other exercises I can do, feel free to suggest any. Thanks for the advice though