Managing Post-Surgery Knee Pain: Seeking Solutions for Recovery

It has been over a year since the arthroscopic partial meniscectomy of the posterior horn of the medial meniscus?

In Germany, a few months after surgery, it was still considered normal to walk and ride a bike, but my condition has been deteriorating.
The time I can walk each day is getting shorter; now I can only walk for a few minutes once a day, and I have to use crutches the rest of the time.
Walking too much causes my knee to feel weak and somewhat painful.
I have been consistently doing the leg exercises taught by my physical therapist and riding a stationary bike at home.
After several weeks of regular exercise, I was able to walk normally for 10 minutes, but if I accidentally walk a few minutes longer, my knee becomes weak again, forcing me to restart my rehabilitation from one minute of walking.
I keep a record of my exercise sessions because if I overdo it, I have to start from scratch again.
Unfortunately, after a while, due to unintentional overuse, my left knee starts to feel weak again! Even the doctors and physical therapists here are unsure why this is happening.
I hope doctors in Taiwan can help me.
What should I do now? Should I completely rest to allow certain sponge-like tissues in my knee to heal fully and ensure normal blood circulation? (A physical therapist suggested a stretching exercise for the knee a few days ago, saying it could improve blood circulation.) Yesterday, a new physical therapist advised me to walk more to prevent muscle atrophy, but walking for more than five minutes makes my knee uncomfortable.
Therefore, I currently only dare to walk about 4-5 times a day, for 3-5 minutes each time, and I have to rely on crutches for the rest of the time! I have tried various rehabilitation methods and knee exercises, but my condition fluctuates.
The orthopedic doctor suggests taking it slow, but it has already been over a year, and I don't know how to "take it slow." If necessary, I will make a trip to Taiwan, but I have to wait until the Christmas holiday.
In the meantime, I am unsure how to care for my knee.
My physical therapist recommends icing before bed, while another rehabilitation doctor suggests heat therapy.
I don't know whose advice to follow.
I hope to receive good news! Thank you very much!

Lully, 50~59 year old female. Ask Date: 2018/04/02

Dr. Shi Guozheng reply Orthopedics

Strength training can also be performed while sitting in a chair by allowing the legs to hang down and repeatedly bending and straightening the knee joints.
This can help maintain muscle strength.
Additionally, lying down and raising the thighs straight up is another effective exercise.
If there is no redness or swelling in the joints but there is stiffness, heat therapy can be applied.
However, if there is swelling and warmth in the joints, ice therapy should be used.
Depending on the situation, alternating between the two methods may be beneficial.

Reply Date: 2018/04/02

More Info

Managing post-surgery knee pain can be a complex and frustrating journey, especially when recovery seems to stall or regress. Based on your description, it appears that you are experiencing significant challenges with your knee function and pain management after surgery. Here are some insights and recommendations that may help you navigate this situation.

Understanding Your Symptoms
1. Pain and Weakness: It is not uncommon for patients to experience pain and weakness in the knee after surgery, particularly if there has been significant trauma or if the surgery involved complex procedures. The knee joint is intricate, and any surgery can lead to inflammation, scar tissue formation, and changes in muscle strength.

2. Activity Limitations: Your experience of being able to walk only a few minutes at a time and needing a cane indicates that your knee may still be in the healing phase. This is particularly true if you notice that overexertion leads to increased pain and weakness.

3. Rehabilitation Challenges: The cycle of feeling better with rehabilitation exercises only to regress after overdoing it is a common issue. It suggests that your knee may not yet be ready for increased activity levels, and this can be frustrating.

Recommendations for Recovery
1. Rest and Recovery: It is crucial to listen to your body. If walking for more than a few minutes causes pain, it may be beneficial to take a step back and allow your knee to rest. This does not mean complete inactivity; rather, focus on gentle movements that do not exacerbate your symptoms.

2. Gradual Increase in Activity: When you do engage in walking or exercises, aim for very short durations and gradually increase as tolerated. For instance, if you can walk for 3 minutes without pain, try to maintain that for a few days before adding more time. This gradual approach can help build strength without overwhelming your knee.

3. Physical Therapy: Continue working with your physical therapist, but communicate openly about your pain levels and limitations. They can adjust your rehabilitation program to focus on strengthening the muscles around the knee without overstraining the joint. They may also incorporate modalities like ultrasound or electrical stimulation to help manage pain and promote healing.

4. Ice vs. Heat: The debate between ice and heat can be confusing. Generally, ice is recommended for acute pain and inflammation, while heat can be beneficial for muscle relaxation and chronic stiffness. You might consider alternating between the two based on your symptoms—ice after activity to reduce swelling and heat before exercises to loosen up tight muscles.

5. Monitoring Progress: Keep a detailed log of your activities, pain levels, and any exercises you perform. This can help you and your healthcare providers identify patterns and adjust your rehabilitation plan accordingly.

6. Consulting Specialists: If your symptoms do not improve or worsen, consider seeking a second opinion from an orthopedic specialist or a pain management expert. They may offer additional insights or treatment options, such as injections or advanced imaging to assess the knee's condition.

7. Mental Health Considerations: Chronic pain and limited mobility can take a toll on mental health. Consider speaking with a counselor or therapist if you find yourself feeling overwhelmed or anxious about your recovery.

Conclusion
Recovery from knee surgery is often a non-linear process, and it is essential to be patient with yourself. Focus on small, achievable goals, and prioritize communication with your healthcare team. If you find that your current approach is not yielding results, do not hesitate to seek further evaluation or alternative therapies. Your well-being is paramount, and with the right strategies, you can work towards regaining strength and function in your knee.

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