Knee Pain and Fever After Spinal Surgery: A Rehab Perspective

Meteorological Station vs. Knee Can Also Experience Fever

Hello Dr.
Pan, it has been a while since I last asked a question.
After undergoing my third surgery for herniated disc (HIVD) last year, my recovery went well, and I seemed to have no complications.
However, in February of this year, I accidentally fell from a height of about one to two meters while out, and prior to that, I had been gradually reducing my use of controlled substances.
Unfortunately, after this incident, I began experiencing back pain and intermittent claudication in my legs, making it difficult to exert force.

In the past month, I have fallen twice more, and due to the recent sudden changes in weather, I have developed severe lower back pain.
This pain feels similar to the discomfort I experienced immediately after surgery when foreign objects were placed in my body (pain level 10).
As a result, I have to walk very cautiously and my gait is unsteady.
I am unsure what kind of rehabilitation work I can do now, as my rehabilitation physician is taking a very conservative approach to my treatment, only recommending heat therapy and electrical stimulation.
However, after each rehabilitation session, I experience intense lower back pain, which makes me want to give up on this treatment.
Is this a normal phenomenon?
In recent days, I have also noticed that after sitting for a while, my knees experience a reactive downward force, which has recurred multiple times in just a few days.
Each time I stand, I feel pain.
Additionally, last night I discovered that my knees have been feeling warm, with a noticeable temperature difference between the left and right sides.
I would like to ask if these symptoms are related to my HIVD, or if they indicate another disease process.
How should I proceed with treatment?

gush, 20~29 year old female. Ask Date: 2006/10/12

Dr. Pan Yingda reply Rehabilitation

I'm glad to hear that you are recovering well after your surgery.
Currently, my rehabilitation physician is quite conservative with my treatment, probably out of fear of being sued! Haha! Generally, for those who have undergone multiple surgeries and are still uncomfortable, we tend to take a more cautious approach.
Heat therapy and electrical stimulation are actually quite passive treatments that can only alleviate pain.
Experiencing "severe" pain after rehabilitation is certainly abnormal and is likely related to your positioning during treatment; trying a different position might help.

Since your current symptoms seem to be closely related to falls, I recommend getting checked again to see if there is any structural damage from the falls.
Additionally, I am puzzled as to why you keep falling; this is worth investigating.
After ruling out any significant structural injuries from the falls, if you want to pursue "active" and "intensive" rehabilitation, you should focus on strengthening the structure—bones, ligaments, and muscles.
Here are my suggestions and steps:
1.
Strengthen your core muscles, primarily the transverse abdominis, pelvic floor muscles, and the small muscles around the spine.
Pilates emphasizes this type of training, and if possible, find a qualified Pilates instructor to learn from, as it's difficult to describe in text.
You can strengthen your core muscles through proper breathing, specifically diaphragmatic breathing, but be careful not to let your abdomen protrude excessively.
2.
Ensure correct alignment and posture.
3.
Train the strength of your lower back, abdominal muscles, and lower extremities for at least one hour each day; if done seriously, it will be quite challenging.
Regarding your knee issue, I would ask whether the warmth you feel is a subjective sensation or if there is an actual increase in temperature (you can have someone else check).
If it’s the latter, that indicates a local inflammatory response, most commonly seen in knee joint inflammation (due to injury, improper use, or overuse), or it could be Reflex Sympathetic Dystrophy (RSD), although that typically affects the entire leg.
If it’s the former, the most likely cause is an issue with your lumbar spine, particularly at L3.
As for exercise, remember this professional principle: if it hurts more, stop.
Wishing you safety and health.
Pan Yingda.

Reply Date: 2006/10/12

More Info

After spinal surgery, particularly for conditions like herniated intervertebral discs (HIVD), patients may experience a variety of symptoms, including knee pain and fever, which can be concerning. Your situation, characterized by recurrent back pain, knee issues, and fever, warrants a comprehensive understanding of potential causes and treatment options.

First, it’s essential to recognize that post-surgical complications can arise from various factors, including nerve irritation, inflammation, or even infection. The knee pain you’re experiencing could be related to several underlying issues:
1. Nerve Irritation or Compression: After spinal surgery, especially if there has been a history of herniated discs, the nerves that exit the spinal column can become irritated or compressed. This can lead to referred pain in the knees or legs, often described as a shooting or radiating pain. If you have experienced falls, as you mentioned, it could exacerbate any existing nerve issues.

2. Muscle Imbalance and Weakness: Following surgery, patients often have altered movement patterns due to pain or fear of re-injury. This can lead to muscle imbalances, particularly in the lower back and legs, which may contribute to knee pain. Weakness in the muscles supporting the knee can also lead to instability and pain.

3. Inflammation: Post-surgical inflammation can manifest as pain and swelling in the knees. If you notice that your knees feel warm or hot to the touch, this could indicate inflammation, which might be a response to the surgery or a new injury.

4. Infection: Fever and localized warmth in the knees could suggest an infection, particularly if you have had recent surgery. Infections can occur post-operatively, and they may require prompt medical attention.

5. Other Conditions: Conditions such as arthritis or tendinitis can also cause knee pain and may be exacerbated by changes in activity levels or postural adjustments following surgery.

Given your symptoms, here are some recommendations for managing your condition:
- Consult Your Surgeon: It’s crucial to discuss your symptoms with your orthopedic surgeon or a spine specialist. They may recommend imaging studies, such as an MRI, to assess for any structural issues, nerve compression, or signs of infection.

- Physical Therapy: While your current rehabilitation approach seems conservative, consider seeking a physical therapist who specializes in post-operative care for spinal surgery. They can provide tailored exercises to strengthen the muscles around your spine and knees, improve flexibility, and enhance overall function.

- Pain Management: If your pain is severe, discuss pain management options with your healthcare provider. This may include medications, injections, or alternative therapies like acupuncture or chiropractic care.

- Activity Modification: Avoid activities that exacerbate your pain. Gradually increase your activity level as tolerated, and incorporate low-impact exercises such as swimming or cycling, which can be easier on your joints.

- Monitor Symptoms: Keep track of your symptoms, including any changes in pain intensity, fever, or swelling. If you notice a significant increase in symptoms or new symptoms arise, seek medical attention promptly.

- Consider a Second Opinion: If you feel your current treatment plan is not addressing your concerns adequately, it may be beneficial to seek a second opinion from another spine specialist or a pain management expert.

In conclusion, while knee pain and fever after spinal surgery can be alarming, understanding the potential causes and seeking appropriate medical guidance can help you manage your symptoms effectively. It’s essential to remain proactive in your recovery and communicate openly with your healthcare team about your concerns and progress.

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