You Have Bad Arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis rheumatoid arthritis, an autoimmune condition that causes joint pain and damage or post-injury arthritis.
Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion, says Nathanael Heckmann, MD, an orthopaedic surgeon at Keck Medicine of USC and an assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.
When Lying Down What Causes Pain That Shoots From The Knee To The Ankle
It all depends on where the pain is shooting from. If the pain starts in the buttocks and shoots down the back of the leg past the knee to the ankle, that is most likely a pinched nerve in the back. Patients with a pinched nerve in the back often cant lie down flat, and they will have use a recliner or wedged pillow to relieve some pain when laying down.
However, if the pain is just from the knee down, the issue could be from a knee pathology.
How To Relieve Pain
Immediately after surgery, your physician will prescribe pain medication for short-term relief. Possible medications include acetaminophen, nonsteroidal anti-inflammatory medications or stronger prescription pain relievers, when necessary. Take all medications as instructed.
Attending your physical therapy sessions can help with pain. The main goals of physical therapy are to restore movement and strengthen your knee joint, but gentle exercise can also help lessen postoperative pain. Your physical therapist will give you a set of exercises that are safe for your healing knee joint. During early recovery, you may be prescribed to walk for 30 minutes and exercise 20 to 30 minutes, two to three times daily.
Mild swelling in your knee is normal for up to six months after surgery. To reduce inflammation, slightly elevate your leg and apply a cold pack. Wearing compression socks can also help reduce swelling.
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What To Do If Your Back Is Causing Pain In Your Knees
If your back can cause knee pain, it’s obvious that helping fix your back pain is a necessary part of your treatment plan. Luckily, there are plenty of ways to address back pain.
Speak with your medical provider about evaluation and referral to a physical therapist. A physical therapist can help you with strengthening exercises. Specifically targeting problematic weak areas, or areas that are not as flexible as they should, the physical therapist will help stabilize and strengthen your spine to improve your pain. Physical therapy exercises help strengthen your back, abdominal, and lower body muscles to prevent future damage. It can help you build proper posture and support for your back, so you don’t return to the same problems. Some people choose to visit a chiropractor. Chiropractors have helped many people with problems related to the spine through spinal adjustments . However, in some injuries or cases this treatment is not recommended, and chiropractic treatments also have risks. Consult with a Babylon healthcare provider for more information.
Over-the-counter painkillers can help you manage chronic pain or pain from an injury. These include tylenol, ibuprofen, aleve, and naproxen. Prescription strength ones are also available. You can pair them with heating pads, especially for stiff backs from arthritis, or ice packs, for swelling and inflammation from injuries. There are also some topical ointments available over-the-counter for back pain.
The Connection Between The Lower Back And Hip Pain
Your body is an intricately connected, well-oiled machine. When one piece stops working properly, it affects just about everything. You need your bones for support, your joints to connect them, and all your muscles, tendons, and ligaments to move in the wonderful ways you do.
When one part of the body is injured, weak, loose, or too tight, it impacts how the rest of your body works. Thatâs why even when you have knee surgery, it can create lower back and hip pain.
The lower back and your hip pain are especially interconnected because of the iliopsoas muscle and the piriformis muscle. If one is too tight, it will add tension to the other, and if one part of your low back or hip is weak, both muscle groups will overcompensate and tighten to protect it.
Since the psoas connects to the spine and works hard to stabilize the back, and the iliacus connects to the pelvis to help stabilize the hip and sacroiliac joint, theyâre a primary foundation for both your back and hips.
After surgery, especially hip or knee surgery, your iliopsoas is at a very high risk of tightening and causing an anterior pull. That tug on your pelvic bone strains the connection between your pelvis and tailbone, particularly where the two bones meet.
Thehip socket cradles your femur to allow a perfect fit and comfortable movements. When an anterior rotation begins with your pelvis, the thigh bone no longer sits well into the hip socket, and can cause friction or even pull the hip joint out of place.
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Knee Replacement Pain After Three Months
Swelling and bruising can continue for three months or more following knee replacement surgery. However, it varies from patient to patient and depends on the condition you were in before surgery. Many patients are back to their activities without the pain they had before surgery by this stage of recovery.
If you find that any movement or activity is still exceedingly painful after three months, you may be experiencing chronic pain. Chronic pain is defined as pain persisting for three months or longer. Its a condition that affects roughly 20% of knee replacement surgery patients. It can develop and increase in intensity in the weeks and months following surgery. This can have a huge impact on your overall quality of life. Talk to your doctor for help.
Nerve Pain After Surgery: Why It Peaks And What You Can Do
There are a number of reasons why nerve pain may flare after surgery. It is natural for your body to produce less cortisol at night, which is your natural anti-inflammatory hormone. When you remain in the same position for an extended period of time, you will also stiffen up your knee joints. The procedure itself can cause nerve damage as well. It can also result in neuropathic pain, a condition that is frequently overlooked in patients suffering from pain after TKR. There are several types of neurological pain, one of which is characterized by pain that does not directly affect the nerve, but rather by a problem with how the nerves signal travels to the brain. It usually takes between six and three months for the wound to heal after surgery. Its important to note, however, that nerve pain can persist even after surgery is completed. If you have neuropathic pain after surgery, speak with your doctor to see if there are any treatments that may be beneficial.
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Early And Correct Diagnosis Is Key
When seeing a physician for hip or lower back pain, imaging such as x-rays and MRIs are usually conducted at the sight of the symptoms. Yet, these studies can sometimes show abnormalities that are not actually the root cause of the pain. Let me share a quick example.
A fifty-year-old gentleman had severe pain in the outside of his hip. He saw a physician and had an x-ray of the hip area performed. It was determined that he had mild arthritis in the hip, but the arthritis should not have caused the extensive symptoms he was enduring.
So, he started physical therapy for a period of time and saw no improvement. He then received a cortisone shot in the hip, and that didnt work either. His treatment plan moved on to a stem cell injection with platelet rich plasma in the hip, which also offered no improvement to his symptoms.
This mans symptoms started in April and proceeded to get worse and worse to the point that he was in a wheelchair when he came to the OrthoVirginia office in August. I looked over his symptoms and decided to have a MRI performed on his lower back, even though he had absolutely zero pain coming from his lumbar spine.
It turned out that the L3 and L4 nerves in his back were being compressed, and the symptoms were appearing in his hip. A minimally invasive surgery was performed, and his pain was gone immediately.
Who Will Get The Most Pain Relief From Back Surgery
Before we talk about post back surgery pain, its important to discuss with your surgeon the best course of action. After all, not all back pain is created equal and not all pain can be relieved with surgery. The spine is a very complex joint system and unlike replacing an arthritic knee or hip, it can be difficult to address the root cause of back pain with surgery. If your back pain is more general and chronic and not stemming from a visible, mechanical/ structural issue, surgery may be like a stab in the dark. For your surgeon, patient selection is of the utmost importance when choosing who spine surgery can help.
Dr. Singh, Scottsdale-based orthopedic surgeon explains, if someone has shooting leg pain and on an MRI we can see structural findings that can be fixed with surgery , then a successful outcome is likely. In other words, seeing a structural issue that is linked to the type of pain the patient is experiencing allows for a more reliable surgical result.
Back surgery is most successful at relieving pain if:
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Age And Gender Issues
Age and gender are important factors to consider when diagnosing low back pain. In a young patient, a benign tumor of the spine called an osteoid osteoma may be the culprit. Inflammatory bowel disease in young people can be connected with spondylitis and sacroiliitis . Low back pain from disc disease or spinal degeneration is more likely to occur as people get older. Conditions such as abdominal aneurysm or multiple myeloma are also considered in older individuals.
Osteoporosis and fibromyalgia are much more common triggers of back pain in women than in men. Osteoporosis is a progressive decrease in bone density that leaves the bones brittle, porous and prone to fracture. Fibromyalgia is a chronic disorder that causes widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips.
Fractures And Lower Back Pain
are often very difficult pain problems and indicate the possible presence of . In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma the patient does not have to fall to fracture a vertebrae.
Patients with spinal compression fractures experience spasms and, often, very high pain levels.
In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI can often reveal these fractures.
It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.
Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. may be needed for pain control, for as brief a period as possible.
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What Is Your Opinion On Acupuncture If Surgery Is Not An Option
Back pain often has low success rates when it comes to surgery compared to buttocks pain that has high success rates. So if surgery is not an option for you, I think the answer is yes try everything else.
Everything else can range from physical therapy to acupuncture to chiropractic care to stem cell therapy. I have had patients respond to every version of therapy, and I have had patients respond to none of these options.
I would absolutely recommend trying acupuncture to see how much relief that provides you.
How Long Does Back Pain Last After Knee Replacement
Most people report that their back pain improves significantly after knee replacement surgery. However, some people may still experience some degree of back pain after the surgery. The back pain may last for a few weeks or even a few months. If the back pain does not improve with time, you may need to consult with a doctor to determine the cause.
It is critical to understand that pain and recovery from a total or partial knee replacement will differ depending on the type of replacement. A typical total knee replacement requires one to three months to fully recover from a walker or cane. Patients who have partial knee replacement usually do not require assistance for at least two weeks after the operation. Depending on the source, you can expect to experience knee replacement pain in a variety of ways. Due to the preoperative swelling, bruising, and the use of prosthetics, this is not surprising. In addition to your knee, there are places in your body where you may feel pain. Chronic pain is defined as persistent pain that lasts more than three months.
A Corticosteroid injection is a great way to reduce knee swelling and flare-ups. Pain signals are halted by injecting anesthetic into one or more of the genicular nerves in an attempt to block pain signals being transmitted to the brain. In rare but serious cases, you may require a revision surgery to replace your knee.
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What Can We Do If The Diagnosis Isnt Clear
If you are still in pain after trying more conservative treatment options such as anti-inflammatories and physical therapy, and the x-ray or MRI imaging studies arent showing us what exactly is wrong, we can do a series of numbing injections to clear the fog. Essentially, we will numb up an area of the hip or lower back and see what happens.
If there is no response to the numbing injection in the hip area for example, then that is obviously not where the root cause of the pain is located. However, if your pain has dispersed after a numbing injection, then we have located the area of the root cause. These injections act as both a therapeutic and diagnostic tool we can use as physicians.
Another route we can take is an EMG or nerve conduction test. Needles can be put into your leg to see the conduction or activity of nerves. If some nerves are slow or are not signaling correctly, then we know that an angry nerve is the culprit of the symptoms.
Knee Replacement Complications In Former Athletes
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.
However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.
- The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
- The healthier post-traumatic total knee replacement group had the following complications:
- higher rates of superficial surgical site infections,
- bleeding requiring transfusion,
- increased length of hospital stay,
- and 30-day hospital readmission.
In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.
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Ask Your Physical Therapist: Why Does My Lower Back Hurt After Knee/hip Replacement
- Steve MillerCardin & Miller Physical Therapy
There are many reasons why the lower back may hurt after a knee or hip replacement.
One of the most common reasons for lower back pain following knee or hip replacement is because, since the surgery, your leg length is uneven. What I mean by this is that you feel uneven due to the fact that one leg is longer than the other. This is called leg length discrepancy. Leg length discrepancy can occur for many reasons including some that follow:
- Due to a hip or knee replacement. When you have a knee or hip joint replaced, the replacement joint is thicker or not as thick as the joint that has not been replaced, and this can cause a difference in leg length.
- Fracturing a leg bone. When you fracture a leg bone, as it heals, it does not always heal to the same length as prior to the fracture.
- Scoliosis. This is the curvature of the spine, which elevates the pelvis on one side versus the other, which makes one leg appear longer than the other.
- One can be born with a leg bone that is longer than the other.
- Your pelvis is out of alignment.