Painful cramps following knee replacement surgery – How To Treat/Prevent Cramping

Subject: Post operative leg cramps following knee replacement surgery…

Bob,

My 80 year old mother, a life long right leg amputee, had knee replacement surgery about 6 weeks ago. While she is mobile and is celebrating her increasing accomplishments, she is suffering from reoccurring leg cramps in her calf muscle (which she refers to as a “charley horse”). She describes the leg cramps as being very painful (note: she has a very high tolerance for pain, so I believe her). Her doctors have said that they have never heard of post operative leg cramps, and so, have not offered any possible solutions.

As a runner, I start eating bananas when I get cramps, but she is allergic to them… so this is not a possibility.

Questions: Have you ever heard of this situation following knee replacement surgery? Do you have any suggestions?

Thanks (in advance),

John P.

Answer to consider:

Hi John,

Historically when a person was having surgery they would put a tens unit on them immediately post operatively and at first the assumptions were the stimulation would:

1.        Lessen need for pain meds

2.       In abdominal area would reduce “gas”, therefore less pain.

Over time it became apparent:

1.        For most surgeries not worth the time, hassle, cost to use tens when drugs did the job and patient only used for couple days in most cases

2.       The “less gas” was probably the result of restoring muscle tone by accelerating tissue repair with the electricity.  The muscle had been literally “cut” and the stimulation we know accelerates tissue repair.

In your Mom’s case what may be happening is she is “favoring” her leg, due to the pain from the knee, and has put additional stress on the calf muscle not only due to pain but has probably shifted her posture which adds additional stress.   Now the issue is not to treat the cramps but to prevent the cramps.

One of reasons tens has helped is it literally reduces the “tenseness, tightness” of the muscles involved and there is less “tightening” of the muscles which often results in “spasms”.  One would intervene when it is felt the calf muscles are getting tense and apply the estim then.  The estim will literally make the muscle relax and prevent the buildup of lactic acid which is what happens when muscles are in constant tightness.  The lactic acid from the fatigue builds up and the result is muscle spasticity or spasms/cramps.

Also before doing any tens have her use warm, MOIST heat to her calf couple times per day to prevent.  The moist heat attracts blood which in turn removes the lactic acid that is building up to cause the cramps.

Both of the above methods do not involve drugs and can be done externally so there is or should be no questions on her alertness, drug interactions, dosage etc.   Of course the two above will be even better if used conjunctively.    When your Mom can, be sure to make sure she is inverting her foot to stretch those calf muscles and increase the elasticity as long term that is also a solution.

Happy Thanksgiving.

bobj



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Reader Comments

So much great information here re: pain management. My brother had a knee replacement last year, and over the past couple of years, my own joints are not cooperating as they used to. His experience, and my escalating pain and “down time” (from exercise) caused me to suddenly become very interested in the subject.

You’re providing a lot of help here. Keep it up – and thanks!
Adam

#1 
Written By Adam Gleason on March 16th, 2011 @ 1:39 am

6 months ago I had bilateral total knee replacements. After a few months I was suffering what I called “spasms” in both legs, it was extremely painful especially at night, a Chiropractor who is also family friend advised me to take magnesium oral powder – I took 1 tsp at night with 1/2 glass water and found it has worked. ‘Jumpy leg’ some would call it but it was extremely painful and I needed pain medication to cope. He’s since been treating me for a build-up of lactic acid in thigh muscles saying this physiotherapy treatment should have been part of the rehab. I’m now told to work out on a captive bike to strengthen the muscles. A very painful operation but I had no option because as a trekker for 20 yrs I’d worn out the cartileges in both knees and they both had bad arthritis.

#2 
Written By Shirls on February 16th, 2012 @ 6:08 am

Hi Shirls,

Thanks for insight and you were brave doing both knees at once. I think your chiro had excellent advice that you should have begun strengthening immediately to rebuild the lost muscle tissue and increase the strength of the supporting structures. Often lactic acid is a result of muscle fatigue or of muscles staying tense, rather than relaxing when not needed. Lactic acid is a byproduct of that process of not relaxing and staying tense. Athletes slow down and lose strength based upon fatigue setting in which is the buildup of lactic acid in muscle tissue.

Going forward one very strong potential for many types of replacements is to do what is called functional restoration. That is nothing but strengthening muscles so there is no impingement of nerves, no bone on bone, and in many cases the replacement surgery can be eliminated. Of course it also requires a patient willing to invest the time and pain of exercise in conjunction with electrotherapy. Thanks again for sharing your experiences with everyone.

bobj

#3 
Written By painguru on February 16th, 2012 @ 3:00 pm

I have severe lower leg cramps that can reach into my feet, i had surgery on my right leg to connect the tib-fib after being hit by a car, and now i can have charlie horses that will make my right foot stiffen up to the point it would look as if i had a pair of invisible womens high heel shoes on, and it takes so long to relax, as well as most usually my right foot will charlie horse and twist outwardly at the same time along with my toes cramping, and i need to literally pull my foot back inward to start to relieve the atrophy, so my question is if anyone has a suggestion as to how to lessen the effects, i will also add that it seems to be more frequent when it gets cold, and never had this prior to having a broken leg

#4 
Written By Jim on November 18th, 2012 @ 5:56 pm

Hi Jim,

Your description sounds as though could be very painful!!! One suggestion, other than some form of muscle relaxants – ‘just in case’, is to sleep at night for while with high frequency interferential stimulator on, or more simply use warm moist hot packs frequently. Here’s why.

It could be something is provoking your muscles to cramp such as you’ve changed your natural gait/posture and it is causing undue stress to supporting musculature. A result of continual stress is cramping. If you can give the muscles some relaxation then that may help prevent cramping. Also should see a physical therapist or podiatrist to learn what can be done to strengthen the weak muscles that are not holding your foot in proper alignment. The strengthening is the permanent cure as there’s a reason for the cramps and the problem is not the muscles actually causing the cramping but the antagonist muscles which are not strong enough to prevent the movement.

bobj

#5 
Written By painguru on November 18th, 2012 @ 7:10 pm
This post was written by painguru on November 24, 2010
Posted Under: knee replacement surgery,surgical pain
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