Extreme Pain of Flexing after Patellar Fracture

I had a my patella fracture into three parts and had a surgery done this last month on March 5th. Did not do any physical exercise as for first two weeks as I had a brace and was using crutches for working. Do have metal wires in my right knee. On removal the orthopedist recommended me to a physiotherapy, initially exercises for mainly elevating the leg. After a week of rigurous exercise, was fortunate enough to lift my leg and unable to flex. At the end of the second week, he suggested I start on flexing and this is where the real problem begin.

I will admit, I do have a short pain threshold and am not much of an atheletic person. Barely go to the gym as I am skinny fella. Initially tried to bear the pain and be strong. First week went by with no change at my flexing angle 45degree same as the day the brace was removed. In addition, I do have extreme swelling on my knee and looks like its protruding outwardly. In addition, the swelling has rendered me helpless as I cant elevate my leg anymore.

Had to attend work conference for a week and travel thus was unable to go for therapy.
Today after an extruciating pain of therapy session, my therapist told me I am not doing enough and need to be strong as my knee is still at 45 degree.

I don´t mean to be a whinning kid here, but I may have reached my limit here. I almost felt dizzy and nouseous after the session. I really was on borderline crying. Further she told me if I do not bear the pain, it will be worse with every passing day.

After work came home and did little online search, basically do see if there are perhaps oral medications I can take to ease the pain during flexion manipulations. On managed to read about anesthesia? Would anyone recommend this? Is this local anesthesia and how effective is it.Maybe some numbing sprays. Would anyone recommend these extreme measures as this is having a major toll of my personal and work life. I barely slept the last few nights from extreme pain.

Please help and advise accordingly. Thank you.

The patella is a unique type of bone in that it is part of the quadriceps muscle - the big muscle in front of your thigh that straightens your knee. It is designed to improve the mechanics of the muscle as it moves around the trochea of the femur. This is basically a pulley arrangement where the inside of the patella and the muscle is like the cable around the fulcrum which is the femoral condyle. While I don't know what exactly has happened in the case of your fracture it is likely that the rehabilitation is about remodelling the knee cap to slide around the condyle of the femur. The fracture will have disrupted the smooth cartilage surface of the patella and you have to try to get the the surface has lost its smoothness and now your job is to strengthen the quadriceps muscle and also improve the flexibility of the muscle and to improve the smoothness of the patella where is contacts the femur.

In addition to the surface problem the tissues around the front of the knee may have probably contracted due to the immobilisation and the inflammation. These tissues have to be gradually mobilised and stretched out so that you can properly bend your knee.

This is where the pain comes in. You have to apply the appropriate forces to cause the beneficial remodelling, but it is going to be hard work. However there is no virtue in suffering the pain.

The swelling is probably due to increased fluid in the knee joint due to inflammation. One source of the pain is the inflammation. If you can reduce the swelling by such techniques as ice packs this may help. The ice also temporarily numbs the area so this can be a useful modality to combine with your quadriceps exercises that no doubt you have been given to do. Another modality is a battery powered electrical device called TENS that can modulate the pain while you exercise. Your physio can advise you on the use of TENS

As I said - no virtue to the pain so I would get some advice about managing the pain Non steroidal antiinflammatory drugs maybe one option to talk over with your doctor. but there are other options. I would get some professional advice about this however.

The physio has put the hard word on you about getting on with the rehabilitative exercise. They are most likely right and delaying the exercise is only going to prolong things and may result in a worse outcome. However getting some pain management is a great idea. You really do have to get going on it but there are no medals for being in more pain than you need to be.