Being Assertive Re: PT

babette12

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I'm learning that there are (at least) 2 schools of thought re: post-op PT. The work through the pain model v. the slow healing, slow moving model. I have a feeling my Dr. is a bit more in the former group. I'm going to have in-home PT beginning the week I get home. I'm of the slow healing, walking as much as is reasonable school. I'm thinking about asking this question at the "Knee Class" my husband and I have to attend. Good idea?
 
Personally I wouldn’t mention it at the knee class, but if you want to, go for it.

I have not found any one I’ve met in person who is of the Bonesmart belief. I gave up discussing it because people don’t want to hear it, they “know we must do PT and it’s going to be a lot of hard work”.

I prefer to spend my time here on Bonesmart with people who are more willing to consider the Bonesmart approach.
 
Working through the pain is never a good idea and it can harm your knee. Pain is a warning sign that your knee is being asked to do more than it can handle. If you disregard that warning, you could cause your knee to become angry and inflamed.
Myth busting: no pain, no gain

Exercise gently - that's all your knee needs, especially in the early days.

Knee replacement is major surgery that causes a lot of trauma. I've never understood why anyone would think it a good idea to add more stress on top of that. After all, even a broken arm is given 6 weeks or so of rest in plaster before you start exercising it.

I wouldn't bother mentioning anything at the Knee Class. You'll just be brushed aside, because they have a one-size-fits-all attitude at those sessions.

Just remember this: It is your knee and you are the only one who has the right to say what will happen to it. Your surgeon and PT therapist may suggest and advise, but you have the right to choose whether or not to accept or follow that advice.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used
 
Here's what I learned about my own PT after getting my first knee replacement in March and having both in-home PT for two weeks and outpatient PT for six weeks after that.

It's up to you to set the intensity level. At first I found myself working really hard, to the max so to speak. That's even though I'd already read this forum and knew the wise philosophy offered here. Well, I learned very quickly that to the max was a bad idea. It was very painful, unsustainable. I considered quitting altogether.

Decided that I was swinging the pendulum too far in the opposite direction by thinking about quitting, and that best healing was probably in the gentle middle between nothing and to the max.

When I backed off, and took it easier, it was sustainable and rewarding. Happy I did it, in hindsight.
 
I had my first replacement about a year ago, I honestly thought PT was a waste of time. I am having my other knee done next week and my surgeon is fine with me skipping PT this time. He says just doing stuff arou the house will suffice.
 
I’ve had two knee replacements, one each leg. My husband commented the other day, after helping me thru both times (including being 2.5 weeks post op on my right TKR, “Those who think it’s easy to come back from this-especially therapists who want ROM back quickly-should have to go thru one to experience it.” Sometimes a good way to judge recovery is to ask ask your helper. “Do you hear me moaning?” “Do I seem rested at times?” “Do you think I am having to push where I shouldn’t be?” They can give helpful insight.. . slow and steady does win this race.

It’s your leg so speak up for it because it’s also your pain in the night and the therapist won’t be there.
 
If you choose to do PT, it can be helpful. Ideally, your outpatient PT will ask what YOUR goals are and build a program to help you achieve them. My outpatient PT told me if something was more than uncomfortable to let him know, and he'd come up with an alternative. One time something seemed merely uncomfortable at the session, but I was in pain for two days afterward. I went in on the next session and told him, and he said, "We won't do THAT again!" This is what you want in a PT. Any other response is unacceptable. On a couple other instances, he asked me to do something, and I knew the second I attempted it that I wasn't ready yet, so I told him, and he provided an alternative that worked every time. PT needs to be an interactive process. Ask questions, give them feedback about what they are asking you to do feels like. Frequently, they would then explain what was going on or why they were doing a certain thing. It built trust, and I think our sessions went better because of it. If the PT you get doesn't interact with you in this way, you should strongly consider seeking another therapist or therapy place.

I had a great in home PT who massaged my lower leg several times to help ease tight tissues and, I think, help keep fluids moving back and and into the system to be cleansed. She never asked me to do anything that hurt, but some things were a little uncomfortable.
 
I agree with speaking up and telling the therapist what works, what doesn't, what hurts, what doesn't. Just today, at PT one of the exercise "helpers" tried to give me a hard foam roller to put under my knee for some short arcs, but I hate that thing. It hurts to press a swollen knee down on the hard foam, so I told him I wanted the cushy padded one. He kindly switched it for me and I explained why and he said oh, he had never thought of that. So speaking up can be a win win.
 
So much depends on what kind of therapist you get. The good ones help assess where you're at and have reasonable suggestions and don't crank on your leg (which you should never let them do anyway). Still there are times when you have to say "enough." They will have you try to do more repetitions until you say "that's it for today." They don't know unless you tell them.

My technique for dealing with PT was to do most of what they wanted (except squats which I refused) and simply said "I think that's it" when they wanted me to do another repetition etc. when my knee was telling me to stop.
You won't go through this recovery process without discomfort, but you should not be causing yourself intense pain in PT or home exercise or by doing too much too soon.

I think PTs are trained to believe people will sit like lumps without PT. Maybe some would. But for most people who come here their problem is they try to work too hard too quickly. That leads to more swelling and pain and it takes longer to gain bend.
 
I initially got in-home PT which I greatly enjoyed, he took me slowly thru the healing moving process. Slowly building up exercises, teaching how to go up and done stairs, taking longer walks. Later I went to outpatient and they slowly increased the exercises, ROM improved and pain levels went down as time progressed. Guess all depends on your PT, he/she should know is a slow healing process. Good luck!
 
Thanks for the support, everyone. I will be having my early PT at home, which feels like a big relief. I guess the PT will know when I'm ready to leave the house for more PT out in the world!
 
I like the in home PT at first. Tops in my book with knee #1 was the PT who massaged my leg (very sore muscles) and also coached me through that first trip up and down the basement steps.
 
Personally I wouldn’t mention it at the knee class, but if you want to, go for it.

I have not found any one I’ve met in person who is of the Bonesmart belief. I gave up discussing it because people don’t want to hear it, they “know we must do PT and it’s going to be a lot of hard work”.

I prefer to spend my time here on Bonesmart with people who are more willing to consider the Bonesmart approach.

What is the “Bonesmart belief?”
 
The Bonesmart belief is just the gentle approach to recovery that Bonesmart recommends. Many of our surgeons push an aggressive approach on us, and PTs can get carried away with giving us too many exercises, some of which do more harm than good for a knee replacement recovery.

Bonesmart says, “if it hurts, don’t do it”. In contrast, many surgeons and PTs tell us to “push through the pain. “

Bonesmart recommends that just using our knee in our daily activities, as we are able as we heal, is all the therapy we need.
 
I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)
Same for me. The physiotherapists actually sent me home 'Nothing we can add here'.

PT is IMO good where something is wrong -- walking with incorrect gait, for instance -- but is of little help in a normal recovery. Gentle stretching exercises are all that's needed.
 
PT is what scares me most about this surgery (still pre-op). I've been to PT three times for other issues and once for the knees. Every time I've been physically hurt (pushed to the point of extreme pain, where I refused to go back) or it made the condition so much worse I stopped going. I was discussing the "bonesmart" way on a facebook knee replacement group and had pretty much the same reaction Jockette has. Several people joined the discussion and kept saying how "you'll never walk right if you don't go to PT and really work at it". And, "that is the way for old people it's the sedentary way of recovery. You'll never get back to work that way, you need to fast track to get back to work." I grow weary of hearing all the PT stories! LOL I like it here!
Denise
 

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