TKR Aggressive Physical Therapy

@wander03 Been there, done that! As most of us have. It seems most PT & even surgeons love to force the knee to bend. Didn't understand it then. Don't understand it now. It defies logic to expect a swollen joint to easily bend as one with no swelling.
But I'll tell you as I've said so many times before on this site, DON'T let anyone push you to the point of pain. It's simply not necessary. I am an excellent example of that. I had only 3 PT sessions and had to quit due to hips that made it impossible to do most of the exercises. My PT sessions would set me back days & my knee was perpetually swollen.
I quit PT and just did very simple heel slides, marching in place, leg lifts etc. Most from a sitting position. My knee, one year out, is just as strong as those who sweat out months in PT. My ROM & extension are both excellent. I often forget I even had a knee replacement.
So please, don't let anyone push you to the point of awful pain or overwork you into setbacks!! And oh by the way, ice & elevation is a must! Give that baby knee what it needs most!
 
regaining our ROM and strength is more about Time than repetitions of a list of exercises
I assume you don't need the exercises that I do ... they are all fairly simple and I can't imagine I'm doing any that you wouldn't recognize.
 
My daughter sent me the link for the BoneSmart website on September 22 because I was discouraged about the length of time it was taking me to recover. She wanted me to know that other people took longer to recover than the articles I had read said it generally takes. Ironically, that was the day the damage was done to my knee. I joined the forum the next Monday after I met with therapist Joe and he told me if they could not stretch my leg, they could not help me. I am grateful to my daughter for doing the research to find the website. The information and encouragement I have received from all of you helps to keep me going.

It seems to me it would have beneficial for me to have known one should not let anyone push to the point of awful pain, as abbylayla and others have said, before I allowed the therapists to push me to that point. But I know that things unfold as they should at the time they should; therefore, I know that the experiences I had in physical therapy were necessary, although I would prefer to not have had them.

As lovetocookandsew said, it seems I am basically back to the beginning of recovery, but I think the work I’ve done will enable me to progress more quickly when the current trauma in my knee has been resolved. There does not seem to have been any improvement in the two-and-a-half weeks since September 22, but I am trying to be patient and know that healing will come in time.
I think you you are correct, hawk2go, that I do not need the exercises that you did. I do thank you, however.

Thanks again for the information and encouragement.
 
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But I know that things unfold as they should at the time they should; therefore, I know that the experiences I had in physical therapy were necessary, although I would prefer to not have had them.
I agree. If I hadn’t had a bad experience in PT I would never have gone online looking for information about stopping “therapy” and I wouldn't have found Bonesmart. None of my online searches for partials before my surgery led me to Bonesmart.

Now I spend my time supporting members here and trying to protect them from inappropriate PT.
 
I haven’t been in the mood to post, but I decided I needed to post an update about my physical therapy. Chris with Elite Home Health did a 3-hour evaluation on Monday. He was very thorough, much more so than the evaluation I had by Baptist Health on July 22. However, I suppose the eval would be different since the one by BH was on the third day after surgery, and the one by Elite was 12 weeks after surgery. it seems to me that the therapy by Elite is basically to undo the damage done by the BH therapy and to help me continue my recovery. Chris worked with my knee and said the bulge above my knee is due to muscle trauma caused by BH therapy over-stretching my knee. I had told him about the PT methods used by BH when he called me on Sunday to set up an appointment. On Monday he said the stretching method used by BH on my knee to the point of extreme pain is outdated. He said he winced when I told him about it on Sunday. Chris explained the relationship of the muscles and helped me understand the cause of the trauma in the muscles around my knee.

Daniel, a PTA, came yesterday. I really like him and his PT methods. He said my muscles are very tight and guarded. I said that makes sense considering what they have gone through. He agreed. He did a great deal of massage of the muscles and had me work a bit on my recumbent bike. He said to use the bike and work on bending my leg; that most of the therapy will have to be hands-on because it involves relaxing my muscles and that I need to work on consciously relaxing them. If I am not successful in doing so, he may want me to take a muscle relaxant. During the night and today, my knee has hurt a great deal and my hip some. I told Daniel about the pain when he called to check on me this afternoon. He agreed that it is a result all of the work he did on my knee yesterday, but he says some is it is due to the great amount of rain we have had yesterday and today.

Chris said that Medicare will allow nine therapy sessions in four weeks and fewer in the next weeks, but I don’t remember that number. I hope that Elite will be successful in undoing the damage done by Baptist Health. My muscles are so tight that I doubt I could relax them sufficiently on my own, so I hope that Elite will be successful in helping me to do so.

I have been reading other threads and rejoice for those who are walking with a cane and are well on the way to recovery after only four weeks or so. Chris said he had a client in her 70s who started therapy with Elite immediately out of the hospital. She progressed so well that she was discharged before her projected discharge date. Daniel said he has had other clients who had problems with the therapy at Baptist Health. One of them quit after just a few sessions because she said they were hurting her so much. I said I continued even though they hurt me because they said the pain was a necessary part of the therapy. They were the therapists, the professionals, and I knew nothing about therapy. I have learned.
 
My whole leg was very tight months after my partial replacement. I wondered if a massage therapist could help, but after the PT I had early on, I couldn’t bear to allow anyone to touch my leg. It took well into my second year for my leg to continue to heal and relax.
 
My experience is much like what Jockette described. I'm two years post surgery and would dearly love a massage. However, the thought of anyone touching my leg just doesn't fly with me. I suppose I could have a massage minus the legs - but frankly I don't see the point in that.

My tightness / swelling continues, but finally it is oh so slowly getting better.
 
I am fortunate that I don’t have a problem with having my leg touched. The massaging I have had is only in the knee area and was done by physical therapists. The more I read on this forum, the more I realize how smoothly the healing of my knee, at least the exterior, has been. The physical therapy I received seems to have been the biggest and only major problem, and now I have hope that the damage done can be remedied. The other pain I had during the healing process was normal, according to other posts. So I continue my recovery.
 
They were the therapists, the professionals, and I knew nothing about therapy. I have learned.
I'm giving you a virtual hug {{{{{@wander03}}}}}. I'm glad you're in better care now. I started outpatient PT today and made sure we had an agreement that I would push myself to some discomfort but never to the point of pain. She agreed and we were off!

I wondered if a massage therapist could help
I had a lymphatic massage of my left leg on a day when I had really overdone it. The reduced swelling and relief were immediate. I'd love to repeat that experience one day for the right leg (massages really are fantastic in general).
 
The physical therapy I received seems to have been the biggest and only major problem, and now I have hope that the damage done can be remedied.
@wander03 I'm so sorry you were treated so poorly by your original PT. When I hear about such an old school approach I almost expect them to suggest leaches for the swelling. Fortunately the actual implant itself is extremely tough so it's all the already traumatized soft tissues that the PT aggravated even worse. It will take some extra time to recover from what was done to you, but there shouldn't be any permanent damage.
 
hawk2go, It’s great that you have an understanding with your therapist as to how far you are willing to push yourself. I am confident that your outpatient PT will be much more satisfactory than mine was.

Jockette, I hope that you will be able to tolerate having your right leg touched so that you can have it massaged.

FCBayern, i hope that Baptist Health will make some changes to their therapy program for knee replacement patients after I write a letter about my PT experience to the administration after the damage to my knee has been rectified. I may be overly optimistic in that hope, but hope springs eternal in my heart. It definitely is taking extra time to recover, so I suppose it is good that I don’t have to ”go to work” daily. But I am looking forward to resuming normal, enjoyable activities, many of which were curtailed for close to three years before my knee replacement.
 
I have had three physical therapy sessions with Elite Home Health and will have another one tomorrow. I wish I could say I am doing better, but I’m not. Despite massages to my knee, the muscles and tendons are still extremely tight. I do not walk as well as I did before starting this round of therapy. i am definitely discouraged. I wonder whether Elite PTs will be able to undo the damage done by Baptist Health.
 
I'm sure its not what you want to hear, but time. Lots of time to heal. For swelling to go down. Its very easy to become discouraged, but hang in there. I'm wondering are you using a cane? Walker? If PT discourages it, don't listen to them. I'm asking since you say your not walking as well as before. It is much better to use a walker/cane for stability than to walk improperly. This doesn't mean you'll be using them forever, just now until your walking correctly. Frankly I walk better with my cane, more upright and I'm certainly more aware to heal toe walking.

I didn't make myself clear about massage. My leg(s) can be touched, pants don't bother me, etc. What I can't handle is the thought of a massage on my leg(s). Putting lotion on them is about all I can stand. I'm certain this is a mind thing with me, but to me its real!!

See how this PT session goes and then maybe simply stop them and see how you do. Ice and elevation are your friends right now.
 
hawk2go, It’s great that you have an understanding with your therapist as to how far you are willing to push yourself. I am confident that your outpatient PT will be much more satisfactory than mine was.
I've actually skipped the last 3 sessions because after the 1st session (10/15), I was in pain the following day, unable to complete my daily walk. The pain lasted nearly 5 days with real intensity for the 1st 2 days (think week 2 pain flares without the good drugs). We had an understanding, but I may have pushed myself to get through the exercises she thought I should be able to handle. I have another session scheduled today and I am going to cancel that one as well. I'm pushing myself to test my limits every day and I don't try to compact all of my tests into a 1 hour session. I will likely have a conversation with my PT today to find out what she can offer that I'm not already doing. The bottom line for me is that I think I have a fantastic bend at this point, when The Knee is not swollen, and am gaining capability every day as far as strength, stamina and flexibility are concerned. When The Knee is swollen, I give it a break (and ice).
 
eaglemom, I accepted from the first therapy that it will take time for healing. What is so difficult for me to accept is the setback because of the damage done on September 22 by the overly aggressive therapy. I do not have swelling. The problem is with the muscles and tendons. I use a walker all of the time and am unable to walk without it. I can walk a short distance with a cane, but my knee is not strong enough to walk very far with it, and I am concerned about my knee collapsing. Before the damage, I could walk further with a cane than I can now. The PT said that icing and elevation will not help in this situation because the problem is taunt muscles and tendons, not swelling.

hawk2go, it sounds like you have taken charge of your therapy and are doing great! I am delighted for you. I think I would have progressed much better had I not believed the PTs when they said the pain, often intense, that I had after every session was a necessary part of healing.

I thank both of you and Jockette for your continuing encouragement.

I had a therapy session with Daniel today, and he assures me that I am making progress. He said during Tuesday’s session that I have the original surgery, the damage done by the previous therapy, and the fall on October 18 from which I have to recover, so it is going to take more time than it would have without the complications.

I hadn’t mentioned the fall. I was rushing to the bathroom early in the morning on October 18, and one of the rear wheels on my walker caught on the leg of a table. I fell hard, and the walker (a Nova 8, which is relatively heavy) fell on me. I managed to get myself up from the floor eventually by getting on my left knee and holding onto the corner of the built-in bookshelves and a handle of the walker once I managed to get the walker upright. I went to my chiropractor the next day, on Tuesday, because T7 and L1 were displaced. Fortunately he was successful in realigning them. Since I ended up having to change my clothes anyway, it would have been more prudent to not rush. Lesson learned, I hope.

Time to heal. I just have to accept that.
 
@wander03 - so sorry for your mishap. I'm glad you have Daniel. Be sure to let him know how you fared after your therapy session each time. He'll know what he introduced that may have triggered any negative outcomes. Good luck. Slow and steady.
 
I’m so sorry you fell. That’s one of our biggest fears. Hugs to you as you continue on the healing journey. :console2:
 
I used my recumbent bike last evening, and this afternoon I did one of the exercises that Daniel told me to do. My hips hurt so much afterwards that I can only sit 4 or 5 minutes without excruciating pain in my left hip. It has been painful for months, but it is worse now. I have to get up for a bit; then I sit back down for a bit. I am taking ibuprofen, and it seems to help some. But not enough. The right hip hurts when I walk, but that pain is not nearly as bad as the pain in the left hip.
I plan to call my OS on Monday and ask if he can do something such as give me shots in my hips to help with the pain. Several years ago I had a shot in my right hip after which I did not have pain. However, i was not bob-on-bone in both hips as I am jaw. I’m quite certain that I will have to go in and have x-rays again. I’ll do whatever is required to get something to help alleviate the pain.
I feel bad about whining about how I feel, but I hurt constantly and am finding it very difficult to deal with.
 

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