TKR 14 weeks post op

[julie1968]

@JDinCT I'm definitely having a talk with her tomorrow. She is a good PT but she seems rushed and always talking about how many clients she has in a day. I may knock her down to 2 days a week.

 

[Jockette]

You can knock her down to zero days a week and you’ll do just fine on your own.

 

[julie1968]

@Jockette Thank you. I'm at 90 ROM she seems shocked after 1 week PO. I do my list of PT daily and walk around the house throughout the day and feel good. So Thankful for a his group and your advice. After this week I'm going to tell her I'm ready to do my own and out patient

 

[kneeper]

90 is awesome at this point! I would cut the exercises you describe way down.
In my experience it seemed to work better to do a few repetitions a couple of times a day rather than a lot at once. You can always do more as you start to heal more.

 

[Josephine]

1. Pain level is about a 4. After PT it goes to a 7 in soreness

3. Moderate swelling

Moderate swelling adds about 4 points to your pain score so that would make it 11!

2. Take 1000 mg Tylenol every 6 hours during the day and 1 oxycodone at bedtime. PT days I take 5mg oxycodone after PT if very sore.

You shouldn't take pain killers to help you cope with PT. Pain has a function which is to let you know when you are doing to much or being pushed too far. If it's masked with medication then you will do too much and it will harm you. If you are in pain, use ice to manage it.

PLUS you are inadequately medicated for pain. Considering you are not even two weeks out and also considering the pain level you have, you should be taking the oxycodone as prescribed which I would imagine is 4 times a day. Obviously you can't do that AND take the Tylenol as well but you can do this

oxycodone x 4 daily as 6hrly intervals = 325mg acetaminophen so you can also take 2 regular 325mg Tylenol as well.

I know the FDA has ruled that 3,000mg acetaminophen is a safe maximum but that would be assuming that the patient is taking another medication that also contained it and thereby inadvertently take an overdose. Since this regimen gives you 3,900mg you will be well within the actual the maximum safe dosage per 24hrs 4,000mgs.​

4. ROM is 90 she didn't give me number for straighten Friday.

I see you fell into the usual trap of thinking that ROM only refers to flexion. It doesn't. The term range of motion includes BOTH flexion and extension. I thought I explained that carefully in the question. So your flexion is 90 degrees.

To tell me your extension, you can do that yourself using this method
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. Ice my knee every couple hours for at least 30 mins and at night
6. Elevate my leg at least 30 mins out of every hour

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

7. Haven't done any house work yet. Just heat my lunch in the microwave

At 1½ weeks that's excellent!


Laying down left lifts 10 x3 - nope, not a good idea just yet. Try it again at about 4 weeks
Laying down heel slide 10 x3 - also a no-no. Read this Heel slides and how to do them properly
Ankle pumps 10 x3 - these you only need to do in the first 24-48 hours before you start walking around. After that, not necessary
Seated long arc Quad 10 x3 - this is a seated half leg lift and it's far too early to be doing them
Seated knee flex stretch 10 x3 - never use any assistive things like straps, bands or towels. Very bad
Standing hip flexion 10 x3 - not for knees! It's a hip exercise!
Do these also with PT x3 times a week- I strongly suggest you quit these

In summary:
1. amend your pain meds as recommended
2. stop taking pain meds before (or after) PT
3. adjust your elevation and icing as suggested
4. stop all the exercises as I have crossed them out
5. decline PT

It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

There are many, many members here, including me!, that never did any exercising at all and yet came out with excellent results. This is because we've figured out that exercising actually causes more harm than good and will result in excess swelling and pain which will actually BLOCk your ROM and progress.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[julie1968]

@Josephine aftwr reading your response the PT is definitely pushing me too hard right now. She just left and I'm at 100 ROM but now pain is a 9 was a 3 before started. I see her again on Wed. I feel I'm progressing well when she doesn't come I do the exercises not as much pain and still progressing. Thank you for your help and advice

 

[Josephine]

You definitely don't need exercises or PT with a flexion of 100! Cancel it all!

 

[julie1968]

@Josephine i just left a message for my Dr. Letting her know I'm cancelling PT 3 times a week and doing once a week

 

[Lindylee]

Ouch! You don't need a PT like that, that's for sure, especially this early on. I only did the exercises I came out of hospital with for the first 3 weeks and didn't start formal physio until week 6 and then only once a week. None of it has caused pain like yours. Anything that hurt, I avoided and after taking advice from the kind ladies on here I reduced my other exercises that seemed to cause swelling as opposed to pain, although I know now we need to factor swelling in as well.There's always something new to learn! Take care and I hope you are soon more comfortable.

 

[Josephine]

Well done! I'm proud of you.

 

[julie1968]

@Josephine After PT today I have been in pain all afternoon. Also I was at 97 ROM. The PT told me she wanted me at 100 ROM before she left. At that point I felt my number was a goal for her not me.

I'm calling tomorrow and stop her from coming and will be doing my own PT. I'm only 10 days PO. I feel I shouldn't be pushed like this.

 

[ebungalow]

@julie1968

Sounds like you’re doing well in recovery and especially well in being assertive!

My first PT had those random goals for me as well.

One of the most valuable things I’ve learned on BoneSmart is that I can give my very best effort (however each of us defines that), but in the end the body will do what the body is going to do.

You’re doing so well in advocating for yourself.

 

[julie1968]

@ebungalow until talking to people on here I thought pain after PT was normal and I had to do it. After going a few days doing my own PT and feeling better I see I can do it myself. Thank you for your message

 

[Zommom]

Sorry that you were treated like a number - 97 ROM at this point in your recovery is really good! Each day and each hour of the day is different for your new born knee. It wants to work right but all those muscles and tendons are in shock and irritated. that PT is further inflaming them good idea to take a break you’ll see improvement in a couple of days I know I am seeing that. I try to remember that our days are good then bad and then good hopefully more good than bad to come

 

[Jolease]

I’m sure glad we don’t have in home PT here. They usually have you go 7-10 days post op but have a gentle approach. When I was called I said I’d go at 2 weeks as my swelling was just to much. I go because I benefit from it, but they certainly don’t push or force anything on you. I’m glad you stood up for yourself and will heal much better because of them not forcing the knee.

 

[Celle]

I'm lucky!
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

His regime and its success supports the advice we give here on BoneSmart - It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

 

[Josephine]

I'm only 10 days PO. I feel I shouldn't be pushed like this.

No you shouldn't. I think I already told you this.

And this: It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

I thought I also told you that lots of us never did ANY exercises at all and because of it, we got excellent outcomes. Trust me, you can have this too.

 

[julie1968]

I’ve been doing good back to work full time since week 10. This weekend my knee has gotten very tender to touch on outer side and pain when I walk. Is this normal after not having this pain for weeks?

 

[Celle]

Hi @julie1968
It's good to hear that you're doing well.

You'll notice that I have merged your newest thread with your original recovery thread.
For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.
Don't worry that we won't see your question because, between us, the staff read all new posts every day.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Lindylee]

Have you been doing anything different or,more than usual? I was talked into doing an exercise that my knee didn't like and had the same problem as you. It's taken 10"days for it to calm down. Even at this stage it seems we can have a backward step!