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TKR 2nd TKR - 6/26/2025 - repeating same good BS post op protocols!

I don’t have a definitive answer for that. It depends on your body and the current situation plus other factors such as your activity levels and how much you push yourself. That’s why I’m saying you can either continue on the medications for a while or test doing without them and see what happens. The Tylenol works primarily on pain. NSAIDs work primarily as an anti-inflammatory medication.
 
Hey folks. I went to get my xray done in preparation for my OS visit next week so I decided to go to PT. He softly chided me for not coming for over 2 weeks and said he was worried about me forming scar tissue. I told him I wasn’t worried about scar tissue.

He put me thru some warm up exercises to see where my ROM was - 120/0. He said he was scared I would come in with a bent knee but he said I wasn’t worried doing really good.

Then he put me thru some tough exercises that really pushed my quads/strengthening.
- 1 legged leg presses - 2 sets x 20
- wrapped a band around my waist and he pulled behind me while I walked forward. 4 sets across the room. Then walked backwards 2x across.
- 1 legged step down from stairs touch heel on other foot.
- then rubbed my incision with massage lotion and some metal butter knife looking thing.
- did same with a numb part of my lower leg which was super painful that made me sweat.

Pretty wiped right now and elevating. Really seemed like it was a bit much for being just over 4 weeks. But he said I wasn’t worried doing definitely doing good and I must have been doing my homework. I wanted to tell him I’ve been following the BS protocols Danggit! Haha.

I don’t know if I want to go back even though it seems the exercises may have helped my quad strength. I just don’t want to push too hard too soon.

Thoughts?
 
Yay for a ROM of 120/0 at just one month post-op! You are doing remarkably well, @ferddword. Clearly, his concern about your "forming scar tissue" was completely unfounded.

I think your concern about pushing too hard too soon is well founded because the exercises you describe sound really aggressive for so early in recovery. We generally advise against weighted exercises -- like leg presses -- until 10-12 weeks out. Soft tissues aren't fully healed until that point.

Why don't you wait to see how the knee feels tonight/tomorrow before making any decisions on PT. If you find yourself in increased pain, you'll know it was too early for these exercises. If not, and you decided to go again, remember that you can say "no" to any exercise that causes pain or concerns you. It's YOUR knee and YOUR recovery, not his.

ferddword said:
I must have been doing my homework. I wanted to tell him I’ve been following the BS protocols
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He probably wouldn't have believed you! :heehee:
 
My goodness, I will say the PT did work you out. No wonder your tired.

Your numbers are fantastic at one month, good for you. However, the exercises your PT put you through are far too aggressive for this stage of healing. Have you elevated and iced? If not please do so.

Personally I would take a hard pass at attending PT for several weeks and see how you do on your own. Clearly you will do stretching and exercises, gentle exercises, as your knee allows. If you do go back, you can tell PT you won't do certain things. The PT person usually complains but, that's their issue not yours. Don't let anyone push down on your knee/leg, ever.

Your doing great, baby steps and you've got this.
 
Icing/elevating and 30 min nap. I’ll see how my knee feels tonight/tomorrow. I just wasn’t prepared for PT to do those exercises that really tested my strength. I prefer to continue to heal and make sure my swelling is down before pushing.
 
I wanted to wait until my OS 6 week visit before I did anything intense. But at this point i guess I can’t hurt or damage the structure of the knee and if pushed too hard would just be the swelling I would have to deal with.

If I do go back to PT, since I’m already at 120/0 what can he really give me to do other than push me to do strength training? So for that reason, I may go again after my check up.
 
You won’t damage your implant, but you can really inflame tender, still-healing soft tissues. I’m going to be really surprised if you’re not feeling the effects of this workout tomorrow. There is no such thing as “just swelling.” The swelling comes as your body’s response to injury or inflammation. This is what you’re trying to avoid! Push it like you did today and you risk putting your body in a cycle of constant inflammation. This can become chronic if you’re not careful (meaning it won’t go away with just rest and ice). Please don’t be swayed by this misinformed physical therapist. You were on a good path. Don’t feel like you have to do therapy to recover. Or, at least if you go, set boundaries and stick to it with this therapist. He’s not doing you any favors.
 
Good stuff @Jamie. When he was rubbing my numb area and was so painful I was sweating. I told him it’s probably from the Iovera shots. He didn’t even know what it was. I’m a bit worried he is pushing too hard too early. He was the one that pushed and pulled my knee in week 2 to get the numbers and my knee was on fire for the whole weekend.
 
Please…..consider stopping therapy and working on this yourself or request a different therapist. This person is not going to help you and could cause your recovery to be slower.

Numb areas on your leg after a TKR are the result of nerves being cut during surgery. It takes months for them to reconnect and for feeling to return. He should not be rubbing these areas and definitely should not be causing you pain during anything that’s done. This is not the guy for you. A good therapist would know that.
 
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The more I’ve thought about it post session I totally agree with you @Jamie I’m not against working out with a steady increase in intensity but this PT puts me in the wringer/pain the last 2x times I’ve seen him. So yep, I’m done with it or definitely him. And even though I’m doing “pretty good” at 4 weeks I won’t really start doing strength training till at or close to 3 months.
 
I pray you are doing OK this morning after that torture PT session yesterday. That therapist has no idea at all on the rehab for a joint replacement. Please don't go back to him, he will only set back your recovery.

ferddword said:
And even though I’m doing “pretty good” at 4 weeks I won’t really start doing strength training till at or close to 3 months.
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You are not just doing 'pretty good', you are doing exceptionally well! Don't listen to him.
 
ferddword said:
I wanted to wait until my OS 6 week visit before I did anything intense. But at this point i guess I can’t hurt or damage the structure of the knee and if pushed too hard would just be the swelling I would have to deal with.

If I do go back to PT, since I’m already at 120/0 what can he really give me to do other than push me to do strength training? So for that reason, I may go again after my check up.
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I took a break because like you I had early return of range of motion. It's universal at least in USA from what I read here that PTs push strength training inappropriately if ROM returns early. I guess it's the only way to bill for service?

You absolutely can injure muscle, tendon, ligament.

The key with home exercise is no more than 1 set in a session, and spread the daily exercises out thoughout the day. You can do a lot if you keep each gentle stretch and exercise session to under 10 minutes but do several a day with your ice and elevation in between.

The big problem even with PT after basic healing is we and our muscles lack stamina. We're deconditioned! A 45 - 50 minute session is too much. Three sets of 10 reps per exercise is too much.

What I did: if I was supposed to do three sets of 10, and I knew 10 was ok, I did my 10 super slowly (a better workout! Spend as much slow time relaxing as contracting) then smiled and said "that's all I can do today. What's next?" At the next session I tried 15 slow reps of that exercise as a single set. Smiled and said "that's good! What next?" Etc

WE'RE IN CHARGE! Drove my PT nuts but I progressed at my own pace.
 
ferddword said:
And even though I’m doing “pretty good” at 4 weeks I won’t really start doing strength training till at or close to 3 months.
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Exactly. As others have said, pushing soft tissue that's not fully healed will not help. Imagine exercising hard in recovery for a broken leg or a sprained muscle; counter-productive, obviously, and would worsen the damage. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain.

Exercises to regain ROM are *stretches*, exercises to make you fit are *training*. Stretching exercises are gentle and do not make you breath hard, sweat or have an elevated heart rate. Training exercises do this.

You cannot do training until healing is complete because it worsens damage to the ligaments and tendons that were affected by surgery. You can easily tell if this is happening because your knee will get stiff, will hurt, will swell up in the 24 hours afterwards. When this happens, stop.

Here is a longer explanation of the training/healing differences https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/

Here are some ROM and extension stretches (there are loads, these are just examples) https://bonesmart.org/forum/threads/rom-and-extension-stretches.13159/
 
Hi @sistersinhim - a bit sore today and the numb area he rubbed is feeling a bit inflamed. I’m certainly taking it easy today - icing and elevating. I’m not going back to PT. I’ll stretch and exercise on my own. I’ll be patient with the healing!

@mendogal and @Roy Gardiner - thanks for the tips and information on proper gradual recovery training. I’ll put those in my regimen.

The PT is a nice guy, but I feel like someone (maybe me) needs to tell him the BS approach. He could injure or certainly delay people’s recoveries. I’m thankfully recovering pretty good and was in good shape pre operation. I was thinking when he asked me to pull him across the room like this can’t be right only 4 weeks out from surgery. ‍
 
OMG! There's no reason to rub at the numb area of the lower leg. I have never heard of that and see no physiological basis for it.
 
ferddword said:
I mean shouldn’t he know that nerves will regenerate slowly?!?!
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One would think he should know!

ferddword said:
then rubbed my incision with massage lotion and some metal butter knife looking thing.
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The method he used is called the Graston Technique. Personally, I will never consent to it, because I don’t think it’s necessary, at least, not for me. My son had a PT do it on his incision after he had surgery for a broken arm. Back then I didn’t know what I know about it now, and my son was an adult at the time. They convinced him that it was necessary or else his scar would never settle down and blend in with his skin. I now believe in letting healing take its time and that all will be well in the end.
 
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