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TKR Aggressive Physical Therapy

Thank you patriciad and hawk2go for your input. This is the third day for the steroids, and there does not seem to be any decrease in the size of the bulge above my knee. Since I see the OS on Tuesday, maybe I’ll get more information as to what has happened to my leg. When I saw the NP ON Thursday, she said the OS said not to do physical therapy until the problem with my leg clears up. I said I haven’t been able to do therapy since Friday (September 25), so that is not a concern.
I do not understand why I continued to participate for so many weeks in therapy that was so painful. I don’t accept the word a physician as gospel, so why did I accept the aggressive, painful therapy? I suppose it is as patriciad said, “…your OS has made you fearful about your ROM so you have tried to cooperate.” Another painful learning experience.
One of my brothers, who has had therapy on his knees, told me last evening about his experience. His therapist, who came to his home, did not push him to go beyond discomfort to the point of pain. As hawk2go said, "if it hurts don't do it and if it hurts after doing it, don't do it again" seemed to be the attitude of John’s therapist. After the damage to my knee has healed to an extent, I will probably contact the provider of his therapist and see if they can provide therapy when I am ready to resume.
I like the ballon correlation. Be assured, I have no intention of resuming my push for recovery until after the inflammation has decreased appreciably. Having had my recovery progress set back by PT is a big disappointment; however, I presume that the inflammation will eventually go away and I will fully recover. I guess it will just take considerably longer. I am trying to keep my eye on the goal and not get discouraged.
 
@wander03 I am SO sorry yhave to go through all this after having to just go through the surgery itself, it's a lot. I started off with PT being moderately aggressive, and after inflammation and pain, and everything I read here, I went into my next appointment feeling empowered by everyone here. My first words were that I had made a decision, that I was going to back off doing anything that was at all forceful. No weights, no leg machine and all I would do was gently cycle. I told them I was going to take 2 weeks off and that I would return then and we would gently proceed. To my delight they said fine.
I took it easy at home, cycling, short, slow walking, and then after a week, I added leg raises. When I went back to PT, everything had calmed down and they were impressed with my ROM and my condition. I am glad I put my foot down, and made myself heard.
 
You have a great attitude. I was really knocked for six by the set back from the aggressive PT. Apart from feeling I was back at square one with pain and inflammation I was very angry at myself for going along with the PT. I had a blue period that lasted several weeks afterwards. I was very poor me. That’s the best thing about this forum - there are many available to pat your back then give you a positive push forward. Your aggrevated tissues will heal and it will be just a blip in the big picture of your recovery. Hope you are feeling better.
 
Your comments are very encouraging Reader525 and patriciad. Thank you. Although there has been no change in my knee situation, I know that it will heal and this will just be a blip. I’m hanging in there.
 
I saw my OS this afternoon. He felt around on my knee including the area above my kneecap and said the tendons, muscles, and tissue are sound. He said the bulge above my knee is swelling. I reiterated that the “swelling“ was not present until the PTs had me force my knee back two weeks ago to the point I screamed and cried. He kind of raised his voice at me and said the implant, tendons, muscles, and tissues are fine and there is nothing more he can do. I don’t think he is used to being challenged. I asked if he thinks it is appropriate physical therapy to force my knee to the point that I screamed and cried. He said no; they probably should have left me alone then. I said it seems that they have a boiler plate PT program for all knee replacement patients whether they are 25-year-old men or 75-year-old women. I said that is not okay. He said he guessed he needs to talk to Joe Bridges, the head of PT at Baptist Health Therapy Center. I said I hope that he does talk to Joe. You may recall that Joe is the person who said they could not help me if they could not stretch my leg and measure it. I have left a VM for Joe to call me so that I can tell him what Dr. Evans said and cancel my remaining appointments.

After I talked with a friend of mine just a few years younger than I who had replacement knee surgery in June 2020 by an OS at Mercy Medical Center. I asked Jim if his physical therapy included forcing his knee back by pulling on a strap. He said absolutely not; that if they had tried to force his knee in any way, he would have been out of there. He said his flex was measured when he was lying down or sitting against a wall and pulling his knee back himself with no assistance. He said forcing the knee back would not have reflected actual ROM. Of course, I agreed.

I talked with my brother, who has had considerable PT for his knees four or five years ago, and he said the PT that worked with him in his home never pushed him past the point of discomfort to pain. I called the OS’ office and gave them the information so they can contact Elite Home Health and have them contact me about therapy. I have learned so much through the overly aggressive PT and this forum. I will not hesitate to tell a PT what I am comfortable doing and if something is uncomfortable.

Before I left the hospital after the surgery, I was told patients who receive physical therapy as an outpatient recover more quickly than those who have home physical therapy. I wanted to recover as quickly as possible, so of course, I chose to be an outpatient. That didn’t work out so well for me. All I now want is to recover at a steady pace and not have any more setbacks.
 
As a nurse who worked with many MD's and other practitioners over the years, I can tell you it is a rare day that one likes to be challenged on anything. Good for you for questioning and showing your evidence that aggressive PT created aggressive, unwanted, unnecessary results.
You as the patient are the customer. Remember the old adage "The customer is always right?" Modern medicine (99% of it in my opinion) has forgotten that. You reminded him who pays for his second home in Malibu....never stop advocating for yourself! :flwrysmile:
 
At my PT appointment on the one week anniversary of my surgery, my PT continued to push my knee into a further bend causing me excruciating pain. I gripped the sides of the table I was laying on as hard as I could because of the pain. Went home in tears and took a nap. I woke up an hour or so later with extreme pain in my left shoulder, and the dilaudud I was taking for the knee didn’t touch it. The shoulder pain continued in intensity for several days and I called my surgeon who had me come in for an X-ray. Diagnosis, acute tendinitis. Thanks to my PT.

My surgeon was also a fan of pushing my knee to a painful place, so he could get the highest ROM number. Check ups became extremely stressful for me. It took until I was 7 months post op before I refused to get up on the table and give him easy access to my leg.

I wasn’t as vocal about it to the PT and surgeon as you, so I applaud you there. But I did determine that no one will ever do that to me again. And I’ve learned so much more from Bonesmart since then ( more than 4 years ago) that I’ll be much more confident being vocal in the future. If I ever have another replacement, I’ll be doing my rehab on my own.
 
@wander03, well-done! Congratulations on being your own advocate and standing up for yourself!! I am virtually patting your back!

I also had to steel myself for possible battle when going to PT, as I would not allow them to push on my knee or leg, and I told the person I was assigned to (by choice at the recommendation of my usual PT who was out of town) that rule at my first appointment. She would often try to sneak in a push, but my quads are strong enough to resist and push back! I said to her, “Don’t you dare!!” And she sheepishly admitted to trying. I reminded her of our agreement!

I did cancel my last appointment when someone else worked with me on my next to last day there. That person left me to push on a leg press for about 10 minutes while she wandered off! It took me 3 days to recover, but at the time, I “could” do it so I did, despite growing concerned after a few minutes…I eventually just kept my legs up, straight, until she came back so I could say what the heck!!

We do have to be our own advocates! And you did a great job!
 
wander03 said:
Before I left the hospital after the surgery, I was told patients who receive physical therapy as an outpatient recover more quickly than those who have home physical therapy.
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That is such a fear tactic. I'm glad you're standing up for yourself. I have run into people who had knee replacement that was unsuccessful because they didn't put in the work before or after surgery. I think those people laid around too much and also let others care for them too much. So I walk this delicate balance between not doing enough and doing too much.

By the way, I had home PT then outpatient PT on my left knee and did very well. I will never know if I could have done better, but 6 years out, I suspect there is no difference. I graduated from home PT on my right knee last week and will be evaluated for outpatient PT next Friday. I don't plan to do more than 1-2 sessions a week because I'll do some work every day at home (if my body permits, a great line from my yoga instructor).

eta: I did use that pull strap in outpatient PT but much, much later in my recovery and never to the point of severe pain and tears.
 
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Jockette, your experience seems very close to mine except my OS has not taken a measurement; he just bends my knee and estimates what he thinks the ROM is. He checked the extension, with which he was pleased, and flex. He reiterated that I only have until four months to obtain maximum flex/ROM. I did not challenge him on that. It’s ok with me for him to think whatever he wants to think.

BBCG, I considered going back to the therapy clinic when I was ready to resume therapy and ask them if they would continue my therapy without the forcing of my knee, but I decided that I did not want to work any more with therapists that seemed so oblivious to the pain they caused me.

hawk2go, it appears you graduated from home therapy after about three weeks. What did home therapy accomplish?

I called the therapy clinic yesterday and left a VM for Joe Bridges, the head therapist. I had left a VM for him on the general mail box the afternoon before, but he had not returned my call and I needed to cancel yesterday’s appointment and the others through October 13. I don’t know the exact words I used or the order of what I said, but my VM contained the following:
I had seen my OS the day before and he told me the tendons, muscles, and tissue are fine; that the bulge above my knee is swelling, although I’m not certain I agree with him.
I told the OS that I did not have the swelling and I had been making good progress until September 22 when I was pushed to force my knee even more than usual with the result of not being able to walk at all without a walker.
I asked OS if he considered it acceptable physical therapy to push me to force my knee to the point that I screamed and cried. He said no; they probably should have left me alone then. I said I told him that it seems that the therapy clinic has a boiler plate PT program for all knee replacement patients whether they are 25-year-old men or 75-year-old women. I said that is not okay. He said he guessed he needs to talk to Joe Bridges. I said I hope that he does talk to Joe.
I plan to work with a more compassionate therapist who does not use such seemingly sadistic therapy methods. That what his therapy did to me is criminal.
Canceled the remaining appointments.
If he wanted to return my call, I would be glad to talk with him, but I wanted him to know what I had said in the event he did not call me back.

I was not surprised that Joe did not call me back.

Eryn, one of the therapists with whom I worked, called me about 30 minutes after I left the VM for Joe and an hour and eight minutes before my appointment time. She said they had been told that I was goi use home health care but I had a 1:00 appointment with them. I told her about having left the two VMs for Joe to call me and having canceled all remaining appointments in the second VM. She said he was with a patient and probably had not heard the VM. I repeated some of the things I said in the VM for Joe and said he probably won’t like the VM I left. She said he probably won’t. I said I appreciate the work she and Alaina had done with me except for the forcing of my knee; that I suppose they were required to follow the seemingly sadistic therapy program that Joe had instituted.

Today I requested copies of the progress notes and therapy notes from the date of my surgery through today. I am supposed to receive them in five to seven business days.

The swelling, if that’s what it is, above my right kneecap has not decreased. I am icing and elevating it at times during the day and taking ibuprofen. I hope the swelling decreases in the near future. I want to continue the progress in my recovery that I was making before September 22.
 
Wow, you go, girl!

Swelling seems to decrease much slower than it appears, but it will. You will heal fine, in time. Try not to worry. :console2:
 
@wander03: well done! Congratulations for taking care of your new baby knee! Your PT clinic and the one I first went to sound like they are following the same playbook: no different protocol regardless of the patient! When my usual PT came back (from rafting the Colorado), I went back to her as she knows not to force me, that I'm stubborn and strong! She released me at about 3 months when I was at 120 and 0, and my OS was pleased as well. I followed the Bonesmart protocol this time, now that I knew the scoop and my healing this time was twice as fast as last time: i was driving and off Tramadol by 4 weeks, because I was not re-stressing my tissues with aggressive PT.

I also tend to swell easily, too, and the difference this TKR in my diet might be partly due to decreasing consumption of things that I know tend to trigger inflammation in my system. But, I also am a great fan of icing and elevation, too!

You are smart to document your messages, etc. The first clinic tried to bill me for appointments I had canceled, maybe just to try to get away with it? I called them back and asked for the billing people and had the tiem and date of my cancellation call so they were very prompt to fix my bill!
 
wander03 said:
hawk2go, it appears you graduated from home therapy after about three weeks. What did home therapy accomplish?
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The PT set up a home exercise program that I practiced with him then followed on days when I didn't have PT. He checked my BP, incision, knee health (red, swollen, or hot?), gait, extension and flexion at each session - sometimes adding exercises when he thought I was ready. He moved me from walker to cane when he thought I was ready but told me to keep both handy in case I needed the walker for fatigue or pain. He let me know when my gait was stable enough to walk outside. He encouraged and pushed me but I warned him from the start that I would not allow any activity that threatened to set back my recovery. My ROM changed throughout the day, depending on activity/rest, so I let him measure but didn't stress if I knew I could sometimes bend more than what he measured. My last session was Sept 29th, so 3 weeks is correct. I continue to do the exercises and walking therapy and expect to be in better shape when I start outpatient PT.

I can list the exercises in the program, if helpful.
 
Jockette, I have been feeling discouraged about the swelling not going down. Thank you for the encouragement.

BBCG, the swelling in my leg before September 22 had generally decreased. I had some tightness, but the swelling was definitely a relatively minor concern. Now the swelling above my knee is my major concern.
I requested the information concerning my therapy sessions mainly because I may want to refer to it when I write a letter to the hospital administrator concerning my physical therapy. I will send copies of the letter to my OS and Joe Bridges. I think it is possible that if other patients have suffered as I did, they may not have notified the hospital or their OS. I want the pain I went through to be documented in the hospital records and hope that the hospital will take action to prevent other patients from being treated as I was.

Thank you, sistersinhim.

Thank you for the information, hawk2go. It sounds like you made more progress with three weeks of home therapy than I did in over nine weeks of outpatient therapy. The possibility of doing home therapy first and then outpatient was not presented to me, and I did not have any experience in therapy, so I didn’t consider doing so. I hope your outpatient therapy has better results than mine did. I have not yet regained enough strength in my legs to rely solely on a cane, much less walk without assistance. The slow recovery of strength in my legs may be due to my having had difficulty walking for over two years due to the pain in my right knee. Therefore, I did not walk much more than was absolutely necessary, and the strength in my legs declined appreciably. I was not aware of how much decline there was until after beginning therapy. I need to walk more to gain strength, but that is difficult right now because of the swelling. Oh well, everything will work out in time.
I appreciate your offer to list the exercises used in your home therapy. Some of them may duplicate what I have, but some probably won’t. The exercise information given by BoneSmart is excellent, and I am using it, but I don’t think one can have too much information.
 
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wander03 said:
The slow recovery of strength in my legs may be due to my having had difficulty walking for over two years due to the pain in my right knee. Therefore, I did not walk much more than was absolutely necessary, and the strength in my legs declined appreciably. I was not aware of how much decline there was until after beginning therapy.
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Even if you had stronger legs before surgery, this surgery does cause a lot of trauma that we have to recover from, so factor that into your “weakness.” A certain amount of strength returns, by default, as we heal.
wander03 said:
I appreciate your offer to list the exercises used in your home therapy. Some of them may duplicate what I have, but some probably won’t. The exercise information given by BoneSmart is excellent, and I am using it, but i don’t think one can have too much information.
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Some exercises can be helpful, but also keep in mind:

Regaining our ROM and strength is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for 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. Normal activity is the key to success.
 
Thank you, Jockette, for reminding me that regaining our ROM and strength is more about Time than repetitions of a list of exercises and that normal activity is the key to success. It appears that it is going to take some time, but encouraging to know that I don’t need to push myself with a lot of repetitive exercises. I’m feeling joy!
 
I am approaching 4 months since Bilateral TKR, and I had battles with PT experts early on, with painful bends that hurt and made my knees swell, and then ignoring my concern that the reason my ROM was getting worse was due to more swelling!
Also, after I stopped going to PT, at my 6 week checkup, my surgeon said while eyeballing it that my ROM was fine.
I have been doing Daily heel-to-toe walking outside and in the pool for the past month. I measured my ROM today and it is now 130, extension almost 0. Knowledge is Power. BoneSmart gave me the knowledge and support I needed.
 
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17 weeks yesterday. Last night is the first night I slept the entire night in my bed from 9PM to 6AM.
After trying everything, even different sleeping pills, my Dr. highly recommend CBD for everything I was suffering from. No not THC.
Sleep slowly came.
Still having Knee pain, back on Celbrex & Gabapentin.
Cancelled second knee Oct. 21st. until Surgery knee heels.
 
Congratulations on standing up for yourself! Remember; just because your OS repaired your knee does NOT mean he now owns your knee. It is YOUR knee and 100% your decision on how you want to treat it and how you choose to recover. No one, not your doctor, any PT, any relative, or friend can tell you how to rehab your knee. ONLY YOU make that decision. You will choose which advice you take, and the road you travel in this recovery.

To date, I have not had my ROM measured by anyone, and don't know what it is. And, I don't care about any ROM number. My OS doesn't measure my ROM; at the most he has eyeballed it. He has checked my extension, which is great, but has never measured my flexion. As long as your knee is swollen, whether it's visible external swelling, or internal swelling you can't see, your ROM won't be great. But as you continue to spend a lot of time each day icing and elevating, your swelling will go down. It may take a while due to the damage done by a sadistic PT, who btw, should follow the creed of "FIRST, DO NO HARM", but over time your knee will respond to a more caring and gentle approach.

Over time, as you recover, you'll naturally spend less time icing and more time doing your ADLs. In some ways, you're basically back at the beginning of recovery, although because your knee has already done some recovery from the surgery, you should recover from the PT trauma at a faster pace, but who knows how long it'll take. That poor knee has been through a lot of trauma and needs as much time to recover as it needs. Listen to the signals it sends you and allow it the time needed to recover. Don't be a couch potato, but do give it what it needs now, which is time and patience.
 
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