TKR Aggressive Physical Therapy

[Jockette]

Very often a different surgeon will not take on another surgeon’s case before a year is up. I think it might be called professional courtesy. I’m sorry that’s the case here.

 

[wander03]

@Jockette Daniel, the PT that was here on Tuesday, explained to me that surgeons only do surgery; they do not deal with anything else. He said the only time an OS would deal with a muscle/tendon problem is when it requires surgery; otherwise, the matter is handled by physical therapists. I observed that PT has been working on my traumatized knee muscles/tendons for over two months, and I don’t think there has been improvement. He said my recovery is not where we would like to be and where it would be if the PT had not created the problem it did, but that it is improving. I asked if he thinks there could be miniscuse tears in the patella tendon. He said he doesn’t think so; that the human body is quite resilient, and the overly aggressive PT created trauma in the muscles and tendons around my knee, but he does not think there is anything that requires surgery.
After our conversation, I have a better attitude knowing that Dr. Evans is not responsible, per se, for my knee problem. I still do not intend for him to perform my hip replacements or my other knee replacement because I have a very negative attitude about Baptist Health in general since their physical therapy program did such damage to my knee and prolonged my recovery for an appreciable length of time. i prefer to not deal with anyone who works for Baptist Health. I need to find a general practitioner in the Mercy system, but that will happen in time.
I am tapering off my use of pain meds I have been taking for the excruciating pain I had in my hips. Since Tuesday, I have been decreasing the time between pills from every six hours to seven hours to eight hours, and the current interval is nine hours. I have had minimal discomfort, and plan to be off pain meds in a few days. I hope I will have minimal to no pain in my hips as I continue to decrease my use. My hope is that the five weeks or so I have been on the pain meds has enabled the trauma caused to my hips from the fall with my walker to ease. I will find out.
I called my general practitioner’s office today and told Amy, the office manager, about the tapering off and requested another refill to complete the process. I checked My Chart and saw that a prescription was transmitted to the pharmacy. My doctor had become reluctant to prescribe more pain meds, but i thought the fact that I am tapering off might make a difference.
I am feeling hopeful again. Knowing that time and therapy are all that can help my knee recover from the PT-caused trauma has helped. Logically I should have accepted that weeks ago, but I thought something more could be done to accelerate the process. Apparently not. I need to just plod along knowing that in time “this too shall pass.“ Patience has never been one of my virtues, but I think this process has finally taught me that it is necessary. I certainly hope so.
i will obtain information from this forum concerning getting prepared for a hip replacement and will be better prepared than I was for the aftermath of the knee replacement. I did a considerable amount of research before the knee replacement, but I did not know about BoneSmart and the less aggressive approach espoused therein, so I will know more about appropriate physical therapy and other matters related to hip replacement Prior to the surgery.
i am very grateful to those on the forum who have commented on my situation and given excellent counsel. it has made a difference in my recovery. Thank you.

@Jockette, after I completed writing the above, I read the first several pages of your thread from 2017 and realized that my experience is very much like yours. That certainly explains your understanding of my situation and your extremely helpful advice. Thank you, again.

 

[Jockette]

I am feeling hopeful again. Knowing that time and therapy are all that can help my knee recover from the PT-caused trauma has helped.

I’m glad you have renewed hope.That will definitely help you continue on.

I was pretty angry, for quite a while, after my PT hurt me, twice, and overworked me, though they did slow things down after I found Bonesmart and learned that I really could say no to things. My surgeon was also a fan of pushing my knee to a painful level. I will not go to him again.

I can’t remember, so I’ll ask, have you had an MRI after this damage from the PT? Did it tear anything?

 

[Jockette]

Take a look at some of the hip recovery threads, and especially read the recovery guidelines, and check out the Big Tip at the end.

Feel free to start a thread in the hip pre op forum, to ask all your questions.

I think I have hip issues, but I am still trying to ignore it, mainly because of my negative PKR experience.

 

[Totallyready]

I had a TKR of my right knee on July 19. After the first few weeks, I did not have intensive pain. I tend to forget the degree of pain, but I do not have pain in my knee itself now at 10 weeks. However, the physical therapy, which I have done in the PT Clinic three times a week beginning the week after surgery, has been very aggressive, particularly in trying to increase the flex of my knee. I have screamed and often cried as the PT pushed me to pull the strap back harder to increase the flex. On 9/20, I pulled to 115. On 9/22 I was urged to pull harder, and the flex was 118. Two weeks ago the flex was 92 unassisted.

After Wednesday, my knee is swollen above and to the right of my kneecap, and I can hardly walk, even with my walker. Prior to Wednesday, I walked some with my cane, but use a walker nearly all of the time. My leg has not strengthened enough to not use the walker. Although, for the first time, the PT did not measure on Wednesday, she still had me do 15 pull backs, which stressed my knee. When I went in on Monday, 9/27, I told the PT that I am not going to pull my knee back again to the point of screaming. He said if they can’t stretch it, they can’t help me. He looked at my knee and suspended therapy until after my OS looks at it. He said he’ll wait to see if the OS says where I am is fine or that they need to continue the aggressive therapy. My OS said he could not see me today and he will be out of his office until Tuesday, 10/5, so I have an appointment that day.

My OS told me at the 8-week checkup that I would obtain no additional ROM after 4 months, so I have been concerned. I have been reading posts on here since last week, and it appears that I am not limited to 4 months. I also understand that the excruciating pain I have suffered in PT is unnecessary. I do not intend to continue allowing the aggressive therapy. Medicare and my Medigap insurance are paying for my therapy. It seems to me that if I want to use therapy to increase my ROM without such extreme measures and to strengthen my leg, I should be able to do so. I will discuss it with my OS next Tuesday. Meanwhile, I am icing my knee three times a day and taking Tylenol to forego pain and ibuprofen for the swelling.

I have read all the links concerning BoneSmart’s procedures for healing and am now basically following them. I guess I would like to have encouragement in my decision to not allow any more aggressive physical therapy. If I refuse it, I may not be allowed to have the therapy, but I’ll deal with that if it happens.

I finally said enough. I am so thankful for Bonesmart. I was almost in your situation. I realized I am the one wearing this knee, and I know my limitations. After reading many stories, I followed suit and quit PT to work on my own. doing great, and you will too!!

 

[MoragsMum]

I have been completely thrown - in the very best way! - by finding Bonesmart today. Your stories are both harrowing and immensely helpful...My TKR (first) was on November 8th, and I've had two PT sessions a week since then. MY PT came to my home for the first 6, and on the second we went outside with a single crutch, later progressing to no support at all, and walking along the street for far too long. It left me with a swollen knee, and very exhausted. At the time I asked him what was he trying to prove, it's not as if I'm in some contest for the toughest 73 year old. I live in a very crowded city, with uneven pavements, people on bikes and found the whole experience terrifying. Yesterday I met with the OS, and told him it seems more within my capacity to walk gently around the block a couple of times a day rather than one arduous forced march. Happily, he agreed with me. Then today the PT placed 3 kgs weights on my knee for ten minutes!! Long story short, I am so heartened by everything I read here, and at our next session will start taking PT back to something more in line with what I've read here, a bit of teenage rebellion... Cannot thank you enough for all your input, and for this brilliant site. Wishing us all smooth recovery through more moderate PT!

Moderator note, this post can stay here in this thread, it has been copied to MoragsMum’s recovery thread

 

[Catalien45]

Seeing this post.....ouch! Your walking experience made me wince! Fortunately, our streets & sidewalks are good, & it’s a quiet neighborhood. I still take my cane anytime I’m outside, lest I get off- balance. We have a wonderful PT facilitiy 5-10 minute drive from us. I’ve used the same therapist for years, & she is incredible. Recently I had to have home therapy for a while due to a second surgery for infection. The home therapist was very determined to get my extension improved. Some of the exercises were downright painful, one like what you described, mine was 20 minutes with books in a backpack draped over my leg. I should have said “ no”. I didn’t, & had to rest it for a couple of days, my knee was sore & swollen. I’m now back at our local place, working with 2 therapists. Some new exercises, none of them painful. Some uncomfortable, but not painful, basically stretching that I can feel, but nothing downright painful. He just seemed really determined to get those numbers.
It sounds like you are progressing well. And yes, this forum is really helpful, & you get lots of encouragement. Best wishes on your continued recovery!

 

[wander03]

@Jockette I did not have an MRI of my knee after the damage from the PT. The OS office took an x-ray three days after, and it showed the knee replacement components were intact. I talked with my PT about the possibility of tissue or muscle damage that would be shown on a MRI. He does not think there is damage other than the overworking.
Chris, who has a doctorate and is doing my PT now, is concentrating on deep tissue massage. He first worked on the patella tendon, which is now more flexible. Then he worked on the area beside my knee on the inside, massaged out knots, and restored some of the blood flow. Yesterday he started intensive work on the IT band. He massaged out quite a few of the knots, but there is still much to be done in that area. He said he can’t do it all at once or I would not be able to walk. I can hardly walk with a walker as it is. Chris said I am scheduled for once-a-week sessions through the end of January, and he thinks I will be walking by then. His main objective is to have me walking unassisted before the replacement surgery on my right hip. I don’t know when that surgery will take place. I will meet with the OS on January 4.
@Totallyready I’m glad that you stopped before you were in my situation. Unfortunately, I did not discover BoneSmart until after the damage was done.
@MoragsMum I think PTs need to consider the age of the patient and adjust the therapy accordingly. I have said that it appeared to me that the clinic that did the damage to my knee used the same therapy techniques on a 20-year-old athletic male and on me, a 77-year-old female who is not at all athletic.
Onward and upward!

 

[Sigma1]

@Jockette Daniel, the PT that was here on Tuesday, explained to me that surgeons only do surgery; they do not deal with anything else. He said the only time an OS would deal with a muscle/tendon problem is when it requires surgery; otherwise, the matter is handled by physical therapists.

There is a type of physician called a physiatrist . I suspect Chris is doing what you need, but if not, try looking up that term.

Personally, I think a surgeon just doing surgery has its advantages.

You might look into lift chairs before your hip surgery. Get one that fits, and I think that includes the ability to have feet flat on the floor while seated. Also, it seems to me that not too deep is an advantage, rather than needing a stack of throw pillows. Your insurance would probably cover part of the cost if you can get a prescription (not hard to get if getting hip surgery). Pride is a good brand, but there are others. Note that petite is smaller than the small, I think. There may be an extra petite.

 

[wander03]

@Sigma1 Thank you very much for your informative comments. I looked up the meaning of “physiatrist.”“These specialists have extensive knowledge of the nerves, muscles, bone, and brain.” There are three DOs and three MDs in my city whose specialty include “physical medicine and rehabilitation.” I appreciate your telling me that there is this type of physician.
Chris has told me about additional training he has had in addition to his doctorate in physical therapy. He seems to have extensive knowledge about nerves, muscles, bones, etc. He has explained how the nerves, muscles, and tendons in my right knee, thigh, and hip are involved in my situation. Daniel, the physical therapist that was working with me before Chris took over my therapy, appears to be a good PT, but i don’t think he has the depth of knowledge that Chris has. Since Chris seems to be starting to get results, I think I will stay with him for as long as I seem to be improving. I am pleased, however, to know about physiatrists in the event I decide I need to see one.
Concerning a lift chair, my research has indicated that it is a good idea to have one after hip surgery. I have a Smith Bros. leather recliner that has lumbar support. It is very comfortable and supportive, but it does not have a lever on the side. Ones legs must be used to lower the foot rest. I have read that is not acceptable after hip replacement surgery. But there is no way I am giving up my recliner. When I am recovered from both hip surgeries, I will want to continue using it.
I have now researched Pride lift chairs, and I would want an Infinity model so I could sleep in it. However, I expect that Medicare would only cover the cost of s basic lift chair, which would be a small amount of the cost of an Infinity. I am 5’7 1/2”, so I would not need a very small chair. I will have my daughter take me to a store that carries Pride when she is here Thursday and try them on for size. Unfortunately, I do not have space in my house for another large chair in my living room. I guess I need to check out the lift chairs first and then address the problem of where to put it.
i note that your left THR was on November 9. I am reading your thread and see that it was anterior. that is what I will have.

 

[wander03]

BTW, I quit taking pain meds after the one I took at 1:15 pm on December 15. I had waited 15 hours since the last dose when I took that one. I am very pleased that I was able to taper off and not suffer severe withdrawal. I have some discomfort in my hips but nothing like the agonizing, excruciating hip pain I had when I started taking the pain meds. i am taking Tylenol 8HR Arthritis Pain Relief, and it seems to help.

 

[hawk2go]

Wow @wander03, I had no idea that you were rehabbing your TKR on bad hips. I hope you are living pain free in the very near future.

 

[wander03]

@hawk2go Thank you. It is a challenge, particularly due to the setback created by the overly aggressive PT. I am trying to keep a positive attitude and expect to be living pain free in the very near future.

 

[hawk2go]

You're my newest hero!

 

[wander03]

July 19 was the second anniversary of my right TKR. And my right knee is still constricted. I know of absolutely no one else who has had a knee replacement who is not walking normally, generally a few weeks or definitely two or three months after the surgery. I think I need to accept that this may be the way my life is from now on. I have had many kinds of physical therapy after the overly aggressive therapy that seems to have created the situation, but there does not seem to be any lasting improvement. There have been days when there was a bit less constriction, but there has not been one day in the last two years that I could walk normally without a walking aid. I can walk without using a cane, but i start limping after a while and my back starts hurting. However, I am grateful that I do not have pain in my knee and that I can walk with a cane. I need to focus on the positive.

I want to assure people who are planning to have a TKR that my case is not typical. As I said, I don’t know anyone else who has had the complications after surgery that I’ve had. And I am happy that they don’t. I just wish my TKR could have had as great a result as both of my THRs.

I am also grateful that I am able to work. I haven’t worked very much in the last year or so, but I had an offer to do an assignment that I thought I could not refuse. As an independent contractor, I am paid a day rate and expenses for my work, and this assignment pays better than any I have worked in several years. I want to build up a fund for things that I don’t have the financial resources to do on Social Security alone.

I worked out of town from Tuesday through Friday of last week, which entailed sleeping on a bed in a hotel. Since I have not slept anywhere except a recliner and then my lift chair since my joint replacements, the results were not stellar. When I tried to sleep on either side, my hips hurt. When I tried to sleep on my back, my back and right knee hurt. I only slept about three hours a night and was very tired while working. The physical part of this assignment is pulling very heavy books from shelves, obtaining information from the books, and hoisting the books back on the shelves. Many Counties in Arkansas have all their records accessible on computers in their offices, but this County only has the very recent records accessible in that manner, so I have to pull the books since I am going back to inception of title. After working eight hours on Friday, I drove three plus hours home. I was a bit tired, but I made it. Friday night I slept in my lift chair from about 12:15 AM until about 10:50 AM, and I slept soundly. It was wonderful!

I have ordered a 65” Meiz (Pregnancy) Pillow for Sleeping from Amazon that is scheduled to arrive on Monday. Since I will work in my home office this week, I can try using the pillow on my bed at home before I spend another week on the road. I have high hopes that I will be able to sleep comfortably using it. There are reviews from users who have relief from pain in hips, back, and knees by sleeping with the pillow, so I expect to have a positive result. I have decided that learning to live with my current physical condition may be the only way forward. I don’t seem to have any other recourse, so I shall continue to keep on keeping on.

Onward and upward!

 

[sistersinhim]

I pray that as time goes on you will see improvement in your new joints. Sometimes is just takes longer for us to heal and for our bodies to adjust to the new way of walking.

 

[Layla]

Aww, wander...I am sorry, but I do pray along with sistersinhim that you notice gradual improvement given more time. You'll have to let us know how the pregnancy pillow works for you after a few weeks use. You may find it an asset when you need to travel, even though cumbersome. Comfort is key to a good nights sleep so I hope you find it useful and love it. Your gratitude in inspiring even in the midst of the constriction you're adjusting to. May it get better for you!
@wander03

 

[Jockette]

I know of absolutely no one else who has had a knee replacement who is not walking normally, generally a few weeks or definitely two or three months after the surgery.

We have many members who are not walking normally in this time frame, including me.

I have decided that learning to live with my current physical condition may be the only way forward. I don’t seem to have any other recourse, so I shall continue to keep on keeping on.

This is what I’ve had to do with the results of my PKR. I have more problems now, even 6 years later, than I had before the surgery. Three second opinions find nothing to fix. I‘m thankful that it’s not any worse. With some adjustments I am able to manage life well enough.

I was aways a side sleeper before my surgery but haven’t been able to sleep on my side since. I now sleep with my legs up on an elevation wedge, which I found is very comfortable, so I do take it with me when I travel.

Best wishes as you move forward.

 

[wander03]

Thank you all for your prayers and, as always, your support. I will let you know how well the pillow works to ease pain when I sleep.

@Jockette I am sorry to know that you and others still have challenges after PKRs or TKRs. I wish I were the only one. I checked back in this thread and saw that your experience was very similar to mine. Since I always had pain in my knee before the TKR, not having pain is a beneficial outcome of the surgery. The constriction is a definite inconvenience, but having no pain is good. As to limping and my back hurting after I walk without a cane for a bit, perhaps that is associated to some extent with the bout of Covid I had the latter part of March. I feel like I have not yet regained the stamina I had before. Perhaps with more time …

Using my Lounge Doctor might make sleeping on a bed less uncomfortable. I did not use it much during my recoveries because I was unable to get my legs up on the (very firm) sofa that I laid on without someone lifting them for me, and I have not used it for a considerable length of time since then. Thank you for the reminder that the Lounge Doctor might be beneficial.

 

[Jamie]

@wander03 .... The "constriction" you describe sounds like you may have developed some adhesions following your knee replacement. Is this anything you have discussed with a surgeon? If not, it might be worth a consultation with a good revision surgeon who is familiar with this problem. Think about this option and let me know if you'd like help finding a surgeon. Here is one recommendation for a doctor that's outside of Little Rock, about 2 1/2 hours away from you.

Dr. Jerry Lorio
Arkansas Bone and Joint
2010 Active Way
Benton, AR 72019
Phone: 501-315-0984