Bilateral TKR Am I overdoing PT?<

[Thing1and2]

I am SO glad to have found this thread. I am wondering if I am over doing it with pt. Going three days per week. About an hour and a half of stretching-painful when they do it, strengthening, including ankle weights and weight machines. I also do stretching and stationary (recumbant) bike. After that, ice and electrical stim.

My ROM is good 125, and extension is 0, so has been good since surgery.

The nights are getting better but the days are bad. Felt like I have been back tracking and experiencing more pain, especially day after PT.

Is there a recommended time to go to PT?

Also, question for Josephine. You mentioned Tylenol 1000mg four times a day...did you mean total 1000 mg or 1000 mg four times per day?

Thank you. Hate to admit it but I was reduced to tears this morning from pain and frustration wondering how I was going to be able to function at work and get off these pain meds. (Percocet).


My surgery was 2/4/16 and I had bilateral tkr.

 

[KarriB]

@Thing1and2 first I think you should start your own thread because BoneSmarties will see it on the listing and answer your questions. Also @Celle or @Pumpkln can help you when they see your new thread.

You are very early on in the recovery progress, but have great ROM. If you had to go back to work, don't worry too much about pt, full time working is all the pt you need. Your new knees are too young for weight or strength training, that's something better when you are 4-5 months out. Riding a bike is ok, just no tension at this point if you feel the need to do something. Biking seemed to help my knee loosen up. Take a week or so off of pt and see how your knees feel.

 

[bottomshollow]

@Thing1and2, so pleased that you have joined us here on the forum. As you can see, I have moved your post and its response into a thread of you own. Having you own thread will assure that you and your questions and concerns get the attention they deserve. I'm giving you links to Library articles that I think will answer a lot of your questions. However, I can tell you right off the bat that you are doing way too much----your poor knees a chance to rest and heal---plenty of time for additional exercise later down the road.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
- If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it.
- If you won't die if it's not done, don't do it; if you must do it, short and sweet, not hours on your feet.
- Don't stand if you can sit; don't sit if you can lie down, don't stay awake when you can go to sleep
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

Please don't be overwhelmed by the list. The articles are not lengthy and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish; giving you a place to vent, whine, complain if you need to; sharing experiences with one another; and having fun and some laughs along the way.

Take care and keep us posted. We care.

 

[JLP]

I am a couple of weeks ahead of you in my recovery and I have to say that I was an exercise slug. The only time I ever did any exercise was when I went to PT and I only went to about 7 sessions. After that, I tried going to the gym to just ride an exercise bike and walk on a treadmill but found my knee swelled up quite a bit and was very sore. So I stopped doing everything except my daily activities (I am retired) and my knee has improved dramatically. The swelling is way down and so is the pain level. I am going to wait a while before I start any new exercise program and let my knee heal. I also have always had good flex after surgery and my extension has been up and down because of swelling but my knee now seems pretty straight.

 

[bdink21]

@Thing1and2 i will just echo what others have said, PT is too much, especially if it causes any pain. With my left TKR the PT added ankle weights at 7 weeks out and I couldn't walk for a couple of days after that. Now that knee at 7 months out can easily handle weights with absolutely no pain. Your ROM is great you just need to finish healing. Back off on the PT, you knees will thank you.

 

[Celle]

I'm also going to echo what the others have said. Yes, it seems that you are doing too much exercise and it isn't helping your recovery. I think you could cut your exercise right back now. You have good flexion and extension and you wont lose those.

Exercise should never be painful and it's too early in your recovery to be dooing anything with weights - we usually recommend not using weights for at least 3 months after your surgery. Your knees have undergone major trauma and they need time and gentle treatment, in order to heal properly.

Recovery from knee replacement takes a long time - as long as a full year for complete recovery - so there's no need to rush to achieve any milestones. If you think of it as a race, it's more of a marathon than a sprint.

Your ROM (Range of Motion - bend and straighten) can continue to improve for a year, or even longer, after this surgery. There's no need to get ROM within a certain time frame, so be gentle with your knees and gentle with yourself.
Myth busting: the "window of opportunity" in TKR

So that we can see it at the bottom of every post you make, and thus advise you appropriately, please will you create a Signature, in which you put your knee surgery and its date in full? Write the name of the month, so there's no confusion.
Hover over your username, top right of the page, and select Signature from the drop-down box. Enter your surgery details and then save. This article also explains how to do it:
How to create a signature
If you can’t do it, please let us know, so that we can do it for you.

Thank you.

 

[Celle]

It appears my post didn't post. I, too, seem to have significant pain and it has gotten worse the past two weeks. This does correspond to my increasing intensity of physical therapy workouts. I have good ROM and Extension. Still going three times per week, to PT and doing about an hour and a half of stretching, bike, weights, and then ice and electrical stim to address swelling.

I am going to take a few days off and see if there is a difference.

I wonder....is there a general rule as to how long and what to do with PT? The stretches have helped...but they are quite painful, still.

So grateful to find this forum.

@Thing1and2
You posted this on someone else's thread.

Please read all the advice that you've been given, above.

Yes, you are doing too much PT and you need to cut back severely, not just for a couple of days, but for all time.

Also, please bookmark your own thread, so you don't lose it. Alternatively, this article may help you:
How can I find my threads and posts?

 

[tjcteacher]

Hoping you feel better if you stop the PT

 

[Josephine]

Also, question for Josephine. You mentioned Tylenol 1000mg four times a day...did you mean total 1000 mg or 1000 mg four times per day?

Safe total per 24hrs is 4,000mgs. Therefore 1,000mgs can be taken every 6 hours.

I, too, seem to have significant pain and it has gotten worse the past two weeks. This does correspond to my increasing intensity of physical therapy workouts. I have good ROM and Extension. Still going three times per week, to PT and doing about an hour and a half of stretching, bike, weights, and then ice and electrical stim to address swelling. I am going to take a few days off and see if there is a difference.
I wonder....is there a general rule as to how long and what to do with PT? The stretches have helped...but they are quite painful, still.

I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! )

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

Exercises done at home: 3 sessions a day
(enter exercise) x10 (reps)
(enter exercise) x10
(enter exercise) x10

At PT
(enter exercise) (reps) x2 (sets)
(enter exercise) x5 x2
(enter exercise) X5 x2

 

[kneeper]

The longest PT session I ever had was 45 minutes.

 

[referee54]

I had a BTKR a bit over eight years ago, and I can tell you that there is nothing you can do to speed up your recovery.

I would say that all of us were in a hurry to regain normalcy in lour lives----to reclaim a pain-free life that arthritis has stolen from us; but, in reality, there is nothing you can do to speed things up. Hard work at PT---too much PT and too many PT appts.----will only slow things down and cause more inflammation and more stiffness---and more frustration.

It seems contrary to what we have been taught, but this is a time where hard work does not advance ourselves, and "less is more" is the appropriate attitude. Do not work harder---work smarter!

I went to two PT sessions a week for about 50 minutes to an hour for each one. I did go to a gym on Saturdays and rode an exercise bike, used exer-bands, and did some stretching in the sauna---and that was it.

You will reach your destination of being fully recovered---and you will be very glad that you had the BTKR---but it all will occur on your knees' schedules---not yours. Take it easy, take it gently, and take it slowly.

 

[Thing1and2]

Thank you all so much for the feedback. Tears of joy this morning! I appreciate all the info, and resources that you all sent my way. Will get on it about adding surgery dates/info. Still figuring out how to navigate my way around website.
Gentle stretching and iced this morning, along with meditation tape. Took meds but without worry about being addicted...huge concern for me. The pain scale article and need for adequate medication was most helpful.

I guess, in my superwoman world, I thought I would be up and running (not literally!) by now. This set back really set me back. In my mind, by eight weeks, I would be pain and swelling free and off meds.

Now I know better. Will spend more time today getting acquainted with this site.

Again, thank you all, and especially to a dear friend, who directed me to you.

Take care and hope you all have a great day.

 

[Thing1and2]

Josephine, Here are the answers to the questions:

1. Pain level right now, is 2, while sitting, having take one Percocet at 7:30 am. (5 mg-325 mg)
2. Percocet-Oxycodone/Acetaminophen-5/325. I take between 4-6 per day.
3. Two to three times per day, 25-45 min
4. Same as above, usually when icing.
5. 120 rt, 125 left, 0 extension- flat to the table.
6. Moderate, past two days. Fluctuates between moderate and slight.
7. Some shopping, some cooking, dusting, vacuuming. Have walked ,6 to a 1 mi. over the past three weeks, several times per week.
8. Home:
heel slides, with hold....30-60 seconds x 3,
holding leg upright with band and letting gravity pull shin down from knee 30-60 seconds x 3.
Stationary bike- 10-15 min, up to level 4 resistance,
calf stretches.
Quad stretch and ham string stretch, same as above.
(Was also doing steps (8 ") and later step, squats, lunges, balancing on one foot, but stopped last week. PT said strength was good so only needed to continue these at pt.)

9. Recombant bike 10-15 min level 3 resistance.
Then knees are stretched out on back and belly-ROM. This is painful each time-even with pain meds.
Weights: 4# while I do the following:
Bridge while "marching",
knee flexion,
glute lift,
straight leg raise,
sidelying abduction and adduction
prone hip extension
terminal extension.
squats-on balance roll
lunges, steps and lateral steps-8 "
calf raises
balancing on each foot, on foam mat.
20 reps of all the above.

Then on machines:
leg curls, 20#
leg presses, 30#,
long arc quad 30#
I do 20 of these as well.
Followed by ice and elec. stim, 15 min.

,

 

[Josephine]

Thank you - your answers were perfect!

1. Pain level right now, is 2, while sitting

Okay

2. Percocet-Oxycodone/Acetaminophen-5/325. I take between 4-6 per day.

Okay

3. Icing two to three times per day, 25-45 min
4. Elevating Same as above, usually when icing.

Not bad but do remember you accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

5. 120 rt, 125 left, 0 extension- flat to the table.

Not bad for 8 weeks out!

6. Moderate

okay

7. Some shopping, some cooking, dusting, vacuuming. Have walked 6 to a 1 mile over the past three weeks, several times per week.

Probably too much. In fact, DEFINITELY too much!


My comments in bold
Home: these are how many times a day? Once, twice? I shall assume twice but actually once is enough and none at the weekend
holding leg upright with band and letting gravity pull shin down from knee 30-60 seconds x3 - really don't see the point of this at all
Stationary bike 10-15 min, up to level 4 resistance - no resistance.
calf stretches - okay
Quad stretch and ham string stretch, same as above - same as about where?
Was doing steps (8") and later step, squats, lunges, balancing on one foot, but stopped last week.
PT said strength was good so only needed to continue these at pt - I'm very relieved. All these exercises are very hard on your knees

Recumbent bike 10-15 min level 3 resistance - again, bike okay but NO resistance
Then knees are stretched out on back and belly-ROM. This is painful each time-even with pain meds - no to this then! Never ever do anything that hurts.
Weights: 4# while I do the following: NO weights - it causes muscle pain
Bridge while "marching" 20 reps - marching is a big no-no, it causes muscle pain
glute lift 20 reps - 20 reps is far too many
straight leg raise 20 reps - a tip about SLRs, once you can do them, there is no need to ever do them again!
side lying abduction and adduction 20 reps - these are hip exercises and unnecessary
prone hip extension 20 reps - these are hip exercises and unnecessary
terminal extension 20 reps - these are hip exercises and unnecessary
steps 20 reps - steps are very hard on the knees, don't do them
lateral steps 8" 20 reps - also hard on the knees, don't do them
calf raises 20 reps - do you mean half leg raises with a roll under the knee? Read what I said about SLRs
balancing on each foot, on foam mat 20 reps - punishing, don't do them

heel slides hold 30-60 seconds x3 - heel slides are terribly easy to do badly and doing these in one or two intense sessions is bad! Read this Heel slides and how to do them.
knee flexion 20 reps, squats-on balance roll 20 reps, lunges 20 reps - these are all flexion exercises. You're already doing heel slides, you don't need any more.

Then on machines: don't use machines - far too early
leg curls, 20# x20
leg presses, 30# x20
long arc quad 30# x20

Quite apart from this boot camp your PT has you on, do you realise you are doing 300 reps of different exercises! All on a knees only 8 weeks out of surgery! No wonder you are having pain!

I suggest - strongly suggest - you stop PT and home exercises altogether and just allow some walking to be your therapy. Your ROM is amazing so you don't need all this. I would predict that if you keep this up, you will eventually find your ROM starts to regress.

I actually did my two knees with NO exercising at all and got great outcomes. I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[Thing1and2]

Thank you for all the support and information. I am still feeling my way around the website and forums.
I have not attended pt all week. Feel somewhat better but still a good amount of pain. I have increased my icing time and am only doing 10 slow minutes on recombant bike per day, with no resistance.

I am discouraged that I have not been able to cut down more on the pain meds. Am trying to supplement with ibuprofen but need to be careful of my stomach.

I am still scheduled for pt next week but think I will put it off longer, at least until the acute pain has subsided.

I am nine weeks post op. It is unusual to still need pain meds at this time?

Going to meet a friend who will be having TKR next week. Have already alerted her to this website.

Thanks, folks.

 

[Pumpkin]

Many need pain medications for 3 - 4 months, everyone is different. I agree with putting off PT another week to let your knee heal. You may want to add tylenol, adding up all sources so you do not exceed 4000mg a day.
Remember to Rest, Ice, Elevate, and Medicate on schedule as prescribed.

 

[Josephine]

I am discouraged that I have not been able to cut down more on the pain meds. I am nine weeks post op. It is unusual to still need pain meds at this time?

Very usual. For my first knee I was taking the full dose of Tramadol (100mgs x4 daily) for 4 full months and needed it!

You may find the cessation of exercises doesn't produce any improvement for a month or even more. Just remember how long you'd been doing them and then double it!

 

[Thing1and2]

Good to know. I know there is a push here to limit use of opiods, so I feel like a drug addict when I have call in every ten days for another supply!

I am going to take it slowly. Icing longer than I ever have which is helping a lot. Navigated outside of the house without a cane today, for the first time.

Also met with a friend who will be having tkr later this week. Told her she definitely needed to check out this website.

Thank you again, folks.

 

[Thing1and2]

Hi Folks, Just wanted to check in. Life has been a whirlwind. Completed my third full week at work, full time. The weekends find me exhausted, but a little less so each week. I am still on pain meds...Percocet, 5 mg., and down to twice a day for most days.

I am learning acceptance, as I truly figured that I would be up and about like normal in 6 weeks. It has been 12 this week, so I know that ain't happenin.....lol. But there is progress, and for that I am grateful.

I have a knee buddy, who is close to two years post op. She and this website have kept me going. It has been a struggle and a humbling experience, in many ways. I don't know what I would have done without her and you folks, here. Knowing it was normal and ok to stay on pain meds, realizing that depression can be part of post op, learning to pace myself....so many things I learned here.

I have learned that I need to keep out of the way and let my body heal itself. I have learned that there are some things that you can't push through and that more is not better. I backed way off on physical therapy-a suggestion here, from Josephine-and am so happy I did. I was pushing my recovery further and further away by trying to do too much to fast. No pain, no gain, is definitely not the rule here.

I was fortunate to have a friend who is an occupational therapist, who loaned me raised toilet seat, shower chair and walker. Glad to say I have graduated out of these, but was so happy to have them and not worry about insurance, copays.

I ice, and ice more...I started massage therapy, which seemed to help with swelling and tightness. I am peddling each morning on my stationary bike-but gently, with little resistance and for 20 min, or so.
I am frustrated because spring is here and I want to be out doing gardening, but I know that will come, too.

I am finally in a place where I am starting to be happy I had this done. People would ask...are you glad? And I would say... I will be. Actually, I was hoping, because this was not fun and two at once was more difficult than I anticipated. But we can't know what we can't know.

My buddy would keep saying, it will get better. This website gave me tools, and my dear husband would say, remember when...you couldn't lift your legs up on the bed without assistance, when maximum pain meds were not controlling the pain, look at how straight you walk today, and without limping. He also told me recently, how his heart would break when he would watch the contortions I would need to do to navigate stairs.

So, I am healing! It has been hard, and still is sometimes. I am frustrated that I am still not sleeping well, for example, but I learned there, that is normal AND it gets better. I still can't wait until I can get through each day and night without pain meds. But I know this will come.

Again, I want to thank you for this website, and my dear buddy who told me about it. I have shared this with a number of people and have told my surgeon's office to let people know it is here.

Take care.

 

[Josephine]

I backed way off on physical therapy-a suggestion here, from Josephine-and am so happy I did.

I'm so pleased you have but now you are back at work but do remember, if you are working, never mind if it's full or part time, you cannot do exercises at all. It's just too much for you and so unnecessary.