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TKR Assigned PT exercises and sharp pain – told to just work through it…….

jds

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Hello – I discovered the BoneSmart community today and sure wish I would have found it so much earlier. I’m almost 13 weeks post TKR (my first joint replacement), and I “graduated” from going into PT about 4 weeks ago.

I’ve been attempting to be diligent about performing my assigned exercises, both strength and cardio, every day. I have my bike setup on a stand in the living room (it’s winter here in Minnesota) for my cardio work and that is going OK. The problem is with the strength exercises. At this point I don’t have much swelling although my knee is stiff and achy a lot but stretching and moving help with that. My big complaint is I have sharp pains along the inner front edge (and to a lesser degree on the outer edge too) of the tibial component. This sharp, specific location pain has been there pretty much from day 1. It doesn’t hurt when at rest (now) but walking and specifically during and after my strength exercises it is pretty bad. It also hurts when rubbing the area. I can get through 2-3 days of the PT exercises and then I’m hobbling for a couple of days before I feel like I can get back to it. I have had a lot of snapping feeling in the knee when I walk, with the worst of it at the same location as the pain. The more it snaps the more it hurts. Is this tendinitis and if so, will it heal itself with rest?

I’ve had 2 post-op appointments with the surgeon and multiple discussions while at PT and the answer is always to just push through it and it will eventually get better. Interestingly, my assigned exercises are pretty much exactly what Josephine has listed as those not to do in her post titled “BoneSmart philosophy for sensible post-op therapy”.

Sorry for the long post. It helps getting finding others here with the same concerns. Luckily my wife has been amazing supportive through all this. Mostly I’m concerned that the PT exercises are making things worse rather than helping. This TKR has been more of a struggle than I thought it would be. Thanks!
 

Celle

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Hello @jds - and :welome:

Here is the recovery reading we give to everyone with a new knee. take particular note of the BoneSmart advice about exercising.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. You should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.


Exercises that cause pain are counter-productive, because they keep your knee irritated and inflamed, which slows down recovery.

PT that hurts is bad PT and no PT at all is better than bad PT. Pushing through the pain is the wrong approach for knee replacement recovery.
Myth busting: no pain, no gain

This is your knee and you are the only one who has the right to say what happens to it, so speak up on behalf of your knee, and refuse to do those painful exercises.
Saying no to therapy - am I allowed to?
 

Tykey

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Hi, and welcome.
These surgeons and physics are highly qualified, have their qualifications nicely framed on the wall, and wear nice white coats or scrubs(?). It's difficult to believe they talk Codswallop, yet they do.
My second TKR is the same age as yours, as per instructions from my surgeon and PT, I've just done very light stretches and got on with life's activities. Recovery has been highly successful, I'm back doing everything I want with virtually no bad reaction from my knee.
Be kind to your knee, it will show it's appreciation to you.
 

bikinglynn

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Codswallop??? :heehee:

I keep questioning why there is this party line about the encroaching scar tissue with a 6-week doomsday timeline? Have the insurance companies pushed this to get PT over and done?
 

Tykey

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When I had my first TKR, 10 years ago, my hospital had just abandoned those silly CPM machines, and we were given lots of gentle exercises such as leg lifts and heel slides. However, they still mentioned the possibility of my knee "setting like concrete" if I didn't do them.
With my recent one (4 months ago) the same surgeon never even mentioned the concrete option, his message was essentially "go off and heal, do a few exercises, just get on with your life"
They had just looked, listened and learned

Some don't!! They once read a book many years ago, perhaps. In the absence of learning, they could actually try applying common sense

PS Codswallop is a lovely word, isn't it! I'll not explain its derivation, but it's an English slang word meaning total utter rubbish
 

Jaycey

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PT shouldn't hurt and no you should not be "working through" anything. You knee is telling you to stop. Please listen to it. Ice and elevate to reduce stiffness.

Take Tykey's advice - easy does it gets you better results.
 
OP
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jds

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Thanks everyone for the replies and encouraging words. I so wish that I would have found this supportive community earlier. It really has been a physical and emotional struggle. I will likely have my other knee done sometime in the not too distant future and know (hope) it will be easier the second time around.
 
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jds

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And thank you Celle for all the links to the reference info. Your one reply contains more useful information about my TKR than all the other pre-op information packets and meetings provided to me by the hospital/surgeon combined.
 

Celle

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You're very welcome. I do hope the BoneSmart advice helps you and your knee.
 

kneeper

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Glad you've been "released" from PT boot camp. At week 13 I was far from doing strength training. Just walking more as the knee tolerates it, some exercise bike--I don't think I added the Nustep for strengthening after a few more weeks, and even then started small.
I was back at work and exercising on top of that (more than a little bit every few days) was too much for the knee. But gradually I could do more and more.

My approach was to start by feeling like I was "under doing" and then add minutes or repetitions as I saw what the knee could handle.
Exercises should not leave you hobbling. My PT told me if I was sore for more than an hour after doing exercises I had done too much.
I would totally stop the "strength" exercises for now.
 
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jds

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Thanks kneeper. I was pushing myself to increase reps/time etc. so some fault lies with me. I tend to push like that. Part of the problem was that I was tired of sitting around and being tired. And since I was given the green light (and pushed) by PT to regain my lost strength, I was going for it. I had already been dealing with pain and limited mobility for 2 1/2-3 months so hurting a little more after exercising did not seem so out of place. I've now stopped all strength exercises (none for three days) and already feel a little less pain. I have continued riding my bike indoors against minimal resistance once per day which I find helps to loosen up my knee stiffness.

I elected to have my TKR and recovery during the winter thinking that it would be a good time to hibernate and recover. If/when I have my right knee replaced I will opt to have it done in a more temperate time of year so I can get outside (even if it's just to read and feel the sunshine and fresh air) and not feel so cooped up.
 

Celle

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I have continued riding my bike indoors against minimal resistance once per day which I find helps to loosen up my knee stiffness.
It's best if you use the bike with no resistance at this point.
 

Roy Gardiner

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I've now stopped all strength exercises (none for three days)
:thumb:
continued riding my bike indoors against minimal resistance once per day which I find helps to loosen up my knee stiffness
Good; using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 
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jds

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Thanks Roy. My ROM is already pretty good - I can get to 0° extension and about 135° flexion after some mild stretching. I've always been naturally flexible and could essentially sit on my heals before my replaced knee got bad. I still can on my other knee. I'm guessing that my new knee will never get back to that degree of flexion. At least it doesn't feel like it at this point in time.

What is a realistic maximum degree of flexion long term? I know everyone is different, but is there an inherent mechanical limit of the replacement joint?
 
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jds

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Well, I had my final follow-up visit with my surgeon last Wednesday (14 wks post TKR). I told her I felt like I was doing just OK in my recovery, frustrated that I wasn't further along but understood this is a marathon not a sprint. My biggest complaint is a snapping feeling along the inner surface of my knee when going up and down stairs. It feels like a muscle or tendon is catching on something when the knee is flexed with a load on it. It gets fairly painful. Walking on a level surface doesn't produce the snappin. This was a big part of what was hobbling me after doing my PT exercises (stopped altogether about 10 days ago) which included lots of stair work/squats etc.

Anyway, after examining my knee, my surgeon believes that I have developed a pateller clunk and peripateller arthrofibrosis. She recommended a knee arthroscopy and debridement procedure to free things up in there. I've done a little research on pateller clunk syndrome so I have an idea of what exactly is going on inside my knee that has been giving me grief lately. The procedure is scheduled for this Wednesday. Hopefully all goes well. I'll feel a lot better about the decision to have the TKR done if the arthroscopy can relieve the painful snapping.
 

Loobs39

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Hope it goes well for you, and sorts out your problem. Bad enough to go through the nightmare of a TKR but to then still have a problem weeks later is rotten.
 

BCBSM

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JDS,
I am 8 weeks post TKR and developed what sounds like a similar painful problem, except on the outside of my knee. My dr told me it was scar tissue and gave me a cortisone shot directly where “the catch” is located. He also told me to keep moving it and apply deep massage to try and help break it up. I asked about infrared light therapy. He said that it should also help, but some of the things I’ve read said NOT to use it on a metal implant. I’m currently trying to find more information about it. Oh, and I just started using a TENS unit a couple of times a day. Not sure if I like it, or if it’s helping yet.

Does anyone else have info about Infrared Light Therapy for TKR?
 

Helizabug

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Well, another surgery stinks, but maybe it can help. I look forward to hearing about your further recovery.
 
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jds

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Helizabug - Reading your bio, it looks like you've been through hell and back with all those procedures over the years. Especially on the left side. I didn't know what a MUA was so I looked it up. It seems like it could be pretty painful for a while after the anesthesia wears off. Has it brought some relief or is it still too early to tell?

BCBSM - My surgeon didn't discuss cortisone, infrared light therapy (or MUA) as possible solutions. The arthroscopy procedure is significantly less traumatic than the original TKR and I guess it just seems like a good idea to go in and actually visualize what is going on in there. So I'm feeling OK about the added procedure.

I'll definitely updates as they develop.
 

Helizabug

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I think the MUA has brought some relief, not from pain, but I have more flexion, which I really wanted. Pain hasn’t been my biggest complaint, anyway. Folks on BoneSmart gave me good information about the MUA, including how it might set me back at first. I wasn’t completely unprepared, so that was good.

I’ll be trying out my new ROM at theater this week, so we’ll see if the MUA helped me accomplish my goal of being able to sit in a row of seats. Seems like a small thing, but it’s important to me.

As much as I’d like to keep sharp implements out of my knee for a while, I think I would have agreed to your arthroscopy too. I hope it goes well.
 

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