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TKR At my Lowest point

vjice00

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Hello group, my name is Venus and I I’m a 44yr old mail carrier who was hit an ran by a car while out delivering the mail. I had a scope done on the knee before my total knee replacement in hopes it would heal on its own. I walked on that knee 17 blocks for 365 days and nothing got better it eventually got worse my range of motion was terribly and I was in pain every day.

The doctor said 'Venus while you're to young for a knee replacement it is imperative that you get one to improve your way of life'.

Fast forward to January 28, 2019 I had my surgery and it was kinda rough the first couple of day as I don’t do good under anesthesia and I lost too much blood in surgery which elevated my heart rate and had things going all wacky.

Two weeks later I was released from the hospital and my body started healing. My knee look to be healing quite good on the outside and my staples were removed before I left the hospital, the scar looked great but my knee was stiff and hard and I was concerned about my range of motion.

The next day I was scheduled for PT everyday 5 days a week which I thought was a great idea but now I’m not so sure. My doctor put on my script “aggressive” therapy so every day I go to therapy I’m in tears and she’s forcing my knee to bend and straighten and when I leave it’s swollen and in pain. And I’m just done with the day and the next day it all starts again. My ROM is only at 75/0 at 10 weeks post surgery. My PT isn’t happy about it and I’m totally depressed at my progress.

I’m doing bending exercises and extension exercises at home. I ice and I go to the pool but to no avail this knee will not bend anymore. I just don’t know what to do and I think I will have to have a MUA.
 

catkin69

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Hi Venus. I’m so sorry you are having a rough time. What I have learnt from this forum is you shouldn't be doing things that hurt.
The experts will be along soon with advice but I will just send a virtual hug.
 
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Lemondrop

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Hi Venus. I can't imagine going to PT every day. How can the inflamation and swelling in your poor knee decrease if they work you so much? There can not be much bending if you have swelling. I'm soo sorry to hear you are having so much trouble. You are 1 month ahead of me. Only today I realized that my knee isn't very swollen and I am bending better. Relax at home and ice. When the swelling goes down you hopefully will be able to get your knee to bend better.
 

Roy Gardiner

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Hi, welcome to BoneSmart.
while your to young for a knee replacement i
No such thing, if your quality of life is compromised, as yours was.
so every day I go to therapy I’m in tears and she’s forcing my knee to bend and straighten
when I leave it’s swollen and in pain
Cause and effect, this is not helping you.

You can stop going, it won't do you any harm. Indeed, this 'therapy' is harming your knee by further damaging it. And at 0 extension that doesn't even need any help!

Can you imagine this approach to recover a broken leg or a sprained muscle; walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. 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.

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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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. Here is a week-by-week guide for Activity progression for TKRs
6. Access 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 a 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 history before providing advice.
 

Lindylee

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I'm a week ahead of you and apart from the basic exercises given in hospital I didn't start formal PT until week 6. I had a PT assessment at week 3 and my ROM was fine 100/0, then at week 4, stupidly, I decided to try a different exercise that hurt at the time, although not too bad, but put me back by at least a week and made for a very painful, swollen knee. I eased right back after that until PT started and their advice has always been 'don't do it if it hurts'. They would find ways to adjust an exercise for me if it was painful. You'll get good advice from the nurses and moderators on here and a lot of support. It's a good place to be, especially when you're struggling.
 

Irish471

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@vjice00 , I am so glad you joined this forum! Members like you really need to hear what folks have to say. You will get a lot of support. And by the way, I am 48 and I don’t think you’re too young. We have quite a few members in the 40-something club :)

PT five days a week?!?!? I can’t imagine how that could be even remotely helpful. I think that is the root of your problem and I know others will agree. I go 3 times/week and they don’t recommend doing two days back-to-back. They prefer the Mon, Wed, Fri schedule.

Please consider cutting way back on the PT. Aggressive PT is not going to help. Have a talk with them and re-strategize.

:console2:Hang in there!
 

Jockette

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Hi and Welcome to Bonesmart!

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

I’m so sorry you are suffering the abuse of aggressive PT, and abuse is what it is. There are therapist who don’t do aggressive rehab, and doctors who dont recommend it, so it all comes down to opinions. Which means that you are entitled to your opinion also, and you don’t have to comply with theirs.

Take a break from PT and just gently move your knee and take short walks around the house so your knee can heal. All this daily abuse is not helping your knee heal.

It’s not exercising that gets our range of motion back, it’s Time:

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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 
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vjice00

vjice00

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I’m so grateful for all the replies of encouragement. I just called and canceled my PT for the rest of the week and push it back to three times a week I really need this new knee to work in my favor. Your encouragement helps me push through the day because it’s hard please keep the advice coming it’s greatly appreciated ❤❤
 

Jockette

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I’m glad you cancelled some appointments, but knowing what I know now, I wouldn’t even go 3 times a week.

That said, if they will just do some massage and other things to help reduce your swelling, then 3 times a week might be good for that.

Next time you go tell them you don’t feel the aggressive technique is working for you and that you no longer consent to it. If they won’t change their technique, walk out and research other facilities until you find one that will offer you gentle treatment and better support. Or, don’t go at all, as it’s really not as essential as we are led to believe. You can rehab at home just fine, we have members who have successfully done it.

Saying no to therapy, am I allowed to:
https://bonesmart.org/forum/threads/saying-no-to-therapy-am-i-allowed-to.36688/

I would also suggest taking a friend or family member with you to back you up.
 

JDinCT

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@vjice00 … welcome aboard! You will find a wealth of information directly from members and moderators here... I would also encourage you to read through some of the recovery threads to glean some additional information... best of luck on your road to recovery.... there will be some good days … and unfortunately some not so good days... but that's how this process goes.... :welome:
 

Jockette

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I also want to add, as I got distracted with your PT issue, I’m so sorry this whole thing started with a hit and run accident. :console2:

I have developed some level of PTSD from my PT experience, and sometimes I come across rather strongly in my advice about PT. Bonesmart has been a game changer for me with all I’ve learned here and the support I’ve been given. I hope it helps you as much as it’s helped me.
 

PegGar16

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5 time a week...wow. Glad you cancelled some of them. I know you have heard this a bunch of times but.....elevate and ice it as much as you can. The knee moves better when the swelling is taken care of.

Try not to feel too down or depressed. Sometimes I feel that is worse than the knee healing. I couldn't bend my knee for the first 6 weeks and I got my ROM back. Don't let their expectations get you down, everyone is unique and heals differently. Try to do things or talk to friends that will keep you up and smiling :)
 

Josephine

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I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 

FCBayern

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@vjice00 I'm at 10 weeks today, I'm only doing PT once a week and nothing aggressive. While I was measured at 110 flexion and +5 extension today yesterday I was experiencing one of those days when my knee was swollen and painful, and I couldn't have gotten anywhere near 90 degrees. The swelling totally inhibits our range of motion, I think you'll have much better results following the BoneSmart approach.
 

CAdesgirl

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OMG, I'm so sorry to hear that you're struggling so much. I am at 13 weeks and, while my ROM isn't where I'd like it to be, I would never go to PT even 3x a week. I go 1-2x a week because I swell up from doing the exercises and I've learned that isn't helpful. When I went to my OS last week, I told him that I didn't need help with the ROM any more, I just need help because my IT band is really tight. He sent them new orders to that effect.

My ROM is at about 102/+5. I'm fine with the 102 flexion because I can do everything I need to do at that. I'd like to get the extension to 0 because it's difficult to stand for any length of time with a partially bent knee. I learned on Bonesmart that it's the function, not the numbers, that matter.

I'm really glad you found this amazing group. I found them prior to my surgery and they were so helpful in calming my fears before the surgery. I still come back for the camaraderie and, honestly, because I really like everyone that I've had contact with on here.
 

Roy Gardiner

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I just called and canceled my PT for the rest of the week and push it back to three times a week I really need this new knee to work
You don't actually need PT to heal. You can do all you need yourself, just stretching exercises without pain.
 

Josephine

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Here y'go then!

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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vjice00

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1. Pain is moderate maybe 3 out of 10 but with swelling and stiffness is like a 6

2. Norco 10mg once a day when I go to therapy my other pain is tolerable or nonexistent sometimes I take a Tylenol pm to sleep when my leg is throbbing

3. moderate to huge depending on my activities of the day

4. my bend is 70 my Straightening is at 2

5. 1 to 2 times a day 50 minutes at a time

6. not much at all

7. I live on the third floor I may go out twice a day (three tall flights of stairs) I do all my daily chores around the house cooking cleaning washing clothes as normal. I live alone so everything that needs to be done.

8. I WAS doing PT everyday
TKE’s 17½lb 30 reps
CPM 1hr day
Stationary bike 10min but not correctly because I can’t bend so well
Heel slides 3min
Calf stretching
Step ups and down
Band walks
And then the therapist would stretch me and bend me to get me at a good range of motion

@Josephine
 

Josephine

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A little more detail, if you will.
2. Norco 10mg once a day when I go to therapy my other pain is tolerable or nonexistent sometimes I take a Tylenol pm to sleep when my leg is throbbing
The question was: how much are you taking (in mg please) and how often
4. my bend is 70 my Straightening is at 2
Is the straightening (extension) plus or minus? Meaning if you can get it almost straight then it's above the zero and a +. But if you can get it more than straight, like the back of your knee touches the floor or bed, then it's a -.
TKE’s 17½lb 30 reps
WHAT is a TKE, please!
Heel slides 3min
Calf stretching
Step ups and down
Band walks
The question was
- how many sessions you do each day
- how many repetitions of each​
 

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