United StatesIt is probably a bit early for the pool, but many people love it. But remember it is even easier to overdo in the water than on land. You really need to listen to the knee--hard to hear it underwater. 
TKR Help! I've developed right hip pain 3 months after LTKR.
- Thread starter sunny-island
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sunny-island
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@tiredwife. I hear you but it doesn't make it an easier. I don't want to set up an adversarial relationship with anyone in my doctor's office or with my PT. I spoke with someone on my doctor's team today, I asked about the aggressive physical therapy. She said it was probably necessary because my knee is still stiff. So that's the party line in their office. I've decided to stay with the same therapist but I'm going to talk with him about this. First of all, I do not want to be at PT for 90 minutes to two hours ever again. That's too long. Second, I want him to agree to stop whenever I say it hurts too much. Today was supposed to be a PT day but I called yesterday and cancelled it. My next appt is Tuesday because of the holiday weekend. This is good. My husband and I make pretty good progress doing home PT. This afternoon we got into our pool. It was a very warm day here and the pool water was warm. This was the first time in the pool (I had permission to do this from my doc and my PT). I did my own version of hydrotherapy. Felt very good. So my short term plan is to do home PT every morning and pool PT every afternoon if the water is warm enough.
You said Hydrocodone is Norco. Is that an effective pain med? Is it strong enough? That might be a silly question as this is probably one of those highly personal things and I'll just have to wait and see. My guess is that it will be fine. It's just that they gave me that when I was in the hospital and it did not touch the psin. The pain isn't as bad now so maybe it will work at this point. I hope so because there's no way I'll be doing any PT without pain med.
On a positive note, I felt good today. Slept well last night. Things are looking up! Yes, I know there will be more ups and downs but today was super. Tomorrow our daughter is coming to visit (she lives 5 hours away) so that's going to be fun. How's your husband coming along? He's only one day behind me. I hope all is well.
You said Hydrocodone is Norco. Is that an effective pain med? Is it strong enough? That might be a silly question as this is probably one of those highly personal things and I'll just have to wait and see. My guess is that it will be fine. It's just that they gave me that when I was in the hospital and it did not touch the psin. The pain isn't as bad now so maybe it will work at this point. I hope so because there's no way I'll be doing any PT without pain med.
On a positive note, I felt good today. Slept well last night. Things are looking up! Yes, I know there will be more ups and downs but today was super. Tomorrow our daughter is coming to visit (she lives 5 hours away) so that's going to be fun. How's your husband coming along? He's only one day behind me. I hope all is well.
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sunny-island
member
@kneeper. I just saw your post warning me about the pool. Well, I did get into the pool this afternoon. I took it slow and easy being well aware that the buoyancy of the water could give a false feeling of well-being. Most of the time I just floated around. No harm in that. I did some gentle movements mimicking the exercises I do for my home PT. Much easier in the water. The real test will be: how will I feel tomorrow morning?
tiredwife
alpha
@sunny-island I hope you and your PT come to an understanding. Norco (for my husband) doesn't work quite as well as Percocet. His OS put him on it today because he was getting anxiety attacks (probably from the Percocet) every time he goes to use his cpap machine. Percocet can suppress breathing some and with sleep apnea this time it probably did something to him and he finds it hard to exhale with his machine. Didn't happen last knee. As he walks around now he often forgets his cane. His thigh muscle still has some pain. He starts outpatient PT the 2nd so we hope they can do something to help that muscle.
Glad you enjoyed the pool, just keep an eye on your incision, they make a clear bandage that is water proof.
At less than 4 weeks your knee will be stiff. The stiffness is usually worse when you stand up from laying or sitting for awhile. It is something that slowly gets better, a lot of it goes when all the swelling is gone.
Take care of yourself and your knee !
Glad you enjoyed the pool, just keep an eye on your incision, they make a clear bandage that is water proof.
At less than 4 weeks your knee will be stiff. The stiffness is usually worse when you stand up from laying or sitting for awhile. It is something that slowly gets better, a lot of it goes when all the swelling is gone.
Take care of yourself and your knee !
madinana
post-grad
@sunny-island I had the problem where they wanted to push on my knee more than once so I took my cane as had been walking with no assistance. He asked me are you hurting today you have a cane. I said no I brought it if you don't stop when I say no I am gonna pop you in the head Never had a problem after that True Story
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sunny-island
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@madinana. I don't guess you ever actually DID pop him in the head, did you? Was he pushing on your knee to increase ROM? Mine wants to do it for that reason. My knee stiffness is a barrier, it's also the reason I'd like him to go easy on it a d let the swelling go down. Won't the swelling go down, albeit slowly, on it's own? Isn't that a natural part of healing? I get confused when the PT and the doctor's nurse both say that stiffness requires aggressive PT or I might need MUA, while the Bonesmart philosophy never advocates aggressive PT. And yet there are people posting on this forum who have had MUA.
@tiredwife. My PT used electrical stimulation on my thigh muscle to get it to work again. I believe he's done that three times. It's working now and I have no problem doing straight leg raises whereas at first I couldn't lift my foot an inch. Maybe that will work for your husband. You said he still has some thigh pain - do you mean he has no other pain at all? Doesn't his knee hurt? He's started walking without a cane at times. I just did that for the first time yesterday, too.
@tiredwife. My PT used electrical stimulation on my thigh muscle to get it to work again. I believe he's done that three times. It's working now and I have no problem doing straight leg raises whereas at first I couldn't lift my foot an inch. Maybe that will work for your husband. You said he still has some thigh pain - do you mean he has no other pain at all? Doesn't his knee hurt? He's started walking without a cane at times. I just did that for the first time yesterday, too.
madinana
post-grad
@sunny-island no I did not bop him in the head. I had swelling pretty much 6 1/2 weeks My knee would feel stiff when first got up in the morning or if I sit to long I am just now not getting the stiffness. Yes he was trying to increase rom but I don't agree with forcing. Also the icing brought down the swelling and elevating. Try to remember you and your knee have the control if there is one thing I learn is your knee will tell you enough is enough and boy I learn to listen to it
tiredwife
alpha
@sunny-island Hubby says he "has a little bit of pain in the knee once in a while, it comes and goes". His main pain in the thigh muscle. Not much swelling left. He healed super fast from the first one, but his ROM was slow coming. This one just the thigh pain is holding him back.
I know it can be confusing about PT saying one thing and bonesmart saying another. Just remember that your PT probably has never had TKR, verses over 2000 members that have had TKR on bonesmart. Yes there are a few people who have had MUA but there have also been plenty that had OS's that wanted them to have one, that didn't and did just fine. As long as you have swelling you won't have descent ROM. The more PT pushes, the more your knee swells, the harder it is to bend and get ROM. Swelling only leaves your body by being absorbed in the body, the way to do that is elevating your leg so that the fluid causing the swelling goes down into your trunk area of the body so it can be absorbed. Spend more time getting rid of the swelling, and your ROM will get better. Let the PT push on your knee or leg and you will have more swelling. Hubby only had one PT push his leg(1st knee the day he was to be released from the hospital), she did it without warning (and I turned in a complaint and she never was allowed near him again) and he was in such pain and his knee swelled because of it. I think that is part of the reason it took so long for him to get good ROM with his first knee.
The decision is yours, but you do have a right to say NO.
I know it can be confusing about PT saying one thing and bonesmart saying another. Just remember that your PT probably has never had TKR, verses over 2000 members that have had TKR on bonesmart. Yes there are a few people who have had MUA but there have also been plenty that had OS's that wanted them to have one, that didn't and did just fine. As long as you have swelling you won't have descent ROM. The more PT pushes, the more your knee swells, the harder it is to bend and get ROM. Swelling only leaves your body by being absorbed in the body, the way to do that is elevating your leg so that the fluid causing the swelling goes down into your trunk area of the body so it can be absorbed. Spend more time getting rid of the swelling, and your ROM will get better. Let the PT push on your knee or leg and you will have more swelling. Hubby only had one PT push his leg(1st knee the day he was to be released from the hospital), she did it without warning (and I turned in a complaint and she never was allowed near him again) and he was in such pain and his knee swelled because of it. I think that is part of the reason it took so long for him to get good ROM with his first knee.
The decision is yours, but you do have a right to say NO.
happymum
junior member
Hi Sunny,
I have been reading your thread. It really makes me feel angry how your PT has been hurting you and you drs nurse is very rude.
My PT is a hard task master only in that she asks me to do a few extra reps but she never puts hands on me to push further. I had my tkr on July 2 so I'm 4 weeks ahead of you and I'm at 95 rom. I'm hoping that as my swelling decreases I can get more bend. ;) my OS certainly thinks I will.
I love the pool physio too and I try to do it every second day. If I go to the pool that's all my exercising for the day ;).
I think you are doing a great job ~ it's your body and you can organize to do your own thing with the PT assisting you but not hurting you.
Best wishes and blessing to you,
From Deb
I have been reading your thread. It really makes me feel angry how your PT has been hurting you and you drs nurse is very rude.
My PT is a hard task master only in that she asks me to do a few extra reps but she never puts hands on me to push further. I had my tkr on July 2 so I'm 4 weeks ahead of you and I'm at 95 rom. I'm hoping that as my swelling decreases I can get more bend. ;) my OS certainly thinks I will.
I love the pool physio too and I try to do it every second day. If I go to the pool that's all my exercising for the day ;).
I think you are doing a great job ~ it's your body and you can organize to do your own thing with the PT assisting you but not hurting you.
Best wishes and blessing to you,
From Deb
@sunny-island
I know it's hard to go against what your PT and doctor's office say about you needing aggressive PT, but remember that it is your knee (not theirs) and you have the right to say what you will allow. They believe they are right, but people here on BoneSmart have found that there are gentler (and actually more effective) ways of getting rid of the swelling. That's why we recommend Rest, Ice and proper Elevation, with only gentle exercise.
Remember the BoneSmart mantras that we posted for you earlier, especially the first two:
- 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 physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never 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 lay down!
Follow the links (the words in blue) to see how to do it properly.
Get rid of the swelling and you will probably find that the ROM was there all the time!
Please, tell your PT that you will not allow him to push on your knee, or to hurt you. You don't have to argue, or debate reasons. Just say that it is your knee and you have the right to decide. Say it quietly, but firmly, and then say you will not discuss the issue any further. Try not to listen to any dire threats - because they are a load of bunkum. Your knee will not set like concrete if you don't allow aggressive physiotherapy.
Yes, there are people here who have had a MUA. Some of them believed their PT and allowed aggressive physiotherapy. Some believed the people who told them that there was a "magic" window of opportunity, beyond which time you had no hope of achieving good ROM. And some had a genuine, physical reason for needing a MUA.
You do know that the Window of Opportunity is a myth, don't you? Read these articles:
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS
and these:
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
I know it's hard to go against what your PT and doctor's office say about you needing aggressive PT, but remember that it is your knee (not theirs) and you have the right to say what you will allow. They believe they are right, but people here on BoneSmart have found that there are gentler (and actually more effective) ways of getting rid of the swelling. That's why we recommend Rest, Ice and proper Elevation, with only gentle exercise.
Remember the BoneSmart mantras that we posted for you earlier, especially the first two:
- 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 physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never 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 lay down!
Follow the links (the words in blue) to see how to do it properly.
Get rid of the swelling and you will probably find that the ROM was there all the time!
Please, tell your PT that you will not allow him to push on your knee, or to hurt you. You don't have to argue, or debate reasons. Just say that it is your knee and you have the right to decide. Say it quietly, but firmly, and then say you will not discuss the issue any further. Try not to listen to any dire threats - because they are a load of bunkum. Your knee will not set like concrete if you don't allow aggressive physiotherapy.
Yes, there are people here who have had a MUA. Some of them believed their PT and allowed aggressive physiotherapy. Some believed the people who told them that there was a "magic" window of opportunity, beyond which time you had no hope of achieving good ROM. And some had a genuine, physical reason for needing a MUA.
You do know that the Window of Opportunity is a myth, don't you? Read these articles:
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS
and these:
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
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OP
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sunny-island
member
This forum is such a god-send. I feel very emotional to think that so many people who don't know me at all are willing to take the time to offer me help.
@happymum. Thank you for the support. You seem to have a lot patience. You are a month ahead of me and not worried with a ROM of 95. It sounds like you have a good PT and OS, who both think more along the lines of Bonesmart.
@Celle. Both my husband and I will read every word of the articles you sent. I've read some of them already. My biggest hurdle, as I see it, will be working out a relationship with my PT that isn't adversarial. He is a very experienced man, set in his ways, and I'll be telling him not to do the very things he truly believes MUST be done. This will not be easy for me. My recovery is more important to me than how he feels about me, but in order to work with him in the future I need to have at least a friendly relationship. We will see him Tuesday. I'd like to schedule only two PT visits a week going forward, down from three per week. Do you think that's reasonable?
Getting the swelling down is Job Number One now. We've been measuring my knee in three places, morning and evening, each day. In ten days the swelling has gone down about 1" with about 1" more to go (in order to be the same as my good knee). The lower part of the knee only needs to go down another 3/8". I expect this to happen slowly but seeing measurable success helps me enormously.
@happymum. Thank you for the support. You seem to have a lot patience. You are a month ahead of me and not worried with a ROM of 95. It sounds like you have a good PT and OS, who both think more along the lines of Bonesmart.
@Celle. Both my husband and I will read every word of the articles you sent. I've read some of them already. My biggest hurdle, as I see it, will be working out a relationship with my PT that isn't adversarial. He is a very experienced man, set in his ways, and I'll be telling him not to do the very things he truly believes MUST be done. This will not be easy for me. My recovery is more important to me than how he feels about me, but in order to work with him in the future I need to have at least a friendly relationship. We will see him Tuesday. I'd like to schedule only two PT visits a week going forward, down from three per week. Do you think that's reasonable?
Getting the swelling down is Job Number One now. We've been measuring my knee in three places, morning and evening, each day. In ten days the swelling has gone down about 1" with about 1" more to go (in order to be the same as my good knee). The lower part of the knee only needs to go down another 3/8". I expect this to happen slowly but seeing measurable success helps me enormously.
I think that 2 PT visits per week is quite sufficient. Remember that it's your knee and your life and you have the right to decide.
Best wishes!
Best wishes!
tiredwife
alpha
@sunny-island Good morning, maybe if you explain to your PT that you are having a lot of pain, and what he is doing to you is making it unbearable and is causing more swelling. I think 2 days a week are fine, on the days you don't have PT you can do some stretching and flexing exercises. Always remember to elevate and ice after exercising to help with the pain and swelling. Have a great day!
I think 2 PT visits a week is plenty. You will be doing exercises like heel slides etc at home on your non-PT days. On my first visit my PT actually asked if I wanted 2x or 3x per week. I said 2x b/c I'd be doing my exercises at home the other days.
The way I think of the exercises thanks to B.S. and my own experiences is that you need to try to go past your comfort zone--it won't be comfortable to do the heel slides, but (as I think someone on the forum said) if you're groaning a lot it's too much. Also don't let the PT hurt you. Again, discomfort (what I think of as mild pain) but not *pain!* pain. If that makes sense.
The way I think of the exercises thanks to B.S. and my own experiences is that you need to try to go past your comfort zone--it won't be comfortable to do the heel slides, but (as I think someone on the forum said) if you're groaning a lot it's too much. Also don't let the PT hurt you. Again, discomfort (what I think of as mild pain) but not *pain!* pain. If that makes sense.
OP
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sunny-island
member
@Celle, @tiredwife, @kneeper, All of you agreed with me that 2x week for PT would be just fine. So today I went to PT and told Larry, my PT guy, that I didn't want the sessions to last much longer than that because I get too sore. He agreed, after telling me that he didn't usually look at the clock, he just did what he thought needed to be done. I'll give him the benefit of the doubt on that one! I had planned to also tell him I didn't want him to push on my leg but I didn't end up saying that. However, I told him when to stop when did push on my knee. He used E-stim on me again. That's very effective. It was after he finished E-stim that he started to gently push. He got my bend to 107 degrees, stopping when I said to. We had gotten to about 100 degrees at home without any silly shenanigans. After that I was ready for him to ice it and let me go home but he had other ideas including shallow squats. I did them. I wish I hadn't. Maybe it's okay (I'm at the 4 week point as of today). It went pretty well but I should have been more assertive I think. My next appt is Friday. Now I'm wondering, do I need formal PT at all? Couldn't I do this at home? I saw somewhere on BS some stats showing that, in the long run both groups - with PT and without PT - ended up almost identical results. It makes me want to just stop going to PT. Any comments?
The swelling in my knee is going down (I hope today's PT didn't undo that).
The swelling in my knee is going down (I hope today's PT didn't undo that).
tiredwife
alpha
@sunny-island I would say if you have some equipment at home, and are willing to exercise and try to flex and extend your knee than PT isn't really needed. My husband goes because they have equipment like a recumbent bike that we don't have and they can gauge his progress. Basically this time he only had a little home PT and she did no more than see how he was doing and suggest exercises. Today was his first outpatient PT on this knee and he was already at 125 and 0. Just remember if you don't do your exercises to bend a flex your knee and if you aren't active it may stall out and not get any better.
Hi @sunny-island
If you are going to continue to go to PT then, yes, you do need to be more assertive. Tell your PT not to push on your knee. Tell him you don't want to do squats yet. Tell him that twice a week is plenty and that the sessions do not need to be long.
You can do your own exercises at home, if you wish. Here is an article that gives some suggestions:
Exercises for TKRs: do-it-yourself exercises from basic to advanced
Roy Gardiner has also written a helpful post, with suggestions for the exercises he did:
ROM, Extension and Quad exercises.
I only had three formal PT sessions in total, did most of m y exercises at home, and got an excellent result.
The key to all exercise for recovery is little and often, and be gentle with yourself. If it hurts - stop. If it is sore or stiff the next day - don't do it again, or do it less frequently and more gently.
If you are going to continue to go to PT then, yes, you do need to be more assertive. Tell your PT not to push on your knee. Tell him you don't want to do squats yet. Tell him that twice a week is plenty and that the sessions do not need to be long.
You can do your own exercises at home, if you wish. Here is an article that gives some suggestions:
Exercises for TKRs: do-it-yourself exercises from basic to advanced
Roy Gardiner has also written a helpful post, with suggestions for the exercises he did:
ROM, Extension and Quad exercises.
I only had three formal PT sessions in total, did most of m y exercises at home, and got an excellent result.
The key to all exercise for recovery is little and often, and be gentle with yourself. If it hurts - stop. If it is sore or stiff the next day - don't do it again, or do it less frequently and more gently.
OP
OP
sunny-island
member
@tiredwife. Your hubby is on the recumbent bike on his first day of PT? What else is he doing? How about the treadmill? My PT wants to start me on the treadmill at my next appt. Do you think that's a good idea?
As for having equipment at home: we don't but our community has a wonderful fitness center with equipment and all kinds of things. We're a 5 minute drive from that facility. At home, my husband has been helping me do PT everyday. We do simple exercises as well as using a step and some stretchy bands. And I walk around the house several times each day.
I'm so impressed with your hubby's progress! I want to do whatever he's doing. You must be very pleased with how this is going.
As for having equipment at home: we don't but our community has a wonderful fitness center with equipment and all kinds of things. We're a 5 minute drive from that facility. At home, my husband has been helping me do PT everyday. We do simple exercises as well as using a step and some stretchy bands. And I walk around the house several times each day.
I'm so impressed with your hubby's progress! I want to do whatever he's doing. You must be very pleased with how this is going.
tiredwife
alpha
@sunny-island He walked the track for 6 minutes, stood on each leg (crane like) for 15 seconds each, did the stand on wedge lean into the wall, bike for 5 minutes (the bike is always first), walked up and down the stairs (practice stairs) like a big boy 5 times, put foot up on second step and stretched it straight, stand heel to toe for 15 seconds, and I can't remember the others. You got to remember that no two knees are the same, and his legs were really strong before surgery! Yes I am thrilled!
A little walking is fine, but I'm not sure about a treadmill. If PT keeps it short and sweet it could be ok. My PT didn't have one so I don't know if they'd have tried it.
I have a personal bias against squats because I developed continuing tendonitis with my quad tendon in my first knee after doing too much too soon--including squats. Some of that could be from my own prior condition, but I'm a fan of easing in slowly to building muscle.
Let pain be your guide and say no if you need to.
I have a personal bias against squats because I developed continuing tendonitis with my quad tendon in my first knee after doing too much too soon--including squats. Some of that could be from my own prior condition, but I'm a fan of easing in slowly to building muscle.
Let pain be your guide and say no if you need to.
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