How much PT is enough?

[dcdowden]

I am now at 6 weeks post RTKR and have completed 8 of my 12 scheduled outpatient PT sessions. I see my OS next week and am wondering how much more PT I should be planning after I finish the next couple weeks. I am walking with a cane for short distances and driving the car. My flex is measured at about 120 and my extension at -4. My extension has been limited to no better than about -10 for the past 13 years due to a car accident and my OS had told me I may not get it back to 0 post op. I am happy to report that I have enough flex already to tie my shoes and cut my toenails which took me a lot longer with my two hip replacements. I have a recumbent bike at home which I ride daily. So my question for all the knee vets here is basically how did you decide how much outpatient PT was enough. I'm fairly sure my OS will write me another scrip for the PT, so I suspect it will be up to me. I like my therapist, but I am already wanting to just get on with my life and put this phase behind.
Thanks for your advice.
Doug

 

[Jamie]

Doug, I think most doctors do leave it up to you (within reason, of course) to decide at what point you are not benefiting from therapy. Some people like the regimentation and forced workouts. Others want to be rid of the hassle of going to therpay and just do their own workouts. You certainly have good ROM, so I really think it depends on what you feel would be best.

As for me, I had home therapy for 6 weeks and then went to outpatient for 2 visits....just to learn some exercises I could do for myself. I have to tell you, I gained ROM little bits at a time for the next YEAR after that. I'm now 1 1/2 years out and am very happy with my knee's movement. The trick is to KEEP MOVING and DOING!!!

 

[sykeRN]

Hi--I had home PT for 4 weeks total (OS says no to outpatient PT while his patients are on Coumadin for 4 weeks( for two weeks I had daily PT and then x2/week for two weeks. My home PT was excellent (had worked primarily in outpatient PT for many years) and tough but did not cause a lot of pain. I achieved great ROM and she said I would not need further PT. I've designed my own exercise program that works on ROM, strength especially for my legs ,using an exercise bike and walking as much as I can. I do different things each day--I'm working on progressing slowly (hard to do for me--I want so much to do lots--I LOVE exercise) and may join the local YMCA for the pool. My OS said it was up to me if I wanted more PT---but he also thought I could do it on my own since I had progressed so well.

I do agree with Jamie--I think the key for me is moving and doing!!

 

[Texas]

Hi there me to I had home PT them went to some out pt to get the excercises as the amt that pt was charging i could no longer o.........You sound like you are doing very congratulations..............

 

[cindy88fan]

To me it sounds like you are doing great! I did 6 sessions of in home PT and 12 sessions of out-patient PT. If you feel you are doing well, let your OS know. But you still need to continue your exercises at home. I just finished PT week before last and I'm still with a cane. My PT told me I will know when to let go of the cane.I walk around the house without the cane and when I walk on this black topped trail I don't use my cane.

 

[backbay38]

You sound very motivated and like Jamie and the others said -- continuing to move and bend is the key. I had 2 weeks PT at home and then started driving and went 3x a week for another 6 weeks at which point my PT threw me out because I had already transitioned back to the gym. My surgeon authorizes 3 months of 3x/week PT but many insurers will only pay for 6 weeks to 2 months. I went over my usual gym weight training routine with my PT and added a few balance and strengthening exercises he showed me. I dropped a few others which he felt would put too much torque on the new knee. I walk a lot - 2 to 3 miles every morning and more on weekends and do some stationary bike and elliptical trainer plus a couple of days a week I do the rowing machine for flexibility. Where I can I use daily activities as exercise, doing stairs instead of elevators, walking hills whenever possible etc. Lots of that kind of "movement" is a good substitute for the gym work. I also bend and stretch my knee and the rest of me daily. But I work particularly on lengthening the quad muscles with gentle bending until it just begins to really pull. I got back my ROM and extension very quickly because I had them before the TKR.
I think your PT can tell you when you're ready to quit. Just be sure you go over your daily exercise plan with him/her and then stick to it. If you're really disciplined you'll do fine; most of the PT stuff you can replicate yourself easily. But if you slack off the moving and bending and strengthening (however you accomplish it) you will lose what you've already gained --- . THis isn't an operation you can just have, recover from and forget about. Not, at least, if you want to get maximum results!

 

[pallen]

I have been wondering the same thing. I am 13 weeks from my LTKR and still going to PT 3 times a week and exercising at home twice a day. It is taking so much of my time that it feels like I don't have my life back yet. My Rom is 105 and my extension is -2, which is not very good, but I am walking just fine without a cane and my knee is feeling good. I thought I had to continue PT until I have a decent ROM, my target is 120 because that is what I had before the surgery. It sounds like my ROM will improve even if I quit PT.

 

[loggon]

Some folks do not take PT. You do not need it to gain Rom.

You can do it on your on. Good luck.

 

[moe]

I had PT for 4 months after RTKR. I am now 8 months out and for the most part am happy with my knee but still would like more ROM. I am not sure where exactly I am at with ROM but no where near what I was before surgery. Flexibility was not the issue. I have stopped obsessing with the numbers and stretch and bend and ride my bike. Some days it feels more bendable than others but it sure is sturdy and I am not afraid of it giving away every step I take! What does everyone think is the best way to get more ROM?

MOE
RTKR 1/27/09

 

[Jayhawk]

If you have 120 degress of flex would assume you are ready to work on your own with the re-hab. That was the target for my doctor on the flex...I worked extremely hard in physical therapy and fortunately reached 120+ on flex and 0 on extension very quickly with both knees. What is your physical therapist recommendation...with both my knee re-hab programs my physical therapists told me I had reached a successful point of recovery and should begin to exercise on my own. My physical therapist communicated with my doctor on a weekly basis and both were in agreement on the completion of the physical therapy program.

I continue to work at the gym with a weight training and cardio program.

Steve

 

[backbay38]

Lots of people on this site have written about gaining ROM on their own in the first year and even after that. As my PT explained it you have to very gradually stretch the quad muscles and it can take awhile. Your PT will show you the bending exercises (essentially what he/she does now) and you just have to be faithful about doing them yourself. And after about 2 or 3 months once a day is enough for strengthening. I do serious weight work on my legs 3x a week (like PT) at the gym but I do cardio, hills, balance and perhaps lunges or squats on a balance cushion (or some mix of these) virtually very day. And every morning with my coffee I sit on the floor and in between starring vacantly at the TV I do 3 sets of isometric quad tightening with leg flat on the ground and in between, sitting up, I gently bend my knee up and then pull my lower leg back and toward my butt for ROM (holding each time for a count of 10 or 12). I go very easy the first time and get more flexibility by the 3rd or 4th time.

 

[Josephine]

Well said, backbay - very well said!

and in between starring vacantly at the TV

I know that mode! Spend a lot of my day doing that exercise. :hehe:

 

[dcdowden]

Thanks to all for the great advice and personal experience. My therapist recommended I do a couple more weeks of PT to continue strengthening exercises and my surgeon wrote the scrip for that today. At PT they have me using the total body gym to strengthen the quads which is something I can't do at home. They also have been using 'Russian Stim' on the quads as I do leg raises for ten minutes as well - not the most pleasant thing, but also not something I can do at home either. Besides general conditioning stuff, I think my next major goal is to be able to comfortably go up stairs with my new knee - my quads really scream when I do that now.

I also saw my primary care doctor today for a post op check up and a flu shot. He was very happy with the mobility I have achieved at 7 weeks, so I guess I am also very pleased. Thanks again for your perspective. I am planning to cut back my PT to twice a week as a transition to finishing up over the next few weeks.
Doug

 

[Judles]

Sounds like a plan, Doug! And good luck! You're doing great!!:thmb:
:p