TKR Injured Knee 3 Years Out
- Thread starter readymade
- Start date
Suz
graduate
Welcome to Bonesmart @readymade! In a few months you will look back and realize that joining this site is up there with the very best recovery actions you took in the early days of your recovery! There is plenty of support here so feel free to ask questions and vent any frustrations you are having. We have all 'been there done that' and love to help others find their way through the recovery maze!
![[Bonesmart.org] Injured Knee 3 Years Out](https://data.bonesmart.org/attachments/44/44860-71145ade7e5f2b97abf76656b6b988ed.jpg?hash=cRRa3n5fK5 "[Bonesmart.org] Injured Knee 3 Years Out")
I corrected your surgery date, @readymade.
Hello @readymade
Josephine is correct. I did no formal PT at all after my last knee replacement. I have a perfect result. I can straighten my leg fully and its flexion is over 125 degrees. The knee is strong and reliable.
My surgeon and the others in his practice do not allow any formal PT for the first month after a knee replacement. He says that your knee has been wounded and it needs that time, to begin its journey of healing. During that month, I didn't just lie around like a log, doing nothing at all. I walked a bit around the house and gradually resumed some of the activities of daily living. I did lots of rest, elevate, ice and take your pain meds by the clock.
My knee wouldn't bend at all for about 5 days, but as the swelling went down, it gradually began to bend more and more. After about 2 weeks, I would occasionally (and very rarely, I admit) do a few Heel slides and how to do them
https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/
After that first month, my surgeon allows outside PT, but only one visit every 2 weeks. At those visits, the therapist shows a few more exercises, which you do at home. I followed that regime for my first two knee replacements, but I had no formal PT at all after the last one.
My surgeon emphasizes that at no time should you do anything that takes your knee beyond discomfort into pain. His patients all do well and he has not had to do a manipulation to help with ROM (Range of Motion) for almost 4 years.
In spite of what your therapist tells you, bad scar tissue is quite rare. It isn't just sitting there, waiting to pounce if you don't exercise enough. It doesn't develop in the first few weeks anyway.
I know it's not easy when you're being given advice that seems to differ from what your therapist says. Do what you feel is right for your knee, because you are the only one who has the right to say what will happen to it.
Be kind to yourself and kind to your knee.
Josephine is correct. I did no formal PT at all after my last knee replacement. I have a perfect result. I can straighten my leg fully and its flexion is over 125 degrees. The knee is strong and reliable.
My surgeon and the others in his practice do not allow any formal PT for the first month after a knee replacement. He says that your knee has been wounded and it needs that time, to begin its journey of healing. During that month, I didn't just lie around like a log, doing nothing at all. I walked a bit around the house and gradually resumed some of the activities of daily living. I did lots of rest, elevate, ice and take your pain meds by the clock.
My knee wouldn't bend at all for about 5 days, but as the swelling went down, it gradually began to bend more and more. After about 2 weeks, I would occasionally (and very rarely, I admit) do a few Heel slides and how to do them
https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/
After that first month, my surgeon allows outside PT, but only one visit every 2 weeks. At those visits, the therapist shows a few more exercises, which you do at home. I followed that regime for my first two knee replacements, but I had no formal PT at all after the last one.
My surgeon emphasizes that at no time should you do anything that takes your knee beyond discomfort into pain. His patients all do well and he has not had to do a manipulation to help with ROM (Range of Motion) for almost 4 years.
In spite of what your therapist tells you, bad scar tissue is quite rare. It isn't just sitting there, waiting to pounce if you don't exercise enough. It doesn't develop in the first few weeks anyway.
I know it's not easy when you're being given advice that seems to differ from what your therapist says. Do what you feel is right for your knee, because you are the only one who has the right to say what will happen to it.
Be kind to yourself and kind to your knee.
This is so stupid it's silly. Unfortunately most of these physios have never had joint replacement. They are just doing a tick box exercise trying to apply the same strategy to every patient. Stick to your guns. You don't need to push to get ROM.
34120
member
Welcome, readymade! In a nutshell: I had bilateral knee replacement on July 13. Stayed in hospital for one week, w/group PT, stayed in rehab 3 weeks, w/1 on 1 PT, 2x daily. Then, waited 2 weeks for outpatient PT appt. During that 2 weeks, I got a little lazy, did home exercises 1x every other day, walked around the house a little, lots of RIME! [emoji6] ROM leaving rehab: 115 & 117. ROM @ outpatient yesterday: 135 & 136! What does that tell you about the Bonesmart way? [emoji2]
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Sent from my SM-G920V using Tapatalk
@readymade, I'll add my 2 cents worth, too. I never had pt after 11 knee surgeries, 3 of them major surgeries. I am a single lady that has to take care of house, yard and 11 cats, as a rescuer. I'm doing just fine after having no pt. I just live my life and do the things I have to do. Read my thread. You'll see that I've also had bad days when I do too much, but all those bad days were caused by ME, not a therapist. You know what your knee needs to do. When you use it in your daily, it will rehab itself. When you go to pt, you be in control and never let them touch your leg to push or pull. Don't listen to their threats. Your ROM will improve for a year or more. If you push it, it will swell and you can't move it as much. It's counter-productive. You are the boss of pt. You are paying them and they have to do what you say. Don't ever let them hurt you!
BBCG
Former BoneSmart Staff Member
Hi readymade, Josephne, Pumpkin, Zzevi, smarttoys and others have given you great advice, here, and I'm so glad I found this site on one of those middle of a sleepless nights I had. You'll see from my signature that I'm only 3 days ahead of you, on my left knee...which is not as confused now, thank goodness...it's still a bit angry at me, though!
I suspect they're referring to an MUA that they will want to do (charging you again for that procedure, too, of course!) as I've also been threatened with that at my last appointment with my OS this week.
Like you, my ROM isn't ideal, at my last OS visit only 12 - 80, so I was given the "dreaded MUA" talk, at my 6 week follow-up visit. So, now I am told I'll have to have an MUA in a month if I'm not at 0 and 100 degrees. So, FWIW, I'm not going to do the MUA at that time, I'll tell them I want to wait to see how I'm doing when I'm 3-4 months out, but I am doing as much as I can, without causing too much pain, to increase my work on it, though. They wanted to sell me a board with straps that has a raised foam shelf on one end that I was to strap myself into 10 minutes a time, 3x a day to help increase my extension towards 0. But, before agreeing to take it, I asked to be informed of how much my insurance will cover...because 'fer gosh sakes: I could make the thing myself out of foamcore and a thick piece of the stuff that computer stuff comes in, that thick foam bedding! And for that matter, my couch isn't as firm a surface, but the arm rest is raised about the correct amount...or other similar methods of getting to the same kind of thing.
The other thing they told me is that I should increase my pain meds to the point where I can work through more of the pain and get more ROM. This after here in the US we're hearing all the time about the epidemic of opioid overuse and deaths and addiction. But, okay, I am using the meds as they suggested, and taking them ahead of the time periods I plan to push myself more in ROM exercises.
So, it seems that here in the States, we're under the influence of doctors and a system that believes in the no pain no gain model of care, even though we're not healing from an athletic injury, where perhaps that model is seen as more appropriate, but from surgery, where the healing is a bit different. They seem to believe the same model of care applies. My PT has been pushing me, too, but I've known her for years and she is much more humane than many are. She knew I'd probably get that talk on Monday, as I did, so she and I have been working on the ROM more, too. She did a really cool thing yesterday: she lifted my skin and surrounding tissues up a bit off the knee and had me move through ROM slowly, to see what that felt like and it was quite impressive: without that tissue pressing down on my knee, it moved much more freely! She thinks that as the swelling continues to decrease, I'll indeed find the ROM that is there. I'm using a TENS type of stimulator too, that I borrowed from my daughter, to stimulate the are right next to the incision to help decrease scar tissue and it does seem to help that area too. She also does ultrasound on the sore areas too, almost every time and now can press more and the knee tissues are much looser and less tight than even a week ago.
I'm also using a pain cream that someone on this forum mentioned, and although mine is a different formula, it works quite well to calm the hypersensitive areas around my incision and in the swollen tissues adjacent to the knee that are causing the restriction.
I'm also very fortunate to have found a good PT that does listen to me and I told her my intention is to not do the "dreaded MUA," I call it, but to indeed give it the old college try and see how much ROM I can recover by the time I see the OS again. Part of my issue has been (if you read back in my story) that I was unable to get anyone to listen to the problems with pain I was having and sleeplessness for over 2 weeks. I was unable to make ROM progress at all then, so being behind in my goals is partly due to their gatekeepers not listening to their patients and blowing us off. I told him how unhappy I was about that, and that it was unnecessary and I finally had to see my PCP to get any help. She told me to call and get an appointment that week for a knee expert and not to take no for an answer! (She's feisty!)
So, I'm happy to keep in touch with you, too, as we buck the system here! Hang in there and we just have to realize we're bucking an entrenched system that has a belief structure that is very ingrained. Any time you go counter to what they believe is right, they feel challenged and want to try to scare you into compliance. I may take in a printout of some of the discussions here about how it is done differently in other places and folks still get back their ROM over a longer period of time, most of them, at any rate! I doubt he'll read it, but he did write down the formula for the pain cream and knows where I got it, and although he may not have realized he approved it (he seemed not to) he was on board when he heard it was helpful to me.
Will keep you posted on how my ROM improves over the next few weeks, but try to read more about successful outcomes here, too, and you'll see that the preponderance of the evidence is that your ROM comes back as the swelling retreats!
I suspect they're referring to an MUA that they will want to do (charging you again for that procedure, too, of course!) as I've also been threatened with that at my last appointment with my OS this week.
Like you, my ROM isn't ideal, at my last OS visit only 12 - 80, so I was given the "dreaded MUA" talk, at my 6 week follow-up visit. So, now I am told I'll have to have an MUA in a month if I'm not at 0 and 100 degrees. So, FWIW, I'm not going to do the MUA at that time, I'll tell them I want to wait to see how I'm doing when I'm 3-4 months out, but I am doing as much as I can, without causing too much pain, to increase my work on it, though. They wanted to sell me a board with straps that has a raised foam shelf on one end that I was to strap myself into 10 minutes a time, 3x a day to help increase my extension towards 0. But, before agreeing to take it, I asked to be informed of how much my insurance will cover...because 'fer gosh sakes: I could make the thing myself out of foamcore and a thick piece of the stuff that computer stuff comes in, that thick foam bedding! And for that matter, my couch isn't as firm a surface, but the arm rest is raised about the correct amount...or other similar methods of getting to the same kind of thing.
The other thing they told me is that I should increase my pain meds to the point where I can work through more of the pain and get more ROM. This after here in the US we're hearing all the time about the epidemic of opioid overuse and deaths and addiction. But, okay, I am using the meds as they suggested, and taking them ahead of the time periods I plan to push myself more in ROM exercises.
So, it seems that here in the States, we're under the influence of doctors and a system that believes in the no pain no gain model of care, even though we're not healing from an athletic injury, where perhaps that model is seen as more appropriate, but from surgery, where the healing is a bit different. They seem to believe the same model of care applies. My PT has been pushing me, too, but I've known her for years and she is much more humane than many are. She knew I'd probably get that talk on Monday, as I did, so she and I have been working on the ROM more, too. She did a really cool thing yesterday: she lifted my skin and surrounding tissues up a bit off the knee and had me move through ROM slowly, to see what that felt like and it was quite impressive: without that tissue pressing down on my knee, it moved much more freely! She thinks that as the swelling continues to decrease, I'll indeed find the ROM that is there. I'm using a TENS type of stimulator too, that I borrowed from my daughter, to stimulate the are right next to the incision to help decrease scar tissue and it does seem to help that area too. She also does ultrasound on the sore areas too, almost every time and now can press more and the knee tissues are much looser and less tight than even a week ago.
I'm also using a pain cream that someone on this forum mentioned, and although mine is a different formula, it works quite well to calm the hypersensitive areas around my incision and in the swollen tissues adjacent to the knee that are causing the restriction.
I'm also very fortunate to have found a good PT that does listen to me and I told her my intention is to not do the "dreaded MUA," I call it, but to indeed give it the old college try and see how much ROM I can recover by the time I see the OS again. Part of my issue has been (if you read back in my story) that I was unable to get anyone to listen to the problems with pain I was having and sleeplessness for over 2 weeks. I was unable to make ROM progress at all then, so being behind in my goals is partly due to their gatekeepers not listening to their patients and blowing us off. I told him how unhappy I was about that, and that it was unnecessary and I finally had to see my PCP to get any help. She told me to call and get an appointment that week for a knee expert and not to take no for an answer! (She's feisty!)
So, I'm happy to keep in touch with you, too, as we buck the system here! Hang in there and we just have to realize we're bucking an entrenched system that has a belief structure that is very ingrained. Any time you go counter to what they believe is right, they feel challenged and want to try to scare you into compliance. I may take in a printout of some of the discussions here about how it is done differently in other places and folks still get back their ROM over a longer period of time, most of them, at any rate! I doubt he'll read it, but he did write down the formula for the pain cream and knows where I got it, and although he may not have realized he approved it (he seemed not to) he was on board when he heard it was helpful to me.
Will keep you posted on how my ROM improves over the next few weeks, but try to read more about successful outcomes here, too, and you'll see that the preponderance of the evidence is that your ROM comes back as the swelling retreats!
OP
OP
readymade
junior member
Your story is most encouuraging! My visiting nurse came today (she's not a PT person) and was very encouraged at my rate (11 days out) of healing. As far as I'm concerened, that's what should be focused on more than anything right now! The bruising and swelling have backed off considerably, mostly due to constant elevation, as stressed on this site. Staples look good too...ready to pop out soon, and I'm happy about that. She also encouraged me to stand up for myself during upcoming PT, just like all on this site. This actually made me feel better mentally than any amount of ROM would at this point. Huzzah! Thank you for your kind words, all!
PegGar16
Former BoneSmart Staff Member
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Along with all the great advise above...next time your PT threatens just ask them when they had their TKR done??? Sounds like you are doing great
jmdearras
graduate
took me 9 months to reach 0. no rush. And especially no pain.
You have it right. Concentrate on that healing and don't worry about ROM!
BBCG
Former BoneSmart Staff Member
Cool, readymade: my friend who had a bilateral TKR 6 months ago also had a home health nurse who was a phenomenal advocate for her! SHE — the nurse — called the OS to get my friend in early for them to look at one of her knees that was farther behind the other. So, my friend was very surprised to hear of my very negative post-surgical experience of getting a run-around from the OS office when I needed help. What that told me then was that I would need an advocate to deal with them if I wasn't my usual feisty self! I'm taking an "easy" day today, resting a lot, writing here on the forum, doing one computer post card ad project, as tomorrow I'll have my 5 year-old granddaughter with us most of the day! We're planning a quiet afternoon so Grammy can ice and elevate her knee after a morning of fun outdoors at parks, at the water park since it's supposed to be in the 80-90s until late in the day!
dianehelen
supremo
Hi @readymade just wanted to chime in with another voice of agreement for the Bonesmart way. You are just 2 days ahead of me, and I too had to keep the pt guy in check about my thoughts on the no pain no gain threats on rom progress. They all seem to read from the same script. My rom is 78/8 after 9 days and the talks have already begun how my OS wants 90/0 at my follow up. Ya well I want a glitter pooping unicorn , so we dont always get what we want, do we. I have seen time after time here that the gentle BS way just works. Its sad and frustrating that the medical community is slow to carch up to things outside the traditional ideology. I'm doing very little, short walks every few hours, gentle heel slides, glut presses, just a few a day, and that's how I intend to continue. Pt called yesterday, and I just told him I had a migraine and cancelled. I'll see if I want to see him again.
Bottom line, be tough, stand your ground and remeber you are paying them, you have a voice in your care.
How are you feeling in general? Pain managed well? Sleeping ok? Its quite the adventure isn't it.
Feel good, we'll get there!
Bottom line, be tough, stand your ground and remeber you are paying them, you have a voice in your care.
How are you feeling in general? Pain managed well? Sleeping ok? Its quite the adventure isn't it.
Feel good, we'll get there!
gazelle7777
post-grad
you are barely two weeks out for goodness saks! You are going to have swelling and pain at this point in your healing journey.... look to 7-8 weeks out for a big turn around. As far as ROM, it will come with time as the swelling goes down. Do not listen to them telling you you need to push harder. Baloney!
birdwatchr
graduate
I was threatened with mua before I even had pt and was 1 week out. If I hadn't been in so much pain I would've laughed in his face.
OP
OP
readymade
junior member
Gazelle, Diane, BBCG, sistersinhim, JM, thank you all so much for the reassurance!
Healing wise on the outside, I'm doing well, but for some reason last night was terrible as far as pain I was kinda worried, actually. But by this AM it backed off some. I have to be careful with pain meds as I have IBS (apologies if TMI) and many pain killers also kill my stomach, so sometimes I depend on Tylenol and just a bit of ultram. But I'm managing! Looking forward to the day I can have a bit of energy, as well. I know that's a ways off, but a chick can dream, right?
Healing wise on the outside, I'm doing well, but for some reason last night was terrible as far as pain I was kinda worried, actually. But by this AM it backed off some. I have to be careful with pain meds as I have IBS (apologies if TMI) and many pain killers also kill my stomach, so sometimes I depend on Tylenol and just a bit of ultram. But I'm managing! Looking forward to the day I can have a bit of energy, as well. I know that's a ways off, but a chick can dream, right?
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