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Revision TKR Instability Question

rah2435 said:
It's called "our part" of the TKR process.
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What I have learned through this forum is that it’s not exercise that gets ROM, it’s time. Time to to recover, time for pain and swelling to settle, and time to heal. Our ROM is right there all along just waiting for that to happen.

“Our part” is giving our knee the best opportunity to heal, and doing lots of exercises this early is counterproductive to that. Many of us are told we must do exercises in order to improve, but that is not true. Yes we need to move the knee gently to help regain motion.
rah2435 said:
Also, I think the therapist might get some blame if a person's ROM isn't where the doc wants it to be...
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Your therapist nor your doctor are “responsible “ for where your ROM is. That is determined by the way your particular body heals. They may want a certain number and even by a certain date, but they can’t control that. They can, however, influence it for negative by insisting you do too much that will keep your knee swollen which reduces ROM.

There are many approaches to recovery/rehab which tells me there is no one way to do it, so we get to choose which one suits our body best. It’s your knee, your choice.
 
And read my recovery thread. I had no PT after 11 knee surgeries!
 
ok @Josephine - I've cancelled todays PT session. I moved it to next Tuesday. We'll see if I improve over the weekend. Looking forward to the JRAD tomorrow! Will the topic of PT be discussed?
 
rah2435 said:
Looking forward to the JRAD tomorrow! Will the topic of PT be discussed?
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Yes, there is a session on “Can I Do My Rehab At Home”. I am looking forward to hearing this one myself!
 
What impressed you about this article? It seems it is still recommending exercises, but done at home instead of in actual appointments with a physical therapist. It did not define what kind of exercises. Exercises can just as easily be overdone at home as in a PT office.

For example, my PT told me to work on ROM by using a sheet to pull my foot as close to me as I could stand, while laying down, therefore bending my knee. And I did. I didn’t force it as much as the PT did in the office, but I did force it. They also told my husband to push my foot back under the chair I was sitting in, forcing the knee to bend. And we did. He’d push my foot back until I cried because it hurt so bad. This was not quite 2 weeks post op. My husband certainly did not enjoy hurting me, but we both “knew this is what recovery/rehab takes to get the ROM back.” This was all done at home.

I didn’t know any better because I had not found Bonesmart yet.

The Bonesmart approach offers a successful outcome without doing painful exercises which can hinder recovery. Yes, we want to move the knee, but in a natural way, like walking and the movements in our daily activities. That is a gentler way to regain our knee function while allowing our knee to heal.

Personally, if I have to do this again, I will not go to PT, no one will force bend my knee (my surgeon was also fond of doing that to measure my ROM at each appointment) and I will recover the Bonesmart way all the way.

The painful way? Been there, done that. Not again.
 
rah2435 said:
I've cancelled today's PT session. I moved it to next Tuesday. We'll see if I improve over the weekend.
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That's not what I suggested. I meant for you to cancel them entirely. Plus which, 4 days isn't going to see any improvement for you at all. Try 4 weeks at least!
 
Josephine said:
Try 4 weeks at least!
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Wow! Yes - I know you meant cancel PT completely. It's hard to do that after the doc just gave me a script for more PT. This is a radical approach - as you know. I'm thinking it over......
 
I do agree, in the US, the Bonesmart approach is very radical. Probably in other areas also.

I agreed with it very quickly, but when I was still going to PT, my husband had a hard time grasping it. We were both afraid if I stopped going to PT, and then had a complication come up, that maybe my surgeon would not be willing to help me. But my husband could see that I was having more pain as PT increased my program.

So we compromised. I did very little exercises at home. Just one rep here and there, so that, at least in my mind, I could say, yes, I’m doing my exercises and tell the surgeon which ones. And it did always come up until I was 7 months post op.

Then, at PT, I started saying no to things I didn’t feel were in my best interest, and the PT accepted my no without any arguments.

I got what I call an “honorable” discharge at not quite 8 weeks post op.
But during those 8 weeks they did things to me that increased my pain, sometimes it took me 2 and 3 days to recover from, before I found Bonesmart. Those activities did not enhance my recovery, they only kept setting it back. Which is why I won’t go to PT next time. Many people recover just fine without it.
 
@Jockette - You took the words right out of my mouth. Exactly right. PT is considered to be just as important as the operation! It's an industry. LOL! But - I woke up today in so much pain (I'm almost three weeks out) I am blessing my pain meds and ready to listen to anyone who will help me get pain free and on my feet again.
On the one hand are the surgeons and the therapist who tell me that these exercises are imperative and on the other I very much understand what @Josephine and bonesmart are telling me. It seems to make sense.

I've been doing very little and I think I'm going to continue to do very little until I feel less pain and swelling. I'm considering cancelling PT altogether - but like you @Jockette I am afraid of the backlash from the establishment here. LOL!
 
The recovery is bad enough without all this pressure to do exercises that clearly cause us more pain!

I honestly don’t know how physical therapy got so big, it is indeed an industry. I don’t understand why surgeons don’t acknowledge the body’s need to heal before stressing it with PT.

One of the great mysteries of the world!

I will take my chances next time and buck the system.

At least when you are not in the presence of a PT you have total control over what you do.

Best wishes for better days ahead.
 
rah2435 said:
I've been doing very little and I think I'm going to continue to do very little until I feel less pain and swelling. I'm considering cancelling PT altogether - but ... I am afraid of the backlash from the establishment here.
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If doing very little is working for you, and your ROM is improving, and your knee is getting stronger and less painful... your surgeon isn't going to care very much how you got to those results. Mine wanted me to do PT, so I did (though I refused half of the exercises and NEVER did any at home on my own) even though I also told him I was going to do the BoneSmart approach. He never asked if I went to PT. He was just happy when at my six week checkup I was doing really well.

I understand, though, about being hesitant about this approach. I meet people in real life who know I had the surgery and can see for themselves how well I did, but for their own surgeries they get scared and afraid of "not doing it right." We want a good result -- we all want the best result we can get -- but we're confronted with two different approaches. Which one is right?

We here at BoneSmart advocate for our approach because it worked for us. But it's a leap of faith for those who come here. The reason I signed on for the BoneSmart approach pre-surgery was because I found out about it before my operation, and the more I looked into it, the more sense it made. So I said, "Let's see what happens when I try it." It worked wonderfully. But other people have done other approaches and had wonderful results. I think in the end it comes down to you.

You know your body and yourself better than anyone else ever will. I think you'll find out right quick if BoneSmart's approach works for you. :)
 
I did very little PT after my TKR revision in 2011 and none at all after my left TKR in 2014.
Both knees are strong and reliable. They straighten fully and then bend to over 125 degrees.

You see, my surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.

His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

Not all surgeons think that PT is imperative. My previous surgeon, back in 2000 had the same policy as my current surgeon.
rah2435 said:
I'm considering cancelling PT altogether - but like you @Jockette I am afraid of the backlash from the establishment here. LOL!
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Remember this: It is your knee and you are the only one who has the right to say what happens to it. It is your job to do what feels best for your knee.

Others, like your surgeon and your PT therapist, can advise you, but you have the right to choose whether or not to accept that advice.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used
 
Dead right, Celle! On JRAD yesterday there were two surgeons who said that they quite categorically told their patients not to do any exercising or PT, just that usual ADLs (activities of daily living) and they affirmed that they found their patients have very good outcomes with minimal pain and therefore minimal use of opiates.
 
Wow. Week three and I am really feeling the house-bound blues. :-/
 
This has been a winter that is never ending! Hopefully when spring does arrives and stays, you can get outside and break the home bound blues.
 
rah2435 said:
Wow. Week three and I am really feeling the house-bound blues. :-/
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You have entered the most difficult part of recovery: Cabin Fever, which is often accompanied by the Can I Make My Knee Heal Faster phase. Resist the temptation to go on long shopping trips, rounds of lunches with friends, baseball games, or resume those visits to the gym. Your brain is weeks ahead of your knee in recovery. It doesn’t help that this winter has been inflicting cabin fever on just about everyone!
 
My OS gave me a prescription for PT, too, and I just threw it away! He was very happy with the outcome of my tkr's ROM! It doesn't have to hurt anymore than the surgical pain!
 
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