Is It Necessary?

[nopurse]

Is it necessary in physical therapy for the PT to stretch your knees until they are in horrible pain? Is this common practice? Can it cause other problems? Just courious to know other's experience with this.

 

[SusieSW]

I think we've all had painful experiences in PT. What particular stretch is causing the pain for you? When I was in physical rehab right after my surgery, I had a PT who was amazing. He helped me use deep breathing and muscle relaxation during our sessions, and I was able to tolerate a stretching technique pretty well - he would push my bent knee back toward my body. It hurt, but he let me set the pace and really worked with me on the breathing and relaxation. I haven't worked with anyone quite like him before or since.

My current PT is obviously very skilled, but we had an absolutely horrible session one day. I had an appt with my surgeon for follow up, and I'm convinced she wanted to impress him. My right leg had responded much more slowly than my left, so she decided to "manipulate" my right knee before I saw the doc. I was literally screaming and almost stopped going to her after that session. I tried to use the breathing and relaxation techniques but it didn't help. She pushed harder, held it longer, and repeated it more than my previous PT. I have dreaded a repeat of that ever since.

This is a really good question! I wonder what others' experiences have been?
Susan

 

[nopurse]

While laying on my stomach the PT pushes my leg towards my body. This causes a tremendous amount of pain in my leg and also in my lower back. I just thought anything that painful couldn't be good for you. A little pain and a slow stretch I can understand, but I am not so sure about this. I quit letting them do the stretch on me. It may prolong my recovery, but I'd rather it prolong it rather than cause a more serious problem.

I WONDER IF OTHERS EXPERIENCE THIS TOO?

 

[referee54]

My PT at home---before I went to the outpatitent, had to bend my knee so much that I would bite on a towell so she wouldn't hear my profanity. If you cannot get your range of motion, there is this procedure called "manipulation." they put you under, and then basically rip your quads to get it back to a good ROM...I was told about that and decided any amount of pain would be better than that. I would dread and look forward to the arrival of my PT all at the same time.

All I can say is that I had to rip the adhesions--or she woudl do it for me. The other alternative was go back in and have it done under an anesthetic---and I was told that this was not a nice thing at all.

I used weights on my ankles as well as exercise bands to help break them up, and now my ROM is just fine...all I am working on during my PT sessions is strengthening my muscles and balance.

Remember, "no pain, no gain." You have to work on getting the nasty adhesions to break and to pop---and then the ROM will improve drastically.

Tim C.

 

[Skeet]

I have not experienced this at all with my PT. She was quite good at putting me through the paces, but not causing me extreme pain. I am at 0 flex and can get to 115 degrees bent. I don't know what the expectation is long term. I had one time when my leg hurt a lot. I was lying on my stomach and she had 6 pounds on my ankle with me bending my leg up behind me. On the third rep I almost cried but I made it through.

So, not not everyone goes through this. But not everyone may need to. I think it depends on your ROM (range of motion) and how far you need to go to reach the optimal level.

Skeet

 

[Doug]

Prior to the surgery, my knee had such bad arthritis that I had poor flexation so the quad was tight already after the surgery. They bent my leg. I let them and like the Ref said, it's going to hurt badly. But I feared going back under for him to "manipulate" it. In fact, I'm just darn sure not going to do it. Although I've been released from PT, I continue to work my leg out six days a week. I also soak it in a hot tub twice a day and force the leg back. I have my 14 yr. old son help me bend it back. There have been times I wondered if I was going to break the joint but I was told not to worry about it.
Since this was my ninth knee operation, I can only say you have to push it and work with the therapist or it will have a major impact on your recovery.
Best of luck and let us know how you 're doing.

 

[Josephine]

Seems odd to say - when our bodies are designed to figure that pain = damage - but this pain will not cause damage. Conversely, it is harmful this this excessive stretching NOT to be done.

 

[Pattipoo]

okay....maybe I'm the odd rabbit, but I never did lay on my stomach while they stretched my knee......or did I read it wrong?

BUT.....the PT takes "the stretch" much farther than we'll take it ourselves.

 

[TitaniumMan]

Is it necessary in physical therapy for the PT to stretch your knees until they are in horrible pain? Is this common practice? Can it cause other problems? Just courious to know other's experience with this.

Nopurse....I have said it many times here....NO PAIN-NO GAIN. Try the deep breathing and concentration someone suggested here. Bite on a towell or in my case just yell or sing out loud. It makes some other people in PT a little nervous and it made others laugh at me. I didnt care, I was there to get better! Yes, I personally beleive its necessary. But Im not a Dr or PT so dont hurt yourself on my suggestion.

Im thinking that NO PAIN-NO GAIN should be out motto here. Whaddya think Josephine?

Godspeed to all here. I love this forum

See ya all later tonight.
Godspeed,
Chuck

 

[Josephine]

I'm sayin' nuttn!

 

[beachcomber]

Darn it.... I got rid of the VooDoo doll someone gave me as a gag gift a few years ago. I am thinking I could have put in to good use for members of this discussion group!

I wished I had it last week when my PT, just as I was relaxing and enjoying the nice knee massage and gentle, progressive flexion he was doing with my knee--- suddenly bent it way far! I yelped, jumped about a foot, and grumpily acknowledge that yes, it was great that my flexion was now 120 degrees.....

About 12:30 AM that evening I was REALLY wishing I had that VooDoo Doll so he could share in the left knee pain keeping me awake.....

I know---- no pain, no gain--- but sharing is good too! LOL!

 

[kath]

Well I will keep you posted on my advancements. The hardest stretch for me is the one on the stomach. I did ask my PT for a piece of leather to bite on. But overall I wouldn't say that he puts me in unbearable pain. My arthritis was so bad for so many years that I feel already like I have come a long way. As long as my knee feels good, works good and looks good I am not asking for anything else. So far it works better than the old beat up one.

 

[Doug]

That's exactly how I feel Kath. The new knee even though it hurts, works well and I'm not getting the mystery super sharp pains that would make me utter sudden yelps while walking.

 

[kath]

Yeah, I know what you mean Doug, I had those all the time. Still do in my other knee, but not for long. Well here we are though at almost 1am. Not in a lot of pain though at the moment just enjoying a few minutes of peace and quiet (except for my husband snoring, now that I don't sleep as sound or fall asleep first wow it is worse than I realized., he is getting a cpap machine tomorrow though, so that may be great for us both) anyway kept my 8 year old granddaughter and 18 month old grandson over night for the past 2 nights. My grandson keeps you moving believe me. Don't think I could have done it without his sister here to help. Finally they are asleep, so I thought I would check in with my friends. Oh brother, spoke too soon, he is up again....

 

[kath]

false alarm, back to sleep. Well Doug, here's to a hot shower and some sleep.
If not, I will be thinking of all of us that are watching yet another night of crazy late night tv.

 

[gatiger]

Nopurse, what you are describing is what my therapist has done every visit I have gone for for the last 5 weeks. There are several positions, on your stomach with leg up behind you, on your back with knee up in front, etc; the point to all of that they tell me is to stretch/tear/ break loose the scar tissue that formed post surgery. This scar tissue won't allow the muscles in and around your knee joint to move normally and, the doc and the therapists tell me it MUST be broken up. The so called 'manipulation' is done when the scar tissue is so heavy and strong that breaking it frree would be far above a person's ability to withstand. It does not solve the problem because unless the stretching is continued it will re-form. I think of it as like a scab inside my knee, you know how if you have a scab form over a wound on the outside of joint, say your elbow and you bend your elbow it will break open the scab because the scab doesn't flex; this is how I understand what is going on inside my knee. My PT says everyone has 'a point' that they will reach where the "scab" is broken away and frrom that point things get much easier. The problem is everyone's has a different 'point' and everyone has a different amount of "scab" to break. The doc told me everyone builds this scar tissue at a different rate and amount, thus everyone's experience with the breaking loose will be different. The only way I can tolerate mine is trusting the therapist and trying to survive. I yell so loudly in pain that the Dr.s in the offices next door have complained that it scares their other patients. I guess I'm causing them to loose business. I hate it. I wish I could be more helpful, but so far I haven't found any amount of Vicodin that works; prayer helps me, but there have been times that I have broke down and cried, sobbing, in front of everyone there. I'm a 52 year old man that thought I was a fairly tough guy, but the pain of this process and knowing that it is going to be done over and over until ?, is almost un-bearable on an emotional level. Some days I cannot help crying before they even start, just knowing what is coming. I can tell you, that my ROM has improved, but it is a slow and extremely painful process. Hang it there anyway you can, forget about being tough, and just try to survive. Remember, it won't last forever and it has to be done.

 

[Doug]

Man I really feel for you . I wouldn't worry about the appearance of crying. I'm sure the experienced therapist have seen it all. And I will tell you that after 30 years of policing, I have seen the absolute toughest individuals you can imaging just break down and cry over some of the things that we saw. No one would dare call them a wimp. Instead you are drawn closer.
I have a tendency to scar heavily. So I'm working my knee every day. I vary the intensity. But I do something every day. I still maintain that the hot tub is my best ally in getting the maximum stretch. Give it a try.
I took my son and his friend to a movie today. I lifted the arms of the seats around me and did stretches during the movie. The movie took my mind off of the pain.
Best of luck and let us know how you are progressing.

 

[gatiger]

Thanks Doug. I have tried your idea of soaking in the bath tub with hot water and it does seem to help. I've mentioned it to my therapist a couple of times and he just says 'Do whatever it takes". Here's a little funny story about 'appearances'. I had finished therapy one day, all the bending and all' and the therapist had put the ice bag on my knee along with the little electrode deal whatever that is, as usual the last thing before I leave. He was talking to me as I sat there and noticed the bag was leaking as the ice melted. He got this towel and put it under my leg to catch the water. I asked him if he was afraid of electrocuting me or if he was just trying to keep his table clean. He said he didn't want the water to wet my shorts and people think I had peed on myself when I walked out. I told him that when I walked out of there, I couldn't care less what any of those people thought. Gotta find something to laugh at.

 

[beachcomber]

Hmmmm... I remember back in the "olden days" when I had my first 3 knee surgeries and PT (ok... it was 25 years ago) they always had me sit with my knee in the whirlpool for 20 minutes before starting my therapy-- then the bicycling and ROM/Strengthening stuff and then 20 minute icing....

If heat helps increase ROM I wonder why they don't do that anymore? I will have to ask at my next PT appt.....

 

[Skeet]

When I had my first knee surgeries back in the 80's they didn that whirlpool thing. I had forgotten that. I do wonder why they don't do that now.