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[TKR] Is my PT rushing my recovery?

lablover64

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I had left TKR on October 7, 2019. I attend PT at a facility owned by my surgeon's practice. I went twice before surgery and have been twice since. I cancelled my last appointment because I couldn't make myself go. Two therapists bent my knee forcibly and I screamed and nearly passed out. They said I am behind where I should be in my recovery and that if I didn't work it harder, I would have scar tissue and never be able to bend it properly. I am doing my home exercises, icing and medicating per post op instructions. I haven't had full ROM of this knee in over 20 years - I don't know what makes them think that I would have it barely 2 weeks post op. I reported this to my surgeon's PA and nurse. The nurse was going to call PT and tell them to ease up a bit. I am supposed to go again tomorrow. I feel sick at the thought. I don't want them touching me again. I want to do my exercises and heal at my own rate until I can go to aqua therapy. Has anyone else had this kind of pressure from PT and how did you handle it?
 

Pumpkln

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@lablover64
Welcome to BoneSmart, glad you joined us!
In answer to your first question, the answer is Yes! Not only are they trying to rush your recovery, most likely they are setting your recovery back.
Suggest you cancel your appointment with these out of date PT's. Take a week or so off and let your knee settle down.
If you want to continue PT find an office with a gentler approach to recovery.
PT should be helping with getting your swelling down, showing you how to gently increase your ROM on your own, work on your gait, sit to stand, teaching you how to pace yourself so you can do what you need to do with out aggravating your knee and causing swelling and pain.

Here are a couple of gentle activities you can do on your own.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
 

Jockette

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Hi and Welcome to Bonesmart!

I am so sorry that you were hurt so badly by a medical professional that you trusted. Unfortunately, too many of us have had the same experience, including me.

There is no need to force the knee to bend like that. It just further upsets the surgically traumatized knee.
I am supposed to go again tomorrow. I feel sick at the thought. I don't want them touching me again.
I totally understand these feelings :console2:

I agree with Pumpkln, take some time off from PT so your mind and body can settle down. This recovery is hard enough without being tense about what might happen at PT.

Look for another facility with a gentle approach. Talk to them over the phone and ask about their philosophy before you make an appointment.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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lablover64

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Thank you both. I never thought about telling the PT that I would not allow them to bend my knee like that but you can bet they'll hear it tomorrow. I feel that everyone heals differently and they are trying to make me adhere to some schedule they arbitrarily came up with. I'm going to tell them tomorrow that I AM IN CHARGE and I will do gentle exercises but will not allow anyone's hands on me. If they discharge me, I'll find another therapist. I felt so violated at the last visit. All the patients are in one big room and they forcibly bent my knee to the point where I screamed so loud that my son heard me in the parking lot! It was painful, embarrassing and demeaning. I cried the whole time they were icing it and all the way home. Thank you for showing me the guidelines and encouraging me to take my treatment into my own hands.
 

Roy Gardiner

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Jockette states the BoneSmart position 100% correctly. My tuppence worth is:
Two therapists bent my knee forcibly and I screamed and nearly passed out.
Never go back. That's dreadful incompetence.
They said I am behind where I should be in my recovery and that if I didn't work it harder, I would have scar tissue and never be able to bend it properly
Wrong. Just about the opposite of the truth.
I haven't had full ROM of this knee in over 20 years - I don't know what makes them think that I would have it barely 2 weeks post op
That's because you have some brains and they don't.
I want to do my exercises and heal at my own rate
:thumb:

Gentle pain-free stretching will help you, and as you correctly say it will take time.
 

Celle

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Thank you both. I never thought about telling the PT that I would not allow them to bend my knee like that but you can bet they'll hear it tomorrow.
Jockette and Roy Gardiner are right.
It's your knee and you are the only one with the right to say what happens to it. There's no need for a PT therapist to bend your knee at all, so don't allow it.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

If your therapists won't listen to you, remove yourself and your knee from their harmful "care". Find a place where they will listen to you and pay attention to your knee's individual progress. There's absolutely no need to adhere to some theoretical, one-size-fits-all schedule.

Don't listen to any threats about "scar tissue" forming if you don't work your knee hard enough. That's a harmful myth. Your knee isn't lazy or unfit - it's wounded and it needs rest and gentle exercise, not boot camp.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet. There's no need to feel you are "behind" in your knee's progress.
Myth busting: the "window of opportunity" in TKR

In any case, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start and its ROM will gradually increase as your knee heals and the internal and external swelling decrease.
 

Jockette

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There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement.
I am 2.5 years post op and I still occasionally see a further improvement in ROM.

My knee was not pushed to a point that I screamed, but what I did was grab the sides of the table I was laying on and held on tight while I thought my knee would explode. This was exactly 1 week post op.

I went home and took a nap. An hour later when I woke up I had an excruciating pain in my left shoulder. I could hardly move my arm. The pain was a 10 and the Dilaudid I was taking didn’t touch it! A couple of days later my surgeon’s PA did a shoulder X-ray because the pain was still so bad. She called it acute tendinitis. I’m sure this happened while I was holding that table so tightly. It was probably the final straw after a week of having to use my arms more than usual because I had little leg strength, and also due to leaning on a walker and grasping that.

Other incidents in my PT experience have led me to the conclusion that next time around I will do my own rehab at home. There was nothing that my PTs did in their office that I couldn’t do at home on my own.
 

sistersinhim

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There have been many of us who never took formal PT or did exercises. I am one of those many, even after 11 knee surgeries, including both kneecap removals and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed more I was able to do more. Icing and elevation was a huge part of my recovery. My knee and body was always in control.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.
 

Tykey

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I've just been discharged 6 weeks after my TKR, with excellent ROM figures, no residual pain, just a bit of stiffness. Not once has a physiotherapist actually touched me. They just look at my progress, and give advice. I mentioned the aggressive approach taken by some ignorant pt's, particularly in the US, and they were astonished.
That's pretty good proof that the gentle approach works.ie the Bonesmart way!
 

Tykey

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I forgot to mention that she also said, that my progress will continue for another 6 months if you just take it as it comes!, ie no forcing it!!!
 

sistersinhim

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No one, not even me, ever forced my knees after my surgeries. I am doing just fine now. I can hike and ride my bike, and take care of all my yard and house work. These were things I couldn't do before my TKR. I'm doing them now without having forced my knee to do anything that it wasn't ready to do.

A joint replacement is different than any other surgeries and it's rehab needs to be different. Your knee isn't out of shape, it is extremely injured from an invasive surgery. Look at what's inside your infant knee that has to heal. Even when your incision is healed, all this inside of your knee still has to. That's why we say it takes at least a year to become fully healed.
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691
 

Rockgirl4

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I am so sorry you have experienced this, and I completely understand.:cry: I had the same experience in 2016 after another knee surgery, and it was common practice once a week to "make Lisa cry." It was the PT clinic joke for months, as the recovery from that type of surgery was long, requiring me to rebuild my hip/glute/quadriceps muscles. In between strengthening exercises for the leg, the other goal was to force the knee to bend further. I simply didn't know better back then though, and after 5 months on crutches, unable to drive, I listened to whatever nonsense they told me.:headbang: I would swell horribly for 2 days after that, and I needed valium to get through the forced bending sessions....All this did was delay the recovery, create loads of scar tissue due to chronic inflammation, and gave me "PT PTSD." .

I don't use that phrase lightly either. When I knew the knee HAD to replaced, I found a surgeon with the Bonesmart philosophy (while not even trying!!), and he said NEVER, EVER let anyone force my knee to bend or straighten. I found a PT person I knew and trusted (from an ankle injury the winter before), and asked her how she did things following a TKR. She was great overall, but this involved very open communication involving what I would/wouldn't tolerate. She also said she would do whatever my surgeon wanted and not let her own ego get in the way (meaning she wouldn't blow off his suggestions!!). She cried with me when I described what I had gone through before, and she said NO ONE in PT should ever subject a person to that!!!!

My surgeon DID have her go slower/gentler than she would have liked, but in the end, it worked. She agrees I was an interesting case that taught her a lot, and "gentler is better." I still only have 105-110 degrees of flexion (bending) depending on the day/week/activity level, but at least I didn't end up with another chronic inflammation problem. I also only had 120 before the TKR, and it's well-known that range of motion pre-surgery is a big factor in your post-op range of motion. It's not a guarantee but does play a role.

Another interesting thing to note---- during my TKR (May 2019), my surgeon had to cut out a huge amount of adhesions from that 2016 rehab experience. The knee was FULL of adhesions. :gaah:The ONLY way that could have happened was from PT-induced chronic inflammation in 2016. I had documented EVERYTHING and had the data to prove it.....1) I had had a scar-tissue removal surgery 3 months after the 2016 surgery--followed by more months of intense PT, 2) I had had an MUA 9 days later, after the scar-tissue removal surgery, because I lost 20 degrees of ROM overnight. So the smart-aleck in me asked my surgeon how was it possible to have a knee full of adhesions after they had been cut out???? He gave me the answer I had felt in my gut for 3 yrs-----the forceful bending and overaggressive PT created chronic inflammation, which has been scientifically proven to CAUSE adhesions. A lack of movement didn't cause them----too much bending and overuse caused them!!! :hissy:

If only I had known ALLLLLLL the range of motion issues were NOT my fault or just dumb luck----it was from too much PT, the wrong kind of PT, and not letting the knee heal before abusing it terribly. I swore no one would ever abuse me in such a way again, and I try to preach it like crazy to anyone walking this same path. I wish you the best in your journey, and I hope you will advocate for yourself, even if your surgeon or PT makes it difficult. Sometimes the only real advocate we have is ourself.

--Lisa
 

Rockgirl4

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I forgot to mention something.....you asked how some of us handled the PTs that hurt us. I did try to go back to the same PT when I had a Microfracture surgery done to the "good" left knee in May 2018. It all happened so fast, and I knew this would be a uch easer recovery, so I didn't really have time to find a new place in just a week's time. However, I explicitly told my main PT guy that he wasn't to force the knee like he did in 2016. I reminded him it causes rebound swelling and just sets me back.

Fast-forward 3 wks. All had been going great...then one day he handed me off to his PTA (assistant) because he was leaving early. That day she forced my knee to the point I screamed. I yelled at her to NEVER to do that again. I reported it to him at the next visit, especially since I had the swelling and decreased ROM to prove it. He apologized and admitted he'd given her instructions to force it "a little more, just to see....". My jaw dropped!!!!:yikes: I finished the visit, told him she was never allowed to stretch my knee again, he would either respect my limits or I'd find someone new....and as soon as I could walk without crutches in another week or so, I never went back---EVER!!!!!! That was knee surgery #10, so I figured I was smart enough to do the rest on my own.

I have since told everyone I know you can't trust that place, what he or his people say, and that they broke my trust. They hurt me on purpose after I had given clear instructions on what I wouldn't tolerate. I haven't gone out of my way to badmouth them, but I HAVE given my opinion when asked where to go for PT and why.
 

mainegirl1

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We are not a hunk of meat.
My OS prescribed gentle pt the first two weeks and gave me some things to do at the six week appointment by myself at home.He made PT after that optional
I did however go to PT for a month twice a week and it became clear that I wasnt getting anything new I couldnt do at home
I did like the Game Ready icing unit
She did not force me but it eventually seemed to me to be a money grab
She wanted me to come three times a week at a cost to me of $600 a month
I said no and left and did not return
If you feel PT has helpful aspects do it but you are in charge and it is fine to JUST SAY NO!
 

lovetocookandsew

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There are some things about PT that I do not like at all. I've noticed that any rehab program is vastly different from therapist to therapist-there doesn't seem to be anything close to a standard of care or procedure for any type of rehab, IME. I totally disagree with any kind of extreme therapy after a TKR when your knee needs time to recover from the assault it's just gone through; any PT that includes pushing, pulling, forcing, threatening, manipulating the patient to guilt or shame because they're not meeting some arbitrary guideline, and so on is, in my book, inexcusable and needs to be called out. But, if you choose to attend PT and find a therapist who believes in a kinder and gentler recovery process, while not allowing you to be a couch potato, then I think that PT can be helpful for some patients.

The problem is balancing the need to allow your knee to recover with the need to be up and moving around more and more as time goes on. I had a conversation with my OS about PT one time, asking him if he knew why I was choosing to not go to PT at all after my revision. He replied, "Because they make things worse". I then asked him, if he knew that, why he still prescribed it for his TKR patients. He told me it's because he has a hard time knowing which patients will be up and moving around enough after the surgery vs the patients who'll do nothing at all if they don't go to PT. I then asked him why he doesn't change how PT is done for post TKR patients so that all patients get the kind of PT that helps but doesn't harm? He said he'd like that, but apparently he has no control over that department, so my thought is the best way to handle PT is through patient education, which needs to start with the surgeon and his staff, to what we do here at BoneSmart, and maybe over time things will change.

Here at BoneSmart, we advocate for gentle PT for those who choose to attend PT and for patients to be up and moving around after their surgeries. We want them moving, walking and doing light stretches and bending after the surgery. As time passes we like to see them doing more and more, until they've fully taken their lives back and once again get to enjoy their lives without the bone-on-bone pain and limitations of a bad knee.

But PT such as you've described is never okay in any of our experience and knowledge. It not only puts the patient through agony, it harms and does not help. My advice to you is, if you wish to continue going to PT, to find a new therapist and facility, one that will first, listen to you and your guidelines for YOUR body, who will never try to force your knee to do anything, but will allow you to bend and straighten your knee on your own without major pain. A little discomfort is okay, but actual pain that causes tears or screams is NEVER okay.

If you can't find a therapist who'll follow your plan then I suggest rethinking the whole concept and maybe think about doing it on your own following the guidelines here. Always remember, it's YOUR BODY and only you can decide how you want your recovery to proceed. You can, and should IMHO, listen to advice from those who are in a position to advise you, then in the end only you decide how to proceed. We here at BoneSmart will support your right to decide and will support you no matter what you decide. We only want the best for patients, and want them to be informed fully before making decisions, as opposed to following random guidelines without understanding their options.
 

Tykey

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A lot of good stuff in there @lovetocookandsew.

Over the last several years, our NHS has adopted a policy of expecting the patients to play their part, both in staying healthy and recovery after treatment.
If people didn't want to do any exercise, stay obese etc etc they don't see it as their role to do it for them. If we do our part in good faith they help.
They are putting the money they save into health education, monitoring for early warnings (eg diabetes or cancer) to reduce the need for intervention further down the line.
Essentially they aren't now a nanny state.

I'm pretty certain that's why all we get from our PTs is guidance, and they leave it at that.

If we don't do our part, it doesn't get done.
 
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lablover64

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I went to PT and told both therapists that I would do any exercise until it caused pain and would then stop. I also told them I would not permit anyone to forcibly bend my knee. They stammered something about not getting the full range of motion, that there is a small window of recovery and did I realize I might not ever walk without a limp. I said I didn't care. I would recover the knee at my own rate and if I was left with a limp, that would be on me, not them. An older woman they were treating who had had the surgery 10 days before mine leaned over and said "Good for you, dear. That's what you have to do. I told them the same thing."

When they came over with their little measuring devices to see if I had progressed since last week, I shooed them off. They asked whether I didn't want to know if I was getting better. I replied that I didn't need their rulers to tell me anything. If I feel I am bending and ambulating with less pain and stiffness, I will know I'm progressing.

By the time I left, I WAS feeling better. I wasn't in pain, my knee felt stronger and I was walking pretty well with the cane. In addition, I felt like I had made my point. I no longer feel like a victim. I think the term "PT PTSD" is right on the money. I had it last week, but never again.
 

Celle

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Well done for being assertive at PT.

Here's a thing that may interest you.
My surgeon doesn't allow any formal 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. The walking is our exercise and we increase it a little each week.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home each day.

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.

He never measures ROM, but assesses it by looking at what you can do. He says "Show me what your knee can do" and asks us to bend the knee as far as we can, then do a straight leg raise. He'll say something like "That's coming along well." He's more interested in what you can do (function) than in the numbers.
 

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