TKR Larry’s LTKR Recovery

[MSgirl]

@Larryhg3, you and I aren't the only ones on Bonesmart who have found out that outpatient PT works for us. The problem is that there are a lot of bad ones out there. After #1, the first place I went to was horrible. They really hurt me but I thought that was how it was supposed to be - never had any PT before. When I went for my post-op, my dr. asked what I was doing and told me to stop some of their exercises.

Finally, I got smart and found another outpatient facility. They knew what they were doing with knees, gently got me going, helped me strengthen my quad and I had to really press them to measure my ROM. What a difference they made for me. I went back to them for #2 and they did the same great job. It was fun being in their "gym" with other people and we laughed and carried on while we did our exercises. Finally, they dismissed me when I was 140/0.

Do what you think is right. You have your head on straight and know how far to let them go. Good luck!

 

[Larryhg3]

And why do they bother with Steri-strips? They put 10 on my incision site today I put on long pajama pants because it is cold in CT and 2 are about to fall off completely already. Looking forward to my shower tomorrow.

 

[Jockette]

Steri strips are most annoying! Josephine says they’re an American thing.

 

[HoneyB]

I agree with you on the hassles of having those steri strips. I ended up buying a large bandage and wearing it loosely over mine. I left the bandage adhesive on the top and bottom of the bandage, but cut the adhesive away from the sides so I got good airflow, but my clothes didn't rub against the steri strips. I'm happy to hear that you're doing well and that you've had good luck connecting with a good physical therapist.

 

[Rhodyrhody]

And why do they bother with Steri-strips? They put 10 on my incision site today I put on long pajama pants because it is cold in CT and 2 are about to fall off completely already. Looking forward to my shower tomorrow.

Great question, Larry. After putting the steri-strips on, my OS office said to do what I want, wear what I want, shower, etc., and they will all/each fall off exactly when they are supposed to. First one came off in a day or two, and it took about a week or so for them to all fall off. My 'guess' is that it's almost an optional precaution. I think if it were important for them to stay on, they'd be covering them with some other gauze/tape kinda thing to keep them in place. Since they didn't...neither did I. Was just glad when they were all gone, although, I usually didn't 'see' them fall off, it was more like someone would find them on the floor, in bed, in my clothes, etc....

 

[Larryhg3]

Had my intake appointment for PT today. I am back at the same practice with a different therapist for this go round. We began with my very simple ground rules:
1. I will work as hard as my knee allows without pain (not discomfort which is part of what you sign up for with TKR) or swelling.
2. I will not measure my success based on a ROM measurement
3. I will not allow anyone to push or pull my knee for any reason
4. If any of those are violated at any time I will be leaving for a new practice
Once those were established and agreed to I allowed them to do my assessment. My current flexion is 85 my current extension is -8. My strength is moderately impaired but I had TKR 2 weeks ago. Recovery from this is not a spectator sport, it will not get better without some effort on my part. Slow and steady will win this race.

 

[sistersinhim]

Perfect guidelines you have set!

it will not get better without some effort on my part.

Oh, yes it will. Just use your knee in your daily living activities. That's all it needs to get better!

 

[Larryhg3]

@sistersinhim we are going to have to agree to disagree on this point. I am a middle of the road kind of guy. I am fortunate that I have a wonderful OS and a great PT who understand my goals and support me in achieving those goals. My goals have NOTHING to do with a ROM measurement. I believe in physical therapy and believe that there are people (like me) who have an emotional/mental need to assist in their recovery through PT.
I also believe in all of the ideas that BoneSmart promotes. I believe that “aggressive PT” is counter productive and do not allow it in my program. I believe that ice, elevation and rest are key to getting better. I know that I can’t work harder to get better. My knee is in charge it guides my journey and let’s me know what works and doesn’t work. Finally I believe strongly in the wonderful support that BoneSmart provides. There is nothing more therapeutic than coming here and sharing where I am in my journey (both good and bad) and having a group of wonderful friends that I have never met reinforce that everything will be okay. You,Susieshoes, Jockette, Josephine, Celle, HoneyB, Kneeper and so many more have guided me gently through my journey with Lefty and now with Righty. Words can not express the value you have all added to my recovery.
For those like me who believe in PT remember to follow the guidelines. You can try anything you want but if that evening or the next day or two your knee gets cranky stop and let the knee rest. Give it a couple weeks and try again. Add things in slowly and with low intensity. Pay attention to your knee it will guide you. Remember that ROM number while important should not dictate how you feel about your recovery. Under no circumstances should your PT or Doctor push on your knee. Not ever. As professionals they need to assess if there are issues with the replaced joint but they can accomplish that gently. Remember to celebrate your successes no matter how small and take setbacks in stride. This journey takes a up to a year, that doesn’t change no matter what side of the PT conversation you support.
I know this one is long and rambling sorry about that. I believe that my journey would have been so much more difficult without all of you. I may not agree with everyone but I do appreciate and respect the input you have all given me and wanted to say thank you again.

 

[HoneyB]

Very well said, @Larryhg3. I often mention my physical therapist pushing my knee. I should add that it is always a gentle push while he watches my face for signs of pain, and the push is done with, what I think, is a good purpose. Another thing is that he has rarely measured my ROM unless I (and I’m stressing the “I”) brought it up. The measuring followed by pushing has generally followed this scenario. I would question why I couldn’t bend my leg more. He would measure my ROM. He would then massage the part of my leg that was causing my bending problem, gently push my leg, and show me that it wasn’t my knee holding me back but a tight “something” holding me back, and tell me that when that “something” loosened up I’d be able to do that bend on my own. He would then tell me which stretch or exercise loosens that “something.” Other times he would use a firm press to support a weak “something” to show me that when that “something” was adequately strengthened, I’d be able to do that bend on my own, and he’d tell me which exercise strengthens that “something.”

I’ve also mentioned many times that I’ve used several weight machines in PT. Most of those went well on the first try. When I had real pain (not discomfort, but pain) on the first try, or when weights were increased and caused pain, I’d be told I wasn’t ready for that yet and we’d try it again in another week or two.

I think PT is great for some of us, psychologically, when it’s done well. It has helped me to watch people with all varieties of issues ranging from a toe problem to a neck problem steadily work toward a goal. I’ve also watched people show up with a knee replacement a month newer than mine and then “graduate” from PT while I’m still there. If I say anything about that to my therapist, I get the “everybody has different recovery issues and some take longer” talk.

By the way, yesterday I ignored the advice of my therapist and, even this far out, I'm paying for it today. Before my knee replacements, I walked 2.5 - 3 miles per day EVERY day. I've missed that. Now I'm usually walking a mile in the morning and a mile in the evening, but I want to do that walk all at once. My therapist told me to increase just ONE of those walks by 1/4 mile and stay at that distance for a week before adding 1/4 mile to the other walk. Yesterday I increased both walks by 1/2 mile. My hamstrings and quads aren't happy about that today. I should know by now that slow and steady wins.....

 

[Jockette]

@Larryhg3 Very well said! You have a good handle on your recovery/rehab.

Bonesmart is not against PT, it’s against bad PT, or excessive exercises that some of us can’t handle (which is bad PT)

You have a wonderful outlook and have good things to say to other members. We’re glad you’re here with us.

I agree with all you just said, but I also agree with @sistersinhim that just ADLs will rehab a knee replacement fine. For some of us and our activities, our ADLs require a bit of effort and mimic the exercises, but spaced out time wise and “rep wise, so you really are both on the same page, just different paragraphs.

Each member brings something special to this forum that makes it such a good place to come to. The support and camaraderie we have here can’t be beat. Thanks for what your experience adds to it.

 

[sistersinhim]

@sistersinhim we are going to have to agree to disagree on this point. I am a middle of the road kind of guy. I am fortunate that I have a wonderful OS and a great PT who understand my goals and support me in achieving those goals. My goals have NOTHING to do with a ROM measurement. I believe in physical therapy and believe that there are people (like me) who have an emotional/mental need to assist in their recovery through PT.

I totally agree with this and the rest of your post. Some people do need the structure of PT, some don't. For you it's a mental and emotional thing. I was speaking of a physical thing. Some people even do need that, too.

Some of us have so many yard and home responsibilities that we don't need to go to PT. I am single and couldn't drive anyway for 7 weeks and really didn't have the time or money to go to the half an hour away PT. By then, I already had a good ROM and didn't need them.

 

[Celle]

And why do they bother with Steri-strips?

An excess of caution, I think.

@sistersinhim we are going to have to agree to disagree on this point. I am a middle of the road kind of guy. I am fortunate that I have a wonderful OS and a great PT who understand my goals and support me in achieving those goals. My goals have NOTHING to do with a ROM measurement. I believe in physical therapy and believe that there are people (like me) who have an emotional/mental need to assist in their recovery through PT.

That's OK. There's no one right or wrong way for this recovery.

What is important is that you find the right sort of PT therapist - and it seems that you have.
Unfortunately, there are so many PTs out there who are fixated on achieving good ROM numbers, often at the expense of their patients' comfort and peace of mind.

 

[Rhodyrhody]

I sometimes wonder if ADL's are really 'enough'? Part of the reason I had the surgery was to be able to do stuff that I consider a bit above and beyond ADL's. I don't consider being able to walk 3-4 miles a day several days a week or to play 18 holes of golf to be part of ADL's. I don't consider walking around a mall or standing at a concert for a couple hours to be ADL's. For some of us, I think there's great benefit to PT that goes above and beyond ADL's and I don't know that saying no to PT is right for everyone. Seems that it may well depend on what one's end-game objectives are?

 

[Celle]

ADLs are plenty in the first few months. After that, as healing progresses, it's fine to increase your activity. The extent to which you increase your activity probably depends on how active a lifestyle you want to end up with.

Of course, some of us are pretty active, even just in our ADLs - and if walking or playing golf was in your pre-op activities, then I guess they're going to be part of your post-op ADLs as well.
I know that sistersinhim does a lot of cycling as part of her everyday life.

 

[Kiwigirl62]

@Celle @Rhodyrhody @Larryhg3
I totally agree with all your comments above re PT and daily activities.

After putting up with a slowly degenerative knee for 20yrs, the only thing that drove me to a surgeon was not being able to hike.

*Daily living was OK,
*still cycled 20km every to/from work, *managed inflammation with tumeric (no pain killers taken).

Down to Walking 6 blocks presurgey was . Figured its quality NOW as no one knows how long we got in this life, so i took the leap and the gamble.......just early days

 

[sistersinhim]

I know that sistersinhim does a lot of cycling as part of her everyday life.

I also enjoy hiking, especially in the mountains! Both of those activities were pretty much non-existent before my TKR. I was back in the mountains 4 months after it. Though, I didn't hike on rocky trials, mostly paved ones. But, I did it! The biking started before that! My ADL were the things I had to do to take care of my home, yard, cats and myself.

 

[kmak81230]

I also benefitted from PT -- not the bad, aggressive kind, but the PT that focused on my functional mobility and not ROM - things like balance, proper gait, and strengthening the surrounding muscle groups. I am looking forward to PT after #2 in a couple of weeks.

 

[Smurph]

Larryhg3 I have made note of your wise and very simple ground rules and plan on sharing them tomorrow with my initial PT visit:
1. I will work as hard as my knee allows without pain (not discomfort which is part of what you sign up for with TKR) or swelling.
2. I will not measure my success based on a ROM measurement
3. I will not allow anyone to push or pull my knee for any reason
4. If any of those are violated at any time I will be leaving for a new practice
Once agreed to I will allow them to do my assessment.

You said it so well: "I believe that ice, elevation and rest are key to getting better. I know that I can’t work harder to get better. My knee is in charge it guides my journey and let’s me know what works and doesn’t work. Finally I believe strongly in the wonderful support that BoneSmart provides. There is nothing more therapeutic than coming here and sharing where I am in my journey (both good and bad) and having a group of wonderful friends that I have never met reinforce that everything will be okay. "

I will push to discomfort but if it causes increased pain within the hour of completion or increases the swelling I will not repeat it.

 

[traceys]

@Larryhg3
You and I have approached pt almost identically. My pt has my guidelines actually written out in my file.
I need the push to achieve. I need the trigger to make me mad and drive me out of complacency.
But I also need to have days where it’s ok to not push myself and relax and recover. Grateful found another with the same mindset.

 

[Ceegee]

I'm another Forum member for whom PT was beneficial, and like others, I was lucky enough to have a therapist who didn't force things. My specific goals were to compete with my dog in agility, which involves running for short bursts, and to be able to hike in the mountains again. Since both these activities require strength, the PT focused on achieving that. Now, at 8 months post-TKR, I can do both, although hiking is still limited to hilly as opposed to steep mountainous terrain. And I'm virtually pain-free for most activities. My ROM isn't as good as some - last measurement was 0 to 120 - but my surgeon is thrilled because I've achieved the goal of running.

I also think I would have healed and recovered perfectly well with just ADL - we have a huge yard that requires a lot of work, and I walk a lot. But I'm not sure I would have been able to run again without the PT, or at least, not so soon. The therapy helped physically, by strengthening and developing the muscles, and mentally, by giving me the confidence to try. I still remember the panicky feeling I had when the PT first asked me to try and jog a few steps in the treatment room. I told her I didn't think I could; she told me I was ready. So I did it, and to my surprise it was easy. I'm now running faster and with more confidence than at any time in the last 10 years. It's a good feeling.

Anyway. We all have our own individual journey and needs. And I agree with others on the tremendous job BoneSmart does in supporting people through that journey.