TKR Last visit

[Jockette]

Lots of our members did their own PT at home, and some even did no PT, or exercises, just went about their ADLs (Activities of Daily Living) You don’t even have to discuss this with either your current PT, or your surgeon, you don’t need their permission. Take charge of your recovery and do it your way, it’s your knee, not theirs.
Saying no to therapy - am I allowed to?

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Flutter1]

@Reader525 please listen to the advice you read here. I had my TKR 8 weeks ago, only had at home gentle PT for the first 3 weeks. I am now hiking 2-3 miles and lifting weights, and doing most things I want to do with no discomfort most days. I told my surgeon that I liked to do things my way, and he was supportive. It is hard to stand up to the health professionals, but I alwsys tried to make a joke about myself, saying that I was their problem child and firmly saying no. When I had my 2-month check-up yesterday, no one even asked about PT!
Please give the BoneSmart recommendations for progressive activity a try. I followed them religiously. You can focus on healing and stretching and slow walking if you like. I did add the stationary bike at home at about 3 weeks. I started with 2 minutes and added a couple more minutes each week. Best of luck and please keep us posted.

 

[Reader525]

You have had such success! Did you do your own PT or have a therapist visit you at home? It sounds like what I need right now, to stop pushing so hard and heal. I am a driven person by nature, an ex marathon runner, who overdoes everything. I don't think I need them to push me because I push myself. Would it be appropriate to cancel appointments for now and do my own thing? Do you think I should go and tell this 25 year old therapist who has no idea what pain is that I'm taking a break? Or perhaps call her because if I go, she'll stick me on the bike immediately.

 

[Jockette]

Would it be appropriate to cancel appointments for now and do my own thing?

Yes, it’s fine to cancel your appointments. I cancelled many of mine and they never said a thing.

 

[Reader525]

Lots of our members did their own PT at home, and some even did no PT, or exercises, just went about their ADLs (Activities of Daily Living) You don’t even have to discuss this with either your current PT, or your surgeon, you don’t need their permission. Take charge of your recovery and do it your way, it’s your knee, not theirs.
Saying no to therapy - am I allowed to?

People are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

This is the most inspiring thing I have read yet. Thank you. I am leaning towards canceling Monday because if I go, she will put me through my package s and if I refuse, why am I even bothering to go? I think I'm afraid of being difficult and argumentative.

 

[Flutter1]

Did you do your own PT or have a therapist visit you at home? It sounds like what I need right now, to stop pushing so hard and heal.

Yes to both! I had at-home PT and did my own PT based on the sheet of exercises she gave me. I did not always do them for as many reps as she suggested. I was lucky that my insurance covered at-home PT without requiring approval. We worked on gentle heel slides (she never physically pushed my leg), lifting my leg to strengthen my quads, gently stretching and flattening the back of my knee (again, she never pushed my knee), rocking back forth heel to toe and a few other things like gentle rocking on the bike. I did tell here that I would work on the rotations on my own and was excited to tell her the next day when I went around twice! We worked A LOT on making my gait even and did some stair work. She helped me with daily activities as well. We walked outside until the cicadas made us crazy! She always made sure I was set up with ice and elevation before she left.
I am only saying this worked for me. If you can find a PT who is responsive to your needs, then you can try outpatient PT with a different therapist. Based on a bad past experience, I chose only 3 weeks of in-home. The PA at my surgeon's office wanted me to go to PT; I just nodded my head and never went. I felt that PT was not a live-or-die situation so I could make my own health decision in this case.

 

[beesknee]

I know this sounds extreme, but I wonder if a knowledgeable person could do her exercises at her own pace at home, involving stretching and leg raises and bends, and not go to a physical therapist. I had a meniscus repair last summer and was very diligent about doing my 25 minutes of PT every day. I know what to do. I just worry that my PT will dismiss my idea. Also the surgeon would probably be appalled.

You definitely can do you PT at home. My plan is to go to PT a few weeks, see what exercises they want me to do and then quit PT and do them at home. There are many people that have never done structured exercises at a health club so having a PT lead them along works best for them. I have worked out 2 or 3 times a week at health clubs since I 18. So I can easily do my exercises without a PT pushing me.

 

[Reader525]

I'm overwhelmed with the feeling I should back off for now, just do stretching and walking around the house. I'm on Day 10 now...do you think I should make an appointment for 3 weeks for om now to be assessed? I actually see the PA to get stitches removed July 28th, and I know he'll check me out as well. This might be the first time I will have ever said no to a medical professional. Maybe it's time?

 

[Reader525]

Please give the BoneSmart recommendations for progressive activity a try.

@Flutter1 is there a list of progressive activities? Or any other suggestions for home rehab?

 

[Lazy Susan]

I am 3 weeks out and at 115 degrees. I didn’t even know a regular knee could bend that much, OP!!!!! My PT is getting harder but it has never hurt or made me not want to go. If I were you I would go somewhere else, if you’re not scared off from PT totally, and I wouldn’t blame you if you were!!!!

 

[Celle]

Today is the first morning I have less nausea which I attribute to not taking any hydrocodone. I dread using it again but I'm sure I'll have to when I see the physical therapist on Monday.

Any PT you have to take pain medication to get through is bad PT and it's worse than doing no PT.

We advised you this in the Recovery Guidelines:

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.​

​

"No pain, no gain" is wrong for this recovery. "No pain, more gain" is best.
Myth busting: no pain, no gain

Don't fall for the PTs' claim that you have to achieve a certain level of Range of Motion (ROM) within a stated time frame - that's just a hoary old myth that should have died long ago. We know from experience that ROM can continue to improve for a year or even longer after a knee replacement.
Myth busting: the "window of opportunity" in TKR

I wonder if a knowledgeable person could do her exercises at her own pace at home, involving stretching and leg raises and bends, and not go to a physical therapist.

Of course. You could even just use your Activities of Daily Living (ADLs) as your therapy - they're all exercise, after all.

The only exercises you need to do are these:
Heel slides and how to do them properly
Extension: how to estimate it and ways to improve it
That and walking around your house and garden are all the exercise you need to do.

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 has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

I know what to do. I just worry that my PT will dismiss my idea. Also the surgeon would probably be appalled.

It really doesn't matter if your PT dismisses your ideas. It's your knee, not hers/his. You have an absolute right to say what happens to your knee.

In any case, your PT works for you, not the other way round. Whether you pay directly or through your insurance, you are paying your PT, so you are the boss. You don't have to please the PTs. They have to please you.

And your surgeon has probably heard it all before. You won't be the first patient who chooses not to follow the PT's schedule.

Don't mention PT to your surgeon unless he/she brings up the subject. If they do, just say you chose not to do painful therapy, because it had a bad effect and you feel it held you back. Your knee, your choice.

Not all surgeons think the same way.
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.

 

[Reader525]

@Celle Thank you SO MUCH for your extremely informative posting. You took each point and laid it out so clearly. I feel more confident now about doing my own recovery program.
I messaged the physical therapist to let her know I would be canceling my appointments and why. I also wrote the orthopedic surgeon and let him know what I had done and why.
I know PT can be a better experience than I had, I just got a bad one.
I saved the exercises you recommended, thank you!
In your experience, how long does it take to walk without a limp? I am acutely aware of the pain and soreness in my knee at this point on Day 10, and therefore can't walk without an extremely odd gait.
Thank you everyone, I'm thrilled I found you.

 

[Flutter1]

@Flutter1 is there a list of progressive activities? Or any other suggestions for home rehab?

Hi. I think they are No. 5 in the first response Jockette sent you. Click on the link under No. 5 or see if this will open for you.

Resting after Joint Replacement surgery

Even with so many advances in surgical methods that allow surgeons to replace traditional open surgery with less invasive approaches like robotic, laparoscopic, or arthroscopic surgery, any procedure is considered to be a major stress on the body and mind. Your body spends a lot of energy...

bonesmart.org

 

[Celle]

In your experience, how long does it take to walk without a limp? I am acutely aware of the pain and soreness in my knee at this point on Day 10, and therefore can't walk without an extremely odd gait.
Thank you everyone, I'm thrilled I found you.

Thank you for the appreciation. I'm glad to be of help.

It can take several months to walk without a limp. Usually, your knee needs to be able to straighten completely before you can do that. Also, your body has to re-learn to walk properly again, and not to be walking while you're trying to protect a sore joint, as you did before surgery.

We usually advise people to keep using a walking aid - either a walker or a stick - until they can walk without a limp. The walking aid is for security, to prevent you from falling, and some people use it for months. There aren't any prizes for giving it up early.

It's still very early days for your knee in this year-long recovery, so don't try to rush anything. Let your knee take as much time as it needs. It's been through a lot, so try to be patient with it.

Some people find they can increase their knee extension by taking bigger strides as they step forward, still using a heel-to-toe way of walking. That's illustrated in the article about extension that I gave you, but here it is again, for quick reference:

When you're a little further into recovery, you might like to consider joining the OneStep program - you'll see the link for it on the main BoneSmart Forum page. It looks like this:

OneStep gives you individualised exercises based on helping you recover a normal gait.

.

 

[stevesteve]

Maybe its time to say to your PT that you are taking a week off from it and will contact them when you are ready, In the nicest possible way. Yup its your knee

 

[Reader525]

@Celle You're an angel, thank you for everything. I will let you know how I progress.

 

[Atkinson8]

Hi Reader - At about 3 weeks, I was put on a stationery bike, no resistance, and just oscillated back and forth - and that's how it went for about 2 weeks. Then, one day, my knee went all the way around! You'll know when it's ready, and don't try it until you are. I had a hard time expressing my concerns to the PT (strange, since I usually have no problem voicing my opinions!). I told him I was frustrated and a bit down (this was about 2 weeks ago). He listened, and we've been working well since. I'm listening more to the PT than my surgeon at this point, but my surgery was in early June.

 

[Reader525]

I messaged my PT and told her I'm canceling appointments and will be n touch. I'm not really comfortable with her. The surgeon had said she would change my initial dressing at our first visit, but she wouldn't do it, nor would she even look at the site. After my previous knee surgery last year, the PT I went to looked at my incisions every appointment for the first 4 weeks. I should have returned to him.

 

[Reader525]

One of the most painful things I had prior to my TLKR on July 7, was an inflammation of the bursa on the medial side of my left knee. I was assured surgery would address it. I realize it's only Day 11 for me, but in doing the gentle stretching suggested here on BoneSmart, I felt that exact pain very sharply. Am I the only one who has this? It really frightens me because it's almost a "10" on the pain scale and I don't want to exacerbate it.

 

[Roy Gardiner]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, you have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.