I am thinking that maybe the Bonesmart approach would be better for me. As my swelling returns immediately after exercising or PT and knee gets stiff. After icing, still stiff and I have to walk a few laps around house to get the stiffness out of it. MY PT has me doing 2 of the exercises shown on this article:
the BoneSmart view on exercise
He does #2 on me at PT visits, he will bend and twist knee which hurts, I am always anxious for him to be done with it. However, he will measure my ROM before doing them and after doing them and I gain ROM afterwards. I also gain swelling and stiffness so the gained ROM is short lived.
The second exercise in that article is when your PT pushes on your knee and tries to make it bend further. That's a non-no. It will irritate and inflame your knee which, as you have found out, leads to increased swelling and pain later.
Don't allow your PT to force or manipulate your knee at all. It's bad for it. In fact, tell him "Hands off!" There's no need for a PT to touch your knee at all, except for giving it a gentle massage.
He has me currently doing one of the exercises under #8 three reps of 10 three times a day. A friend comes over and bends my knee into this position while I am lying on the floor. I do not allow it to the point of severe hurt. It only pulls and stretches with minor pain. When we starting do this exercise in week 5 post op, we were finally able to gain ROM and get to 90 degree passive ROM. I was stuck in the 80's prior to that. So it helps but I swell.
Stop this one, too, and don't have anyone of anything helping to increase your bend.
In fact, stop all the exercises listed in that article as bad for your knee.
I am scared to death if I stop the exercises, my knee will freeze up and I will never be able to return to normal. The surgeon is very adamant and thinks I am not doing enough. Heck he wants me to sit in a chair for an hour at at time several times a day and push my knee to bend.
No, your knee won't freeze up. It will thank you. Think about it - if you had a broken leg, would you be doing all those exercises on it so soon after the break? No.
Well your knee has suffered just as much trauma as if it had been broken - maybe even more. It's been cut, had tissues spread apart, had the ends of two large bones sawed and shaped, then had large metal objects cemented and hammered into them, before everything was put back together again.
Your surgeon was taught the wrong approach to knee recovery. He won't change, but you need to change what you are doing, so you can help your poor knee. It's overworked, upset and irritated, when all the poor thing wants to do is rest and heal itself.
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 ROM is there right from the start, just waiting for all that to happen, so it can show itself.
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!
This is your knee and you are in charge of it - not your PT and not your surgeon. You are the only one with the right to say what will happen to it and how it will be treated. You know your own body best, so listen to it and do what feels right for your knee.
Saying no to therapy - am I allowed to?
"They just keep telling me that once the scar tissue builds up I will not be able to gain ROM." Why in the world does the surgeon scare me with that statement?
They are misinformed, wrong, and preaching an old myth that should have died long ago.
First, the sort of scar tissue they are talking about is called adhesions. They aren't just sitting there, waiting to pounce if you don't exercise enough. In fact, they are quite rare. But, you know what? Over-exercising and making your soft tissues hot and inflamed actually increases the chances of developing them.
Second, there is no deadline, no "window of opportunity" within which time you have to gain ROM, or all is lost.
Rom can continue to increase for a year, or even longer after a knee replacement. I even know of someone who discovered that her ROM had increased 3 years after her TKR.
Myth busting: the "window of opportunity" in TKR
So, I recommend that you stop
all formal exercises for at lest a month and let your knee settle down. Your normal activities of daily living and just a little walking are enough exercise for now. Instead of doing exercises, spend that time resting, icing and elevating your knee, to try and reduce its swelling. As the swelling goes down, your ROM should gradually increase.
I'm going to ask Josephine, our Nurse Director, to advise you in more detail about the exercise you've listed.
United States
@IOWAGIRL58 : I don't quite have it figured out as I think with getting back to work more full time I need to carve out more rest & elevate time - and do even fewer exercises.. I hope to spend a lot more time recovering over the long holiday weekend. I love going to PT because it is social, my PT does not measure, he listens to me, and we do fun things that don't aggravate the knee (like balance and mobility exercises). It may be hard to cut back but your knee will thank you - at least that's what I'm counting on
