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TKR Ltkr on 15th January 2020

Roobear

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Hi, I’m a 64 yr old lady, fit and active (usually) horse rider etc. I had my first tkr a week and a day ago. In the uk the emphasis is very much that you can’t do too much physio and that you must push yourself for full ROM, despite horrendous muscle pain I have been doing this as the other thing is they scare you by saying if you don’t exercise you will never regain full ROM and that scar tissue will grow etc. As I am anxious to be able to ride my horse again I have been forcing my knee to bend. So I am interested to read that you have a different approach on here, is it backed by any physicians or just personal experience. I want to do less but I’m frightened of my knee being fixed in a not very good position, I’m early days and want the best result from this op. I have to say the pain has been far worse than I thought
 

Helizabug

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Someone wiser than I will stop by soon with lots of good information and support, but I’m here to tell you that you came to the right place. BoneSmart will be very helpful in understanding what can be understood about what’s going on in your new knee.

One thing I know you’ll hear, no matter how many days or weeks out you are, is to rest, ice, and elevate, so, if you’re not already resting comfortably with your knee a little higher than your heart, and some ice nestled like a beloved pet around your knee . . . What are you waiting for?!

The pain is worse than a lot of us expected, but it gets better, with time and with gentle activity. Forcing your knee to bend will certainly make the pain worse and is just battering those soft tissues that are trying to heal. Push to a little resistance, maybe, but when you hit pain, back off a bit.

I hope you find more and more relief.
 

Jockette

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Someone wiser than I will stop by soon with lots of good information and support
And here I am! (I’m sorry, I’ve been dying to say that every time I see you post this!:heehee: )

@Roobear Welcome to Bonesmart!

We do, indeed, recommend a much gentler recovery approach that works very well, without the pain and setbacks that beiing aggressive can do to us.


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.

Especially read number 4, about PT, and the cautionary articles. Yes, there are surgeons who agree with Bonesmart’s approach.

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.
 

sistersinhim

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I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 11 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovers just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

Your knee will heal the same way as mine has all those times. Just use it and don't worry about ROM. It will come when your swelling goes down. Be sure and read the articles that Jockette left for you. They are a gem of information to recover from your replacement without so much awful pain.
 

Celle

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In the uk the emphasis is very much that you can’t do too much physio and that you must push yourself for full ROM, despite horrendous muscle pain
That is not the attitude all over the UK but, unfortunately, it's the attitude the team looking after you have.

I'm here to tell you that it's your knee and you are the only person who has the right to say what happens to it. Not your surgeon, not your physiotherapist, not your friends and family - just you.
While other people may advise, you also have the right to choose whether or not to accept their advice.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

The pain you get during and after PT is a warning sign. It's your knee, telling you that you are making it do more than it is ready to do. Listen to your knee. It knows what it's doing. It's not lazy or unfit - it's wounded and it needs rest and only gentle exercise, so it can start to heal from major surgery.

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:
Myth busting: the "window of opportunity" in TKR

Saying that you have to work hard, or else your nee will seize up for ever, is a complete myth that should have died long ago.

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 naturally increase gradually, without any painful therapy.

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.

I have had three knee replacements and I followed my surgeon's regime each time. I can do anything I want to with my knees - in fact, they're in better condition than I am - and I'm usually not aware that I have artificial knees.

Stop doing painful PT. All your knee needs is to be kept moving gently. Scar tissue won't form - it's not just sitting there, waiting to pounce.
Instead of doing lots of painful exercise, spend more time resting, icing and elevating your knee, to help reduce the swelling that is preventing it from bending.
 
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Roobear

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Thank you, that advice makes sense, so far each day has bought different areas of pain and a very tight band feeling around my actual knee. The physio in the hospital was so harsh she made me cry, I am due to see her again next Wednesday and I’m determined not to be bullied the rest ice and elevate sound a much better option to me.
 

Jockette

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The physio in the hospital was so harsh she made me cry,
I am so sorry you had this experience. There is no need to be treated like that. Next time you see her picture all of us with you, supporting your decision to recover gently. :console2:
 

sistersinhim

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The physio in the hospital was so harsh she made me cry, I am due to see her again next Wednesday and I’m determined not to be bullied
Please don't let PT hurt you. That's is doing more harm than good. You should not let them touch you at all and should not talk you into doing something that hurts.
 
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Agreed! Hugs to you :console2:. You're just a week out from surgery. It's one thing to push beyond ones comfort in the PT/ Physio process. But the process needs to be paced and incremental, step by step IMO. For example, I'm having some extension resistance (flexion has been great about day five onward) and my PT has been assisting by using differing techniques, increasing over time, in tandem with showing me things to do on my own.

Some of it has been painful, yes indeed, but not excruciating at an extensive, prolonged level. Week 6, my extension is improving. You are still early yet.
 

Lindylee

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I'm in the UK too and have had a very different experience with physios to you. I had my LTKR a year ago and my TRKR 5 days ago. There is just one older woman in the hospital physio team that tries to push things a bit more, but all the others are gentle and encouraging, showing you how to adapt exercises and stretches until you can do them without pain. I was advised that some discomfort was ok, but not pain.

I'm sorry your experience hasn't been as good. Don't be bullied. I found it difficult to do heel slides last time. It helped me more to try a couple frequently rather than trying to do 10 in one go. This time around I can do them easily!
 

kneeidea63

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I’m in the UK too. My LTKR was in December, 5 years after my RTKR. I didn’t start formal physio until 4 weeks after surgery, one week sounds brutal.
The attitude of physios here seems to have changed to a more relaxed approach to recovery in those 5 years. Research, understanding and patient rights have changed.
I pushed hard to get my ROM with the right knee and consequently had a lot of swelling and pain and very slow progress, it took months to get the swelling down.
This time I’ve focussed on resting and reducing the swelling, and taking it slowly. I find heel slides difficult and too much or too many cause pain in the ligaments at the back of my knee. Bonesmart has taught me not to do anything that actively increases pain and swelling, so I do little and often rather than intensive exercising.
The physios are a little concerned that after 6 weeks I’m only at 85, but they aren’t pushing me. Compared to last time I’m experiencing much less pain, the swelling is gone, my walking is good. The consensus is “that’s the way your knee is, and like last time it’ll probably take longer to get a decent ROM”.
(With both knees I had a 0 extension in 5 weeks)

Please don’t let a physio push you and set your recovery back.
 
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Wow! They started me out on home Physical Therapy within days of my TKR. It was pretty mild PT, as I wasn't moving much (still learning walker) but I did stairs etc. with cane fast! Some walking in my driveway about day nine w/ cane.

But I was ready for it and the home PT person did not FORCE anything. I was pretty ambitious and able. On-site PT started right after that onward... for a few weeks with flexion and extension measured for progress. But no forced actions.

I find it nutso that some PTs and docs push for hard PT. Everyone is different and that needs to be respected. And for sure the rush can cause problems!
My LTKR was in December, 5 years after my RTKR. I didn’t start formal physio until 4 weeks after surgery, one week sounds brutal.
 
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kneeidea63

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Wow! They started me out on home Physical Therapy within days of my TKR. It was pretty mild PT, as I wasn't moving much (still learning walker) but I did stairs etc. with cane fast! Some walking in my driveway about day nine w/ cane.
In the UK the physios attached to the hospital get you out of bed, show you how to walk with your sticks, do stairs, and basic home exercises, before you are discharged from hospital. It’s then down to you to follow the programme of home exercises you’re given. One to one physio at home isn’t an option on the National Health Service. After 4 weeks you go to a group physio clinic back at the hospital so they can check on your progress, add in some more exercises for you to do at home and identify those who might need a bit more help.
It really is down to you to manage your own recovery. The good side of that is you can be in control; the bad side is if you don’t know what good progress is then you can do what I did with my first knee and try to force a ROM on a swollen, resistant knee because the physios say it should be further on than it is!
 

Helizabug

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How’d the PT go, @Roobear? I hope you got some more gentle help. And I hope the pains are improving.
 
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Roobear

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Thankyou, the physio was very nice and very encouraging. I’m now 3 weeks post op today, I have such a tightness to the bottom left of my knee replacement, almost feels like the knee is too big for my skin any one else experience this ?
,
 

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