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[TKR] Never satisfied PT office

lira67

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Hi! This has been awesome, reading and finding out " I'm not the only one". Thank you!
I'm 9 weeks out, and can get to 107 degrees. My PT office obsesses over this number every time. I have gained 3 degrees in 3 weeks. Every time I walk out, I feel like I can never get to what they expect. They want me ^110..like yesterday :( I have lots of pain when I leave PT and I have been pushed to tears more than a few times. I want to stop PT, but I'm afraid I'll not gain anymore ROM. I have a recumbent bike, the slant board for stretching and know what I should be doing...and when I'm not throbbing after PT...I do it. I know this is a process and do not regret it for a minute. Nighttime lack of sleep is slowly getting a bit better. Thanks for listening!!!!!
 

Jaycey

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@lira67 Welcome to BoneSmart! Please do not let anyone push you to gain ROM. It will come with time and healing. Your knee has seen major trauma. Rest, ice and elevate. Controlling all that internal swelling will help you gain ROM on your own.
I want to stop PT, but I'm afraid I'll not gain anymore ROM.
In the articles posted below you will see several on gaining ROM. Here is another one Myth busting: the "window of opportunity" in TKR Good idea to stop PT and do this at your own pace.

Have a read and please do come back with any questions you might have.
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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork

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 Activity progression for TKRs

6. Access 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 a 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 history before providing advice.
 

Roy Gardiner

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I want to stop PT, but I'm afraid I'll not gain anymore ROM
Well fear not. PT does not create ROM; time, healing and life do. Gentle, pain-free stretching will help, but pain is counter-productive. You don't have to go to PT
I have a recumbent bike
An exercise bike is a good idea for mobility exercises - even if you can't make a single rotation!

  • Set the bike to zero resistance
  • Set the saddle as high as possible and rock the pedals back and forth as far as you can with discomfort but no pain
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

When you can make full pedal rotations:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

Jockette

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Welcome to Bonesmart!

107 at 9 weeks is fine. PT that brings you to tears is not fine.

There is no need for PT to hurt. Some of our members did not go to PT at all and their knee turned out fine. I will not go with my next replacement, and I’ll recover better than I did this time.
 

LindaO

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Congratulations on your new knee! We are here to listen so let us know how you are doing!
 

Celle

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Hello @lira67 - and :welome:

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

You don't have to go to PT and your particular therapist seems to be doing little, except for hurting and worrying you.
Saying no to therapy - am I allowed to?

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

Your ROM will continue to improve, even without PT.
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. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.
 

InkedMarie

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Welcome! I did PT but it was gentle therapy, with a physical therapist who I spoke to on the phone and found out he agreed with what I wanted. You can stop PT if you want or find a different office/therapist to work with. If you continue where you are, just say no!
 

Motherbone

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Shop around for a physical therapist that will work with your goals and not their arbitrary numbers.
 

Cynof4

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Agree with all of the above. I'm at 7 weeks and my flexion (bend) is at 115*. I got there with no pain and gradually over time. I'm still working on extension (flat). It's not quite 0*, but close. Find a PT who is gentle and LISTENS to you. They are out there.
 

Didot

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I never got to 107 with my first knee even after having had a MUA. I think that number is great so early on. Don’t let them tell you otherwise. It’s difficult enough getting through this recovery.


Sent from my iPad using Tapatalk
 
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lira67

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Thanks everyone! I had a follow up with the surgeon who said I’m doing really well and said to stop outpatient PT and continue at home. So that’s what I did! I “overdid” last weekend by a 2 mile hike and gardening so this week has been recovery mode. Live and learn! I love all the posts and support!
 
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lira67

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Hello @lira67 - and :welome:

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

You don't have to go to PT and your particular therapist seems to be doing little, except for hurting and worrying you.
Saying no to therapy - am I allowed to?

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

Your ROM will continue to improve, even without PT.
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. Its ROM will gradually increase as your knee heals and the internal and external swelling decrease.
Thank you! Left total knee on July 16 2019!
 

Ceegee

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I'm 9 weeks out, and can get to 107 degrees. My PT office obsesses over this number every time. I have gained 3 degrees in 3 weeks. Every time I walk out, I feel like I can never get to what they expect. They want me ^110..like yesterday :( I have lots of pain when I leave PT and I have been pushed to tears more than a few times. I want to stop PT, but I'm afraid I'll not gain anymore ROM.
IMHO there's far too much focus on numbers and not enough on functionality. I'm 20 months past my TKR and my ROM has settled at around 120 degrees. Doesn't sound like much. But I can hike 10 miles over rough, hilly terrain, I can jog, I can run upstairs two steps at a time, I can compete at national level in agility with my dog, I can do all the outdoor maintenance work on my house, including work that requires a ladder, I can ride my bike, etc. I couldn't do any of these things before the operation. Numbers are one thing, functionality is another. My new joint is becoming more flexible over time, but if I never get more than 120 degrees of range, I'll still consider my knee replacement to be a resounding success.

My advice: Don't worry about the numbers and don't let anyone push you. Figure out what you want to do, and ask your PT to help you do it. I told mine that I wanted to hike in the mountains and run agility with my dog, and she gave me exercises to help me achieve that: hopping from one foot to another, changing direction, muscle strengthening, etc. If yours wont do that, find one who will.

Best of luck, and don't worry about the numbers. They don't matter.
 
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lira67

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Thank you so much! I am so happy you responded to me. I appreciate it! I def over did it this week but I’m so happy that I could do that much already! Thanks again! Have a great weekend!
 

Tykey

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We all overdo it, occasionally, how would we know what our limits are unless we give it a go?
Forget about your ROM figure, it's no help in this journey, and there's no prize at the end. I've never measured mine, and never will, but after 5 weeks I can do everything I want, comfortably, and I'm absolutely sure it will increase more.
You are doing great
 

InkedMarie

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I'm 9 weeks out, and can get to 107 degrees. My PT office obsesses over this number every time. I have gained 3 degrees in 3 weeks. Every time I walk out, I feel like I can never get to what they expect. They want me ^110..like yesterday :( I have lots of pain when I leave PT and I have been pushed to tears more than a few times. I want to stop PT, but I'm afraid I'll not gain anymore ROM.
IMHO there's far too much focus on numbers and not enough on functionality. I'm 20 months past my TKR and my ROM has settled at around 120 degrees. Doesn't sound like much. But I can hike 10 miles over rough, hilly terrain, I can jog, I can run upstairs two steps at a time, I can compete at national level in agility with my dog, I can do all the outdoor maintenance work on my house, including work that requires a ladder, I can ride my bike, etc. I couldn't do any of these things before the operation. Numbers are one thing, functionality is another. My new joint is becoming more flexible over time, but if I never get more than 120 degrees of range, I'll still consider my knee replacement to be a resounding success.

My advice: Don't worry about the numbers and don't let anyone push you. Figure out what you want to do, and ask your PT to help you do it. I told mine that I wanted to hike in the mountains and run agility with my dog, and she gave me exercises to help me achieve that: hopping from one foot to another, changing direction, muscle strengthening, etc. If yours wont do that, find one who will.

Best of luck, and don't worry about the numbers. They don't matter.
I cannot like your post enough! I tell people This all the time. My surgeon and PT didn’t care about numbers so why should I?

I could dress myself, put on socks, shoes & tie them and ride my recumbent bike. Good for me. Now, if I had a job requiring me to squat, that would be a different story. Heh.....my job does require that but I didnt know that until after I was hired, post surgery. I can’t so I bend over & now my back is screwed.
Anyway.....great post!
 

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