TKR New Here Looking for Positivity

[Sam67]

@mainegirl1 yes not sure how to link it but its called "13 weeks and counting". Started it yesterday.

 

[LooLoo]

Hello group!
I had my second round of PT yesterday. It was decent and a bit painful to be expected. Not horrible. There was one point however, that my knee was manipulated into close to 90 degrees (a slow process). The last little push took me over the edge in pain—to the point of tears. After all was done i took some Norco and slept. When I woke up, I felt ok. I did the stretches I was asked to do and some other things around the house. Today of course, is a different story and the pain is back with a vengeance.
My PT therapist told me I needed to do a least one set of exercises every day until my next appointment at a minimum. How long do I need to wait? Or do I just drug myself and keep trying?
I know there has to be a delicate balance.
From my experience when lifting weights and such, I can push myself harder than I ever thought. But that’s really not the same kind of pain. I also know, after a day of heavy lifting you need a day of rest. With this—how much is too much or too little?
My therapist said if I wait too long, too much scar tissue gets built up and I’ll have trouble with flexibility in the future.
Can you tell me how I should proceed? How gingerly should I Maneuver around this knee? One thing I’ve learned about myself so far is that I have a very LOW tolerance for pain and I’m kind of a baby. I’m not as tough as I thought I was. I don’t want to push myself because I don’t want to hurt, but I will push myself if it is necessary to be able to be active to the best of my ability in the future.
Can I get your advice? Thank you my knee friends!

 

[Jaycey]

@LooLoo on the first page of this thread - the 3rd post down from the top Celle left you some articles. Have you read these? Maybe go back and read them again.

You should not ever let anyone push your knee and there is no window for gaining ROM. All the knee needs is time and patience - not forcing. You will not build up scar tissue and you will not limit flexibility if you don't exercise.

Please stop all this. Ice and elevate at least 45-60 minutes several times per day. Gentle stretches and walking is all that is needed.

 

[Jockette]

My therapist said if I wait too long, too much scar tissue gets built up and I’ll have trouble with flexibility in the future.

This is not true. Sometimes if we sit too long we can feel a bit stiff when we get up but that not scar tissue waiting to pounce on us if we don’t do enough.

Here’s a good article for you:
https://bonesmart.org/forum/threads/tkr-recovery-and-an-analogy-to-athletic-training.14898/

 

[mainegirl1]

PT has training and healing confused.. You are healing.. Weight lifting etc is training.. That comes way later after healing.. Scar tissue is the way wounds heal.. Adhesions are the thing he /she is trying to avoid.. And from what I have read here they are not at all common whether or not you do PT.. While your knee is swollen ( and much of it is not visible) you can't bend it.
Envision a garden hose.. Try rolling it up when it is full of water. Much easier when empty, no?

Your PT seems to have actually made your swell more and yes if you continue you will have trouble in the future with flexibility and continued pain. The mantra "No Pain No Gain" is not applicable when you are injured.

 

[LooLoo]

@Jaycey @Jockette @mainegirl1
Thank you all! I did read the info Celle sent and I had a feeling I had been pushed too hard. I will go back and read it again for sure.
This is good to know. How to do tell my PT person I do not want to be pushed like this? I like PT. I don’t mind some of it and I understand there will be some discomfort but that’s last bit was too much.

 

[Jaycey]

Here's an article for you on Saying no to therapy - am I allowed to? You just tell PT you do not want to push. PT should never hurt or cause discomfort. However many PT have checklist and want you to get to a certain level by their check list. It just doesn't work that way. Your knee is in charge.

 

[Jockette]

How to do tell my PT person I do not want to be pushed like this? I like PT.

Just say no to things you don’t want to do and tell them what you would like to do. If it becomes obvious that they are more interested in their agenda than working with you as an individual, find another PT or another facility.

This recovery is not complicated. PT is not as essential as we are led to believe. It can have a great outcome without PT.

All your knee needs is gentle movements. Repetitive exercises are not necessary.

This recovery is tough and painful enough all on its own without the added onslaught of excessive PT that makes us feel worse. Been there, done that.

 

[LooLoo]

Beautiful advice @Jockette Thank you.
One other question: Is it possible find a PT facility that follows the BoneSmart method? Is there any way to research this for my location?

 

[gertie]

@LooLoo I don't know of any registry of PT places. I had the same question when I was thinking about starting outpatient PT. I think you'll need to make some phone calls and ask how they approach PT for TKRs. I had in-home PT for the first few weeks after my TKRs. She never pushed on my leg to force ROM but she did talk about the window of opportunity, etc. She was helpful in other ways so I didn't want to "fire" her so I just nodded and set my own pace for bending--ROM came back when swelling went down. I didn't start outpatient PT until I was well-healed and ROM was no longer an issue--we then could focus on function, strength, balance, stamina.

 

[LooLoo]

Thank you @gertie

 

[Jockette]

Is it possible find a PT facility that follows the BoneSmart method? Is there any way to research this for my location?

Probably the only way would be to call facilities in your area and ask questions over the phone. I think it may be a long search, the PTs with gentle approach seem to be few and far between.

Which is why I won’t go to PT next time around. In my case, they didn’t do anything there that I couldn’t do on my own at home.

You really have to be careful with rehab. You can cause just as much of a set back by doing things on your own at home, if you do the things they tell you to do.
https://bonesmart.org/forum/threads/bonesmart-philosophy-for-sensible-post-op-therapy.37103/

 

[gertie]

@LooLoo As @Jockette says it might take some calling around to find someone with a gentle approach. But unlike Jockette, I have found PT to be quite useful at the right point in recovery. You'll need to gauge for yourself what you need. I'm now recovering from a THR and will start PT next week, just after the 8 week point. I've worked with this woman after each of my ops and she is gentle and does let me set the pace--but she gives me structure and guidance on getting active again--and accountability. You might want to think about waiting until you're more healed up before going to PT again--and asking those questions about approach of course.

 

[LooLoo]

So I made some calls. I had a good discussion with one PT person. But he did say that the younger you are the faster you heal and the scar tissue builds faster which is why they push harder. That doesn’t happen with older patients I was told.
Is anyone familiar with this??
He did say he would have me do the PT and of course some pain is normal but he would never push me past what I could not take or to the point of tears. (Yesterday was tears).
But now I’m worried how much to rest vs how much to stretch.

 

[gertie]

that the younger you are the faster you heal and the scar tissue builds faster which is why they push harder. That doesn’t happen with older patients

I've never been told this--I'm an older person but I heal quickly--always have--have no idea whether that's led to more scar tissue. Sounds like more of that "window of opportunity" stuff that I don't think has much validity. You're in early days of recovery--if it were me, I'd opt for rest and healing and save the PT for later.

 

[LooLoo]

Thanks @gertie I think I’m going to have to do what my body tells me. If I’m hurting I’m going to take it easy. I’ve overdone things before and it wasn’t smart.

 

[Jaycey]

But he did say that the younger you are the faster you heal and the scar tissue builds faster which is why they push harder. That doesn’t happen with older patients I was told.
Is anyone familiar with this??

Sorry but this is totally wrong! All this has nothing to do with the age of the patient. Do not let this PT push you. This PT is just working off a checklist. Please be firm - no pushing!

 

[LooLoo]

Thanks @Jaycey I definitely will not. I’ve already switched places to the one I felt would listen to me and do what I asked. They seem like they will be gentle and easy to communicate with.

 

[ApricotPie]

You really do need to find what medication works for you. Recommendations from medical professionals are all over the place. My OS recommended that I avoid ibuprofen for the first 3 months post surgery. He believed that it interfered with healing. Who knows?

I believe there is evidence that NSAIDs do inter fear with bone growth. But, they also fight inflammation which acetaminophen does not do. That’s another reason I alternate their usage. I’m trying to play both ends against the middle.


RTKR July 15, 2019

 

[ApricotPie]

FWIW, I looked at the exercise instructions my PT gave me, they all refer to a ‘gentle’ stretch and then holding it for 5 to 30 seconds depending on the exercise. That sounds a lot nicer than NO PAIN NO GAIN.


RTKR July 15, 2019