TKR Offacliff Recovery Thread

[Offacliff]

It's only 8 days post-op on my LTKR. PT came in twice during my hospital overnight. Got me up, walked 60 steps up and down the hall, to my bathroom, showed me 3 exercises and that was it. Quad is very swollen and meds aren't really managing the pain. Had my first formal PT visit yesterday. I felt ok about my progress going in. ROM was 60 and 25. Stated goal is 90 at 3 days and 0 at 7. Next words from the PT was "looks like MUA". That really called me down. She told me to use a rolling pin to settle the quad and get it working again. We did a short session using a strap to work the flexion, forcing it as far as I could. I was pulling a hard as I could and maybe managed to get to 70. She told me to use a belt or a sheet at home as an "aid". I hurt so bad after that work that I couldn't do any of the other exercises she laid out. I told her I thought the swelling was holding me back. She disagreed. I was embarrassed. She clearly thought I hadn't done any homework prior to the session. My next session is in 2 days and I'm working hard for improvement. But after reading some stories here, I'm questioning the process. Thank you for listening.

 

[Jockette]

Hi and Welcome!

@Offacliff I moved your post and started a Recovery Thread for you, where we can discuss your recovery and answer any questions and concerns you have. We encourage you to read and post on other member’s threads, but this recovery thread is where we’ll concentrate on your own recovery.

I‘ll write more in my next post.

 

[Jockette]

I’m sorry you have a PT who is giving you incorrect information about your recovery. I suggest you find another office to go to, and call around first to see what their approach is, before you make an appointment.

First of all, this surgery causes a lot of trauma, that we have to heal from. The best way, for most of us, is to treat our knee gently and allow it to heal, before stressing it with exercises. All you really need right now is some very gentle bends and short walks around the house.

Stated goal is 90 at 3 days and 0 at 7.

This is a very inappropriate goal, and all but impossible unless one is having an exceptionally amazing recovery. Please disregard!

Next words from the PT was "looks like MUA".

This is so wrong! Please stay away from this PT, this person has not been trained well. No one should mention MUA at one week post op, you have barely begun to heal.

I told her I thought the swelling was holding me back. She disagreed.

You are are absolutely correct that swelling is holding you back. Swelling at this point is completely normal. Your bend will improve as the swelling goes down and you heal.

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.

 

[Jockette]

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.

Just keep in mind all people are 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.

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Offacliff]

Thank you so much for the information and support. I'm going to sleep better tonight knowing I haven't failed completely.

 

[Jockette]

When you feel up to it, please take the time to read through all those recovery guidelines, especially #4, about PT.

We‘re glad you joined us, we’ve all been through what you’re going through and we want to help you recover without causing yourself unnecessary additional pain.

Hang out here with us, Bonesmart has a wealth of advice, information and support.
We will offer helpful suggestions,

Cheer your accomplishments

And send hugs when you are feeling down.

Best wishes!

 

[Jockette]

Thank you so much for the information and support. I'm going to sleep better tonight knowing I haven't failed completely.

You’re welcome! This is exactly why Bonesmart exists.

You have not failed at all. Your body will heal, and your ROM will return. Give your knee the privilege of sorting itself out. It will, all by itself, even if you don’t go to a formal PT office.

Stop forcing the bend, stop using a strap or sheet (I was told to use a sheet, too, and I did, not yet finding Bonesmart) and stop working so hard. Try to relax.

Lose the Work Ethic While You Are Recovering!

Lose the Work Ethic!!! Article by Referee54 (Tim) Many of us have a tremendous work ethic---and for several reasons. I can still remember, to this day, my father saying to me on the morning of my first day on a “real job”, “Give them nine hours of work in an eight hour day.” I believe that...

bonesmart.org

 

[FourCats]

Welcome @Offacliff! This forum has been such a source of information and support. Your PT sounds like a doozy and I wouldn’t see him/her again. I was fortunate to have all my PT in home with two therapists who were amazing.

I had my three month follow up with my surgeon yesterday and he was very pleased with my progress. My ROM is not perfect but it continues to improve. Because my other knee has worsened following my TKR it has hampered some of the improvement so we’re beginning treatment on it.

We all have a long road ahead but I have decided to stay positive and the folks here understand and listen.

 

[Jamie]

Hi, @Offacliff ..... Jockette is so right about needing to find a different therapist. This one is not good for you. In addition to the pushing and stressing of your tender new knee, the comment about an MUA was totally inappropriate and unprofessional. This is something only a surgeon should suggest to a patient. The fact that a therapist wouldn't realize such a statement could be frightening to a new patient is appalling. Then again, maybe the intent was to scare you into pushing harder. Either way, this is bad news for your recovery. There are plenty of other therapists out there who will understand a more gentle approach so your knee has a chance to heal in these important early weeks.

We have a rather extensive section on post-op care in the blue tool bar at the top of your screen. I suggest you read all of it, but especially the part on wounds and how healing takes place. Going through this information will help you better understand the healing process and how aggressive movements and inflammation that comes with it can actually slow down your healing. Your soft tissues are at a tender stage right now. Be good to them.

We'll be here for you to answer any questions you may have and address concerns. You will hear of some people who recover just fine with aggressive therapy, but the vast majority of people do much better with a more gentle approach and by "listening" to their body. When something causes pain, your body is telling you it's not ready yet for that movement or activity. Please know we are not saying to just lie around and eat bon bons all day. You need the movement consistently each day - 5 to 10 minutes of some movement every couple of hours throughout the day. This can be bending and stretching exercises or just everyday living such as walking from room to room or around the house. Any exercise should challenge your knee a bit but not cause more than mild discomfort.

 

[Rain Dancer]

Wow, threatened with MUA at one week out! That is malpractice by your PT. In one week since surgery, my flexion has been 78, 64, 50, 65. The big dip was after a bad PT session the day after surgery that caused my knee to swell. I didn’t allow her to touch my knee during that session, but she encouraged me to do too many exercises/reps the day after surgery. I am slowly climbing back by refusing to do any assisted exercises—no straps, no pushing, etc. I echo the others—please drop this therapist ASAP. The one who messed me up no longer is allowed in my house. You are in control. Your numbers will improve as the swelling goes down. So sorry this has happened to you.

 

[BBCG]

Oh my, Offacliff! I’m so sorry you’ve had to contend with that awful PT! Run away from that person… well, I know you can’t really run again just yet!

Your new baby knee deserves a chance to heal, ‘fer gosh sakes, and this PT is going to make sure it cannot heal with that sort of protocol! Even when I had to go to the surguricenter PT for 2 weeks, even when they’d get another ca-Ching in the jar with a MUA, being part of the same center, their protocol wasn’t that harsh.

Lots of us here have had to put our foot down and cancel PT when we got someone who really didn’t know what they were doing, even if they seemed supremely self-confident.

I’m concerned for your knee’s ability to recover if that person is allowed to continue such treatment, so please do consider dropping them! I’m so sorry you’re having to deal with that treatment issue, as well as just trying to recover!

We are all here to encourage you and help you be a caring advocate for your new baby knee! You have every right to call off further treatment by that person, and if asked why, you can explain their treatments are hampering your recovery.

Hang in there as we’re here to tell you there are far better options for you and your knee!

 

[kneeper]

She told me to use a rolling pin to settle the quad and get it working again.

No, no no! Not on such tender tissues so soon after surgery.
Many of us (including me) have bend at around 60 in the first week or so (due to swelling) and ultimately heal great--with no rolling pins in sight.
I second everything Jamie said above.

 

[VolFan0927]

Agree with those on the board. My wife is recovering form a leg trauma, and over did it last week and ROM was down almost 10 degrees from swelling - and this is 5 mo out. So swelling control is super important to ROM.