TKR Overly Aggressive PT post TKR?

[KneeWoes]

TKR Left knee 11-30-22.

1st PT visit 2 days post surgery, just measurements, gentle movements and leg compression sleeve to try to lessen severly swollen leg. This includes knee and means my entire leg from the top of my thigh down to the bottom of my foot.

2nd visit-stationary bike-I could not make 1 full revolution and PT said that was ok for today, but at next appt. I would have to make a full rotation. Wall slides, after only completing 2 of these on my own the PT pushed my knee and even asked another therapist to come over to help and measure. ROM 100. I told them to stop pushing when I could not take it anymore and they did not listen and continued. This brought me to tears. I was able to compose my self and continue with everything else they asked me to do. After the exercises were complete they applied the e-stem and compression sleeve and turned it way up from the first visit. The sleeve went through its first cycle and did feel stronger but tolerable. On it's 2nd cycle it tightened up so much that I thought my shin bone was going to break and I loudly asked for them to remove it. When they did the tiny incision at the lower end of my shin had leaked or opened up A small amount of red/orange fluid was leaking. PT put neosporin and a bandaid on it. I left this appointment in tears and had a panic attack on the way home and contiued after I returned home.

3rd visit different therapist-I still could not make a full revolution on the bike but the this therapist did not force the issue. Much the same as the prior visit except less pushing the knee, it hurt but was tolerable. I said no to the compression sleeve, only did the e stem after excersizes.

4th or 5th visit-I could finally make a full revolution on the bike on my own. Again with the wall slides and after me finishing only a couple of these, 2 therapists began pushing my knee. I told them to stop when unbearable but again they did not! They pushed 3 more times as I am lying on the table crying and hyperventilating. ROM was increased, sorry but I don't remember exactly the number.

I have gone to 8 session in total. The description above explains basically all of them except for the last one. At my last appt. I had the therapist that I had on the 3rd visit. I rode the bike then did 10 wall slides then she measured without pushing and I was at 125 on my own with no pushing. Yea me! On extension (flat) I was at 2 degrees. When I lie down and stretch it out slowly I can get it flat. Also walking I can straighten my leg after walking for a few minutes. When I straighten it out lying down after a couple minutes I get a sharp pains from one side of my kneecap to the other. This is where the majority of the swellling is located currently.

At my 2 week post op appt with my surgeon I told him about the horrible 2nd visit and my panic attack. He did not seem interested and told me that I had until the 6 week mark to get it moving. Now most of the swelling has backed off except for the kneecap area itself. It still looks like a baseball and is 2 times the size of my other knee. Dr will not prescribe more pain meds, all I am left with in NSAIDs.

I am still in alot of misery with this knee and have just in the last week been able to get more that 3 or so hours of sleep at a time. I still ice 4 or so times a day for 15 minutes each. This seems excessive and overly aggressive to me. I will not be going back to that PT office no matter what my Dr. says, this practice has to approve of which PT practice you go to, Or so says the paperwork. Any advice please?

 

[Arjay]

Please…listen to your instincts! More experienced ppl than I will be weighing in here. But - nothing about your experience sounds good!

 

[Layla]

I will not be going back to that PT office no matter what my Dr. says,

It's unfortunate that you didn't stop sooner saving yourself pain, anxiety and tears. I am really sorry for all you've endured and its good to hear you've had your fill.

Please refrain from engaging in movement that causes discomfort or pain. Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time. You have been aggravating the healing soft tissue, resulting in more swelling, pain and limited mobility and ROM. The fact that your incision opened from the pressure of the compression device must have been frightening.

You do not need physical therapy to heal. Also, you can ice more frequently, while elevating, and for longer periods of time each icing session, which should help reduce the swelling, easing the pain. Please understand that icing for 15 minutes 4x daily is not excessive. You should target icing for 45 minutes 4x daily and see how that works for you. Always remember to place fabric between the ice source and bare skin.

Please don't allow your OS to frighten you as there is no window of opportunity you will miss, or time lines you must meet. You will find a lot of beneficial information below. Please take time to read through it. Especially the articles on Ice, Elevate, Activity Progression for TKR, BoneSmart Philosophy for sensible Post Op Therapy to name a few.

I don't know what you're taking for pain, or your dosage schedule, but we often recommend Extra Strength Tylenol at 1000 mg, every six hours, but no more than 4000 mg in any 24 hr period. You must also calculate anything else containing Acetominiphin into the 4000 mg so you're not exceeding that amount.

Now that you've stopped PT, hopefully you'll begin noticing a difference in your recovery. Try getting your exercise through walking, but not to excess, as well as through the activities of daily living. Target both as activity over the next couple weeks and see how you fare.

Please stay in touch and know that we're here for support if you need us. Wishing you comfort as you continue your healing journey!

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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​

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.

 

[sistersinhim]

I'm so glad you came to Bonesmart. I wish you had found us before your surgery so you would have known that the type of PT you have received is way out of date. Most modern OSs and therapists know that the gentle approach after a joint replacement is the best way to rehab it. Your aggressive therapy has only prolonged your inflammation, pain, and swelling. Be sure to read many threads of those that have had a TKR and you will see that the vast majority have not done the aggressive PT and are recovering just fine.

I'm one of many here who never took formal PT. Due to birth defects, I've had 12 knee surgeries, 2 of them kneecap removals, and 1 TKR. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increasing pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do. Doing too much too soon causes setbacks because your knee has to heal from the inflammation caused by the exercises before it can get back to its normal, after-surgery healing.

 

[kneeper]

I'm sorry you had such rough PTs. :(

I see you mentioned a compression sleeve. Mine had me try something called "Tubigrip" which was nice because it provided gentle compression. It did make the knee feel more comfortable and was easy to take on and off. It might be worth a try.

 

[Sun_Lover]

Wow, I'm so sorry for what you had to endure with your PT. I had a TKR on September 6th and my physical therapy story is very similar, but not as bad as yours. Sadly, I too had many times when the tears were rolling down my face and I would cry out at times even though I was trying so hard to not say anything. I can handle pain too - I birthed two children using only natural childbirth techniques. :0 But this PT HURT! And like you, I did eventually get good ROM back, but after reading the many posts on this site, I'm really thinking now that it didn't have to be what we both experienced. If I ever have to have my other knee done, I'm definitely going to find someone that understands and believes in the "gentle" approach!

Hang in there, keeping icing and taking your NSAID's as needed and celebrate how well you've done. BTW: for me, Ibuprofen works better so that might be an option for you as well. Take care!

 

[LD of Michigan]

Thank you sharing the details of your PT. It's challenging to KNOW you have to say NO to some PT techniques. This being my second TKR I already know what I will not allow. Not just to be difficult (I've bee able to do 90% of requested tasks over time). but knowing my body. For example I will not allow any person to put my on my stomach to manipulate my knee. I have back hardware from other surgeries that don't allow me to lay face down like that on a hard surface.

Keep us posted and speak up as needed. The KNEE RECOVERY GUIDELINES posted on this site are awesome!

 

[KneeWoes]

Update! Today was my first appointment with a different PT practice. This guy was amazing! Gentle strecthes and strengthing and he does not believe in the forceful movements of the knee post TKR. I felt uncomfortable a bit but it was bearable and not rough at all. He said he left a different Ortho practice because of aggressive PT and said all that causes is more swelling and pain, although some patients can tolerate it. I wish I had gone to this place from the beginnning! That probably would not have been possible however since my surgeon is part of a larger Ortho practice and it was their PT I went to. It was in my presurgery paperwork that I had to agree to go there before the surgery. I should have taken that as a bad omen. Anyway, the moral of the story is-just because a practice advertises themselve the "best in the country" don't believe it! Perhaps they are for the professional athletes that they treat, but not for average people. Lesson learned! Thank everyone for all the encouragement and good wishes-it really did help feel that it was not just me! Thanks again!

 

[Layla]

What a lovely encouraging post that I feel may benefit many.
Thanks for sharing that update. I'm happy to read about how pleased you are with the new PT and to hear his outlook on all is definitely impressive. I wish you much success with your sessions and hope you'll come back and share more.
A peaceful evening to you!
@KneeWoes

 

[Layla]

Hello and Happy Two Month Anniversary!
I hope you have a great week, KneeWoes, as your healing journey continues.
@KneeWoes

 

[KneeWoes]

Yes! It's much better! Bend is 128 easily and straight is 1 or 0. I can straighten it to 0 however it's still a little difficult to keep it there for a long time. I am confident that will go away. I see my surgeon for the last time (hopefully) this week and I for sure will tell him again that his PT dept. is far too aggressive and caused my for pain and swelling. So glad I found this website!