TKR Physical therapy


junior member
Nov 1, 2023
United States United States
I had TKR done on my right knee and requested in home therapy because i could not drive.
1st visit was to evaluate and measured day 1 after surgery. My spinal block was still active and i was able to bend my knee around 87 deg. Leg and ankle was swollen. It appears they use this as a starting point. So far pain was tolerable and no issues other than stiff and swollen.

4th day after surgery a different TP assistant visited with a pushy attitude. The comments she made sounded like i was into a few weeks after the surgery and was not achieving what i was suppose to.
She started pushing me to bend and exercise ,
My wife said she sounded like a drill sergeant.
My basement has 12 steps, she quickly worked me up and down the steps, not real slow. She kept commenting the Dr will force your leg if i do not get movement.
When then checked my Rom and was able to get 87 deg. She ask when i had surgery and i told her 3 days ago. Her comment was ohh. Well you are doing good smiled and said we were finished for the session.

The next day my leg swelled double the size . Stiff and was hard to make contact to the floor. I used — ice, ice ice . I think because of the aggressiveness my healing went backwards. It took 5 days to recover.

3rd visit - Another therapist visited and is now my permanent home assigned one. We checked my Rom and could only move my leg 26 deg. She went to touch my leg to help with the bend and I said no do not help and told her about my last visit. She looked up the last therapist name and said yea she can be a little aggressive. She understood and we worked through some exercisies.

4th visit around 9 days. I worked my knee sitting a chair bending and using a bag of frozen vegetables as a ice bag. Slowly getting more Rom . When she arrived we checked and i am now at 67 deg versus 26.

So i think the aggressive treatment is wrong, it does nothing but cause inflammation and un-needed pain . My goal for tomorrows visit is to see a 80 deg bend. Today i will use the ice bag to slowly work my leg back to achieve this at my own pace. My swelling has went way down and my ankle is still a little sore. I will agree healing takes time, there is enough stress from pain. There is no need for an aggressive therapist to take part in any healing processes, if the aggressive therapist returns I will tell her to leave. TKR is painful for sure.
Welcome to BoneSmart

Knee Recovery: The Guidelines

We are all different, as are the approaches to recovery. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart will offer advice and are there to help. The advice may vary, but YOU are the final judge as to the recovery approach you choose.

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:
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 these pages on the website

The Recovery articles:

There are also some cautionary articles here

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.
I think because of the aggressiveness my healing went backwards
100% agree. A perfect demonstration of it in fact, although that will be of course no consolation to you!
My goal for tomorrows visit is to see a 80 deg bend
I'd ease back on 'goals'. Just gentle stretching to improve mobility. You can't really hurry the healing process very much, I'm afraid you just have to rock along with it.
Most orthos are happy to see a 90 degree bend several weeks out.
Mine were adamant that in the initial weeks "less is better," and my exercises were walking every hour while awake, doing very gentle, slow range of motion only within my current comfort range (like heel slides, without pushing things), ankle circles and back and forth for circulation, and a few quad sets while in the recliner - not to strengthen, just to help wake up my quads.
Your muscles won't be ready for more than that for at least six weeks.
@Lee.G Welcome to BoneSmart!

It does sound like you are doing too much, too soon. But, please tell us the exact date of your surgery and whether it was your left or right leg. That way we can create a signature for your thread; we can be more helpful if we know where you are in your recovery.
Today will be week #2. The PT is not pushing me, i am now at 80Deg Rom. Pain has settled and mainly feeling the pain when trying to sleep, stiff feeling.
Swelling is about 1/2 of what is was 5 days ago. Upper leg muscles are very tight. and ankle pain comes and goes.
I am now trying two trekking sticks versus a cane or walker around the house with no issues. Knee joint feels a little weird at times when walking.
Please give us the exact date of your right TKR and someone will add it to your signature for you. Seeing this in your every post helps all of us know where you are in your recovery and better advise and/or relate to you.
Today will be week #2.
Okay...we'll guess on a date :wink:
Going to create a signature for you of October 24, 2023 for your Right TKR. Please let us know the exact date if that is wrong. Thanks in advance!

Thanks for joining us, Lee. I hope you have a safe, easy and uneventful recovery. All the best to you!
Hmm, I did add the 24th , I guess during editing I deleted it. But anyway , day 15 swelling is down, sharp pain at times around the side and the front of the knee.
Two to 3 times a day I will slowly use my walker around the house with one hand moving it with me in case my knee goes weak. I have tried using hiking sticks and they also work good for balance.
I do my daily PT exercises slowly with no egressive forcing, if it hurts I stop.
I take a lot of short naps during the day, most likely due to me not being able to get comfortable trying to sleep at night.
I still use the cube wrap machine mainly at night now when sleeping. I have a timer to leave the cold pack running for 30 min at a time.

Pain is way down and only use prescribed pain meds at night and before PT exercises in the morning. As of yesterday my Range of motion was 79, my extend or straight has not been a issue. Some pain is from very tight upper leg muscle or cramp, at times i massage this area and this helps with the muscle pain. I had a force range of motion 2nd day around 89, after i forced 89 the next day my leg swelled big and pain was bad and could only get Rom around 26. I felt being aggressive may have pushed me back a week. I no longer force any movement, i do expect some pain trying to move my knee, i use the the pain as a guide on when i need to stop. I let my body tell me when to stop. My ROM is slowly increasing daily.
So i think the aggressive treatment is wrong, it does nothing but cause inflammation and un-needed pain .

I had a similar experience with my first knee this past June. Took days to recover from each physio appointment and the swelling was unreal. After my left TKA, I took the advice from this website and planted myself with my leg up and iced it almost every hour. I did the basic stretches recommended but I didn’t let physio push it and now at just about four weeks, I’ve been without any walking aids for almost 3 weeks, pain is reasonably controlled with Tylenol and I’m starting to do stairs in a regular one foot per step pattern. I fully attribute this to not having aggressive physio.

Advocate for yourself when needed and follow your gut. If it feels like too much, it likely is.
My assigned PT is not aggressive at all and said everything is looking good and on track. We did a flight of steps today with no pain. Monday I was 79deg Rom, today i am 82 deg.
Even though everybody treats pain and heals differently this website helps to see what others deal with along with some good advice. Thanks
Thank you for confirming the date!
I am sorry you dealt with a setback after forcing your ROM. Thankfully It is behind you and you've decided not to engage in movement that causes discomfort or pain. Please 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. This recovery can last a full year and even longer for some, so there's lots of time and room for improvement. Take good care and stay in touch. We love updates!
Reading from the beginning, it looks to me like you're following a perfectly normal path through recovery. It's long and tedious and up and down. IMO you're doing it right.

use prescribed pain meds at night and before PT exercises in the morning
I no longer force any movement
i use the the pain as a guide on when i need to stop. I let my body tell me when to stop
Pain is your guide. BoneSmart's view is that taking painkillers before PT weakens that guidance and enables you to overdo exercise. Our advice is not to.
I will slowly use my walker around the house with one hand moving it with me in case my knee goes weak
My knees felt weak and unstable. It was a while before I realised that part of this was not a problem but a feature :). Bone spurs are cut away during surgery, leaving the knee more free to move; this feels wrong to start with but eventually the body adapts and ROM continues to improve, and it feels great.
Thanks for the input.
Day 16 ROM is the same as day 14 around 82 deg. PT says everything is looking good.
Knee swelling and pain level seems to be improving daily.
Started walking with cane in hand around the house without touching the floor trying get my balance back without limping.
When I get up after sitting for more than 10 minutes my leg gets stiff with some pain, it takes a few steps and movements to loosed up everything.
At times I feel deep bone pain, I have no redness around the incision.
I can now go up and down steps comfortably.
Sleeping has improved but I still wake up with some discomfort several times a night needing to move my position. I am a side sleeper, finding that sweet twisted position is hard.
I use ice pack before going to sleep and wake using ankle pumps and stretches before getting out of bed.
Yes, you're definitely doing well!!!
Be aware, some of us (raises hand) have that stiffness after sitting for weeks or months.

Initially, if I wanted to sit up and draw at my desk, I'd set the timer to 7 minutes; gradually increased it to 20 and then stopped using it.

At three months post op, we'd stop the evening movie every half hour to allow me to take a five minute walk.
No one at this time suggested me needing it only at the beginning of PT session it was mentioned as a possible option if my knee does not get enough bend. So what is a the MUA Manual manipulation while sleeping has anyone needed it done?
If so at what reason or at what point would it be needed? Sounds like it can be damaging.
19th day after surgery
I am stiff but i can do the exercises without much pain. Swelling is down.
When I woke up this morning i was surprised to be able to dangle my knee over the side of the bed without pain , a lot of stiff feeling but not does appear to be a 90 deg yet. Still have issues finding the right sleeping postion. If i stay in one position to long I get enough throb to wake me up and have to reposition myself. I am down to one oxy per night before bed and at a point i may be able to stop using the meds completely. i still take Tylenol as prescribed. I start the ice cube before sleep for 30 min to an hour.
Practicing bending as much as possible sitting up in chair and using ice to work the muscle being careful not to force a bend. This will be the upcoming last week for in home PT . I have a surgeon follow up after thanksgiving and will then start PT outside of home.
Curious , how do edit my thread to correct any spelling errors.

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