PT questions

[Hope810]

Hi again and thanks for your input on my previous postings.
They were a great help. Well I have now "officially" joined the group. I had LTKR on Feb 23. Surgery went very well and I came directly home on day #4 using only a cane and could climb stair without problems (one step at a time of course Anyhow, I have some PT questions.

The home care PT said I was doing great with almost full extension and 90 degrees ROM. I could do leg lifts but my angle would swell if I pumped my toes. I'm walking without a cane except for going outside. I have been taking it very easy and have not had much pain. My leg is mostly sore and aches.

I started with office PT yesterday and my leg seemed really, really tight. Not like home at all. The office PT pushed and pulled on my knee and leg making it really hurt. He pushed on my angle bending my knee so much that I could hardly walk the rest of day. This was so much different than the home PT that I didn't know what to make of it. The home PT stretched my leg so easy that it would loosen right up. The office PT was just a joke. Pushing-pulling and the an aide had me running me through a routine to get the hour done and I was off to home.

This morning I iced and elevated my ankle and leg. I then did the full set of exercises and iced some more. All seems limber now and I'm in little pain. I stopped the meds since they were making me tense and sore. I am taking tylenol (acetaminophen) 1000 mg every 4-5 hours now and that seems fine.

Please let me know what I should expect on this PT stuff. Thank you all and my best on your recoveries.

Hope

 

[Jamie]

Here is your official welcome, Hope!! So glad you joined the forum.

PTs come in all shapes and styles....some push their patients VERY hard, others less so and they may employ massage therapy as well as exercises. You need to communicate with your therapist to learn what he or she is doing and why exactly. Tell them if you experience significant pain afterwards. Icing and elevating frequently (more than once a day) is critical. You might also want to apply ice when you go to bed at night.

I'm wondering how you think the acetaminophin is working when you're still having pain? That's not making sense to me. You are right at a month out of surgery and it seems to me you may still need some prescription meds. If the ones you were taking didn't work for you, call your doctor and ask for something else. There are LOTS of choices. Taking scheduled pain medication (not just when you feel pain, but on a prescribed schedule throughout the day and night) should help the pain you are feeling during therapy. Plan it so you take a dose about an hour before you go. Be sure you're not driving yourself if you are on the pain meds, though.....but I'm assuming your surgeon has not cleared you to drive anyway at this point.

Bottom line is that you should expect your PT to push you so that you gain the needed ROM to function well in your everyday life. But the two of you (and your doctor for pain relief) are all partners in the process and all of you need to talk to each other.

 

[backbay38]

Hope -- just some info from my own experience. I am now 2 months post surgery RTKR. My surgeon wanted very little weight on the new knee for the first 2 weeks (home PT). And although the bending was (to my thinking) very aggressive in the hospital and for those 2 weeks at home (hurt alot no matter whether I did it myself or the therapist did it), I know the therapist was also somewhat careful because the incision was healing. once the staples were out -- the therapy became a bit more aggressive and at the 6 week point -- it was like having a personal trainer in terms of heavier weights and much more difficult goals. Which was good for me because I am used to working out in a gym. and you may NOT be used to that so I underscore what Jamie said: talk to your PT and your surgeon. My PT has worked with this surgeon before and I had him from the very first because I asked that he be my home therapist also. (A friend told me about him and how good he was). So he knows the allowed routine.
as for the bending -- it hurts alot until you get to the 130 degree point. I want to go beyond that (and should evenutally be able to) but the stretching is not so aggressive. You make big leaps in the bend at the beginning, tiny steps after and the bending gets less painful because it's basically stretching quad muscles that can't be stretched too aggressively. Your PT can explain all this to you -- and should. You should ask him/her why so aggressive? or why this exercise and these weights if it isn't obvious. You have to trust your therapist and your therapist has to know how (and be willing to take the time to find out) to work with you in a way to encourage you to meet your goals and the surgeon's.
As for pain meds -- I dumped the Percasets after the first home PT session because they fogged my brain. I asked the PT if it would hurt any more than it did that day. he said no. So I experimented the next day with 3 extra strength Tylenol. Which was adequate to survive the few minutes of bending pain. But this was during the first 2 weeks and at that time I was also taking 1 Celebrex and 2 Lyrica a day as well as 2 aspirin for a blood thinner. All three are anti-inflammatories which work different ways. So if you have no additional medications except the heavy duty pain meds -- as Jamie said - you might want to ask your surgeon for something else. Or even ask your pharmacist who often knows more about medications and how people react to them than doctors do.
I iced like crazy the first month of office PT and then discovered I was OK without it. The leg extensions. lifts ,step ups and other therapy exercises shouldn't really hurt; they are just gradually building muscle. Just the bending really hurts and you have to either grit your teeth for those few minutes or take something adequate. I think Jamie has said this before or someone else on this forum but if you are really in pain, your leg will tighten up and even swell and you won't be able to do what you have to do at PT. And reasonably aggressive PT that you understand and can handle based on your muscles is the key to being able to walk long distances again and the rest of the good life!!!
Good luck; it really gets a lot better around the 7th week (or did for me) in terms of leg strength and something really important - balance -- which is a big issue for me because my balance was so bad for so long.
Keep posting because the individual experiences on this forum are really, really helpful!!
Stephani

 

[Hope810]

Hi thanks for your replies. I seem to be having trouble with my postings. I logged in and wrote a long reply but then lost it all.

As a short - I will talk with my PT tomorrow more. I have my doctor appt next week so will be able to find out what he says. I am taking Celebrex and have no pain on the acetaminophen except when the PT was pushing on my leg. I'm walking and sleeping pretty good. I'm fine with exercise routine on my own and can stretch it and extend it well for less than 4 weeks post op. Has others had problems with leg being more stiff at PT office then at home?

(don't want to lose this again so I'll post - thanks again)

Hope

 

[backbay38]

Hope -- just one more thought. and this is really just a thought. Maybe you were simply more relaxed at home period. And that relaxed your whole body, leg/knee included? Maybe you didn't quite know what to expect at the PT's office? This is NOT based on anything scientific so don't take it to the bank: But I knew my therapist (after the 2 weeks of home therapy) and it was still really different the first day in the office. and I have had at least 3 previous rounds of physical therapy for this knee in the last 20 years. So I knew the basic routine. But I was somehow "uncertain" that first day...
anyhow.. let us know how the talk with your PT goes...

 

[Jamie]

Hope, I'm so glad you mentioned that you're on Celebrex. It should help the inflammation, as will the acetaminophen. You're on the right track to talk to your therapist. I bet you feel much better once you've had that conversation and understand more about your therapy. Frankly, I think you are doing WONDERFUL for this stage of your recovery. Do keep up with that icing and elevation, though!

 

[JudyS]

Hi Hope and Welcome
I am a hippy and others have certainly addressed the pt aspect of it. What I am concerned about is the amount of tylenol. I believe the max. is 4,000 milligrams per day. If you are taking them every 4 hours you are exceeding the limit. I would check with your doctor in the morning.
judy

 

[Hope810]

Thanks all for the feedback. Yep just switched to extra strength tylenol two days ago and I notice the max of 4000 mg so switched to every six hours after first day. Gotcha on the ice and elevation also. I did lots of that yesterday and swelling was gone this morning. Now for my morning routine and I'll talk with this new PT this afternoon. I'm sure we can get on same page. I'll let you know how things work out (a little pun there

Hope

 

[Hope810]

ps. I did notice I was very uptight my first visit to this PT so that may have contibuted also. Thanks for the thought. /Hope

 

[Judles]

Welcome Hope!
Relax! Hope you're feeling better & will
Have an easier time with your PT now!

 

[Jamie]

Hi Hope and Welcome
I am a hippy and others have certainly addressed the pt aspect of it. What I am concerned about is the amount of tylenol. I believe the max. is 4,000 milligrams per day. If you are taking them every 4 hours you are exceeding the limit. I would check with your doctor in the morning.
judy

Good eye, Judy. You are right that the amount of Tylenol taken needs to be watched.

And Hope....HOORAY for you for actually reading the label. So many people DON'T for over-the-counter meds, but it's important.

 

[JudyS]

Hope
Good Luck today and do let us know how it goes with the new pt
judy

 

[Hope810]

Hi again. I just thought I would let you know that my 2nd PT session today went much better. I talked with the PT about my unhappiness last time. He readily agreed to work with me to avoid getting back on meds and was much more "mild" with my knee today. Since I was there a bit early the aide started me on the bike and stretching first so by the time he came over my leg-knee felt much better this time. He also worked on it slowly (instead of just pushing on it) and it relaxed way out.

I've already got an extention of -4 and ROM 118 so I'm in good shape at less than 4 weeks! (TKR was 2/23.) We talked that I'm pretty good at doing exercises at home so that can work for us too. I came home iced and elevated - feeling pretty good still with just tylenol. I'll see my dr next week on Thursday and see what he has to say. I can't thank you enough for your support.

Hope

 

[Jamie]

Hope, WONDERFUL!!!! It sounds like you are on the right track with your PT. I'm betting you will do fine from now on. That communication you're doing is sooooooo important. You guys are all on the same team with the same goal....to make you as good as possible in recovery.

 

[Judles]

See???? There's always hope for Hope!!!
Great news & keep up the good work!

 

[backbay38]

Hope that's great that you talked to your PT and he understood your needs!! I showed my own PT your original post today and he said too many therapists push too hard with patients and that ultimately makes them push back instead of relaxing into the stretch. And then people get totally turned off and won't do anything. So hearing your second session went much better is really solid progress!!! and your ROM and extension sound great also; my PT said at the very beginning that if people only did the exercises they are given from the start they would have much better and faster recoveries. He said so many people don't do them on their own and that's a big problem. So it's really good (for you) that you're good with the exercises at home. Hooray and congratulations for speaking up!!!

 

[JudyS]

Hope
That is awesome . I am so happy for you. Glad the therapist understood.
judy

 

[Hope810]

I really appreciate your support on this. I think that many PTs act more like trainers rather than approaching us as hurting patients. There must be a class about that someplace! I think our discussion went well because I remembered to use a lot of "I statements" rather than taking an accusitory tone of "you did" this. I started by saying that "I need more information about the therapy approach and goals" and "I found the last session too hard for me and I needed his help to find a way not to go back on meds to get through the therapy." I also said that "I'm new to all this" to remind him of the obvious. It helped open us up without blame. Best to you all. /Hope

 

[Jamie]

Wow, Hope......you're gooooooood! The way you phrased your comments was PERFECT!!! And it got the results you wanted. What a wonderful thing....BOTH you and the therapist felt good about the dialogue. You're my kind of gal!

 

[backbay38]

Hope your way of starting off the conversation with your therapist is a great "teachable moment" for us all. My husband is always telling me that your method gets much better results than a frontal assault! Thanks for telling us. I especially say thanks
Stephani