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PT: the seriously grave consequences of doing too much of it

Josephine

NURSE DIRECTOR
Nurse Director
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84,925
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78
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I've been waging a seemingly hopeless war against PT or physio that goes to extremes in bending, pushing and generally making patients do excessive amounts of very demanding exercises. I have now amassed several cases which graphically demonstrate the folly of this approach and the self-fulfilling prophecies of the warnings meted out by the PTs. Things like the "window of opportunity" in TKR and no pain, no gain. These are all myths and very dangerous ones at that.

I want you to listen to this warning as it could mean the difference between you getting a good outcome from your knee and ending up, as PT's so often warn, with a knee 'set like concrete to never move again".

Case 1
Male, 59 years of age. Accustomed to using gym daily, ran marathons and engaged in many other similar activities. Had bilateral TKR in 2009. He was home on day 5 where tells me he was prescribed oromorph, codeine and paracetamol. He said he took the codeine and paracetamol but rarely took the oromorph as he felt he shouldn't really need it as he could work himself out of pain!

Within 4 days of being home he was back in the gym doing his usual workout plus exercises given him by the PTs. He was also doing his own shopping, housework and gardening.

His exercise schedule went like this with sessions 3 times a day
- 15+ heel slides
- 20+ straight leg raises
- 10+ times up and 10 times down stairs
- 20+ free standing squats
- 20+ wall slide squats
- weighted knee off end of bed (extension) for 10 mins
- 30-40 forced extensions with a Theraband strap
This added up to a staggering 425+ exercising motions every day!
Plus other gym work, walking 1½ hours twice daily.

He also returned to work at 6 weeks as a shelf stacker in a major supermarket (N.B. this is NOT light work and often requires carrying packs up steps to stock top shelves or kneeling to stock bottom ones)
When asked if his knees ever hurt while exercising and he replied "Oh gosh yes - it was agony"!!!
He iced with frozen peas 20mins twice a day and elevated by laying flat on the settee!

Shortly after the TKR, his surgeon decided to fit a patellar button in his left knee but it made no difference to the unrelenting pain.

At 5 years on, he presented in my clinic with a ROM of 90 on one knee and 100 on the other
His legs were grossly swollen and the knees excessively painful, especially the left one and he was seriously considering amputation. However, he was referred to an neurosurgeon who implanted a spinal stimulator. This didn't work well and he had to have it redone a few months later.

12/07/16 Edit to update
I saw him again one year later. He reported that the spinal stimulator never really worked well and things had not improved. He had been diagnosed with #CRPS and was on excessive amounts of pain meds but nothing really worked. He had also been told he had femoral nerve neuritis.

He was more convinced than ever that he should have this leg amputated but I pointed out to him that if he had a mid-thigh amputation, he would still have a length of femoral nerve left and would then be subjecting that to the use of a prosthesis so his pain would still be present.
 
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Josephine

Josephine

NURSE DIRECTOR
Nurse Director
Joined
Jun 8, 2007
Messages
84,925
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Case 2 is it really supposed to hurt this much??
60 year old member who was well set up to go easy on his new knee but his physiotherapist had other ideas! When she came to his home on day 12, she set right in with the aggressive stuff and even had him bite a pillow while she forced his knee back!

**** said:
Here's what's happened .... my pt has been today and I thought I was prepared and ready to show her my posts and more importantly your posts. The actual visit was horrendous. She squeezed my kneecap and moved it from side to side. I told her it was hot and she felt it and agreed it was burning but did nothing about it.....

She made me do exercises I did not want to do but my daughter aged 20 was present and my wife so I was forced to man up, so to speak. I am not joking it was murder bending my knee back and making me bite a pillow, forcing my knee. It really hurt. I was almost crying ..

She was very unhappy at me for being on this site and read some posts I'd saved. And laughed out loud calling you nutters and freaks. I know what you're all saying now, well tell her to vanish and carry on. But you see some of what she said so made sense...i.e. if you don't move the knee, it will seize up. My wife and daughter totally agreed with her but my friends, the killer was she threatened to tell all this to my surgeon and told me he would go mad with me for abusing a £5,500 operation which I had on the NHS...

I reluctantly agreed to do my exercises. 4 sets of ten reps immediately.
To bring u up to date I'm now 4 weeks. Post op and she came again yesterday to treat me..she was really surprised that even with her payrolls massage my whole knee has seized up and to use her words were going backwards. She has now fast tracked me an appointment with my surgeon next week, I'm not sure why but my guesses were not pleasant.

**** said:
I've now seen 3 physios including the head honcho... their opinion is that my knee will not lay flat no matter what they do and they have tried a lot.. They think it's cos I was put into an inflatable leg cast after my op which prevented my knee being flat..they all now cannot move the patella again they have tried so now they have written to my surgeon about the MUA procedure.but this is the UK and I can be on a list for 6 months to 12..

They can get my knee to bend during treatment but the minute I walk all the bend has gone and my knee to quote them " is like a block of concrete".
**** said:
It's Mon20th October now and to me this is now day one of 21 days rest..
**** said:
(Had a lump in my groin but) they didn't know what it was.. eventually the orthopaedic registrar brought her senior colleague from the operating theatre no less and he told me 'Jimmy you have ripped the middle muscle from above your knee off and it has travelled up to your groin*'. He is not sure if it's repairable which freaked me out but assured me it's not that dangerous and can repair itself.

They are calling me in for an ultrasound scan in a few days and he is asking my surgeon if he will look at it and decide if he wants to repair it whilst I am in for my MUA.
*meaning it the quads tendon/muscle that was torn off the patella by the physiotherapist during her brutal exercising.
 

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