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

Discussion in 'Concerns after knee surgery' started by Josephine, Aug 29, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    Age:
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    84,085
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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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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    Age:
    77
    Messages:
    84,085
    Gender:
    Female
    Location:
    The North
    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!


    *meaning it the quads tendon/muscle that was torn off the patella by the physiotherapist during her brutal exercising.
     
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