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TKR Recovery not the cake walk I thought

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I don't hate PT either - I just hate inappropriate PT that hurts the patient and, as sometimes happens, makes the patient feel like a failure if he/she doesn't follow the expected speed of progress. It's the mindset that everyone "should" be at a certain stage, at a certain time that can be demoralising.
 
Morning here in my part of the country. if Celle's definition of "aggressive" PT is the operative description for that term, then I can't argue with the point and would say that working to the point of excruciating pain that damages the tissue further does not seem to me to be helpful. Working through pain that is not excruciating but still very noticeable is a different animal. When it starts to hurt too much, we stop. My PT has been my best teacher in that regard.
 
I thought PT was only to be pushed to the beginning of pain and no further. That's your warning and cut off point.
 
Diesellily said:
I thought PT was only to be pushed to the beginning of pain and no further. That's your warning and cut off point.
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Hi. If that was the case I would never have started any PT. I always have some pain when I begin and so has everyone I know who has had a knee replacement. I mean, I have some pain when I am not doing PT. Now if this is a definitional thing again that may be the issue. I include any discomfort in the definition of pain. To me it is a matter of degree and common sense.
 
Hi again, Mike,
To a certain extent, I agree with you! Anyone who has ever had a baby and heard "the professionals" describe labour pain as discomfort would probably agree, too! For most of us, labour pains are truly pain, not just discomfort. And yes, pain is measured on a scale from 1 to 10, so there are different degrees of pain.

However, I think that what we mean when we say to only allow a PT to push to discomfort and stop when we feel pain is that the background discomfort/pain is a given and what we mean is to stop the PT when that pain/discomfort reaches a level that is significantly above the background pain, and that we don't wish to continue. Do you see what I mean?

Of course, each of us has a different pain threshold, so the point at which our bodies say "Hey that really hurts! Stop it!" will also differ. But the basic principle remains the same - don't allow the PT to push you beyond that point.

Perhaps doing it "by the numbers" might help:
Background pain/discomfort - pain scale 2
Acceptable PT - pain scale 4
Time to call Stop - pain scale level 5-6 or above

Those numbers are just examples of the progression, not true figures.
 
I think sometimes we talk in circle precisely because of what you aptly identify as a "definitional issue," mgdurand1. I think you have to know your own body and pain/discomfort thresholds. There definitely will be discomfort. But certainly if you're crying or continue to be in pain long after, that's too much.
My PTs were good about doing a graduated approach, so I don't think they were aggressive. Like Jo says and as the healing charts show, in the first couple of weeks you're healing those tissues from the surgical trauma and things like squats are probably too aggressive. Now a bit later, that would be appropriate.
 
mgdurand1 said:
Even controlled studies that do not adequately account for confounders are of limited probative value
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Can you put this in plain penguin please?
[Bonesmart.org] Recovery not the cake walk I thought

mgdurand1 said:
the concern I have about not doing some aggressive yet not hurtful PT during the early healing phase is the potential formation of scar tissue after the trauma of the surgery and the difficulty in achieving motion if that scar tissue has adhered to surrounding tissue and muscle layers.
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By which I expect you really mean adhesions? Adhesions are far more likely to occur when the tissue are hot with inflammation because they are then dry and - well - hot! If the leg is kept cool and allowed to rest, it will produce interstitial (between the muscles) lubrication and so adhesions will not occur. As a matter of fact, adhesions are relatively uncommon and feared quite out of proportion the reality. UK surgeons who tend to instruct their patients to do nothing but very small simple exercises like foot pumps and a few heels slides for the first three weeks and even after that to only undertake a very moderate exercise regime, have significantly less MUAs than their US counterparts. I wonder why that is? :wink: My surgeon (for instance) does about half a dozen MUAs a year at the most. Others I have worked with about the same. It's not magic, it's just common sense. And being over-enthusiastic about exercise ultimately becomes a self-fulfilling prophecy.

I have a lifetime of experience in this field (50+ years to date) and have heard this from many knee surgeons, I have heard it at conferences which I regularly attend to this day. I posted a summary of an article from the Journal of Bone and Joint Surgery (UK) in the Library regarding an allied topic MUA: the ineffectiveness of early MUA (JBJS). I am also a member of a team about to embark on a significant 5 year research into this very issue and will be delighted to impart the findings when they are published. (Sadly this will not be until 2018 at the earliest!:wink:) In short, I think I am reasonably well informed and I do not offer my comments lightly.

Oh, and the article Celle mentioned is this one MUA (Manipulation under Anaesthetic) and Adhesions.
 
Thanks, Josephine! :)

Obviously, there is a difference in philosophy between one side of the Atlantic and the other. Since both approaches (lots of organised PT versus minimal PT) produce similar end results, "you pays your money and you takes your choice". I think we all agree that PT that causes severe pain is counter-productive.

To me, the lower incidence of MUA for supposed adhesions in the UK leads me to prefer the approach of minimal PT - plus the fact that I am essentially lazy!

I've enjoyed the discussion, but I think we've talked this topic to death now, so I'll bow out!

Best wishes to all for continued good progress and recovery! :flwrysmile:
 
Celle, I read your post and the number scale you used made perfect sense to me. I think what we experienced truly was a definitional problem.

Josephine, lighten up. No one is attacking your experience or credentials. There is no need to do so. I agree with Celle at this point. I will bow out as well. Hope all have a great recovery from their surgeries.
 
mgdurand1 said:
I agree with Celle at this point. I will bow out as well. Hope all have a great recovery from their surgeries.
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Mike,
I agree that there are different philosophies on both sides of the ocean. And it doesn't look like anyone is going to change their minds, regardless.
But please do keep us updated on your progress. You sound like you are doing well.

Cheers,
Roger
 
SFBaySailor said:
Plexiburg

I know you are having some problems with your recovery, but please don't mock the title of Mike's post. He has legitimate reasons for titling as such.
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Yes, that was insensitive of me, after all I remember the joys of my first three weeks of recovery from a BTKR like it was yesterday: week #1) six units of blood and five days in a drug haze, week #2) weaning off morphine, my first stool and nights without sleep, week #3) the crushing pain from my legs, nights without sleep, oh yeah and some crazy person from PT trying to put the idea into my head that I was going to walk again someday. Skip ahead a year and three months: Staph infection, exlpant, cement spacer, leg immobilizer, picc line, excruciating pain, no sleep, and a eight week waiting game before they will even consider putting an implant back in. So, Mike will understand that I am laughing with him not at him.
 
Plexiburg said:
Yes, that was insensitive of me, after all I remember the joys of my first three weeks of recovery from a BTKR like it was yesterday: week #1) six units of blood and five days in a drug haze, week #2) weaning off morphine, my first stool and nights without sleep, week #3) the crushing pain from my legs, nights without sleep, oh yeah and some crazy person from PT trying to put the idea into my head that I was going to walk again someday. Skip ahead a year and three months: Staph infection, exlpant, cement spacer, leg immobilizer, picc line, excruciating pain, no sleep, and a eight week waiting game before they will even consider putting an implant back in. So, Mike will understand that I am laughing with him not at him.
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My last post, guys. Saw this and had to let you know it was OK. I fully understand. No offense was taken. Your experience sounds absolutely grueling. I have been lucky so far. Will keep you in my prayers.

Mike
 
I think we are both angry right now, nothing wrong with that given the over all intensity of this procedure. It's healthy for this site to have a little attitude once and a while instead an endless stream of zealously happy and overly affirmative emoticons. Am I the only one who finds the 'dog licking face' emoticon to be stomach turning? Am I making friends or what. :cheers:
 
Plexiburg
Sorry from here, as well. No offense meant. There aren't many men on this forum (why is that?), so I try to at least be friends with the ones that remain.
Your experience has been grueling, no doubt. An infection of the new joint is a terrible thing. I worry about it, as well, since I am going to be having 11 teeth extracted soon. I'm going to be hitting up the Amoxycillin big time, taking no chances!
I wish you the best of luck and hope you get through it as pain free and quickly as possible. I'll post again over on your thread.

Roger
 
Hey guys! It's all OK.

This is a tough recovery and everyone is entitled to crack up at times. Throw a wobbly, pack a sad, spit the dummy - whatever! This is a place where we understand. Most of us have "lost it" on occasions, too.
 
Plexiburg I had my left knee replaced August 30, 2012. So I am almost at 11 mos out. There were some who went thru the tkr the same time frame as I did that were much like you mentioned, "Oh I walked .... miles today", and I did this and I did that. Used to drive me nuts! I remember these folks just going on and on about all the could do, and feeling like I was such a failure for not being at the same level. Thanks to a few of the leaders on this forum, who reminded me that I was doing just fine for the stage I was out. With this surgery, some do wonderful from the get go, and a few of us have added challenges. I am proud Mike is doing so well, and he doesn't seem to be going all over other peoples post, bragging about it. Just sharing on his post, how well things are going. Hugs!
 
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