TKR Rehab begins!

[mopa]

I had the PT today come to the house and she did not do any pushing so I did not have any conflicts. She says my ROM is 4-86 degrees. The pain meds are causing me to lose appetite and feel slightly nauseous. I will just have to deal with that for awhile.

 

[mopa]

I have made it through the first week and see a little progress but realize this is a long trip.

I am kind of confused on the physical therapy advice. My surgeon expects me to work hard and my PT sends her reports. The PT came yesterday with new exercises and gave quite a workout. It was somewhat painful but later I had a lot of pain and just sat around with ice pack and took it easy.

I am trying to keep a happy medium of keeping the PT and surgeon happy and not working so hard I have pain. To me it makes sense to get the swelling down before doing all the stretching exercises to improve ROM. I wish everyone a good recovery with little pain!

 

[Softtail]

Mopa , it’s a tough call here about Pt verses no Pt. Many here have had excellent results by simply letting the body heal on its own time , no specific PT at all other than normal duties around the house. Some use a combo of both. In US it’s very difficult to find a doctor and or PHysiotherapist that believes you can fully recover without doing the stretching/flexion exercises , followed by strengthening the quads, obliques, and hamstring.

I for one if you read my recovery thread, like the exercises, and PT, but as a long time jock, that’s just my style.
I have a fantastic PT guy that I informed up front ( which I believe we all agree to in bonesmart) no pain approach, and so far so good. Believe me it’s not all fun n games. The PT is exhausting and I am sore afterwords, but none of the sessions has led to any additional long term pain, and Thursday evening following PT session, I was pain free from 2:30 in afternoon till bed that night. Probably a fluke, cause pain returned following day at its usual 1 to4 level. 2 steps forward one back lol.no

So, you have to pick your road and stick to it, and hope you are one of those fast healers. The unfortunate reality of it is no matter what ,this is not an overnight fix, so stay positive and committed,

 

[Jockette]

It is a balancing act, for sure. But at the end of the day, both litterally and figuratively, who is the most important person to please? You, who have the pain from the exercises, or the surgeon and PT who don’t have the pain and are only imposing their personal opinion on you.

Not all surgeons prescribe PT, including in the US, as well as other countries. @Celle ’s surgeon is one who doesn’t and she had a great outcome.

@Josephine did absolutely no exercises and also had a great outcome.

This is because:

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle,
and Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Txmomgmom3]

I had home pt and also did outpatient pt. Thanks to Bonesmart, I went in with the mindset...my knee, my rules. If I wasn't sure about an exercise I would ask this forum. While I had a good experience with pt, I have pretty much decided to forgo it this time. It honestly became a chore to drag out 2-3 times a week lol. I discussed this with my OS when we were scheduling my 2nd tkr and he was fine about no pt. He felt it might be more difficult for the left knee since it will only be 5 months between surgeries so I will just walk and get on with the ADL's.

 

[Jockette]

It honestly became a chore to drag out 2-3 times a week lol. I discussed this with my OS when we were scheduling my 2nd tkr and he was fine about no pt.

I want your OS!

 

[Josephine]

My surgeon expects me to work hard and my PT sends her reports. The PT came yesterday with new exercises and gave quite a workout.

Your surgeon can expect all he likes but the upshot is that it's your knee, your body and your choice. Legally they can't make it mandatory for you to follow these directions, specially when you know that it bears no difference one way or the other. Saying no to therapy - am I allowed to?

It was somewhat painful but later I had a lot of pain

This is what I am anxious to avoid as it's not a good thing. No pain after exercises and/or activity is a good thing.

 

[mopa]

Thanks for all the replies and input. I have thought about all this and read some more and have decided that I am not going to try to kill my body doing all these exercises that accumulate at each visit. I will work on gently stretching to increase the ROM and leave all the other exercises to wait until the healing has taken good effect. I guess the PT has to justify her job and keeps adding more exercises. I have exercised all my life and do enjoy keeping fit and feeling good. But exercise with pain to me more is like going backwards and just causes more frustration and stress. Down the road when I am feeling better I will get back to my routine of lifting weights alternating with riding my stationary bike along with knee exercises that I think are beneficial. Good luck everyone and I pray all are pain free.

 

[Celle]

It's very early to be doing exercises anyway, @mopa . I'm glad you're taking control of the amount of exercise you will do.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. We don't just lie around like logs, doing absolutely nothing.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

After my left TKR, I didn't do any formal exercises at all. I just used my knee doing my normal activities of daily living. The result was just as good as when I went to a few PT sessions for my right TKR.

I think that one reason why the PT therapists are so hung up on exercising and measuring ROM is because increasing ROM is something they can use, to demonstrate to the insurance companies (who pay them) that their ministrations have been effective.
They've been taught that the exercises are essential, and they believe that.

There's nothing wrong with doing exercises, provided that the amount and type are adjusted to each person's level of recovery, and the person doesn't experience any pain or increase in swelling, at the time or later.
Unfortunately, many PTs use a sort of cookie-cutter, one-size-fits-all, progression of therapy.
Too much exercise, too soon, causes more harm than good.

 

[Txmomgmom3]

@Jockette yea he's a keeper

 

[mopa]

It's very early to be doing exercises anyway, @mopa . I'm glad you're taking control of the amount of exercise you will do.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. We don't just lie around like logs, doing absolutely nothing.

After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

After my left TKR, I didn't do any formal exercises at all. I just used my knee doing my normal activities of daily living. The result was just as good as when I went to a few PT sessions for my right TKR.

I think that one reason why the PT therapists are so hung up on exercising and measuring ROM is because increasing ROM is something they can use, to demonstrate to the insurance companies (who pay them) that their ministrations have been effective.
They've been taught that the exercises are essential, and they believe that.

There's nothing wrong with doing exercises, provided that the amount and type are adjusted to each person's level of recovery, and the person doesn't experience any pain or increase in swelling, at the time or later.
Unfortunately, many PTs use a sort of cookie-cutter, one-size-fits-all, progression of therapy.
Too much exercise, too soon, causes more harm than good.

Tll

That really makes sense to let the knee heal awhile before all the painful movement exercises. I did a little movement today and iced it afterwards. I have some walking but that is it for today. Thanks for your story!

 

[mopa]

I am 2 weeks post op now and see a little improvement in swelling and pain tolerance. But my ROM has slightly decreased from 84* to 70* since day after surgery. My home PT therapist is concerned and started pushing me to do more stretching and walking. I will change to outpatient PT after 2 more visits from the home PT. I am familiar with the out patient PT and have more confidence in her ability. I am a little worried but this site reassures me that it may just take a little more time.

 

[Jockette]

The best ability a PT can have for a TKR patient is patience, understanding and encouragement. Other than that it is not their ability that gets your ROM back, it’s Time:

Keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

I’m sorry you are concerned your ROM is less than it was. You are in very early days and still have quite a bit of swelling. You cannot bend a swollen legs. Exercises at this point will maintain that swelling, preventing your ROM from improving.

Don’t be convinced to do more exercises right now. Instead, rest, ice and elevate to get the swelling down. Don’t think that resting is doing nothing, by resting you are giving your body it’s best circumstance in which to heal.

Many of us have swelling of various amounts for many weeks. It doesn’t go away quickly.

Patience is the most important thing we have to exercise!

 

[plaidwndr]

I feel like the PT was good for me the first few times when they were doing gentle stuff and simple motion. By that point I was familiar with it and could have continued on my own. The second week of PT they started pushing on it, and pushing me to do much more. This completely stalled my progress. I'm finally doing better again after no PT for a month.

Since then I've done a little research - From a biology standpoint it's pretty much impossible to "build" muscle while you are inflamed and swollen. It's also impossible to bend or straighten well with that leg under pressure from same inflammation and swelling. Think fire hose under pressure as others have said, not going to bend.

Because a claim got done wrong, it drew my attention to the money side of the PT game also. The billing is insane! PT places bill 350-700 for an hour. Between what you pay and insurance, they are actually getting 200-400. This for someone likely running 2 patients at once, and devotes maybe an actual 15 minutes to you in said hour.

 

[sistersinhim]

I personally think most of PT is a ripoff to the insurance companies. Many people do have great success with therapy, but I believe we go much too often and too long.

 

[mopa]

I had my first followup with my surgeon yesterday. She is not happy with my ROM at 90 degrees and said I should at least be at 100 now. She is putting me in outpatient rehab of my choice for " intense therapy" to catch up to her expectations. She wants progress reports every week and if I don't get up to around at least 114 degrees in 3 weeks she is saying she would have to do a MUA. I am at 3 weeks post up and my home PT says I am doing fine at 90 and have come along well. She had a conversation with the surgeons nurse the day before follow up and was astonished at how far they think I should be right now.

I like my surgeon and I believe she did a good job but now am wondering if I should have had her do my knee. I am prepared to decline the MUA if at 6 weeks out have not gotten to 114. I assume I may have to find another Doctor if I disagree on her plan of treatment. This has caused some stress but I have come to the conclusion that I know my body best and what should be done. I would love to hear from the forum advisors on what they think about this. Thanks.

 

[traceys]

Hi @mopa
Glad to hear you feel like things are going well. It definitely becomes a random journey (I’m at week 5) and have learned a lot about myself in this time. Trust your instincts and above all be kind to yourself when those brutal days hit. Ask questions, lots of them. There are some incredibly knowledgeable people here that are very generous with info and support!
Look forward to seeing you recover!

 

[NavyGunns]

@mopa, well at least you are correct that you know your body best and are the final judge of whether you are satisfied with your progress or not. As you said, you have the right to decline the MUA if you don’t want it or feel it’s necessary. Since you do like your OS and are concerned that you might have to find another one should you decline her recommendation, I suspect you have not had a heart to heart with her regarding your knee. When she made the statement that a MUA would be necessary if you don’t reach 114 by 6 weeks, did you ask her why? Did you explain that you felt your progress was fine, maybe slower than her expectations, but ok by yours? If the answer is no, then my personal opinion is that you need to have that conversation with her. I wouldn’t fret about it right now. Keep a positive outlook and if you feel you are making acceptable progress, then be prepared to tell her that. If she says your knee will “freeze” where it’s at, bring along some of the info you’ve received from BS to show how you know that knee flexibility continues to get better up to and beyond a year out. If she replies that she can’t continue to treat you, push her on a reason why. It would be different if you weren’t satisfied with your progress and felt that something more needed to be done, but that doesn’t seem to be the case.

 

[Jockette]

Your ROM will come along at its own pace, not your surgeon’s, not your PT’s, and not yours. (it’s usually slower than we’d like)

No one can pick a number and a date for ROM. Our knees just don’t work that way.

 

[mopa]

@mopa, well at least you are correct that you know your body best and are the final judge of whether you are satisfied with your progress or not. As you said, you have the right to decline the MUA if you don’t want it or feel it’s necessary. Since you do like your OS and are concerned that you might have to find another one should you decline her recommendation, I suspect you have not had a heart to heart with her regarding your knee. When she made the statement that a MUA would be necessary if you don’t reach 114 by 6 weeks, did you ask her why? Did you explain that you felt your progress was fine, maybe slower than her expectations, but ok by yours? If the answer is no, then my personal opinion is that you need to have that conversation with her. I wouldn’t fret about it right now. Keep a positive outlook and if you feel you are making acceptable progress, then be prepared to tell her that. If she says your knee will “freeze” where it’s at, bring along some of the info you’ve received from BS to show how you know that knee flexibility continues to get better up to and beyond a year out. If she replies that she can’t continue to treat you, push her on a reason why. It would be different if you weren’t satisfied with your progress and felt that something more needed to be done, but that doesn’t seem to be the case.

You are right "NavyGunns I did not have a heart to heart talk I just listened to what she was saying. I didn't want to get into a debate with her at that time hoping that maybe I will progress enough the next 3 weeks. I will see her in 2 weeks and will take your advice and have that conversation with her. She did say it would freeze and that I only had a little time left so I will make copies of information from this site that differs in opinion. Thanks.