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MUA Ruby's Tuesday--July 11th, 2017<

I have ended my home PT and will begin a site based program on Friday afternoon. My first consultation with th new person will include me questioning her about her philosophy and style. Hopefully, this will be an improvement . If not, I'll cease it altogether.
 
That sounds like the right approach. It might even be an opportunity for you to educate the physical therapist. I hope everything works out. Good luck!
 
Went to my site based new PT today. I shared my experiences with her about my last PT experience. She was horrified. She said the most important thing she wants to accomplish with me right now is to reduce the swelling on my entire leg. She measured both legs, and my left side is bigger, except for the calf, which she said is probably because that muscle has lost its tone or somewhat atrophied due to the fact that I've had advanced osteoarthritis for years and haven't been walking properly for so long. She showed me gentle massage to get the lymphatic system pumping in the groin area, then down the thigh and knee, always massage upwards to encourage the fluid to Move up and out. I was then given a nice big ice pack to ice up before driving home. I like her!
 
So glad you found a good physical therapist and that you like her. It is so important to have a good relationship with your PT. It may seem corny, but I like that I can trust my PT that when she puts her hands on me, she will not hurt me at all and always asks me if what she is doing is okay. You deserve to be treated with gentleness and respect. I'm glad you found her!
 
I appreciated when she said, "If a fire hosewas full of water, how could you bend it? Your knee is no different in that respect. Let's get that swelling down, and the ROM will come."
 
I ended up with a therapy intern. He was a little put off when I told him I would not allow any pushing or pulling of my leg. ( I had previously talked with the head of PT, who agreed with my rule.) it might make the therapist work a little harder to come up with ways to help you improve that don't bring pain.
My surgeon did say that when I do the exercises, to make sure I am not raising my hip to make it look like my knee is bending more. So when I work with the therapist, I bend as much as possible, but then tell him that if I bend any more, I will be raising my hip, and I know that is not a good way to do things. He can't argue with that.
 
@OJ2 , I can really identify with your "hip raising" comment - after so many years of poor ROM and great creativity in all kinds of contortions to compensate for lack of bend I find that UN- learning the hip lift to be one of the most challenging ! In really have to concentrate and focus to avoid any semblance of hip raise !
@Ruby9297 - glad to read that you have connected with a PT who can help to heal you in a humane way. Your certainly deserve it !
 
So frustrated right now! The PT clinic I go to is a very busy place, so there were no appointments available for me this week until there was a cancellation yesterday. Then I had to go to a different therapist than the one I saw on Friday. My ROM has decreased to 56, (and that was with her shoving my knee back and me having to tell her to stop it) The therapist attributes my decrease in ROM to my not doing all the exercises I was told to do. I then got the lecture/threat of a MUA and how it would put me back to square one in my recovery. So my question is this: shouldn't my ROM be much be improving rather than regressing? And what would be causing the regression? My pain level is way better, but my knee is so stiff! It was 78 when my in home PT last measured me. I feel so frustrated and discouraged. I am at 8 1/2 weeks post-op, and I want to be able to do more. Help!
 
Ruby9297 ~ did the p.t. do some massage or gradually loosening up your knee before the final measurement? i find i'm very stiff in the morning still and probably my r.o.m. is lower than after i do loosen up and then when i get to physio, i'm stiff again from the 20 minute drive. she measures me first thing, then massages, other treatments, then cold packs under and over for 20 minutes, then measures me a final time and it's always a bit better. today she even measured around my knee before and after and noted that the swelling had gone down by a centimetre or so (can't remember exactly). this morning i loosened up before physio, doing my stair lunges and practising walking up and down alternate feet. mind you, i'm 3 months ahead of you, so no comparison.

do you have any idea why your r.o.m. has regressed recently ~ have you been doing a lot of activity, on your feet too much, etc., more swelling than usual? that is good that your pain level is better than it was. i hope the p.t. didn't hurt you too much pushing your knee back. :flwrysmile:
 
Of course you're frustrated. You've been doing everything right and want to see results. A couple of things come to mind.

One is whether the measurement is accurate. Do you feel as if you've lost some range of motion? Do you find your knee more difficult to bend? Measuring flexion is not rocket science, so the measurement wouldn't be off by much unless the therapist didn't do it right. (Hate to think that way, but it can happen.)

Another thing would be if your leg was more swollen. Is that possible? More swelling would lead to less flexion.

In general, yes, your ROM should be improving. That improvement will seldom be completely linear - I had weeks where my flexion was worse by 5-10 degrees, only to improve by that much the next week. You could try some gentle knee bends at home, on your own schedule and terms, to see if a little stretching on your own can help matters along. I did lots of knee bending which in the early weeks, just never to where things hurt. But it felt good to stretch my knees a bit. Once I started walking every day, and gradually lengthening those walks, I felt less need to work on knee bends. It's something you could try.

It's petty of the therapist to threaten you with a MUA. That's something for you and your surgeon to consider, not PT. Ignore that PT and give yourself more time. You're still in early stages, and the most important thing is to give your knee plenty of rest, elevation, and ice when you're not moving around getting back up to speed.
 
My surgeon just had his assistant call me because the PT called him. The assistant asked me if I think I can work a bit harder to improve my ROM or do I need to come in sooner than my appointment on the 20th to discuss a MUA. The clear assumption here is that I'm doing nothing to improve. She didn't even ask if I'm working to improve. I did not appreciate the question because I felt as though I was being spoken to like I was a child. That never goes over well with me! I'm upset and confused. I have all these exercises to do, some of which require help that I don't have because my husband is working and exhausted when he gets home. The Bonesmart recommends no PT, rest, elevate, ice, and ADLs. What to do?

@liam2015 the therapist did massage my scar yesterday and measured before and after therapy. During that time my ROM decreased. I know they think I'm not trying hard enough, but I'm doing everything I can. I have told them that I'm not willing to be pushed to the point of having a setback like what happened to me before, and I think they're all a bit put off by the fact that I drew this boundary.
 
no matter what the reason is for your r.o.m. to have regressed, they certainly shouldn't question you in such a way to make it seem like you're not doing enough. swelling is a huge problem for many of us. that could be the reason or it could be some legitimate medical reason; otherwise, it's a mystery why this has happened. even if you did very little in the way of official exercises, normal a.d.l.'s and some walking, should improve your r.o.m. having said that, mine is very slow to improve and finally it is improving at 4-1/2 months post op. i was stuck at 90 degrees for quite a few weeks. there's another member here @bertschb, that was stuck at around 90 degrees for several months and is now doing great ~ maybe you can look up his thread to see how he managed. i am glad to hear that the therapist did massage you and measured before and after. it will be up to you if you feel you need m.u.a. after discussion with your surgeon. to regress to 56 degrees from 78 degrees does seem alarming but do you think the 56 measurement was accurate? try not to stress too much over this; i know it's hard to do. it may be a good idea to see your surgeon before the 20th if you can get in. hoping things improve for you.
 
Don't worry about your ROM. It's going to improve as your swelling goes down.
I'm not surprised it had decreased after the session with the different PT.
Next time your therapist isn't available, just give PT a miss. You won't lose anything and it won't set you back.

In reality, going to PT and doing lots of exercises is not necessary.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Any exercises that need a second person to help with them should be avoided.

It's all too easy to get trapped into thinking that the harder you work, the better the result will be, but that just isn't true for recovery from a knee replacement.
BoneSmart philosophy for sensible post op therapy
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!

Remember that, in spite of what your PTs and surgeon seem to be telling you, there is no need to rush to get ROM. There's no deadline you have to meet, because ROM can continue to improve for a year, or even longer, after a TKR.
Myth busting: the "window of opportunity" in TKR

How mean and petty of your stand-in PT and your surgeon to threaten and lecture you as if you were a child! You're not! You're a responsible adult.
This is your knee and you are in charge of it. You're the only one who has the right to say what will happen to it. Others can advise, but you can choose whether or not to accept the advice.
Saying no to therapy - am I allowed to?

I know all this must be very confusing, but your knee knows what it's doing. Listen to its messages and try to do all you can to keep it happy.

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.
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.

I didn't go to PT at all after my last TKR and my knee is great! It's strong and reliable. It straightens fully and bends to somewhere between 125 and 130 degrees - all without doing any formal exercises, but just letting the activities of daily living be my therapy.
 
Good question-- I feel like I m being attacked with scare tactics. It makes me to not want to trust anything they say. Very upset right now
 
OJ2 said:
I ended up with a therapy intern. He was a little put off when I told him I would not allow any pushing or pulling of my leg. ( I had previously talked with the head of PT, who agreed with my rule.) it might make the therapist work a little harder to come up with ways to help you improve that don't bring pain.
My surgeon did say that when I do the exercises, to make sure I am not raising my hip to make it look like my knee is bending more. So when I work with the therapist, I bend as much as possible, but then tell him that if I bend any more, I will be raising my hip, and I know that is not a good way to do things. He can't argue with that.
Click to expand...

Yes, I've been told a lot of times not to raise my hip--then stop pushing my knee past it's breaking point!


Sent from my iPad using broken link removed: https://r.tapatalk.com/byo?rid=75543

LTKR scheduled on July 11th, 2017 [emoji51]
 
@Ruby9297 Just reading about what you're going through makes my heart ache for you. I can't imagine too many things on our journey of recovery more frustrating and upsetting than what you are describing. It's very easy for us to say don't be alarmed, don't worry, everything will be all right, but I know it is hard not to be upset. You have every right to feel that way.

I agree that you should not be spoken to like a child, and I can't imagine that any exercise for you is necessary with the assistance of somebody else at this point. I also absolutely hate the idea of being threatened with an MUA. The therapist should discuss with you other possible solutions and techniques to help. An experienced physical therapist should know that recovery can take different paths. I agree you should be remeasured. I know that is a big gap in your ROM, but you never know.

I do think it's best to discuss this with your surgeon, and maybe even get a second opinion. I would also ask your surgeon how many patients he has had who needed an MUA and what their exact outcomes were.

Take heart, and stay strong. Speak up for what you want and believe in. One way or another, you will get over this bump in the road. You have many friends here willing to encourage and support you, listen to you, and give you good advice. We are very lucky to have each other.:flwrysmile:
 
Why not wait until you can get back with the therapist you liked? I bet you have more confidence in that therapist. And no patient should be treated like a child.
 
Ruby9297 said:
Yes, I've been told a lot of times not to raise my hip--then stop pushing my knee past it's breaking point!
Click to expand...
Ruby, you don't have to allow them to do that. Except for massage, there is no reason at all why the PT should even touch your leg or knee. Tell them "Hands off!" If they continue to do what you have told them not to, they are committing an assault on you.
If they start any of that painful stuff, take your leg off the table and walk away. Remove your knee from harm.

To bully you and threaten you with an MUA is completely unacceptable and also very unkind.
 
@SusieShoes I do not feel as though I have lost ROM, which is one reason why I'm so upset, confused, and frustrated with this latest measurement, and their conclusion that I'm sitting on my butt eating bon bons!
My OS's assistant called me again because our last call got interrupted by something in their office. I let her know that I get the impression that they believe that I'm not trying hard enough, and while I've been completely transparent about not being ok with being pushed beyond the point of pain, I am exercising. If that's unsatisfactory to them they have to respect my boundary. I told her that not everyone is a textbook case, and different people heal at different rates. I told her that I too am disappointed with my lack of progress because I want my life back and I want to get back to work, but right now I'm not feeling respected, and I am offended that everyone in their office has concluded that I'm not doing my part. I told her that they're not doing their part either: I can't get appointments twice a week as prescribed because they're booked up. When I can get appointments, it's with someone new every time so they're not getting to know me and vice versa. Surely effective therapy is going to occur when the patient sees someone she has some rapport with, consistently over time.

And since I began writing this post, she called again and asked me to come in on Monday to discuss a MUA because they've never had a patient doing as poorly as I'm doing. Now I'm in tears.
 
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