Lounge Doctor

TKR Stiffness - hard to do exercises

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
You are correct, your PT is using scare tactics, whether she realizes it or not.

Here is why we recommend being careful with PT and painful exercises. The following was written by Josephine, our former nurse director, who has since retired:

I would however, put in this warning about too much PT/physio done too aggressively and especially that causing excessive pain. What this does very effectively is cause the tissues to become over warm and even hot. (though a warm knee during recovery is normal and a sign of healing). This I am referring to is excessive heat. This means that the structures are becoming dry within and dry structures (muscles and ligaments) will get stuck together, resulting in the dreaded adhesions (image below)! So when you find yourself questioning the BoneSmart suggestions of rest and gentle exercising, remember that this is what we are trying to protect you from!

This was taken from the following article from the Bonesmart library:
 

BBCG

FORUM ADVISOR
Forum Advisor
Joined
Aug 6, 2016
Messages
870
Age
70
Location
Eugene Oregon
Gender
Female
Country
United States United States
Hi @LINYKnee,
So, first knee I did a few weeks of aggressive PT and my knee took FAR longer to heal! I couldn’t drive for 8 weeks, I took way more pain meds. Second knee, after finding Bonesmart, no PT for a week then I only allowed gentle PT or I cancelled subsequent sessions! I did indeed cancel a week of sessions. Then, I went to a completely different PT who did it my way!

It sounds to me that you are permitting aggressive PT that is not in your new baby knee’s best interest!

What about cancelling the next week-10 days of sessions to see how you progress if you listen to what your KNEE wants to help it heal? You CAN do that! Everything I have experienced and heard says your PT IS just trying to scare you into doing their protocol! It is ONLY a protocol and not a good one at that, I think. I’ve heard the schtick, of course, too!

I was also threatened with a MUA in 2016, but when I stopped allowing aggressive PT, the swelling inside my knee and above the knee went down, the pain got much better, AND the bend got better!

PT protocols are made up by mean-spirited people I think! You CAN say no to PT and you will do great!! Others here have done so….

Think this through, because you could have a far less painful, easier, more restful and caring recovery than you are currently allowing. IT IS YOUR CHOICE!

Just trying to help you avoid the pain of what you’re experiencing and I do know that no PT works very well too!
 

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."
It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!) :egypdance:
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" :yes:

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. :happydance:
 

Mrty2019

member
Joined
Oct 21, 2019
Messages
175
Age
69
Gender
Female
Country
United States United States
@LINYKnee I can now put the ankle of my surgical knee on my left knee which allows me to put on my shoes and socks without my husband’s help. This is all with gentle exercise. Two years ago when I had aggressive PT on my left knee, it was months before I could do this. Just saying…
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
Thank you for your response. Hopefully I will get this going without pain. Serious pain any way.
it’s a process
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
Hi @LINYKnee,
So, first knee I did a few weeks of aggressive PT and my knee took FAR longer to heal! I couldn’t drive for 8 weeks, I took way more pain meds. Second knee, after finding Bonesmart, no PT for a week then I only allowed gentle PT or I cancelled subsequent sessions! I did indeed cancel a week of sessions. Then, I went to a completely different PT who did it my way!
Thank you so much for all your advise. Inwill
Take this info with me moving forward. Thanks for sharing.
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
@LINYKnee I can now put the ankle of my surgical knee on my left knee which allows me to put on my shoes and socks without my husband’s help. This is all with gentle exercise. Two years ago when I had aggressive PT on my left knee, it was months before I could do this. Just saying…
That’s great. I hope I get there some day with pain like I’ve had. Thank you again
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
Hello, thank you.

is the extreme tightness around my knee normal and is caused by PT or just the healing process ?
thanks
 

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
The extreme tightness is all of the above. It’s painful because:

1. the surgery cuts into your leg and disrupts everything inside.

2. The wrong kind of PT, adds to that pain.

You can’t avoid the first kind of pain, but you can avoid the PT pain by refusing to let the PT do the things that cause you additional pain. You have the right to tell the PT you won’t do everything they want you to. It’s a matter of consent.

Saying no to therapy - am I allowed to?
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
What about Scar tissue forming if you don’t do enough PT due to pain or swelling ?
which is all I’m hearing about.
 

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
The “Scar Tissue” they are threatening you with does not form from not doing enough PT. However, it can form from doing too much PT.

Read again what I posted to you earlier:

You are correct, your PT is using scare tactics, whether she realizes it or not.

Here is why we recommend being careful with PT and painful exercises. The following was written by Josephine, our former nurse director, who has since retired:

I would however, put in this warning about too much PT/physio done too aggressively and especially that causing excessive pain. What this does very effectively is cause the tissues to become over warm and even hot. (though a warm knee during recovery is normal and a sign of healing). This I am referring to is excessive heat. This means that the structures are becoming dry within and dry structures (muscles and ligaments) will get stuck together, resulting in the dreaded adhesions (image below)! So when you find yourself questioning the BoneSmart suggestions of rest and gentle exercising, remember that this is what we are trying to protect you from!

This was taken from the following article from the Bonesmart library:
 
Last edited:

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
I cannot explain it any better, or try any harder to convince you. You will have to decide what you are going to believe.

It is a long journey but if you stick with the BoneSmart approach the journey will be less painful and you will still reach the same final destination. Ultimately you get to choose the path, the tough rocky road through painful PT, or the BoneSmart path through the meadow with the pretty wild flowers. :flwrysmile:
 

Jockette

MODERATOR
Moderator
Joined
Aug 29, 2017
Messages
26,717
Age
65
Location
Delaware
Gender
Female
Country
United States United States
I have one more point to make:

Common sense says you don't push inflamed and painful tissues when they are in that state. You do whatever you can (rest, ice, elevation, pain meds) to get the inflammation and pain under control.
 

sistersinhim

MODERATOR
Moderator
Joined
Dec 4, 2015
Messages
24,783
Location
Virginia
Gender
Female
Country
United States United States
Let me add my experience. I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.

Scar tissue is what is holding your knee together. Adhesion is completely different than those.
The scar tissue (which is more correctly called adhesions) is very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

I will give you this article again in case you missed the one Jockette left for you. This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
Hello Everyone ,
I want to thanks those who had giving me advice about PT.
I have a new therapist ( the 3rd one in 2 weeks ) that gets it. He understands how to give you treatment without mangling my leg as if I was a wild bronco. It was an absolute pleasure today. I left feeling great, physically and mentally. I was over the moon and looking forward to my next visit.
it’s true what you’ve all said about finding the right person ….. and I am blessed I did. So , don’t settle. There are good therapist out there. Just may take a little to find them.
Thanks for everyone’s help. You all educated me and I hope anyone else in this situation does not settle for abusive treatment.
Have a nice evening !
 

Jamie

OneStep AMBASSADOR
Senior Administrator
Joined
Mar 24, 2008
Messages
66,076
Age
73
Location
Kansas
Gender
Female
Country
United States United States
OneStep Ambassador Icon
Good job hanging in there until you found the right therapist for you. It sounds like you are finally on a good path to recovery. I'm looking forward to reading more about your progress.
 

Cstucky

junior member
Joined
Nov 16, 2019
Messages
47
Age
74
Gender
Female
Country
United States United States
LinyKnee,
Regarding the Tylenol you’re using. I had TKR on 11-16 and only took one pain pill. I’ve been fortunate to be able to control the pain with Tylenol too. Good luck with your recovery!
 
OP
OP
L

LINYKnee

junior member
Joined
Nov 22, 2021
Messages
62
Age
59
Gender
Male
Country
United States United States
Thank you all very much
Right therapist makes a world of difference.
yes the Tylenol’s 650, over the counter are GOLD !!
they work great !! Good luck everyone
 

New

OneStep App

BoneSmart #1 Best Blog

Staff online

Members online

Forum statistics

Threads
58,111
Messages
1,479,312
BoneSmarties
35,632
Latest member
Rosamund Doudna
Recent bookmarks
0

Top Bottom