TKR Three weeks post op, so glad I found this forum

[woodsidequeen]

Thanks all. I plan on having a strong talk with the PT tomorrow. And of course will let the surgeon know as well on Wednesday at my first post-op visit. Today is the first day the knee is starting to feel a bit better since PT bent the knee 4 days ago. It certainly was a setback and I have learned a hard lesson.

 

[referee54]

I am glad that you are beginning to feel better.

We here at BS semi-jokingly write that the knee is actually in charge of recovery, but in reality, you are the knee's spokesperson. You need to be more assertive (which admittedly is difficult to do) when you deal with your PT's. Tell them in no uncertain terms what you will accept and what is unacceptable, and do not let them sway you.

 

[woodsidequeen]

Knowing that I am in charge - I get it. I will be 6 weeks tomorrow. Last week I pushed myself to finally get rotation on the bike. Just wondering if it is too soon for this rotation?

 

[referee54]

Last week I pushed myself to finally get rotation on the bike. Just wondering if it is too soon for this rotation?

Do not push---take it easily and take it gently. As Josephine has pointed out many, many times, recovery is not something that you work at---it is something that just happens.

I am not saying that it was too early; what I am saying is let the recovery come to you---do not try to rush things.

 

[woodsidequeen]

I am so worried. Is it possible for aggressive physical therapy to injure the new knee? I woke up this morning and can barely walk (I had the PT bend my knee from 95 (on my own) to 110 last week and have been in pain ever since. The pain is to the inside just below the patella and running across, not up and down. I am scheduled for an xray and surgeon visit in 2 days. Would the surgeon be able to tell I there is a break or a bone cement loose?

 

[Celle]

Yes, aggressive PT can cause your soft tissues to get upset. They get swollen and inflamed and this can slow down your recovery. That's why we always recommend this (from the mantras):
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

You've found out for yourself that pushing and hurting your knee is bad.

Try not to worry too much. I doubt that you've done anything as serious as loosening the implant or breaking anything.
What you need to do now is stop the PT until everything has settled down, and then insist on only gentle therapy and no pushing.
Spend almost all of your time on trying to calm down those irritated soft tissues, so do as much of this as you possibly can - rest, elevate, ice and take your pain meds by the clock.

There's no need at all to rush to get ROM, because it can continue to improve for a year, or even longer, after a TKR. There's no deadline or "window of opportunity".
Myth busting: the "window of opportunity" in TKR

 

[referee54]

I am so worried. Is it possible for aggressive physical therapy to injure the new knee?

The implant itself---I strongly doubt it---those implants are very, very sturdy and strong.

As Cell stated---

Yes, aggressive PT can cause your soft tissues to get upset. They get swollen and inflamed and this can slow down your recovery.

I agree---I would have to say that your PT pushed waaaaaaaaay too hard and caused the soft tissue to become seriously inflamed.

Keep icing and elevating and resting it.

 

[kneeper]

Sounds like the knee needs to take it very easy after that over aggressive PT. just gentle motions until you see the OS and like others have said, be sure to mention how the PT hurt you.

Once you've got a rotation you've got it. You shouldn't have to "force" it. But it may not be easy at first. I sometimes had to warm up a bit just rocking back and forth before I tried a full rotation for the first week or so after I first got a full rotation. That's ok. Pretty soon it will get easier.
Right now the knee is probably suffering from being "forced" by the PT so it may be a bit swollen and not able to do the rotation. It will come back though.

 

[woodsidequeen]

Went back to PT today and told the therapist what had happened since his force of my knee. His answer was that they try to push the ROM once a week a bit harder so that you can get the ROM that the OS requests. I have no idea that my OS state a required ROM, certainly not to me. Thanks all, I will let you know what the OS says! I go to him day after tomorrow,

 

[referee54]

There is no window for ROM, and regardless of what the OS and the PT says, it is your knee and they cannot do anything to you unless you let them.

Everybody recovers at their own rate, so do not worry about it.

 

[Celle]

There's no need to hurry to get ROM. Your knee is doing OK, so let it take its own sweet time.
Your PT has an agenda, but it doesn't have to be your agenda too. Don't get sucked into the numbers game. What you can do with your knee is more important than an arbitrary number.

You might like to read these articles again:
It's never too late to get more ROM!
It's worth the wait for ROM

 

[referee54]

Your PT has an agenda, but it doesn't have to be your agenda too.

I agree---it does not have to meet his expectations.

Don't get sucked into the numbers game.

Numbers are important to the PT's, as they tend to be a very quantitative lot. Numbers and dates and goals. As long as you, in the end and being fully recovered can do what you want and do it pain-free---numbers mean nothing,

Another point that the PT's do not think about is that this recovery is not linear---you do not always progress---sometimes you take stow or three steps forward, hit a plateau, or slide backwards a little bit. Do not let anybody push you into doing something that will hurt you now or down the road. This is much lile a marathon, so it is nor a sprint. Take it easy and be prepared to move slowly and gently.

 

[karol723]

@woodsidequeen, Pushing too hard only sets us back. Had my 2nd knee done on Dec 7th. Only started back & forth motion on bike at pt yesterday. I learned last time that it will happen in its own time. One day I was able to do the complete rotation-yipee!!! Just try to be patient with the process, I know its difficult. My other knee was done in Feb last year. I was just starting to feel almost normal again when the other knee went Sometimes feel like this has been going on forever. Hang in there, it will get better in time. I am still taking Tramadol every 5 hours, hope I can cut down soon. After you still on pain meds, or just aspirin at this point ? Stay well.

 

[kneeper]

Went back to PT today and told the therapist what had happened since his force of my knee. His answer was that they try to push the ROM once a week a bit harder so that you can get the ROM that the OS requests. I have no idea that my OS state a required ROM, certainly not to me. Thanks all, I will let you know what the OS says! I go to him day after tomorrow,

There's testing your limits and then there's hurting the patient. :(

 

[woodsidequeen]

I had my surgeon visit yesterday and he was not happy that the PT pushed my after his explicit prescription to not do so. He said the fact that he didn't warn me what he was going to do was unethical at the least. OS said now I have to heal the damaged tissue. He was pleased with my progress and said 90 degrees was great at 6 weeks. Gave me a new prescription for therapy and it spelled out gentle and at my own pace. He asked if i had a bike at home and so i ordered one to use at home. I am still in pain and still walking with a limp - just like i was back at week two. I wonder how long it will be for all of this to heal. I am considering calling my OS to ask him to look at the x-ray he took yesterday to be sure there is not a fracture in my shin - it feels like shin splints. I had a meltdown when I got home, crying. Took a Percocet and a nap. I have now hung the Bonesmart Mantra on my wall as a reminder. My friend who is 2 weeks ahead of me same OS, told her PT what had happened to me and her PT said, "Oh we push for ROM all the time". My friend told her that a week later I am still in pain and her PT said, "Really, that shouldn't be". What is with these therapists? What is the point? And they all seem to have learned different things in school, none seem to be consistent in their therapy.

 

[woodsidequeen]

Has anyone else been injured by a physical therapist by having them push you too hard.

 

[referee54]

I am glad that your OS was able to reassure you about things. I honestly believe that there is nothing wrong with your implant. They are really strong, but the soft tissue around it is most likely very inflamed and will take some time to "calm down"----in the mean time, take it easy, ice, rest and elevate and let the soft tissue around the knee calm down and heal.

I am not sure why PT's treat TKR folks this way. I do know that at the PT center that I went to, there were two sets of PT's---one for the "athletic injuries" and one for the "joint replacement" folks like me. The two groups never crossed patients.

I think that some of the PT's (yours, especially) treats all surgeries the same---which is definitely not the case. This TKR recovery is dealing with a knee that has had two bones sawed off and the knee joint has obviously sustained major surgical trauma, so it it imperative to take things gently and slowly.

Using a stationary bike can be helpful--but right now, I would ease very slowly onto it and simply let that surgical knee of yours calm down.

I wonder how long it will be for all of this to heal.

Your ROM is great, and it is imperative to keep in mind that recovery from a TKR can take upwards to a year to be complete. My BTKR recovery took about eight months, so please be patient. One of the most frustrating aspects of a TKR recovery is how slowly things can progress---glaciers may move faster!

Patience, Grasshopper, Patience!!!

Hang in there----you just have to be patient---this is a setback that is truly temporary. Ice, elevate, rest, and do not worry about things---once the soft tissue around the knee calms down, you will be able to move slowly and gently forward---and keep in mind that recovery is not linear---it is indeed more like a roller coaster.

 

[referee54]

Has anyone else been injured by a physical therapist by having them push you too hard.

From my time here on the forum---many folks, unfortunately, have felt the pain from a PT who is ignorant about how a TKR recovery should go. Many folks have had that awful pain due to one of these PT's.

Remember, the PT works for you, not the other way around. Now that yo know that, you set the standards and do not deviate from them. You will recover and you will get your life back! You will overcome this painful incident and you will be pain-free!

 

[referee54]

Just a question---how long are you icing and elevating? How many times a day?

 

[woodsidequeen]

I was also wondering if I should go back to PT right away or wait another week for more healing. I am scheduled for today and tomorrow. I elevate whenever I sit down and ice at least 3 times a day if not more. I had been using heat (as suggested by PT) for the stiffness in the morning, which does seem to help.