TKR Two Steps Forward, One Step Back

[referee54]

@referee54--I'm not very excited about being without a PT. Now I have to find another and am not sure how to go about it. I've only had two experiences with PT, and they were both rather unpleasant. There was little or no discussion as to my (or anyone's) expectations. Once the routine begins, the pulling, pushing and bending seems to get out of control... for me, at least!

Please understand that the PT works for you---and you do not have to do everything that the PT tells you to do.

Please be our own advocate and set guidelines and borders as to what you will do and what is unacceptable. I was pretty lucky, in that the PT center that I went to had two sets of PTs---one for "athletic" injuries and one set for joint replacement injuries. The two never crossed their patients. Mine were very careful to never let me work too hard---if I was going in that direction, they would quickly reign me in.

The PT's does not order you to perform exercises or stretches---if you feel pain or that you are going too far, stop. Too often, the patient believes that the PT is the boss---the patient is the boss; it is their body and their recovery.

 

[referee54]

I'm still extremely nervous that I'm going to end up getting their usual, painful routine and not being able to intervene.

Simply speak up and assert yourself; they listen to you; if they do not, move on and find another PT. Remember, you are paying them (well, your insurance is) and they work for you. If you do not like the way that they operate, fire them.

 

[Baystater]

My RTKR was three days after your's so we are at about the same point in recovery. Like you I did not have full extension prior to surgery and limping was a way of life. My OS told me that the best thing I can do is put my heel on an ottoman while sitting watching TV, with my knee over the "gap" between the chair and ottoman and allow the natural weight of the knee and leg to pull the knee downward. Hold it as long as I can as long as it isn't too uncomfortable. I am not at zero yet but I can tell it is straighter by the day. It's still early in the recovery but already I see a vast improvement - my hunch is you will too.

By the way, even if you get that full extension you might find yourself still limping. A good PT can help you correct that. Limping is a learned behavior and we have to reteach our brains as well as our joints. When my daughter was very little she developed juvenile rheumatoid arthritis in her knees. Once the inflammation was controlled she still walked like she had 2 wooden legs, so I had to take her to a pediatric PT for multiple sessions. She is now 26 and has a nice graceful gait!

 

[60mom]

I actually told my OS I thought my PT was too aggressive and he referred me to the one I changed to. I told her up front I felt my MUA was a result of too aggressive PT and she agreed with me. Some OS have the same mentality but I think many understand there is a happy medium with PT and if too aggressive it causes more issues so your OS may actually be able to help but if not I would call around as ask first if they would be willing to work with you and respect your wishes for gentle PT during your recovery.

 

[My way]

I'm waiting for a bilateral replacement and decided to ask my PT what his post op approach was before hand. I was very happy to learn that he feels PT after knee replacement should never hurt! It causes more harm than good. I'm happy I don't have to find someone else. There are gentle PTs out there and I'm sure you'll find the right person for you soon.

 

[Josephine]

You don't actually need a PT. It's perfectly find to do it on your own at your own pace. Here in the UK, we don't have PT like you guys do and I can tell you that our rate of MUA is much, much lower than in the US. You can follow this Home physio (PT) and activity progress: suggestions and do it on your own like we all did.

 

[maryo52]

I agree with Josephine totally. When you think about it, why do we need a PT? For those who need guidance I can see a reason. But you know what you need and have the motivation. Go solo!

That's what I did. Same thing: by the time I said stop, often they had gone too far. It makes you lose trust in them. My own routine worked beautifully.

 

[Florida 1]

I went to aqua therapy once my OS cleared me to go in the pool. I loved it! See if any of your local places offer it. If not, I would either do it on my own or clearly ask potential PT's what their philosophy is in dealing with TKR's. When I brought up the subject with mine after a few weeks (I was doing land PT as well), my PT felt she was in the category of "there's a time limit, so we have to push at time to make sure you get there". However, her idea of push and mine are two different things - she never once pushed me or hurt me. Only got me to the point of discomfort on occasion. (But I found out some of her other patients felt that discomfort was going too far!?)

 

[referee54]

limping is a learned behavior and we have to reteach our brains as well as our joints

There is a saying in athletics and in officiating that "mechanics is muscle memory." This is also the case with limping and the post-TKR recovery. You have to relearn and re-each your body to walk without a limp. You have to make a conscious effort to walk without a limp. It takes practice to change what has been going on for years, but it can be done!

 

[Nyland]

So, true! ^

 

[1ELISEA]

@nlthomp
This question comes up often and illustrates the difference in people and healing.

And there is no need to put up with guessing or hoping that a PT listens; it takes work to find one but it is doable. Approach it as if this person is going to work for you and you are interviewing them for a job.

I am one of those who found my physical therapist priceless and worth more than I can measure.

I can't even imagine making the progress I did without her assistance. She offered lymphatic massage to help with swelling, easy stretching and massage to help my ROM when my OS had me non-weight bearing, thought of unique exercises when I had horrible tendon issues, and on. Much much more than working exercises on my own.

To your question, how to find a physical therapist, I did provide some insight on a post HERE.
I interviewed several and went with one who owns her business, and has several other PT's that work with her. She is the best!

Wishing you the best in locating a PT that will be encouraging, healing and knowledgeable!

 

[Josephine]

I didn't say PT wasn't necessary, I said A PT wasn't necessary. We don't get any really in the UK and you know what? Our MUA rates here are a fraction of what they are in the US!!

 

[forevergimpy]

Josephine :iagree: that distinction between needing physical therapy and needing a physical therapist is an important one to consider! I am so lucky to have a wonderful group of therapists that provide me their expertise in exercises and stretches, but allow me to control how far to push myself and my knee. I am one of those that without the guidance and support of others, I'd probably just sit here in my comfy clothes and do very little ever. I've never been known for my physical prowess !

If I were to be looking for a new therapist I would want to know if they are experienced with TKR recovery. I would also ask if they felt that there was a magic time frame to gain ROM after surgery or if it was dependent on the patient and the knee itself.

Good luck in your hunt!

 

[Josephine]

I've never been known for my physical prowess - I'd probably just sit here in my comfy clothes and do very little ever.

Me neither and that's about all I did but I got there just fine with what I did do! You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[forevergimpy]

Josephine, oh I have read your story and you are such an inspiration! You did more on your first day home than I did yesterday (on my 1 month anniversary)!!

You are 100% correct that the activities of daily life are certainly exercises on their own account!

 

[nlthomp]

Hi everyone--I can't thank you enough for your valuable advice. I was reading like crazy up until the point we had to walk out the door and meet the new PT. I am not a very assertive person and at times, have trouble expressing my needs. Guess you'd say I'm a better listener. Lol. But, in this case, so many of your suggestions and experiences were fresh in my mind that I found myself walking in feeling completely confident. After all, it's my knee!! Right 1ELISEA? Your therapist sounds wonderful and the information you provided was very helpful in my interview. Thank you!

I totally agree with DelawareGirl57, Jaycey, maryo52 and 60mom. You definitely do need to be your own advocate. It's difficult, though, because I'm not sure exactly what to ask for at three weeks PO. What I've learned on this site within the last few days is invaluable. I had no idea your OS could write a Rx for a particular type of PT. Definitely something to fall back on if need be. I love the idea of aqua therapy, Florida 1! Something to look forward to down the road. It sounds like heaven. Enjoy!!

Wonderful advice, challenging recovery. Putting in the effort is key. No one else can do it for you, as illustrated by @Josephine's recovery. You are a true inspiration to all of us. Much stronger than I could ever be! Had to laugh at forevergimpy "I am one of those that without the guidance and support of others, I'd probably just sit here in my comfy clothes and do very little ever. I've never been known for my physical prowess:heehee" Boy, can I relate to that!!

After spending 1 1/2 hours with a dedicated and caring PT yesterday, I returned home with a much more positive attitude. She interviewed me and I came right back with a list of my own questions, many of which were suggestions from all of you. We discussed her "mantra", which is very similar to that of BoneSmart. I received my first knee massage and boy did it feel wonderful!! I'll be going twice a week to start and working at home on off days. I can't thank you all enough for helping me through this. At times, it's such an isolating feeling, but I can now say that I'm truly looking forward to my next session

 

[nlthomp]

Hello referee54!! Thanks so much for checking in. Your words of wisdom sure came in handy during my interview. See? I said "my" interview. Lol! Armed with the knowledge and confidence required to be my own advocate, I found myself asking lots of questions and being upfront with my view on PT. After a long discussion, many strength and muscle-related tests, etc., I walked out of the office feeling very hopeful. Thank you so very much for your time and valuable suggestions. All the best to you, my friend!!

Nice to meet you, Baystater ThanksVM for writing. Sounds like our situations are quite similar. I too, hang my heel off the end of a chair and find it is helping. With a little help from my PT yesterday, I actually felt the table under my knee for the first time in almost a year. Your point on continuing to limp after regaining extension is a valuable one. I hadn't thought much about it, but you're right. After doing something for such a long time it becomes the norm. That must have been very frightening having your daughter develop juvenile rheumatoid arthritis! The good news is the happy ending Ill be checking in to keep track of your progress... maybe we can help each other along. All the best to you

 

[nlthomp]

Sorry, I didn't see your comment, My way! Thank you for the kind feedback. I wish you all the best with your BTKR. Great idea speaking to your PT beforehand. Sounds like you're on the right track. I'll be looking forward to reading about your progress. Take good care

Hi Nyland! Hope you're having a great day

 

[Josephine]

Jolly good!

 

[pdx]

I'll second the aqua therapy recommendation. If there's a warm-water pool where you live, so much the better (so says me). The Arthritis Foundation trains instructors, and their classes focus on range of motion, balance, strength -- I just love them. Perhaps you can find some in your area; Google Arthritis Foundation. And good for you for finding a more compatible PT person. You'll do fine.