TKR I made it

[sistersinhim]

If I don't press through the pain am I hindering my progress? Yesterday I was almost in tears with PT trying to manipulate my knee into bending.

Absolutely not. Forcing you knee into pain is actually slowing down your healing, causing more swelling and limiting your bend because of the fluid in your knee. Can you bend a garden hose that is full of water with the nozzle closed? Of course not. Your knee is the same way. Get that fluid out by doing only gentle, non-painful movements, icing, and elevating. Don't do anything painful, that causes a setback.

. Almost everything I hear about the procedure is make sure I keep up with PT.

This is not true. Many of us here never even took formal PT. I was blessed to have a surgeon who never pushed PT. He gave me a prescription for it, which I threw away and never went. My OS never even asked about PT when I went back for my 3 checkups! Of course, he knew I was a single lady who had to take care of myself and obviously trusted that I would not be just lying around all the time.

Because of birth defects, I had to have 12 knee surgeries, so I've had lots of knee recovery experiences. I knew from these experiences that I did not need formal PT after my TKR, and neither do many others if they do their own daily activities and do not just sit around all day and night. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling or agonizing pain that so many have after taking formal PT. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[mendogal]

Pain is your baby knee's only way to say STOP!

Please don't let your PT manipulate your leg beyond very gentle slow stretches that absolutely don't hurt.

A lot of PTs don't seem to understand that a knee replacement isn't a minor athletic strain or sprain (which still needs 6-8 weeks to heal!) - its effect is more like a bad car accident. You can't promote healing by inflicting more damage.

 

[Jockette]

Yesterday I was almost in tears with PT trying to manipulate my knee into bending.

This is not appropriate “therapy“ for a knee as new as yours. Not all PTs do this, but mine did, and it was awful. It was a month before I found Bonesmart and learned that this is not necessary. Each time they cause you enough pain to bring on tears, they are actually hindering your healing. You have the right to say no to this “therapy.”
Saying no to therapy - am I allowed to?

I see my progress, my husband sees it, but it's nothing close to the expectations of my therapist.

If you, and your husband, see progress, that’s all that matters. Some PTs are not trained in the recovery of a joint replacement and they place unnecessary and unrealistic demands on patients. We all heal at different rates and timeframes, and some PTs treat us all the same. All it does is upset and frustrate the patient.

If your PT won’t back off, find another office with a more up to date, gentler approach to this recovery. We even have some members who don’t go to PT at all, and they have great outcomes.

 

[benne68]

Yesterday I was almost in tears with PT trying to manipulate my knee into bending.

Please don't let anyone do this to you. This is YOUR knee and YOUR recovery. Remember: the therapist works for you, not the other way around. You don't need to please him/her. A good therapist will never push you into pain.

You have the right to say "NO!" In fact, if it causes pain, you have a responsibility to say "NO!"

Almost everything I hear about the procedure is make sure I keep up with PT

I'm not sure where you are hearing that. Certainly not here on BoneSmart! And certainly not in the first couple of weeks when your body is still healing from the trauma of surgery.

You are only one week into this recovery -- and at this stage, you don't need to worry about anything except healing from the surgery. There will be plenty of time to work on your range of motion once the inflammation goes does.

 

[Layla]

Thank you so much. @Layla. I'm struggling with how much pain is too much. If I don't press through the pain am I hindering my progress?

No, deeni, you're not hindering your progress by not pushing yourself to pain. Actually it's the opposite. The pain will land you in what we refer to as the ODIC (Over Did It Club) likely stalling your progress. I am so sorry you were almost in tears due to pain, through no fault of yours other than believing the false narrative of "no pain, no gain". Please don't allow anyone to forcefully manipulate your injured leg. Your leg endured major trauma, in a very small area, albeit controlled. Your muscles, tendons, ligaments and other soft tissue is going to cause you discomfort and pain for a while yet. Take any prescription meds for as long as you need to in an effort to remain comfortably mobile and able to rest easy. Then proceed s-l-o-w-l-y.

Check out the first and second week of activity progression for recovery. It is all you need to be doing at this point

Week 1
Take walks around your home - trips to the bathroom and kitchen count.
Get up on your feet several times a day, A 5-6 minute walk every 3-4 hours is plenty.
Spend most of your time resting, icing and elevating in these very early days.

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes, but no need to get obsessive about it, get into too much pain, or get too tired. Stop before that point.

I hope you have a peaceful relaxing evening, deeni.

 

[MSuki]

My physical therapist has always been very adamant about bending to the point of discomfort but not pain. Also, she has made it clear that if I ever feel a sharp pain during an exercise I need to stop immediately. You may need to see if you can get a different therapist. At this point in recovery you’re already exhausted, so it’s hard to have the energy to argue with a therapist who keeps pushing.

 

[lrj]

I love going to PT! I wish I could pay them on the side as a personal trainer when I'm done with physical therapy. I do think PT is important. I started PT just 3 days out from surgery. Also nice to get out of the house regularly to go!
Pain is not ok. Discomfort is. PT should determine what they do based on feedback from you. My PT changed up exercises completely based on some patella popping I was having. They started working more on strengthening my hip muscles, and that is reducing the pop. (Surgeon said as long as there is no pain, the pop is not a problem and should resolve with increase strength and decrease swelling.)

 

[deeni46]

Thank you so much. @Layla. I'm struggling with how much pain is too much. If I don't press through the pain am I hindering my progress?

No, deeni, you're not hindering your progress by not pushing yourself to pain. Actually it's the opposite. The pain will land you in what we refer to as the ODIC (Over Did It Club) likely stalling your progress. I am so sorry you were almost in tears due to pain, through no fault of yours other than believing the false narrative of "no pain, no gain". Please don't allow anyone to forcefully manipulate your injured leg. Your leg endured major trauma, in a very small area, albeit controlled. Your muscles, tendons, ligaments and other soft tissue is going to cause you discomfort and pain for a while yet. Take any prescription meds for as long as you need to in an effort to remain comfortably mobile and able to rest easy. Then proceed s-l-o-w-l-y.

Check out the first and second week of activity progression for recovery. It is all you need to be doing at this point

Week 1
Take walks around your home - trips to the bathroom and kitchen count.
Get up on your feet several times a day, A 5-6 minute walk every 3-4 hours is plenty.
Spend most of your time resting, icing and elevating in these very early days.

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes, but no need to get obsessive about it, get into too much pain, or get too tired. Stop before that point.

I hope you have a peaceful relaxing evening, deeni.

Thank you! Today was much better. I had a different therapist who only pushed me to the point of discomfort. She said I am making great progress and am actually ahead of what is to be expected. I have one more home visit then begin out-patient therapy.

 

[deeni46]

I love going to PT! I wish I could pay them on the side as a personal trainer when I'm done with physical therapy. I do think PT is important. I started PT just 3 days out from surgery. Also nice to get out of the house regularly to go!
Pain is not ok. Discomfort is. PT should determine what they do based on feedback from you. My PT changed up exercises completely based on some patella popping I was having. They started working more on strengthening my hip muscles, and that is reducing the pop. (Surgeon said as long as there is no pain, the pop is not a problem and should resolve with increase strength and decrease swelling.)

After today, I may start looking forward to it myself. As the swelling decreases, so does my pain. I go back to the doc next week for my follow-up and staple/suture removal (not sure which I have). Thanks for giving me hope.

 

[Layla]

Hi there deeni!
I hope your follow up visit and staple removal went well, swelling continues to decrease and you're enjoying steady progress. Let us know when you have the time. Until then...all the best. Happy One Month Anniversary!
@deeni46

 

[deeni46]

Thank you for checking on me. The staple removal was a little tough, but the incision was healing well. I am progressing nicely, although the PT would like my ROM to be a little better. Week 4 and I'm at 88 degrees. The good part of PT is I determine how far to go, the therapist does not manipulate my leg at all. I went back to work last week and man what a challenge that was! I had to get used to staying up all day and get creative in elevating my leg. The good thing is it makes me take designated breaks throughout the day instead of working through them like I did pre-op. I am also "limping" unassisted, so I am getting stronger every day.

 

[mendogal]

Hi! Thank you for the update. Your flexion at one month is very good - and as you heal and the swelling abates, flexion will improve.

I'm concerned that you're walking unassisted with a limp. That's counterproductive because it throws off your knees, hips, and pelvis. It will interfere with developing a regular gait.

Please consider resuming using either a walker or a cane (cane on the non surgery side) and consciously practicing heel to toe walking.

 

[Jockette]

I’m really glad you have a PT that is not aggressive.

I agree with mendogal, (we were posting at the same time!) since you are limping unassisted you might want to use a cane for a bit longer. You are still very early in recovery and it might even help keep your pain level down. I used my cane for several months, it took a while to regain my balance and confidence and the cane helped with that.

 

[Layla]

You're welcome...my pleasure checking up on you and reading about your progress, deeni!
Thanks for taking the time to respond. Sorry the staple removal was a little tough, thankfully it's now behind you. It sounds like you have an understanding relationship with your PT, which is always an asset and you're making nice progress. I'll bet returning to work this soon does feel a bit overwhelming.

I found using the cane along with the heel-toe pattern of walking really helped me break the abnormal gait I had established even before surgery. The limping can add so much unwanted stress to the rest of the body, from ankles to your back and often causes us to favor the affected leg. Try using the cane for awhile longer and really concentrating on that heel-toe gait that, if you're anything like me, it feels pretty unnatural to get used to, but it does seem to help. Stay in touch and let us know how you're doing. I hope you have a wonderful week!
@deeni46

 

[deeni46]

I forgot to officially acknowledge that I am post-recovery. I am now 6 weeks post-recovery and had my 2nd follow-up appointment today. The doc is please with my extension and wound but would like me to further along in my range of motion. He is giving me 4 more weeks to get to 108 degrees. My last measurement was 93. He mentioned manipulation if I stop progressing. Pt is twice weekly, and I feel as if I am moving adequately. My therapist encourages me to push past what I think I can do, but fortunately he doesn't physically force me. Although I don't enjoy therapy, I no longer dread it.

Working all day still exhaust me, but I'm glad to be back. I was really bored at home looking at the same thing every day and having my husband as my only entertainment. Being around people is a definite motivator. Didn't realize how much I am not made for being home all day every day

Walking is no longer the major challenge it used to be but I am very careful when I'm outside my house. Prior to my surgery it was not uncommon for me to fall. In therapy last week I saw a lady fall while doing her exercises. I am now extra careful since I saw it happen to someone else. I used to have an intimate relationship with the floor and have decided to break up with it.

 

[Jockette]

Prior to my surgery it was not uncommon for me to fall. In therapy last week I saw a lady fall while doing her exercises. I am now extra careful since I saw it happen to someone else. I used to have an intimate relationship with the floor and have decided to break up with it.

You have a great attitude and I love how you worded the above statement.

The doc is please with my extension and wound but would like me to further along in my range of motion. He is giving me 4 more weeks to get to 108 degrees.

Please don’t let your doctor cause you stress about your ROM, you are coming along just fine. There is no date by which you must be at a certain number, and 108 seems to me to be an odd choice of a ROM number goal.

Myth busting: "window of opportunity" in TKR

This "six week window of opportunity" surgeons often speak about is little more than a myth. It presupposes that all patients have the ability to create adhesions which is far from the truth. It also ignores the simple fact that in the first 3-4 weeks after surgery, swelling reactive to the...

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I feel as if I am moving adequately.

Walking is no longer the major challenge it used to be but I am very careful when I'm outside my house.

These are wonderful milestones of recovery. You are doing very well and I’m sure you’ll continue to do so, as you continue to heal.

By the way, I‘ve moved your post above out of the Monthly team thread as we reserve that thread for surgery date information, and so members can see who else has surgery the same month. We prefer all other updates to be in your recovery thread.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?

 

[mendogal]

Your range of motion is FINE!

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[mendogal]

For both my knees, walking was the number one therapy they loved. From the first days, walking five minutes in the house every hour, through graduating to walking in the community, through progressing in increments to my current three miles nonstop, as long as I respected the knee's current time/distance limitations, my knees have been ready to walk.

Doing so mindfully, with good structure and full breathing, heart aimed at the horizon, will restore your sense of your self in space, and eventually you'll gain self confidence.

 

[deeni46]

The nerves are finally waking up and I must admit it is not a great feeling. The other evening while watching TV, I was so uncomfortable I couldn't wait to take my pants off. It wasn't that my pants were too tight, but just the mere touch of the fabric on my skin was aggravating. I'm glad the temperatures are rising so I can relax in my muumuus, caftans, or sundresses. At this point in my life, I need some kind of cover.

 

[mendogal]

I feel your profound discomfort!

Some people get Zingers! Sudden jolts of nerves awakening.

I, like you, have dysesthesia - unpleasant sensitivity that may be hot, cold, itch, pain, or hypersensitivity to touch or friction. A section of my first TKA skin often feels disturbingly as if the fabric of my pants - even soft flannel or fleece pj bottoms - is literally catching on my skin.

Here's to long flowing garments!