TKR Yoga post TKR?

[teacheri35]

I am at day 8 post op. 2 pt sessions down. Greatest hurdle has been heel slides. Despite appropriate pain med use, I am struggling with day after PT swelling and subsequent pain. PT 'listened' to my concerns about pain on PT day 2, yet pushed beyond pain threshold to bring.me to tears. I have fabulous extensions (-2) and was about 60 on natural flexion and 75 forced flexion. My quad is not firing consistently. I have a very high pain tolerance, yet the pain is breaking through. Afterwards, I use R.I.C.E. and just try walking hourly. After day 2, I have swelling and deep leg pain in calf and thigh. PT asked me to focus on flexion using strap to pull ankle to hip when laying belly down. Attempted that last night and made it 30 seconds, but pain was so intense once I released it took five minutes to roll to back. I know tkr is not easy ( like rotator cuffs- I have had 2), but the pain is beyond me.

 

[sistersinhim]

@teacheri35, welcome to Bonesmart! Which knee did you have replaced? Was it on November 2, 2023?

Your PT is way too aggressive for a joint replacement. You need to ask for someone trained in the latest joint replacement recovery methods.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these:
the BoneSmart view on exercise
BoneSmart philosophy for sensible post-op therapy

5. At week 4 and after you should follow this
Activity progression for TKRs

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post-op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here

Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[teacheri35]

It was my right knee. Dr prescribed pt for 4 weeks. I explained to the pt that I wanted to use pain to guide my work. She said she agreed, but told me to do 10 more.

This is so hard.

 

[Jockette]

I’m sorry you are getting such aggressive PT. This is not appropriate and you can choose not to have PT yet, or at all.
Saying no to therapy - am I allowed to?

We have members who do no PT, they just use their knee as it was meant to be used, in their daily activities, and they have far less pain than those who have PTs making them do things their knee is not healed enough to do. One such member is @sistersinhim .

Another member is @Nivea Here’s her thread if you’d like to read it:

TKR - Second Knee Replacement Done

I did well yesterday. Was at the hospital at 5:30 and went back to get the spinal at 7:27. I don’t remember anything else, don’t remember the doctor finishing the epidural. Next thing I remember, I was in recovery. I was there for about 2 hours and then to my room, My husband and...

bonesmart.org

 

[Susie-Q]

She said she agreed, but told me to do 10 more.

If you are going to continue to see this person, remember you have every right to say NO to any exercises beyond what you think your body can handle. There's plenty of time to do them later. Maybe she needs a gentle reminder that you are in the healing stage and not the training stage. Also, please don't force your knee with a strap! Gentle heel slides are enough after you've recovered from this latest session.

 

[mendogal]

Many surgeons have no idea how variable individual PTs are! I was very lucky in that before both my TKAs the entire ortho team (surgeon and 2 PAs) insisted that in the initial weeks "Less is Better!"

I figured out my best regimen for the first several weeks based on their handouts and after some over aggressive PT on my first knee:
walk every hour;
do the ankle movements to promote circulation;
do some quad sets (like a half dozen at a time) not to build strength but to help wake up the quads;
do very light range of motion without stretching - just staying within your comfort zone - using your hands to support the joint as it slowly moves.

When you experience pain or overdo things, it creates more swelling, which further limits your range of motion... so a PT who forces your bend or stretch is actually creating a problem and impeding your healing.

 

[sistersinhim]

Jockette is correct. I'm one of those who never took formal PT. Due to birth defects, I've had 12 knee surgeries, 2 of them kneecap removals, and 1 TKR. Even after these 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 increasing 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. Doing too much too soon causes setbacks because your knee has to heal from the inflammation caused by the exercises before it can get back to its normal, after-surgery healing.

 

[teacheri35]

Dr changed pain meds and added celebrex. Will definitely rest a lot until pt next week.

 

[benne68]

Will definitely rest a lot until pt next week.

I'd encourage you to postpone PT until you are healed a bit more. I sounds like your knee isn't ready.

If you decide to have another session with this same therapist, please know that pushing yourself into pain is NOT going to help your recovery. In fact, it will cause more swelling which will restrict your bend even more.

Please read these articles before you do any more PT:
Myth busting: no pain, no gain
BoneSmart philosophy for sensible post-op therapy

 

[teacheri35]

So, I think I am going to postpone further pt. I have new meds, so after testing out those meds I will give my body a week and start again after we reassess.

 

[sistersinhim]

You will do fine just doing your ADL, (activities of daily living).

 

[teacheri35]

Today is RICE and move gently. I am curious about a problem with elevation. My knee has full extension at -2. When I elevate the hyperextension cause back of knee to make contact despite staggered pillow stacking per Bonesmart. Also, elevation as suggested causes hip pain. The hip pain requires icing alternated with heat. Any suggestions?

 

[Jockette]

I had trouble elevating in the early days also. Alternate elevation with not elevating. Any time I was not in bed, I was sitting on my couch with my leg on an ottoman, as having my foot on the floor was very painful. In these early days it’s hard to find a comfortable position. Just do the best you can. There are no rules!

 

[benne68]

I second Jockette's comment. It's trial and error.

While I didn't have an issue with hyperextension specifically, it seemed as though no matter what I did with my leg, something else hurt!

Just keep trying different positions and different elevations until something clicks.

 

[teacheri35]

Thanks

 

[eaglemom]

You have received very sound advice. No PT person should push a patient to tears. Equally no PT person should lay a hand on a patient and use force. But it happens all the time. Your insurance is paying the PT, so they are working for you - you are in charge. If you have to tell them no, then tell them no.

I've had multiple knee surgeries, but my last one I was determined to do absolutely no formal PT. For some reason my insurance determined that I had to have PT. When the gal came to the house she was slightly distressed that I wasn't thrilled to see her! I explained that I was in charge, she would not touch me ever and all we would be doing was heal slides, some slight stretches and walking. She was not happy, went on & on so I said she could leave and I'd have another PT come. She certainly didn't like that. I told her she was being paid to be my buddy for 1.5 hrs. She kept coming but each time she tried to convince me how wrong I was - until one day I'd had it with her. I was in my jammies, in bed with elevation & the ice machine. She looked at me & I simply said "I'm in charge, pull up a chair because I'm not moving out of this bed today. We'll just talk." She stood there a moment and said yes, if that's what you want - and never questioned me again. Your in charge.

 

[teacheri35]

Day 10. Quads are firing better. Swelling still restricting bending. I am going to continue the gentle approach. I did a shallow leg epsom salt soak with hot water below the incision. My legs enjoyed the soak. I still struggle with elevation methods, so the nights are rough around 3am. The reinforcement found here is a comfort. Thank you for firming my resolve.

 

[sistersinhim]

I did a shallow leg Epsom salt soak with hot water below the incision.

Please be careful to not let any liquid get on your incision before it is completely healed. You don't want to introduce bacteria to your newborn knee!

 

[teacheri35]

Of course. I cover with press and seal and keep water below incision. The incision stays completely dry.

 

[sistersinhim]

Yay! Smart move!