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Scared of pain in PT

Posted by babette @babette, Aug 22, 2018

I'm starting outpatient PT next week ... I'll be 5 weeks out from a R TKR. Until now I've had gentle PT at home and I'm concerned about more aggressive PT being painful. I'm also concerned about it creating more inflammation and, in my case, scar tissue. Reasonable fear? Words of wisdom/encouragement most welcome!

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beryl | @beryl | Aug 28, 2018

Am I glad to hear someone say that PT SHOULD NOT HURT and a good therapist has other ways of getting the same results.....
I was a movement teacher (,Medau Rhythmic Movement) for many years in England and helped to undo people's bad movement habits by these methods , looking , seeing and listening to what the patient said.....but mostly watching and doing something that finally put that movement right or has worked towards it anyway.....Beryl

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ssbionicknee | @ssbionicknee | Aug 28, 2018
In reply to @ginaquilts "Hi @babette! My mother (now in her 80s) has had 2 TKRs. She is not one..." + (show)
@ginaquilts

Hi @babette! My mother (now in her 80s) has had 2 TKRs. She is not one for doing PT on her own, and for the first TKR skimped on the exercises unless actually done with a therapist in person. She made an excellent recovery eventually but it took longer than expected due to her recalcitrance with the exercises. For the second TKR, she was much more diligent with the home exercises and made excellent progress, especially for a person in her late 70s. She added aqua therapy for the second TKR, which she could do in her home jacuzzi, and that did wonders to keep her incentivized to keep up with her therapy.

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I would love to have a jacuzzi to sit in! My knee has been hurting lately and the aquatic center with the therapy pool is closed for 3 weeks for maintenance. It will be back open soon. I have really missed it! It is amazing to me how much better my knee feels getting the pressure off of my knees.

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ssbionicknee | @ssbionicknee | Aug 28, 2018

Hey @babette! I was wondering how PT went. Hoping it went well.

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babette | @babette | Aug 28, 2018

PT Report: Overall, it went really well! Today was my initial evaluation. The therapist did all kinds of exercises/tests to get a baseline and was impressed that my knee bend is at 111. On the other hand, my R quadricep is so weak I couldn't push against resistance. We talked a lot about my goals, which was very smart because my objective to be skiing this season is really what's driving this whole thing! I was pretty assertive about pain and he agreed that we could work "to" the pain but not beyond. He was also realistic about being sore after therapy, which is fine with me and to be expected. So, I'll be going 2X per week.

Oh, another milestone! I drove there myself, first drive since surgery and it felt great.

A good day.

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1 reply
Fjkphx | @fjkphx | Aug 28, 2018

I began outpatient rehab 5 days from left tkr. I medicate before going. There is no escaping the pain. The pt is thoughtful of my pain but pushes me more than I would normally go. She somehow got my knee to 90 degrees for a brief moment yesterday. I am more sore today. This is all a big mystery to me. Am I on target or way behind where I should be? Should this new joint be moving more freely 10 days out? I don't mean to scare you. This has been my experience and won't necessarily be yours. Interested in hearing how it goes for you and others.

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2 replies
babette | @babette | Aug 28, 2018

I can't imagine my knee going to 90 degrees 10 days post op! Then again, I can't imagine getting myself to PT that early on. I still had staples then and as I recall my in-home health care PT focused on helping my walk with my walker! I'm against aggressive PT, which is not to say I'm non-compliant. I believe that if it takes a bit longer to recover, that's just fine. The body does such a huge part of healing *on its own!*

Based on my first session (and I'm 5.5 weeks out) I'm comfortable with my therapist, but if I get too much "no-pain/no gain" vibe from him, I'll switch. I'm hugely motivated to recover, do my home exercises, etc., but there are limits.

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ssbionicknee | @ssbionicknee | Aug 28, 2018
In reply to @fjkphx "I began outpatient rehab 5 days from left tkr. I medicate before going. There is no..." + (show)
@fjkphx

I began outpatient rehab 5 days from left tkr. I medicate before going. There is no escaping the pain. The pt is thoughtful of my pain but pushes me more than I would normally go. She somehow got my knee to 90 degrees for a brief moment yesterday. I am more sore today. This is all a big mystery to me. Am I on target or way behind where I should be? Should this new joint be moving more freely 10 days out? I don't mean to scare you. This has been my experience and won't necessarily be yours. Interested in hearing how it goes for you and others.

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If I am reading what you wrote correctly, you are 10 days out of surgery and at 90 degrees. I am going to give you my honest opinion based upon what I have heard from other TKR patients and conservations between my PT and myself. I believe that I was still using a walker 10 days out and then switched to a cane. My knee was not at 90 degrees that soon, Everyone heals differently and has a different tolerance for pain. But I had a discussion with my PT about a friend who was also recovering from a TKR and going to a different PT. My friend was having trouble with bending, was in a great deal of pain during PT and after PT. This friend also felt like they were being pushed too hard too soon. My PT told me that there are many different ways of working the knee to get range of motion as well as flex back and that it did not have to hurt that bad. Long story short, my friend decided to come to my PT and found that there was a better communication with my PT and that they were no longer pushed to the point of pain. PT is not always comfortable, but it should not hurt the way you described it.

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1 reply
ssbionicknee | @ssbionicknee | Aug 28, 2018
In reply to @babette "PT Report: Overall, it went really well! Today was my initial evaluation. The therapist did all..." + (show)
@babette

PT Report: Overall, it went really well! Today was my initial evaluation. The therapist did all kinds of exercises/tests to get a baseline and was impressed that my knee bend is at 111. On the other hand, my R quadricep is so weak I couldn't push against resistance. We talked a lot about my goals, which was very smart because my objective to be skiing this season is really what's driving this whole thing! I was pretty assertive about pain and he agreed that we could work "to" the pain but not beyond. He was also realistic about being sore after therapy, which is fine with me and to be expected. So, I'll be going 2X per week.

Oh, another milestone! I drove there myself, first drive since surgery and it felt great.

A good day.

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Sounds like you are doing great!! I couldn't drive until after 8 weeks. I had to be driven. The quads really do take a while to get stronger, Those muscles really get moved around during surgery. I am really glad that it went well! 🙂

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Fjkphx | @fjkphx | Aug 29, 2018
In reply to @ssbionicknee "If I am reading what you wrote correctly, you are 10 days out of surgery and..." + (show)
@ssbionicknee

If I am reading what you wrote correctly, you are 10 days out of surgery and at 90 degrees. I am going to give you my honest opinion based upon what I have heard from other TKR patients and conservations between my PT and myself. I believe that I was still using a walker 10 days out and then switched to a cane. My knee was not at 90 degrees that soon, Everyone heals differently and has a different tolerance for pain. But I had a discussion with my PT about a friend who was also recovering from a TKR and going to a different PT. My friend was having trouble with bending, was in a great deal of pain during PT and after PT. This friend also felt like they were being pushed too hard too soon. My PT told me that there are many different ways of working the knee to get range of motion as well as flex back and that it did not have to hurt that bad. Long story short, my friend decided to come to my PT and found that there was a better communication with my PT and that they were no longer pushed to the point of pain. PT is not always comfortable, but it should not hurt the way you described it.

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Appreciate your input. I'm sitting here fearing my afternoon PT session. It shouldn't be that way. I will discuss with my PT.

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3 replies
babette | @babette | Aug 29, 2018

Please post after your session and tell us how it went!

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