Assisted forced flexion PT to pain post TKA

I think the gains are made when you can take yourself up to hard discomfort level or just at the tipping point to pain, and hold that stretch there for 30 seconds without being in extreme agony. You do have to push hard enough so you are gaining flex in little increments over time, so you shouldn't be too easy on yourself. I too, would quit a therapist who force flexed to excruciating pain!

THANK YOU SO MUCH, both for your response and taking the time to respond. I had determined to follow this "plan of attack" and your confirmation encourages me that this is the right approach. One PT at "Bone Smart" uses this approach with her pts in the UK. Thank you again for the encouragement and confirmation.

Hi @mgirouard and welcome to Mayo Clinic Connect.

I'd like to invite @ellerbracke, @donheads, and @softwaredev to this discussion to share their experiences with PT and recovery after total knee replacement.

@mgirouard, pushing yourself is part of recovery after most surgeries, but within a limit. From what it sounds like, you were being pushed past a level you were comfortable with. Did you discuss this with your PT and what was their response? Now that you have left that particular PT, are you planning to seek out the advice from the PT you mentioned that instructs more gentle PT? What is your goal for flexion and is it scar tissue that is holding you back?

Thank you for reaching out to me! Justin, I communicated this to my PT and she agreed to not do forced flexion. I was able to get some extra degree of pain control and achieved 94 degrees of flexion Monday, pushing myself to DISCOMFORT, but not pain. I think she was impressed that I could do this when we took away the anxiety of anticipated pain. We will work again Thursday (my 4 week mark) and I hope to hit 100 degrees, but am aware that I might be a slow recoverer. Re: scar tissue, my PT feels that there is minimal scar tissue, with free movement in the joint and patella, and I am praying hard that any scar tissue is non-existant or minimal. Goals? I would like to be able to walk on a treadmill for more than 4 minutes without having to stop due to pain, hike some of the trails here in Wyoming, and beat my wife in Picke Ball 🙂 Seriously, I would like to get back to the gym on the elliptical. Cybex & rower and recover some mm mass and strength (this knee was 2 inches smaller in circumference prior to surgery). I would also like to achieve the 120 degrees milestone by 3 months, even though this seems a lofty goal presently (pre-surgery ROM was 130 degrees). Finally, I would like to see changes in surgeons' approach to post-op pain management. I was given two and a half days of Percocet on discharge and would have run out on Sunday morning at 2 AM; fat chance of getting any analgesic help except at the ER, which no pt should have to visit on the 3rd day post op (the small town I live in has no pharmacies open on Sunday anyway, let alone open at 2 AM). And considering doctors' hesitancy (fear and terror?) to prescibe opiods amidst the "opiod crisis", I suspect at the ER that I would have received a stick to bite on and two extra strength Tylenols. I would hope that eventually, SURGEONS (I trained as an Anesthesiologist) would be more responsive to post op pain concerms and inform their pts of opiod hyperalgia, do follow-up phone calls to assess pain relief or lack thereof, understand that post-op PT goals are not realistically achievable without adequate pain control, recognize that there are other pharmaco agents that produce pain relief and be willing to offer these analgesics or combinations thereof with proper monitoring and, of course, proper documentation. OR, and maybe better yet, offer the services of pain specialists/clinics PRIOR to surgery and allow these experts to assume care either prior to or at the time of discharge. I realize that for most pts, lack of acceptable post-op ROM goals is not an issue, but for those of us with poor outcomes it is a very big deal. We want to get better; not worse. And we need help getting there. Thank you again for taking the time to correspond. I would appreciate your prayers also! 🙂