Good days, bad days

Posted by amytro @amytro, Mon, Mar 4 9:23am

Good morning, everyone. I had a TKR on 2/7 which makes me almost 4 weeks post-surgery. I was doing very well my third week- getting around the house okay, minimal pain and not using the cane all the time. However, with a new PT regime, I have had a lousy few days. I can't bear as much weight on my new knee as I could last week and the pain has increased instead of decreased. Is this normal? Could I have overdone my PT exercises? Snowy weather and cancellations have made it impossible for me to ask my therapist for another few days but would love some other perspectives. Has anyone "overdone" PT? Did I overdo it myself because I attempted light housework when I felt good? Or is this just the ups and downs of healing from a TKR?

I had my right knee replaced on 1-23-2019 and yes, it can get worse before it gets better. Initially, my in home PT told me to do my exercises 3/day even though I had an immense amount of swelling. When I went to outpatient PT they told me NO, NO, NO. Now I do them 2/day it's much better. Whenever I try to do more, I pay for it with pain and soreness. To answer your question, yes. You can do too much, too soon other than with stretches. You can do those as often as you like. Always follow the advice of your doctor and PT because every person is different. If I didn't have excessive swelling, I would be doing my PT 3/day but after trial and error, I'm finding a middle ground. You will too. When you do too much, take note. Every week, they give me more exercises to do so I'm not staying stagnant. There are definitely good and bad days for months following this surgery. Slow and steady wins the race.

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@amytro I never ran into that, but my orthopedic surgeon advocates "gentle PT", meaning it should not be extremely painful. I had a different ortho for my first TKR and a different physical therapist. She would have me lie down on my back and forcefully bend my knee until I literally screamed in agony. None of that with my second knee, thankfully.
With the first, I did have pain after PT, with my second I did not.
JK

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@dkapustin

I had my right knee replaced on 1-23-2019 and yes, it can get worse before it gets better. Initially, my in home PT told me to do my exercises 3/day even though I had an immense amount of swelling. When I went to outpatient PT they told me NO, NO, NO. Now I do them 2/day it's much better. Whenever I try to do more, I pay for it with pain and soreness. To answer your question, yes. You can do too much, too soon other than with stretches. You can do those as often as you like. Always follow the advice of your doctor and PT because every person is different. If I didn't have excessive swelling, I would be doing my PT 3/day but after trial and error, I'm finding a middle ground. You will too. When you do too much, take note. Every week, they give me more exercises to do so I'm not staying stagnant. There are definitely good and bad days for months following this surgery. Slow and steady wins the race.

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Thank you very much for your response. You validated something I find maddening– that each PT person has a different and even contradictory approach to the therapy. It's been hard to bounce between them (I've had 5 PT people so far in less than 4 weeks). Slow and steady- good advice. I also tell myself it's a marathon and not a sprint. But I sure wish I could sprint!!

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@contentandwell

@amytro I never ran into that, but my orthopedic surgeon advocates "gentle PT", meaning it should not be extremely painful. I had a different ortho for my first TKR and a different physical therapist. She would have me lie down on my back and forcefully bend my knee until I literally screamed in agony. None of that with my second knee, thankfully.
With the first, I did have pain after PT, with my second I did not.
JK

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Thanks, John. Knowing that I have the second knee coming up, this is helpful.

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Hi @amytro – Two points I wanted to confirm from my own experience. First, don't let anyone hurt you – physical therapist or not. My in-home physical therapist told me not to do anything that hurt – some things are uncomfortable but nothing should be painful. Also, when I was just starting walking outside, he told me if you have to wonder whether you can do it – don't. You don't want to risk going to far so that you overstress the knee on the return trip. Second, I truly believe in finding one therapist and sticking with her/him. Before my 1st TKR (Apr 2017), I went to a PT organization that shifted the therapists around randomly. I never felt that I got personal, compassionate attention. So before my post-op PT, I found a place that assigns one therapists and you stick with that person through the whole process. I was lucky enough on my 2nd TKR (1/29/19) to get both my in-home and out-patient therapists back to do my therapy. I felt so fortunate!

I'm wondering if they prescribed you an antiinflammatory – like Celebrex? That was helpful to me in the beginning (I couldn't take it for long because it upset my stomach). Also, do you take your pain meds before PT? At 4 weeks, I still definitely needed them. Good luck with your recovery!

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I would love to have only one therapist but my place rotates between 3 different ones. Although I'm getting to know each one pretty well, I would rather just work with one. I had my right knee replacement on 1-23-2019 and it's been a slow and painful journey so far. I still have a long way to go and there are days when I wish I would have held off but it's a little too late for that. It's all about taking one day at a time knowing that there will be good days, so so days, and bad days. It's just part of the program!

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@debbraw

Hi @amytro – Two points I wanted to confirm from my own experience. First, don't let anyone hurt you – physical therapist or not. My in-home physical therapist told me not to do anything that hurt – some things are uncomfortable but nothing should be painful. Also, when I was just starting walking outside, he told me if you have to wonder whether you can do it – don't. You don't want to risk going to far so that you overstress the knee on the return trip. Second, I truly believe in finding one therapist and sticking with her/him. Before my 1st TKR (Apr 2017), I went to a PT organization that shifted the therapists around randomly. I never felt that I got personal, compassionate attention. So before my post-op PT, I found a place that assigns one therapists and you stick with that person through the whole process. I was lucky enough on my 2nd TKR (1/29/19) to get both my in-home and out-patient therapists back to do my therapy. I felt so fortunate!

I'm wondering if they prescribed you an antiinflammatory – like Celebrex? That was helpful to me in the beginning (I couldn't take it for long because it upset my stomach). Also, do you take your pain meds before PT? At 4 weeks, I still definitely needed them. Good luck with your recovery!

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Thank you, Debbra. I do have a month's worth of Celebrex (they are giving me something for my stomach). And yes, I do take my pain meds before PT and ice right after. Glad to hear that you needed the meds at 4 weeks too. I want off of them but can't imagine doing that now or even next week!!

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@dkapustin

I would love to have only one therapist but my place rotates between 3 different ones. Although I'm getting to know each one pretty well, I would rather just work with one. I had my right knee replacement on 1-23-2019 and it's been a slow and painful journey so far. I still have a long way to go and there are days when I wish I would have held off but it's a little too late for that. It's all about taking one day at a time knowing that there will be good days, so so days, and bad days. It's just part of the program!

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@dkapustin I have never heard of having to rotate through therapists, and I would prefer to not have to do that, but sometimes it can be an advantage. If one person misses something, hopefully the next one will catch it. The last physical therapist I had, whom I had a couple of times before for other things and really liked him, was useless after my second TKR. It was a total waste of time. The therapist I had in my house was great. So I am thinking that maybe a different therapist would have handled me better then.
My ortho insists on "gentle" PT. The outpatient PT had no idea what to do with me.
JK

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