PT for TKR - Pain from stretching & Other rehab questions

Posted by ssbionicknee @ssbionicknee, Jul 11, 2018

I had a TKR on May 14. PT has been going well. I can bend to 125. My leg does not completely straighten. I can get my fingers under my knee. I really started pushing myself to get my hamstring straight. After PT 2 days ago the back of me knee began hurting really bad. I have shooting pain in the back of my knee when I stand on it now. I was doing well and walking pretty well until this happened. I also was having very little pain. Now I am in severe pain and am having trouble walking. Has anyone else had this issue? I am afraid I have injured the hamstring and have undone all the progress I had been making.

@topdog11

I am about 4 months PO and have a pain like a tendon or ligament pulling and then snapping back of my knee. It started about 6-7 weeks, happens every time I go from sitting to standing, and starts about 10-15 minutes when I walk. Is this anything like you have? My OS doesn't seem concerned either, but by the end of the day it really is hurting. It seems like I traded one pain for another. I have really been working on strength exercises thinking maybe if I build my muscles up more it will stop. When I suggested to my OS that I see a different kind of doctor for it, he out and out told me no one's touches my knee except him. I politely as possible told him if it still hurts like it does at my 6 month checkup either he addresses it or I will be seeing another doctor. He believes by 6 months I shouldn't be having this problem. We shall is.

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@mari, from my own experience, I am talking about the internal scar tissue that prevents flexion of the knee. Mine was so aggressive that initially, I only had about 15-45 degrees of range-of-motion! It took two manipulations and about 18 months of work until I finally got to 0-110 or so. It was ultimately less than I wanted, but I am pain free on most days so it has been worth it. I also have to admit that when I was 19, I don't think I was as motivated as I would be now to push through the pain to complete my PT more thoroughly.

Being at 100 three days after the surgery is great Mari!

Liked by marystefy

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@topdog11

I am about 4 months PO and have a pain like a tendon or ligament pulling and then snapping back of my knee. It started about 6-7 weeks, happens every time I go from sitting to standing, and starts about 10-15 minutes when I walk. Is this anything like you have? My OS doesn't seem concerned either, but by the end of the day it really is hurting. It seems like I traded one pain for another. I have really been working on strength exercises thinking maybe if I build my muscles up more it will stop. When I suggested to my OS that I see a different kind of doctor for it, he out and out told me no one's touches my knee except him. I politely as possible told him if it still hurts like it does at my 6 month checkup either he addresses it or I will be seeing another doctor. He believes by 6 months I shouldn't be having this problem. We shall is.

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@marram, that is frustrating and I can relate to a certain degree. I did ultimately end up getting to 110, but it was not the conventional route. After surgery and no progress with range-of-motion I had to try all sorts of things. I had a full leg cast made that had hand cranks in it to force my knee to bend. It was the middle of the summer and this was so unbearable, I had to have it removed. I had two manipulations, but each time the scar tissue came back aggressively. It honestly wasn't until I was playing catch football with my friends that I jumped up for the ball, landed, heard a pop, and within the next few days was able to bend my knee to about 90. Weeks past after that pop and I eventually got myself to 110. As I mentioned to @mari, at 19, I don't think I was as aggressive with my PT and stretches as I should be, despite my dad's best efforts. 70 is functional, but not ideal. I am guessing that 2 years post-op you are not a candidate for manipulation anymore either. Have any possible solutions been proposed marram?

Liked by marystefy

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@topdog11

I am about 4 months PO and have a pain like a tendon or ligament pulling and then snapping back of my knee. It started about 6-7 weeks, happens every time I go from sitting to standing, and starts about 10-15 minutes when I walk. Is this anything like you have? My OS doesn't seem concerned either, but by the end of the day it really is hurting. It seems like I traded one pain for another. I have really been working on strength exercises thinking maybe if I build my muscles up more it will stop. When I suggested to my OS that I see a different kind of doctor for it, he out and out told me no one's touches my knee except him. I politely as possible told him if it still hurts like it does at my 6 month checkup either he addresses it or I will be seeing another doctor. He believes by 6 months I shouldn't be having this problem. We shall is.

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Thanks for your input Justin. I must press my OS on why he doesn’t recommend surgery for me. He thought an open procedure wasn’t a good idea. I’m going to ask home about arthroscopic procedures. From what I’ve read, there aren’t a lot of surgeons who are experts in this particular procedure but he might know of someone in my region who has done a lot of them. In the meantime I will continue to remain active and strive to remain fit.

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@topdog11

I am about 4 months PO and have a pain like a tendon or ligament pulling and then snapping back of my knee. It started about 6-7 weeks, happens every time I go from sitting to standing, and starts about 10-15 minutes when I walk. Is this anything like you have? My OS doesn't seem concerned either, but by the end of the day it really is hurting. It seems like I traded one pain for another. I have really been working on strength exercises thinking maybe if I build my muscles up more it will stop. When I suggested to my OS that I see a different kind of doctor for it, he out and out told me no one's touches my knee except him. I politely as possible told him if it still hurts like it does at my 6 month checkup either he addresses it or I will be seeing another doctor. He believes by 6 months I shouldn't be having this problem. We shall is.

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That should read “him” not “home “ in line 3.

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I've just come out of rehab it's been 4 weeks now with total knee replacement bilateral I am anaemic and nausea all the time get spasms and twitches a lot there is something still showing up in my liver so I need more blood tests next week . One knee was done under work cover and the other knee through my top cover health fund which has complicated things is there anyone that went back to full time work after 7 weeks ? I'm a school teacher – kindergarten and even though I am 98 in one knee and 90 in the other I feel I won't be ready yet. How much should you walk, is a massage chair any use? How much hydrotherapy is good and will a rowing machine do harm? When can I use a tread mill?

Liked by ssbionicknee

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I had a Total knee replacement on my right knee and will need the left one done soon. I used to teach kindergarten and preschool. I now have a job where I am on my feet the entire time. My TKR was in May. I did not go to rehab, but have been in PT and hydrotherapy. I have good bend and flex, but my doctor has increased my time off of work because of the demands of my job. It sounds to me that you are not ready to return to work. To do the job you do you need more range of motion. Have you asked your doctor about extending your leave? @JustinMcClanahan do you have more information or know someone who has has a bilateral TKR?

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@ssbionicknee

I had a Total knee replacement on my right knee and will need the left one done soon. I used to teach kindergarten and preschool. I now have a job where I am on my feet the entire time. My TKR was in May. I did not go to rehab, but have been in PT and hydrotherapy. I have good bend and flex, but my doctor has increased my time off of work because of the demands of my job. It sounds to me that you are not ready to return to work. To do the job you do you need more range of motion. Have you asked your doctor about extending your leave? @JustinMcClanahan do you have more information or know someone who has has a bilateral TKR?

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@ssbionicknee, I am tagging @gailfaith and @10nsmom who have both discussed having a bilateral knee replacement and may be able to share their experience with it again in this discussion.

Liked by ssbionicknee

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5 months ago had Right knee TKR, was stiff legging it for 6 to 7 years prior due to not having the right time or insurance available. This year (2018) I finally did it. IT was bad. The knee had NO menisus and it was bone on bone with pieces of bone floating around the knee. I had 3 prior ACLs done on the right knee, last one 8 years ago, so very familiar with knee recovery. 54 years of age now and got a TKR. After the first month, I was only getting a ROM 10 to 60 degrees, so we did a MUA (1st). Then I gotten 5 to 90. Physical Therapy (everyday) for 4 more weeks, and it was not getting any better nor retaining any new ROM. So a 2nd MUA in August, got 0 to 100, but not retaining it through PT (everyday). Thus another 5 weeks and another MUA (3rd), well no improvements still 0 to 102 and thru PT it is just awful painful to try to get beyond 102 ROM. Doctor and PT thinks that I will get it, but they are not sharing with me HOW? nor WHEN? I loss my job due to this and now Im not sure what to do next? Another MUA? let time tell? leave it be it will get better? I just cant continue with this everyday PT drill and the amount of knee pain I have to endured. Im done with the pill scene it just not right to keep taking pills (heck at one point I was taking up to 5-6 oxy per day) now I take only 1-2 alieve per day. ANY THOUGHTS/SUGGESTIONS on what someone else experience at this point as they were going through this, please share… One simple question to any professional – how is it that during a MUA I can get -10 to 120 ROM (normal knee ROM) but when I leave the MUA procedure directly over to the PT office (~15 mins later) I can only get 0 to 101ROM? how is the retention not there? Is there something else besides scar tissue buildup that can not allow ROM? should I look to be tested some other way? (reaching for straws here). THANKS for reading and if so replying.

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@kded4009

5 months ago had Right knee TKR, was stiff legging it for 6 to 7 years prior due to not having the right time or insurance available. This year (2018) I finally did it. IT was bad. The knee had NO menisus and it was bone on bone with pieces of bone floating around the knee. I had 3 prior ACLs done on the right knee, last one 8 years ago, so very familiar with knee recovery. 54 years of age now and got a TKR. After the first month, I was only getting a ROM 10 to 60 degrees, so we did a MUA (1st). Then I gotten 5 to 90. Physical Therapy (everyday) for 4 more weeks, and it was not getting any better nor retaining any new ROM. So a 2nd MUA in August, got 0 to 100, but not retaining it through PT (everyday). Thus another 5 weeks and another MUA (3rd), well no improvements still 0 to 102 and thru PT it is just awful painful to try to get beyond 102 ROM. Doctor and PT thinks that I will get it, but they are not sharing with me HOW? nor WHEN? I loss my job due to this and now Im not sure what to do next? Another MUA? let time tell? leave it be it will get better? I just cant continue with this everyday PT drill and the amount of knee pain I have to endured. Im done with the pill scene it just not right to keep taking pills (heck at one point I was taking up to 5-6 oxy per day) now I take only 1-2 alieve per day. ANY THOUGHTS/SUGGESTIONS on what someone else experience at this point as they were going through this, please share… One simple question to any professional – how is it that during a MUA I can get -10 to 120 ROM (normal knee ROM) but when I leave the MUA procedure directly over to the PT office (~15 mins later) I can only get 0 to 101ROM? how is the retention not there? Is there something else besides scar tissue buildup that can not allow ROM? should I look to be tested some other way? (reaching for straws here). THANKS for reading and if so replying.

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Hello @kded4009, welcome to Connect. I moved your discussion and combined it with a discussion titled, "PT for TKR – Pain from stretching & Other rehab questions." I moved your discussion so that the members already discussing PT, and the difficulty that comes with it, after knee replacements would see your post.

Personally, I can relate to your situation. I had my knee replaced when I was 19 due to severe arthritis that had deformed my knee to the point of no return. My rehab was a nightmare. My initial ROM after surgery was only 15-60 degrees. I had a manipulation, and it remained the exact same, so I had a second manipulation, with no improvement. I was told I had aggressive scar tissue growth – which may have been due in part to my age and my bodies ability to heal more quickly (kind of a curse in this situation I guess). I had a full leg cast made that had hand cranks on the knee to force my leg to bend, that did not work. In the end, I was playing catch football with my friends, jumped for a catch, landed, heard a pop and the next day I was around 10-110. After that, I slowly gained improvement and am now happily at 0-120(ish) with no pain. From the day I had my surgery to the day I hit my final ROM was probably well over a year and closer to 18 months post-op. My biggest suggestion, is do not take PT off. I don't think I pushed myself hard enough in hind-sight. But, I think what is most important is that you allow yourself a mental break as well. It is tough, and it is hard to not get frustrated when you don't feel like you are getting anywhere. But, in my opinion, you are looking for improvement by a few degrees here and there, even if it is slower than what is expected. You never know when it may just "pop" for you.

Liked by Dee, lioness

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@kded4009

5 months ago had Right knee TKR, was stiff legging it for 6 to 7 years prior due to not having the right time or insurance available. This year (2018) I finally did it. IT was bad. The knee had NO menisus and it was bone on bone with pieces of bone floating around the knee. I had 3 prior ACLs done on the right knee, last one 8 years ago, so very familiar with knee recovery. 54 years of age now and got a TKR. After the first month, I was only getting a ROM 10 to 60 degrees, so we did a MUA (1st). Then I gotten 5 to 90. Physical Therapy (everyday) for 4 more weeks, and it was not getting any better nor retaining any new ROM. So a 2nd MUA in August, got 0 to 100, but not retaining it through PT (everyday). Thus another 5 weeks and another MUA (3rd), well no improvements still 0 to 102 and thru PT it is just awful painful to try to get beyond 102 ROM. Doctor and PT thinks that I will get it, but they are not sharing with me HOW? nor WHEN? I loss my job due to this and now Im not sure what to do next? Another MUA? let time tell? leave it be it will get better? I just cant continue with this everyday PT drill and the amount of knee pain I have to endured. Im done with the pill scene it just not right to keep taking pills (heck at one point I was taking up to 5-6 oxy per day) now I take only 1-2 alieve per day. ANY THOUGHTS/SUGGESTIONS on what someone else experience at this point as they were going through this, please share… One simple question to any professional – how is it that during a MUA I can get -10 to 120 ROM (normal knee ROM) but when I leave the MUA procedure directly over to the PT office (~15 mins later) I can only get 0 to 101ROM? how is the retention not there? Is there something else besides scar tissue buildup that can not allow ROM? should I look to be tested some other way? (reaching for straws here). THANKS for reading and if so replying.

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Left Knee replaced 6/15/18, PT every day and no progress, 7/12/18 aspiration revealed staph infection, 7/13/18 debridement to wash out infection, 7/14/18 started two weeks of daily antibiotic IVs, 8/19/18 MUA since I could not get past 90' bend, no change after MUA, continued with PT until Medicare coverage expired, still no improvement in bending. Swelling, pain, and immobility continue. Fired my doctor. Trying to get well on my own, but still very little progress. Good Luck.

Liked by Dee, lioness

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OMG, where r u? let people know so they don't go thru this hell? So Sorry for your pain.

Liked by Dee

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@sleepy0

Left Knee replaced 6/15/18, PT every day and no progress, 7/12/18 aspiration revealed staph infection, 7/13/18 debridement to wash out infection, 7/14/18 started two weeks of daily antibiotic IVs, 8/19/18 MUA since I could not get past 90' bend, no change after MUA, continued with PT until Medicare coverage expired, still no improvement in bending. Swelling, pain, and immobility continue. Fired my doctor. Trying to get well on my own, but still very little progress. Good Luck.

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@kded4009 sorry to hear of your pain with knee my Mother had infection after her knee surgery but first bout on antibiotics cleared it up do you feel you need more antibiotics? If you can get in the water and do knee exercises its easier water takes the pressure of our joints. As long as there no open areas. Best of luck

Liked by Dee

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@mari

OMG, where r u? let people know so they don't go thru this hell? So Sorry for your pain.

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Dr Moor, Doctor’s Hospital, Sarasota FL

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@kded4009

5 months ago had Right knee TKR, was stiff legging it for 6 to 7 years prior due to not having the right time or insurance available. This year (2018) I finally did it. IT was bad. The knee had NO menisus and it was bone on bone with pieces of bone floating around the knee. I had 3 prior ACLs done on the right knee, last one 8 years ago, so very familiar with knee recovery. 54 years of age now and got a TKR. After the first month, I was only getting a ROM 10 to 60 degrees, so we did a MUA (1st). Then I gotten 5 to 90. Physical Therapy (everyday) for 4 more weeks, and it was not getting any better nor retaining any new ROM. So a 2nd MUA in August, got 0 to 100, but not retaining it through PT (everyday). Thus another 5 weeks and another MUA (3rd), well no improvements still 0 to 102 and thru PT it is just awful painful to try to get beyond 102 ROM. Doctor and PT thinks that I will get it, but they are not sharing with me HOW? nor WHEN? I loss my job due to this and now Im not sure what to do next? Another MUA? let time tell? leave it be it will get better? I just cant continue with this everyday PT drill and the amount of knee pain I have to endured. Im done with the pill scene it just not right to keep taking pills (heck at one point I was taking up to 5-6 oxy per day) now I take only 1-2 alieve per day. ANY THOUGHTS/SUGGESTIONS on what someone else experience at this point as they were going through this, please share… One simple question to any professional – how is it that during a MUA I can get -10 to 120 ROM (normal knee ROM) but when I leave the MUA procedure directly over to the PT office (~15 mins later) I can only get 0 to 101ROM? how is the retention not there? Is there something else besides scar tissue buildup that can not allow ROM? should I look to be tested some other way? (reaching for straws here). THANKS for reading and if so replying.

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I had a knee replacement just over 6 months ago, at the age of 52. After 3 weeks I was not able to flex my knee more than 60 degrees. I started a course of twice weekly physio for 4 weeks. I ended up having a manipulation at the end of June , the diagnosis was made of arthrofibrosis. I underwent a further course of twice weekly physio, there was no improvement, just more pain and swelling. The surgeon then decided to perform more surgery , I had arthroscopic arthrolysis and debridment of the knee, I had extensive fibrosis in the knee. Following this surgery just over 2 weeks ago I was unable bend my knee initially , due to neuropathic pain, my GP increased my dose of amitriptyline. Within a day of starting this increased dose my knee flexion has improved to 90 degrees, the most it has been since the knee replacement. I am also taking baclofen three times a day , paracetamol, brufen and as required oramorph.
I have to get back to work as I will be in no pay next month, but not sure how long it will take for the knee flexion to improve fully, the surgeon suggested 8 weeks.

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