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!

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.

REPLY
@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.

Jump to this post

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.

REPLY
@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.

Jump to this post

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! 🙂

REPLY
@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.

Jump to this post

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

Liked by ssbionicknee

REPLY

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

Liked by ssbionicknee

REPLY
@fjkphx

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

Jump to this post

I was thinking about your posts. Another thing to keep in mind that you are so very early out from your surgery. Surgery of any kind is a huge assault on the body. Surgery that is this traumatic, even more so. I understand there is a push to PT from very early on. I hope you were able to come to an agreement with your therapist about what is reasonable, what will allow you to progress w/out anxiety and unneeded fatigue.

Liked by lioness

REPLY
@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.

Jump to this post

I didn't hit 90 degrees for a few weeks and then it stayed there for a few more. When the swelling went down some I went to 109 and -3 at 8 weeks and I'm still working on more. I think you're doing great, certainly better than I did.

REPLY
@babette

I was thinking about your posts. Another thing to keep in mind that you are so very early out from your surgery. Surgery of any kind is a huge assault on the body. Surgery that is this traumatic, even more so. I understand there is a push to PT from very early on. I hope you were able to come to an agreement with your therapist about what is reasonable, what will allow you to progress w/out anxiety and unneeded fatigue.

Jump to this post

Fjkphx I can understand that it hurts after surgery its a fine line ,the muscles can stiffen up so quickly it is necessary to move them but not to the extent that they hurt all day after a session. As a patient you have to take as much as you can and the therapist has to stop when you say so.In order to get better it will hurt but shouldn't beyond when your body tells you Ive had enough for today.

Liked by ssbionicknee

REPLY
@fjkphx

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

Jump to this post

You are right, you should not fear going to PT. Some days I was not thrilled about going, but I was never as anxious as you seem. I posted above that I have complete trust with my PT. He really watches my face and can tell when I am hurting. He knew when to stop and there were 2 times that I had to say "I need a break." He always listened. Please let us know how it goes.

Liked by lioness

REPLY
@fjkphx

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

Jump to this post

@fjkphx I was wondering how PT went. I had PT tonight and watched as my PT worked with another patient. I could tell it was uncomfortable, but the PT kept asking how he was feeling and stopped or tried something different if he was uncomfortable. I thought about you while watching and am hoping your experience was better this time.

REPLY
@johnk21

I didn't hit 90 degrees for a few weeks and then it stayed there for a few more. When the swelling went down some I went to 109 and -3 at 8 weeks and I'm still working on more. I think you're doing great, certainly better than I did.

Jump to this post

Thanks John. I'm still at 90 two weeks out. I want to feel pleased but I don't think my PT is! Knee is swollen and my hope is that I will improve when that subsides.

REPLY

I went to my new ortho doctor last Tuesday totally convinced he was going to tell me I was going to have to have a total knew replacement as soon as he could schedule the surgery. To my surprise and delight he said he had several different procedure he wanted to preform on my knee before we get even close to the TKR. We discussed the various procedure he does and he is going to do a Platelet-rich Plasma (PRP) Treatment.You take a person’s (mine) blood, you spin it down, you concentrate the platelets, and you inject that in my knee with my own platelets in a concentrated form, his then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation. I am excited and anxious to have this procedure and pray for the very best results.
@babette My doctor did go over some of the other methods he could try if this might not work and what he would do when I do get to the point when I will have to have a TKR. He said that once he gets the whole surgery done he does a Knee Nerve block on the knee he has done the TKR on, while the patient is still under Anesthesia..He does this to cut down on the discomfort and fear that his patient's have about their rehab. They are very worried about what they are to do for pain treatment and management and the nerve block in the knee will drastically cut down on the discomfort and fear that his patient's have about their rehab. He said that these blocks typically contain an anesthetic with a known duration of relief. He just calmly said, why have your patient hurt when there is a simple resolve that will help them to recover easier and with less pain. He did stress that the rehab was the most important part of this surgery. If you don't do all of your rehab the way your PT tells you, you will end up walking with a limp, develop back pain and a plethora of other symptoms your don't want. You want to have this surgery to get better and get it over with and gone, no to create another issue. He is a younger doctor and says that is the way he was taught in med school to do this surgery. I like this idea! Perhaps you should ask him about the Nerve Block? If he won't do it you might could find a Pain Specialist that will do it for you after your surgery. I have them in my neck and they do work wonders. Sorry, if this is way to much info but I do hope that all will go as smoothly as possible for you. More than 600,000 knee replacements are performed each year in the United States. If all those people can make it through everything, I have no doubt that you will do great. I will put you on my prayer list and pray for things to go as well as possible for you, dear. Try to remember when you feel overwhelmed-stop-inhale a lone breath though your nose and slowly release it by slowly blowing out your mouth. Goggle some "self relaxation" practice what they suggest. God Bless YOu. (Keep us updates, please.)

REPLY
@kidsincollege

I went to my new ortho doctor last Tuesday totally convinced he was going to tell me I was going to have to have a total knew replacement as soon as he could schedule the surgery. To my surprise and delight he said he had several different procedure he wanted to preform on my knee before we get even close to the TKR. We discussed the various procedure he does and he is going to do a Platelet-rich Plasma (PRP) Treatment.You take a person’s (mine) blood, you spin it down, you concentrate the platelets, and you inject that in my knee with my own platelets in a concentrated form, his then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation. I am excited and anxious to have this procedure and pray for the very best results.
@babette My doctor did go over some of the other methods he could try if this might not work and what he would do when I do get to the point when I will have to have a TKR. He said that once he gets the whole surgery done he does a Knee Nerve block on the knee he has done the TKR on, while the patient is still under Anesthesia..He does this to cut down on the discomfort and fear that his patient's have about their rehab. They are very worried about what they are to do for pain treatment and management and the nerve block in the knee will drastically cut down on the discomfort and fear that his patient's have about their rehab. He said that these blocks typically contain an anesthetic with a known duration of relief. He just calmly said, why have your patient hurt when there is a simple resolve that will help them to recover easier and with less pain. He did stress that the rehab was the most important part of this surgery. If you don't do all of your rehab the way your PT tells you, you will end up walking with a limp, develop back pain and a plethora of other symptoms your don't want. You want to have this surgery to get better and get it over with and gone, no to create another issue. He is a younger doctor and says that is the way he was taught in med school to do this surgery. I like this idea! Perhaps you should ask him about the Nerve Block? If he won't do it you might could find a Pain Specialist that will do it for you after your surgery. I have them in my neck and they do work wonders. Sorry, if this is way to much info but I do hope that all will go as smoothly as possible for you. More than 600,000 knee replacements are performed each year in the United States. If all those people can make it through everything, I have no doubt that you will do great. I will put you on my prayer list and pray for things to go as well as possible for you, dear. Try to remember when you feel overwhelmed-stop-inhale a lone breath though your nose and slowly release it by slowly blowing out your mouth. Goggle some "self relaxation" practice what they suggest. God Bless YOu. (Keep us updates, please.)

Jump to this post

@kidsincollege
Good Morning!
Sounds like to you found a very inventive doctor. I love docs like this….ones who are not surgery happy.
The only thing I want to suggest is to make sure your medical insurance will cover the procedures he does since they are out of the ordinary.
He might be covered by your insurance, but it might be for only the conventional treatments.
Good luck and let us know how these treatments go since many of us have knee issues.

Have a pain-free day!
Ronnie (GRANDMAr)

REPLY

My excellent TKR doc says (me 5 weeks out) do pt Without pushing into pain now. – Did you vet your Dr. and PT?

REPLY
@kidsincollege

I went to my new ortho doctor last Tuesday totally convinced he was going to tell me I was going to have to have a total knew replacement as soon as he could schedule the surgery. To my surprise and delight he said he had several different procedure he wanted to preform on my knee before we get even close to the TKR. We discussed the various procedure he does and he is going to do a Platelet-rich Plasma (PRP) Treatment.You take a person’s (mine) blood, you spin it down, you concentrate the platelets, and you inject that in my knee with my own platelets in a concentrated form, his then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation. I am excited and anxious to have this procedure and pray for the very best results.
@babette My doctor did go over some of the other methods he could try if this might not work and what he would do when I do get to the point when I will have to have a TKR. He said that once he gets the whole surgery done he does a Knee Nerve block on the knee he has done the TKR on, while the patient is still under Anesthesia..He does this to cut down on the discomfort and fear that his patient's have about their rehab. They are very worried about what they are to do for pain treatment and management and the nerve block in the knee will drastically cut down on the discomfort and fear that his patient's have about their rehab. He said that these blocks typically contain an anesthetic with a known duration of relief. He just calmly said, why have your patient hurt when there is a simple resolve that will help them to recover easier and with less pain. He did stress that the rehab was the most important part of this surgery. If you don't do all of your rehab the way your PT tells you, you will end up walking with a limp, develop back pain and a plethora of other symptoms your don't want. You want to have this surgery to get better and get it over with and gone, no to create another issue. He is a younger doctor and says that is the way he was taught in med school to do this surgery. I like this idea! Perhaps you should ask him about the Nerve Block? If he won't do it you might could find a Pain Specialist that will do it for you after your surgery. I have them in my neck and they do work wonders. Sorry, if this is way to much info but I do hope that all will go as smoothly as possible for you. More than 600,000 knee replacements are performed each year in the United States. If all those people can make it through everything, I have no doubt that you will do great. I will put you on my prayer list and pray for things to go as well as possible for you, dear. Try to remember when you feel overwhelmed-stop-inhale a lone breath though your nose and slowly release it by slowly blowing out your mouth. Goggle some "self relaxation" practice what they suggest. God Bless YOu. (Keep us updates, please.)

Jump to this post

Good Luck with all. I had PRP + cells but for Bone on Bone – it was not expected to help. after couple of weeks, got rejuvenated, better balance, strength, lively – my former self. Dr. says he heard that b4.

REPLY
Please login or register to post a reply.