When to start PT

Posted by bobnaquin @bobnaquin, Tue, Jan 8 10:02am

I had a partial left knee replacement about 24 hours ago. I am/was an avid 70 YO softball player and I want to get back in the game as quickly as possible. I also would like to return to competitive sprint running. Am I expecting too much? I can be a really good patient if there is a chance it will get me back in the game. Thoughts anyone. I know nothing. Please help.

@bobnaquin Hi Bob, and welcome to Connect.
I have had two TKRs (Total Knee Replacement) and have fared quite well after both of them, but I have not done anything as strenuous as sprint running. I think that is something that you really need to discuss with your orthopedic surgeon. I exercise a lot, but I do not run, but I didn't run prior to my knee replacements either.

Regarding when to start PT, they generally start it while you are still in the hospital. I presume you are on Medicare since you are 70. Medicare pays for in-home PT as long as you are "homebound" and that can start immediately. When you are no longer homebound you start outpatient PT. My surgeon recommends "gentle" PT and doesn't even think that formal PT is necessary if the patient knows the right things to do to rehab the knee. The in-home physical therapist had worked with other patients of this surgeon and knows his high success rate so he abided by the recommendations. My outpatient physical therapist was frankly stumped about what he could do for therapy so those sessions were a bit of a waste.

My surgeon is cautious about the strong impact to the knees so that may be a factor with your surgeon also. I do water jogging and use my recumbent bike, a treadmill, and elliptical. I will be curious to hear what your surgeon has to say about this. I think it may depend on the model knee you have, and also the condition you were in prior to the TKR. I hope you will be able to resume the activities that are important to you.
JK

@contentandwell

@bobnaquin Hi Bob, and welcome to Connect.
I have had two TKRs (Total Knee Replacement) and have fared quite well after both of them, but I have not done anything as strenuous as sprint running. I think that is something that you really need to discuss with your orthopedic surgeon. I exercise a lot, but I do not run, but I didn't run prior to my knee replacements either.

Regarding when to start PT, they generally start it while you are still in the hospital. I presume you are on Medicare since you are 70. Medicare pays for in-home PT as long as you are "homebound" and that can start immediately. When you are no longer homebound you start outpatient PT. My surgeon recommends "gentle" PT and doesn't even think that formal PT is necessary if the patient knows the right things to do to rehab the knee. The in-home physical therapist had worked with other patients of this surgeon and knows his high success rate so he abided by the recommendations. My outpatient physical therapist was frankly stumped about what he could do for therapy so those sessions were a bit of a waste.

My surgeon is cautious about the strong impact to the knees so that may be a factor with your surgeon also. I do water jogging and use my recumbent bike, a treadmill, and elliptical. I will be curious to hear what your surgeon has to say about this. I think it may depend on the model knee you have, and also the condition you were in prior to the TKR. I hope you will be able to resume the activities that are important to you.
JK

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JK. Thanks for all of the info. I have a PT person lined up for outside and he faxed me some exercises to get started on. When I looked at them yesterday they all seemed so impossible. Today I am 50 hours post op and I can do most of them. So I am now hopeful I can come all the way back. We shall see

Thanks again and live well and long.

Hi @bobnaquin – I want to add my welcome! Glad you got on Connect. I'm 68 and had a right TKR in April 2017 and I'm having my left TKR on the 29th of this month. It seems to me that surgeons vary greatly in terms of their recommendations for PT. But as JK noted, mine started in the hospital (I spent 2 nights there). That was followed by in-home PT for the first 2 1/2 weeks – until I could drive. Then I started outpatient PT which went on until I was 12 weeks past surgery. I would definitely recommend talking to your doctor about your goals in terms of softball, sprint running, etc. My surgeon asked me what I hoped to be able to achieve prior to surgery. I don't do anything near as strenuous as you, but I walked 2 – 3 miles each morning and I wanted to get back to that as soon as possible. It made it easier that the doctor, the physical therapist and I were all united in our effort to get me back to my beach walks asap! Does your doctor have you scheduled for PT? Are you icing the knee and elevating now? Wishing you the best!

@debbraw

Hi @bobnaquin – I want to add my welcome! Glad you got on Connect. I'm 68 and had a right TKR in April 2017 and I'm having my left TKR on the 29th of this month. It seems to me that surgeons vary greatly in terms of their recommendations for PT. But as JK noted, mine started in the hospital (I spent 2 nights there). That was followed by in-home PT for the first 2 1/2 weeks – until I could drive. Then I started outpatient PT which went on until I was 12 weeks past surgery. I would definitely recommend talking to your doctor about your goals in terms of softball, sprint running, etc. My surgeon asked me what I hoped to be able to achieve prior to surgery. I don't do anything near as strenuous as you, but I walked 2 – 3 miles each morning and I wanted to get back to that as soon as possible. It made it easier that the doctor, the physical therapist and I were all united in our effort to get me back to my beach walks asap! Does your doctor have you scheduled for PT? Are you icing the knee and elevating now? Wishing you the best!

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Debbra; Thanks for your input. I had a partial knee replacement and was in pretty good physical shape before surgery. I have spoken with my doctor about my goals and his reply is, "we'll talk in two months." I have high hopes but I am also a realistic person.
Taking a two or three mile walk without pain would improve my life. Maybe that is what I will have to settle for. I still think I can play softball but will have to move to a less active position perhaps. I am elevating, icing, doing my pre PT exercises and after three days I am amazed by the progress I have made. I am using a cane and sometimes forget to use it. The first few steps after sitting or a killer though. Pain meds are down to half level and I will probably stop them tomorrow. All-in-all I would say I am more than happy with my results.

I wish you well and hope to see you on the beach.

@bobnaquin

Debbra; Thanks for your input. I had a partial knee replacement and was in pretty good physical shape before surgery. I have spoken with my doctor about my goals and his reply is, "we'll talk in two months." I have high hopes but I am also a realistic person.
Taking a two or three mile walk without pain would improve my life. Maybe that is what I will have to settle for. I still think I can play softball but will have to move to a less active position perhaps. I am elevating, icing, doing my pre PT exercises and after three days I am amazed by the progress I have made. I am using a cane and sometimes forget to use it. The first few steps after sitting or a killer though. Pain meds are down to half level and I will probably stop them tomorrow. All-in-all I would say I am more than happy with my results.

I wish you well and hope to see you on the beach.

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@bobnaquin – You'll probably be sprinting when I see you on the beach. You'll just have to look back and wave. Good luck to you too. I feel like you are really off to a good start. (But boy do I hear you about the difficulty of getting started again after sitting. When I went back to work after my 1st surgery, I would literally have to get up and walk around every hour for what seemed like months.) I hope you'll keep us posted on your progress.

Debra;

My great hope is to participate in the Senior Games in the sprint races, 400 meters or less. I don't think I am any good at the longer stuff. I never was. I did take a bronze in the 100 meters two years ago so I would like to get back to that. I have an advantage in that I am now in an older bracket and don't have to run against those 65 YO kids.:-)

I am walking without a cane but I keep it close for those first couple of steps.

I will check back with you when I hit my next home run in softball.

@bobnaquin

Debra;

My great hope is to participate in the Senior Games in the sprint races, 400 meters or less. I don't think I am any good at the longer stuff. I never was. I did take a bronze in the 100 meters two years ago so I would like to get back to that. I have an advantage in that I am now in an older bracket and don't have to run against those 65 YO kids.:-)

I am walking without a cane but I keep it close for those first couple of steps.

I will check back with you when I hit my next home run in softball.

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That is so inspiring. I am a 65 years young male and looking at a TKR this summer. My surgeon gave me an injection and said I have good range of motion in the knee even though I am bone on bone. No pain right now and working out in the gym and doing low impact P90X. My last 5k was in October wherer I placed 2nd in my age bracket with a sub 30 minute time. Since then I have put my running shoes on the shelf and hope for a comeback this time next year after surgery. Fingers crossed.

@santi

That is so inspiring. I am a 65 years young male and looking at a TKR this summer. My surgeon gave me an injection and said I have good range of motion in the knee even though I am bone on bone. No pain right now and working out in the gym and doing low impact P90X. My last 5k was in October wherer I placed 2nd in my age bracket with a sub 30 minute time. Since then I have put my running shoes on the shelf and hope for a comeback this time next year after surgery. Fingers crossed.

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Hi @santi – I'm inspired too by @bobnaquin! I'm going to be waiting to hear about that first homerun! But I have a question for you… didn't you have knee surgery scheduled in January? Have you had it or still waiting? My 2nd TKR is going to be 1/29. Wishing you the best on yours (if I'm remembering correctly. LOL)

Yes Debra you are correct. I was going to have it this month, however; after meeting with my surgeon we mutually agreed to hold of and see how it feels in 6 months or so. He gave me an injection and right now I am pain free.

@santi

That is so inspiring. I am a 65 years young male and looking at a TKR this summer. My surgeon gave me an injection and said I have good range of motion in the knee even though I am bone on bone. No pain right now and working out in the gym and doing low impact P90X. My last 5k was in October wherer I placed 2nd in my age bracket with a sub 30 minute time. Since then I have put my running shoes on the shelf and hope for a comeback this time next year after surgery. Fingers crossed.

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@santi Your running must have really been a challenge with your knees, I can see why you have you have shelved your running shoes. I hope you do continue to give that knee some exercise though to keep the supporting muscles strong. I believe that made a huge difference in the recovery of my second TKR vs my first, and my ortho did want me to keep up the low-impact exercises like the recumbent bike and water exercise/jogging.
I too had injections, first cortisone, then synvisc. I finally got to a point though where the synvisc was little or no help. Then you know it's time.
From hearing you, I am sure you will be back in no time after your TKR.
JK

I am now 18 days post op and I was doing so well until… I developed a killer hematoma that sent everything sideways. While doing PT, the tech noticed this and said I should go to see my surgeon. My surgeon told me to put a compression sleeve on it and to see him in four days. I did. The pain from thia overwhelmed my knee pain and I suffered for two days and then suddenly it seemed fine. I did a few stretches and it was back again within minutes but without the associated pain. This led to another day of nothing but compression and ice.

This morning I am fine and the hematoma has subsided. I can feel the pain in my knee which is not much. I see the doc this morning. BTW I had 122 degrees of range when this started. I hope that I will be able to resume PYT and get back to that range of motion quickly. Wish me luck.

@bobnaquin

I am now 18 days post op and I was doing so well until… I developed a killer hematoma that sent everything sideways. While doing PT, the tech noticed this and said I should go to see my surgeon. My surgeon told me to put a compression sleeve on it and to see him in four days. I did. The pain from thia overwhelmed my knee pain and I suffered for two days and then suddenly it seemed fine. I did a few stretches and it was back again within minutes but without the associated pain. This led to another day of nothing but compression and ice.

This morning I am fine and the hematoma has subsided. I can feel the pain in my knee which is not much. I see the doc this morning. BTW I had 122 degrees of range when this started. I hope that I will be able to resume PYT and get back to that range of motion quickly. Wish me luck.

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@bobnaquinThat's a fabulous ROM, 122! I wish I had that, mine is under 120.
I hope things went well this morning and that you are able to get back to PT. I am curious, what is your ROM now? If you were at 122 before I am certain you will be back there in no time. Good luck. 😉
JK

@contentandwell

@bobnaquinThat's a fabulous ROM, 122! I wish I had that, mine is under 120.
I hope things went well this morning and that you are able to get back to PT. I am curious, what is your ROM now? If you were at 122 before I am certain you will be back there in no time. Good luck. 😉
JK

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Thanks for the well wishes. Doc gave me clearance to restart PT on Monday. He also allowed me to go to the pool which allows me some minimum form of workout. My knee has some pain but nothing too bad. I am even thinking of going to the batting cages today and start working my way back into game shape. My muscles have so atrophied after three weeks of inactivity.

@bobnaquin

Thanks for the well wishes. Doc gave me clearance to restart PT on Monday. He also allowed me to go to the pool which allows me some minimum form of workout. My knee has some pain but nothing too bad. I am even thinking of going to the batting cages today and start working my way back into game shape. My muscles have so atrophied after three weeks of inactivity.

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@bobnaquin that sounds great! I rely a lot on water exercise but was not allowed to get in the pool, until the incision was totally healed. I forget how long that took.
You sound like you are quite athletic so I’m sure you will be back in full form in no time, and if you need meds, take them.
You obviously live in a much warmer climate than I do. I assume batting cages here don’t open here until April.
JK

Liked by bobnaquin

@contentandwell

@bobnaquin that sounds great! I rely a lot on water exercise but was not allowed to get in the pool, until the incision was totally healed. I forget how long that took.
You sound like you are quite athletic so I’m sure you will be back in full form in no time, and if you need meds, take them.
You obviously live in a much warmer climate than I do. I assume batting cages here don’t open here until April.
JK

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I live in Southern Utah which is called Dixie because it is so much warmer than the rest of Utah. The batting cages open up year round at 45 degrees. I did go and di pretty well. Batting does not impact my new knee at all so that is good. I also I did hot laps at Las Vegas Motor Speedway yesterday in my Corvette. So I am healing. Good wishes to you.

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