The Reality of PT after a TKR
Posted , 11 users are following.
Unless someone has different information, I don't know of any other way of breaking down the post-op scar tissue except through PT or an MUA. Yes, the Physical Therapy is right out of The Inquisition (I swore my therapist wore a dungeon master's cowl and had an Iron Maiden covered up with a sheet in the corner...), is extremely painful (some people take meds an hour before a session but then can't drive there), and is full of successes, setbacks and plateaus. I went from -14 / +84 in 10 weeks @ 2x/week to -1 / +123 (the goal is 0 / +120). I got stuck at -4 for weeks...frustrating. But I did a lot of heel slides and squats at home too. I started my PT 3-4 weeks post-op...wait longer and the scar tissue has had more time to build up. Haven't heard of anyone starting sooner...anyone out there who did that?
With the MUA, you're unconscious and the docs get out whatever scar tissue they can in an attempt to give you better ROM. The downside is that you're now dealing with another operation, open incision and post-op pain. Personally, I'd work like hell to avoid that. In my opinion, MUA is a last resort for people who have not had any success with PT.
This is simple: No way you'll get your ROM back by doing nothing but rest, ice and elevation at home. Not a chance. This takes physical manipulation by a PT to break down the scar tissue so you can walk again without a cane or a limp for the rest of your life. Even the people who have reported great ROM numbers within a month of surgery still did the work to get it. Maybe there's even that one in a million patient whose DNA does not allow scar tissue to form. Who knows? For the rest of us, it's hard and painful work...but worth it.
I did ask my PT about people in their eighties...what goals do you have for them? He told me that 0 / +120 is not likely to be achieved by the very elderly so they focus on enough ROM and strength to get a person out of bed, to the bathroom and kitchen, and out to a car. Pretty much self-care basics. Different age...different standard of success.
For a PT session, they will warm you up on a bike...might take a week or two to get one full pedal rotation. Patience...it will come. Then there's more leg work of various types. I loved sitting on a rolling stool and using the bad leg to push and pull me around. Always a fun one.
Down the road, they will try and make you climb a single stair, bad leg first to engage the dead quad muscle. No holding on to a rail, no bouncing on the good leg to pop you up there. This is VERY hard. Could not do it without using the rail for many weeks. Even after PT and 6-12 months of recovery, stairs are still very difficult because of the lack of leg strength. Only serious gym time and lots of leg presses will do that. At home, get a set of exercise bands and do them every day! At 14+ months, I can do two steps at a time alternate legs with no railing. Lots of work went into that (plus residual leg strength from 45 years of hockey...so I cheated...). Be patient.
Now for the exciting denouement. The PT lays you on your back, puts your heel up on a block of wood and pushes down on your knee...maybe 6-10 times, each one harder than the last. Fun, right? Remember the chest-waxing scene from The Forty-Year-Old Virgin with Steve Carrell yelling "Kelly Clarkson!!!.....Richard Nixon!!!"? Yeah, something like that. Then he lays you on your stomach with your knees just on the edge of the table. That's it...just let the knee hang...and hang...and hang. Gravity may be a law but it's also a b**ch!!! For fun, he'll add a 2-pound ankle weight to the bad leg. Weeping and gnashing of teeth...biblical-level pain. Be prepared...
But it's what must be done to give you your life back!!!!!!!!
I'm at about 15 months and most of the time I don't even know the knee is fake. I have to be very conscious of it nonetheless. The only way to get "here" is to go through "there".
Good luck everyone. There is a light at the end of the tunnel and it's NOT an oncoming train. Please add your experiences...
"You gotta go through hell before you get to heaven." - Steve Miller, Jet Airliner
1 like, 35 replies
hope4cure CHICO_MARX
Posted
Mabe try xiaflex. It was used on my hand after surgery build up of heavy scarring, scar tissue is made up of collagen. Originally xiaflex was used to treat Dupuytrens Contracture to straighten my fingers where the collagen had built up in my plam called nodules on cords pulling fingers to fist. Also eliminated the thick scaring from hand surgery can't even see the scar and straighten out fingers. Treatment was xiaflex a biologic injection . Also was used on my frozen shoulder. It's been in studies to remove scar tissue from burn victums. Also used in Peyronie's disease. Mabe you can check to see if you can find clinical studies you could enter if applicable.
just a thought.
CHICO_MARX hope4cure
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jan01779 hope4cure
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Oldfatguy1 CHICO_MARX
Posted
Then there's the one you missed...laying on your stomach while the PT grabs your ankle and tries to jam your heel through the back of your head...over and over and over and over.Pain can be adminersted in so many ways. Pick your poison
CHICO_MARX Oldfatguy1
Posted
That's a new one for me. Ugh......
They all must have gotten their certifications from that place Steve Buscemi mentioned when he was getting strapped into the shuttle in the movie Armaggedon...
Helga's House of Pain...
Oldfatguy1 CHICO_MARX
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lawrence34984 CHICO_MARX
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WILL I NEED THERAPY AFTER
MY KNEE REPLACEMENT?
The best therapy after your knee replacement will be walking. We will arrange therapy for the first four weeks after surgery. Therapy is a very important part of recovering after knee replacement. Our goal is to get you to your local therapist as quickly as we can.
WHAT IS THE RECOVERY TIME
AFTER KNEE REPLACEMENT?While patients are up and walking immediately after their surgery the total recovery time after a knee replacement is long, averaging four to six months. Our goal is to restore your motion in the first month of your recovery. We would also like you to feel well enough to return to work after four weeks of therapy. Recovery is always improved when patients walk and quickly start outpatient therapy.
I did therapy 3 times a week for six weeks, started therapy 2 days after surgery. went home the same day of tkr
Oldfatguy1 lawrence34984
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CHICO_MARX Oldfatguy1
Posted
I agree about the walking, but...
Four to six months total recovery time?
Full ROM in four weeks?
Plus a return to work four weeks after starting PT?
Really????????
You're right OFG...I want to smoke what he's smoking...
Lawrence... Starting PT two days after the op must have been difficult. I was in a rehab place for a week and we did some light stuff but not the full PT I described in the post. That came a few weeks later when I was not completely delusional on the drugs. You're lucky that it all worked out for you. Certainly not the norm.
jan01779 Oldfatguy1
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jan01779 lawrence34984
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John5006 CHICO_MARX
Posted
Hi Chico,
You asked the question ........" I started my PT 3-4 weeks post-op...wait longer and the scar tissue has had more time to build up. Haven't heard of anyone starting sooner...anyone out there who did that?"
?So the answer is me ...............I started within hours of coming round after surgery. I am in UK, I was operated on by a 'Private' health system surgeon in a 'Private' hospital under the UK National Health Service.
Regardless of whether we had a partial knee replacement or a TKR we all had to achieve at least a 90 degree bend before we were discharged from hospital. We all were discharged on 3rd day. We also had to demonstrate we could climb up and down stairs with crutches.
?We all had a booklet of exercises to do at home - up to 5 or 6 daily, right from the time of being returned to the ward after surgery. With plenty of pain relief medication to help we had to do these exercises as instructed. At the 13th day after discharge my dressing was removed and I then consulted my sports injury massage therapist who (once satisfied that there was no infection in and around the scar line) began massaging the scar line and surrounding area to PREVENT SCAR TISSUE forming. This went on for some 6 weeks - not a UK NHS requirement but one that I chose myself and paid for privately.
At 7 weeks I was driving my car again and at 11 weeks was back at work driving a bus in the tourist industry and handling passengers baggage ( weight 15 kgs or more). It was right knee, so it was constantly on accelerator and brake.
?Job done.
No problems ever and now its some 18 months since surgery.
Way to go man !
John
lawrence34984 John5006
Posted
no doubt this is a barbaric surgery and some do it better than others,... patients too.
someday...a thousand years from now they'll snicker at the barbarism of medicine in ancient times. 3D printing new knees while you're napping.
CHICO_MARX lawrence34984
Posted
Yeah...and Dr. McCoy will give you two pills in the hallway of the hospital and cure your cancer. We'll get to the Star Trek Universe someday. Mmmmmm...Tricorder....
CHICO_MARX John5006
Posted