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
mary_ann60812 CHICO_MARX
Posted
Chico - I'm guessing that you're talking about outpatient PT. My worst pain - obviously - was the inhome PT the first 4 weeks after surgery. But I had an awesome therapist 2-3 times a week who was so understanding, I would have thought she went though TKR also. Most of my 4 X a day exercises, I was in tears, but I was so fearful of ending up with a limp, I just cried through the 20 minute exercises. By the time I started out patient therapy at week 5, I didn't have any problems or much pain working with my PT. The "pushing down on knee to straighten" was the only thing that bothered me. I thought the leg would just snap! But I think, some of us just luck out, I know I feel like I did. Recovery has been on target and I'm back to doing what I did before, but with modifications - I just hope this lucky streak lasts forever!! I like to exercise, so that's not a problem and maybe that helped in my recovery. Who knows? I'm a year and a half out from this. There's still stiffness now and then, and I still feel nerves regenerating - feels like a moment of bugs under my skin - yuk! and I do have minor pain on the inside knee when I try to lift my lower leg - sort of like crossing that foot onto my other knee. Have you had any of this inner knee pain? But it doesn't stop me doing what I want.....life goes on!
Mary Ann
CHICO_MARX mary_ann60812
Posted
I'm just about 15 months...don't even know it's there most of the time. Yeah...those 10 weeks of PT were barbaric but you have to break down the scar tissue or never walk right again. Simple as that. Got past it and now have really good results. 0 / +133 ROM, zero pain or swelling, some minor "hotness" sometimes, no band feeling, no meds or walking aids, climbing stairs two at a time, just the clunking sound that I think is permanent. One more knee to go but I'm gonna wait until all of this has permanently shifted in my brain from short-term to long-term memory. It's still too fresh in my mind.
Tip: After the first few brutal sessions of hands-on-knee-and-pushing, I tried very hard to send my mind somewhere else. Gotta push the pain to the back of your mind or else you get engulfed by it. Closed my eyes and did some meditation. Not fully successful but it helped. Just like at home. Don't concentrate on the pain or it will consume you. Put your focus on something else. Engrossing book or movie, binge-watch a whole series, kill zombies on X-Box, whatever.
Great old book by Norman Cousins: "Anatomy of an Illness: As Perceived by the Patient". The man had an incurable disease. Locked himself in a hotel room and watched nothing but The Marx Brothers, Laurel and Hardy and more for months. Walked out cured by laughter.
Duckfan CHICO_MARX
Posted
I started PT 6 days after my surgery. Worked on the NuStep, they massaged a little, measured the bend. I had PT three times a week for six weeks. Exercise bike, NuStep, and the dreaded reformer. Looked like a rack from medieval times that Chico was talking about. You laid on your back with your knees bent and and pushed yourself back and forth. It hurt until you were really warmed up. Worked out on stairs, used the exercise ball and therabands. Used leg weights. The PT also used taping and that felt wonderful. After all this my bent rom was only 98. PT discharged me because Medicare only allows about $1500 and I was at $1000. The PT wanted me to have money left in case I had to have PT after MUA if needed.
I've been doing exercises at home but not working very hard. I need to get to a gym. I measured today and have 105 so it's better.
Went to the chiropractor and after being adjusted the massage therapist used cupping. Went to acupuncture and he used a magnetic pen over the scar and put lots of needles in my leg. Both of these treatments have really helped.
natalie12123 Duckfan
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CHICO_MARX natalie12123
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I've used acupuncture for relief of certain conditions at times. Very helpful. Works great on me. For sciatic pain and hip/spine pain issues caused by walking "funny" after the TKR, I got great results with a chiropractor. These modalities help with pain.
But the scar tissue in the knee? PT or MUA... Someone above mentioned something called Xiaflex. Never heard about it...maybe worth checking it out...
Duckfan natalie12123
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Hi. I'm going to the acupuncture, chiropractor and massage therapist specifically to break up scar tissue. Not so much chiropractor but the others. They both have been working to loosen the scar tissue and break it up. They both have had experience doing this with knee replacement patients. Make sure to ask about this before you make a appointment. It's worked for me, I have more Bend and my knee feels so much better. Insurance won't pay for it, at least mine won't. Good luck. Let me know how it works out for you.
jan01779 natalie12123
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jenny80029 CHICO_MARX
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jenny80029
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CHICO_MARX jenny80029
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jenny80029 CHICO_MARX
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Thank you! Exercises in the pool have been the biggest happiness! Don't know what my ROM is at the moment but physio will measure it in a couple of weeks when the group sessions finish.
CHICO_MARX jenny80029
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Remember...it's just a number...well...two numbers. Ten PTs can measure you and you'll get 10 different sets...then your surgeon will give you another one. Don't hinge everything on two numbers! You'll know when it's straight; you'll know when you can bend it pretty far back. That's what counts.
jenny80029 CHICO_MARX
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Yes, indeed, That is a good reminder! Mine is straight and it can bend back as far as the non operated one. There doesn't really seem much point it going further from a practical point of view! However, I am interested to know what it will be. As you say, it will vary.
jan01779 CHICO_MARX
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Started gentle physio from day 1 released at day 3 with gentle exercises. Had to be able to do stairs to be released but actually coming down one leg in front of the other is still difficult sometimes up is better.
Had 6 sessions of outpatient physio from 1 week post op and rememember the push down only too well (through gritted teeth) but the rest of it was far less aggressive than it seems to be in the USA!! From the first session was given a printed sheet of 10 exercises to do at least 3 times a day building up the reps and sets. Week 2 had me on the bike for 10 minutes rocking back and forth until I got a full forward rotation. Used this at home from week 3 building up time as a warm up. Week 5 physio added squatas in but had to start off with chair squats .
Can rememeber my dismay when I felt the tight rubber band feeling circa 4 weeks!! Posted on here in dismay (no-one warned us of this thought it had all gone wrong). Panic ...everyone was warning me of scar tissue ....was I doing enough exercise....I didnt want a MUA.! I think the 1st 4 weeks did too much and the approach of PT after week 3-4 might be better who knows?
At 8 weeks was told could go back to aquatone but did not manage that until about week 12 as too swollen but I started using resitance bands at home and am still doing that. and light ankle weights.Found u - tube good
AT 6 months still working on quads & extension (long way to go) but can do stairs much better most days depending on swelling or other knee. Dont do gymn work but have just got a really good book about using the pool as a gymn which migh be useful for some with multiple joint issues.
I think its important for each person to find soemthing to suit them, there abilit,condition and age; for me Aquatone and hopefully eventually my road bike ( my Heaven !) . I am in admiration for the chap on her who was on his road bike at week 5 wweks if i I recall right!
My heart goes out to those who have had difficulties its a hard enough journey without that but wishing everone well. I am so pleased I have had it done keep at it.
CHICO_MARX jan01779
Posted
Yes, the pool is a great way to do exercises. Unfortunately, we only have one around at the "Y" and when people have taken up all the lanes to do laps, you can't get in the pool. I rehabbed my hip in a special therapy pool...that was GREAT!!!
So many variables at play here and, yes, it does sound like things are different on this side of "the pond". In the end, everyone has to find what works for them but HAVE TO STICK WITH IT!!! The whole thing takes a long while. And just when you think you're done, the knee will come back to bite you! Gotta see it all the way to the end.