Am I Getting The Best Physical Therapy After Knee Replacement?

Physical therapy is a integral part of the success of your total knee replacement. This video will describe what physical therapy should look like and if your physical therapist is doing what’s best for you and your knee.
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[@brugglife]

I had my TLKR done 5 weeks ago at the VA and I’ve only been prescribed a Easy Stretch machine, 4 exercises, and a floor peddler. I don’t think it’s enough but at my last checkup they were happy with the results and didn’t assign me actual physical therapy. I’m 10/102.

[@thirdactwarrior317]

I have had both knees replaced, seven years apart. Both times, I started with a DPT who was really good and laid out a sensible program. But also both times, they passed me down to Assistant PTs who pushed way too hard and sometimes pushed hard on things that were not aimed at my objectives, straightening, flexing and any measured muscle weakness. They acted more like gym personal trainers than medical PTs. The first time, I had what I call "patient obedience syndrome" and tortured myself trying to do what they wanted. This last time, only three months ago, this started to happen again and I said the heck with it. I went to see my surgeon and he said I had the range of motion he wanted and I no longer needed PT if I didn't want to do it.

[@dr.samanthasmith]

That’s a good point to mention- Physical Therapy assistants (PTA) have 2 years of education. Not saying that to demote them or insult their intelligence- I have amazing PTAs who I consult often for second opinions. But as a patient, you should definitely do what you think is best. Your PT should help you make decisions about your recovery along the way. Every exercise I prescribe has a meaning. I don’t just have people exercise or stretch for the heck of it. If exercising for fun IS the goal, then I’ll have them go to a personal trainer and tell the personal trainer what muscle groups still need work.

[@emanalsiniy5844]

Great information. God bless your heart

[@johnconklin9138]

I am looking today for a new PT started week 2 now 6 weeks Posts op still doing same exercises. I have never left sore and never given a progression? No bike, No squats, No stairs, no strengthening, and Same exercises ! :( I have learned more from your videos in 3-4 days than I have in 4 weeks of PT so I thank you again for caring and sharing !

[@dr.samanthasmith]

Oh geez. That is sad to hear!! Glad to help. I hope you can find a PT you like. You can look into my Post Surgery Course as well. Https://www.succeedcourses.com/post-surgery-course

[@abuzeyadb1831]

Dear Samantha Smith, I am one of your latest subscribers to your channel and I feel you really such a wonderful Dr and good adviser, to tell you my wife did a TKR last September 8/2022 and she had a Smith & nephew prosthesis so far thanks to God she recovering but not totally she still have a sleeping disorder and pain and some little swallowing from time to time and with your resent video you alert us about how to deal with a rehab program and how to talk to the rehab Doctor we thank you so much for your efforts if you don't mind are you part or relative to the Smith & Nephew company? I hope to read a reply from you soon God bless you

[@dr.samanthasmith]

Thank you so much for your kind words. I’m glad my videos are helpful! That is all I hope to do with my channel. I am not apart of the smith and nephew company :)

[@abuzeyadb1831]

@@dr.samanthasmith Thank you for your kind reply and I hope we have chosen a good prosthesis made by Smith & Nephew

[@ckinch9279]

I am 7 weeks post op TKR still having stiff knee. I had to delay any knee bending due to my incision not being healed when staples were removed. Now I am working on stretching with other exercises and PT. My concern is inner and outer pain when walking as I do daily walking about 10 minutes x 2 times a day. The pain subsides after elevating and icing but during the walk it is sore. I don't see my surgeon for another 5 weeks so was concerned what might be causing this type of pain and is this "Normal". Enjoy your TKR videos. Thanks

[@sparklander]

I appreciated this video as it made me respect and value my physical therapist even more. She always asked how my knee was feeling when I arrived at therapy after my previous session. She did push me pretty hard initially at 2 weeks and then again at 6 weeks after my infection cleared up. I musk confess that I took ibuprofen pain medication.before I went to therapy, so I could endure a bit more pain and push harder through the bending and straightening exercises. Is it okay to take pain meds before therapy or is that a bad idea?

[@dr.samanthasmith]

Timing pain meds before PT is Super helpful! I recommend this to my patients

[@Peter-rs6vz]

Hi Doctor,question its been 4 weeks since my knee replacement,i had physio this week and my knee had fallen back to 70% from 80% week before,after my physio she got my bend to 85% but i was totally in pain when i got home,and it feels tight again,still swelling around the knee,i do exercises at home and i have a exercises bike but iam not able to do a full turn on the pedal,i feel it wants to go but the pain kicks in when i try to push further,can you advice me if gets going well and any exercises that might help me going forward,peter (uk).

[@user-qm6xu6ho1s]

Hi! Yes I am worried. Had tkr 8 months ago. Still having lots of pain, mostly a burning or electric shock. Mostly on the outside, sometimes on top. Leg looks good, except for swelling. I am allergic to maloxican which would have helped with pain and swelling. I talked to orthopedic and he just moves my leg and says it looks good. But something doesn't feel right. I expected pain and feeling a little unusual, but what can I do? I still do excercises and walking. Can you offer any advice.

[@coringtonbaldwin7629]

I had a Great Physical Therapist for my my Total Knee Replacement...I have 3 reasons for this...First, my first visit, my Therapist ask a multitude of questions to completely understand where I should begin in my Therapy Regiment...Secondly, my therapist would push my stretches and exercises to exceed my pain tolerance that I normally would not do at home...If for my next visit...if my knee had excessive fluid build up , my Therapist would back off my session for that day. Lastly, My Therapist encouraged me to continue with my therapy in the gym at 6 months when most Therapist state that you should go to the gym after 9 months from your surgery. Note: My Therapist was so good...that I had him for approximately 80% of my therapy...because he saw all first time patients...His support team was great with the exception of one individual..He stated" How long have you been here?...you should have discharged after 2 weeks"...I required surgery because when I caught Covid...The Steroids used to clear my lungs attacked my Knee...killed the bone ( no blood flow)...I was not a typical " Arthritis " patient...I don't know about you...but when beginning therapy..you could be in a depressive state because of the pain and lack of mobility...Therapist should always encourage you and not tear you down. Note: I have done every exercise for my knee to date with the exception of squats...That will change after today...Thanks

[@dr.samanthasmith]

I am so happy to hear this!! Everyone should get this level of care. PTs have such a huge role in so many aspects of patients lives not just their knee.

[@nalikasaai5108]

As you said”Don’t know why the knee surgeon said “ Not to do Squat”” I also what is the reason for saying so. But as I am a patient every time I do squat exercise , after finish squat my knee pain got worst. 😢😮

[@dr.samanthasmith]

You would just need to do the squat a different way or don’t bend the knees as much. Half squats or quarter squats to begin.

[@kevinmiles5420]

Hey Doc, Hello to You!!! I had TKR on the 5th of July, and I went through all of the motions of the Physical Therapy... But once I hit the 12 week mark, I had to to back to work at USPS as a Tractor Trailer Operator, my Issue is that I NEED Help because I have No time to do any home Therapy!!! Can you help me PLEASE!!!

[@dr.samanthasmith]

Hey Kevin! I can guide you to some resources. Can you tell me a little bit more of what you are needing? Curious if you are interested in exercises since your time is limited. Lmk!!

[@sallyhudson7196]

The timing of this couldn’t have been better! I am 9 weeks post op and struggling with flexion. To be fair, I was struggling prior to surgery as well, While I have surpassed where I was pre-op by a small margin, my surgeon told me at 6;week visit he wasn’t happy. I relayed this information to my therapist and she has not made any changes in her treatment plan at all. We do the same exercises every time. I feel as though she has just given up on me. I see surgeon on Monday and I am considering changing to a new PT facility. I have already booked appointments with new place. Do you think this is a great idea to start over at this point in recovery?

[@dr.samanthasmith]

As a PT, if the surgeon wasn’t happy with the patients flexion, that would definitely light a fire under my booty. Making a surgeon mad means they won’t refer any more patients to me. The PT should definitely be changing the stretches and making things more challenging. If you go to a new facility, you wouldn’t necessarily be starting over- they would definitely easily pick up where you left off!

[@sallyhudson7196]

Thanks so much! I’ve done every thing my PT has asked of me and haven’t missed any sessions. I think a fresh set eyes is the way to go. Have a great Weekend!

[@dr.samanthasmith]

Good luck! Keep me posted!! Have a great weekend too :)

[@nancyjorgensen7253]

Can’t find you on FB.

[@dr.samanthasmith]

Https://facebook.com/groups/3278770492360139/?ref=share

[@jazpwr8613]

Hi Dr. Smith, I’m 8 weeks out of TKR . My PT person really tried to push my flexion . Unfortunately my pain would zing beyond at 10 if push pass 110 . On the bike I can hit about 115. Im concerned because of your statement regarding 6 weeks and scar tissue build up. Yet I hear on your site and other research that this is a marathon not a sprint and everyone gets to ROM differently. Is that not true? Do you feel I’m stuck at 115 due to this 6 week window??? So confusing 😫

[@dr.samanthasmith]

Great question!! We say 6 weeks to motivate people and to emphasize the importance of stretching during that 6 weeks. If you are at 115 at 6 weeks you are doing great! Unlikely you have any scar tissue in there. Probably just tight muscles.

[@jazpwr8613]

@@dr.samanthasmith Thank you so much for the reply. It’s very reassuring to hear that from you.👍🏽😊

[@ralphparker]

I had a TKR, left knee, 6/22. I progressed and had my last PT on about 8/31, Where I started going to the Gym and doing other equipment exercises, ball squats and lunges. A few weeks later about week 13 or so, the restriction on ROM totally went away. I had my right knee done on 8 Nov and now at about 11 weeks in, I've got about 120 deg and hoping that in a few weeks I'll get that full ROM on this knee.

[@jazpwr8613]

@@ralphparker Thanks for the reply. It true about give it time, However within that time do everything you can. The body is healing everyday. I’m 11 weeks RTKR, I’m at 0 extension and 122 flexion,as I’m on a stationary bike replying to this . Listen to your body and put in the time.😊

[@rhmckibbin]

I am 10 days post-op. It's extremely hard for me to sleep on my back that I was told to do. Are there other sleeping options. I am normally a side sleeper.

[@dr.samanthasmith]

Yes! You can sleep however you like technically… www.succeedcourses.com/blog/how-to-sleep-after-knee-replacement

[@marytesta3003]

I'm more worried about home PT. Most aren't great. I'm told many many times it's a waste. If you can to go straight to out patient PT.

[@dr.samanthasmith]

Some are good. Some are bad. Our patient may “do” more but doing more isn’t always beneficial

[@marytesta3003]

@dr.samanthasmith You are correct! The PT sent is wonderful. He listened to my concerns and did talk about it being OK to change PTs if there isn't a connection etc. Also like yourself, he does hip and knee rehab so really understands the healing process.

[@marytesta3003]

That's my issue. Pure bordom at PT. I'm thinking about stopping PT and getting a personal trainer. No offense but PTs are a little lazy. They have techs doing all the exercises with you because they have so much paperwork. Not their fault. I do all my own scar work and any massage. All the stuff I do in PT I do at home everyday. Plus water classes. Walking, working etc. I haven't progressed at all.

[@dr.samanthasmith]

I totally understand your frustrations. Personal trainer might be the way to go. I also have an online exercise class. We’ve had awesome reviews! The exercises are much different than regular PT. check it out: succeedcourses.com/Exercise-class

[@TL-pz2kp]

I was doing great six weeks after. BUT, the PT I saw last pushed down on my leg at the thigh & shin to straighten my leg. I seem to swell more than typical, & that day I was extra swollen but he pushed down so hard I cried. It caused bruising & my leg has ballooned, & I’m in SEVERE PAIN constantly. I feel like I did on day I was discharged from hospital. My bend was great but the flex was at 8 & he tried to get me to 0 by mashing down fast. I’ve been in pain for 11 days & the pain is worse than bone on bone. I can barely walk now. Is this normal? My surgeon is out of town so I don’t know how to get an honest answer. I am very upset because the pain is excruciating. I understand no pain no gain & I tolerate pain well. I’ve have shoulder surgery & several others so I get pain. I feel like I’ve gone backwards & no one seems to get my concern. They want to say PT know what they’re doing, but that’s not always a given. If he set me back almost two weeks how is that good? I continue to do exercises but I am in such pain so it’s hard. I’m not getting better. Any advice?

[@marytesta3003]

Your surgeon must have a PA or someone covering. Go to any ortho knee doctor. Tell them it's an emergency.

[@barrysmith8193]

Call your lawyer

[@nancyhope1395]

I was asked last week by my doctor if I would like him to go into my knee and break up scar tissue? I had knee surgery 8 weeks ago and have not worked out as much as I had been asked. I started going to the pool and work out 1/2 hr on my knee in hopes this will help with mobility. Does anyone have any suggestions on "breaking up scar tissue"? I don't like the thought of having anything done on this knee. Is it too late to work on the scar tissue on my own?

[@marytesta3003]

Cupping?