Why Pushing On The Knee Is NOT Helpful: Total Knee Replacement

[@lorriewhalen2430]

What a coincidence. I had my need replaced this past Monday. I went into my PT eval yesterday. She was pushing, pulling, tugging, etc. It was past the pain point. I was gripping the table. I’m a registered nurse and was saying to myself that is not a good thing to do. However I’m not a physical therapist. What do I know. When I was done, my knee was swollen and painful and felt like I had taken a few steps back. She kept preaching we have to do 0 degrees and 90 degrees by the end of next week. This morning I see this. I think something was reading my mind. BTW your videos have helped e a lot. Last night I was miserable in bed with position. I am not a back sleeper at all. I watched your video on sleeping positions, and lo and behold I can sleep on my side. That made me very happy. I got more sleep than I did the night before but not my usual amount. Thank you for what you do. You are a very educated physical therapist. BTW I don’t know why you don’t have more subscribers. Your information is gold.

[@dr.samanthasmith]

Wow thank you for your kind words. I am so happy to help. It is rare to have a PT specialized in knee replacements. It’s really not a subject therapists chose. Usually it’s sports or pediatrics or stroke - something like that but very broad. I have decided to niche down to a very small population. But yes, all of what your PT did to you is NOT OKAY. I would either find another PT or have a good talk with her. Ugh. I am so sorry you have to deal with this. My career goal is to change this problem!!

[@beyoncecole8103]

Isn't she AMAZING!!!

[@beyoncecole8103]

​@dr.samanthasmith Need help please. Am ONLY able to slide back on my OWN at 105. My Total Knee Replacement was 09-22-2023. It's now November 19, 2023. I squat well. Ride the bike well. Back lunges are okay and curtsey lunges. It's the bending BACK is my issue. My PT wants me to get to a 120 bend

[@bonniebrown1951]

I started 4 days after surgery at o degrees flat and 145 degrees bent. Wow says the pt this is great. After the first session of therapy my knee was so swollen I missed the next two sessions. The next week I explained what happened. The same pushing happened and again I was swollen my knee looked like a large cantaloupe. I'm a slight women with thin legs and small knees. So again I'm missing two sessions this week. I'm ready to quit pt. This is my second tkr in one year. I did not have this problem seven months ago. I'm ready to just do my own pt. I'm not a quitter and totally believe in pt had thousand of hours of pt for different reasons in my life.

[@teresaobryant9076]

It is totally ok to fire your PT

[@camillesamples8790]

I was doing well with my 2nd TKR until a PT student pressed on my knee HARD. I was I constant pain. I went to see my surgeon and he said stop therapy. I had to continue pain killers longer than I should have. My surgeon wants me to go back to a different therapist and has told them to be gentle. I’m concerned that I’ve lost the window of opportunity to bend my knee. I gave the real therapist at the first place a piece of my mind. That was never done to my knee the first time.

[@SheilaEnglish2]

The physiotherapy I have is at the hospital and your point that the pt pushes so as not to disappoint the surgeon really clicked. When I am meeting all the markers but it doesn’t seem to be enough for the pt, her painful treatment of me seems to be for another audience. This will be my last session at the hospital, then I am going back to the private pt I worked with before the surgery.

[@sherrybarfield8446]

I am a retired Social Worker and have no issue advocating for myself or teaching others to do the same! When the PT mentioned Manual Manipulation I simply informed her I would push myself to bend to reasonable pain tolerance. I politely told her if she pushed to intollerable pain I would loose trust in her..... so she agreed (what choice did she have) to coach and support me without physically manipulating my knee. We have done wonderfully well together.

[@coringtonbaldwin7629]

My Physical Therapist tried to bend my Knee as much as possible..I started outpatient therapy 3 days a week and after a month it was reduced to 2 days a week..I started at 110 degrees and quickly progressed to 127 degrees..My Therapist continued to push my leg to 132 degrees..Each time I came in...One thing that helped eliminate some of the pain was riding the Ergometer for 10 to 15 minutes..If my knee had swelling my therapist would back off trying to maximize the bending of my knee and message my knee while flexing my knee cap from side to side..I quickly came to the relalization that therapy did not concentrate on exercises but more about pushing the limit of bending the knee and increasing my tolerance of pain = Breaking up my scar tissue...Once again...Excellent Video

[@hongtramnguyenle4978]

Thanks a lot for your helpful advice, Dr. Smith!❤.

[@dr.samanthasmith]

My pleasure!

[@gailcole9913]

I am an RN. My PT is wonderful over 30 years experience with knees. She would agree with this. I am pre-knee replacement a bilateral in Jan 2024. Surgeon has great results with Bilaterals- all Ohio Cleveland Clinic health System. We get results and she never has caused me more pain, it has been less when I leave PT. I rehabed meniscus tears with them too 12 years ago with great results. Make sure your surgeon and PT are very experienced in knees and work together!!!

[@dr.samanthasmith]

I am so so happy to hear this!! You have a great PT

[@johnhickey1326]

Good advice Samantha 👍🏻

[@greghamilton4129]

So, I'm now 2 weeks past my 2nd knee replacement surgery. After my 1st week my PT pushed too hard on my knee after the 1st week. The knee swelled up and set me back a week. Asked her why she would do that when my 1st knee got to 125 degrees quickly and my 2nd knee will get there shortly without her over doing it. It's a week later and the knee still is not right. If you're doing the exercises and making progress, pushing too hard too soon will only cause problems.

[@Factorydirectdesignersworkroom]

Thank you so much for all your helpful videos and advice! I have liked and subscribed as well as joined your Facebook support page! You are a huge help!!!

[@dr.samanthasmith]

Happy to help! And thanks for following along!

[@yvetteandrews7967]

Thanks so much, U need to remember this when I go to PT as I have different phhysical therapists on different days

[@tomcollins1441]

Very well explained. She was being nice though and I probably would have said something like some people can have a higher tolerance for pain than others

[@RoderickEmanuel-m7d]

Best to avoid Phys Therapists. After my TKA I did all my own phystherapy.

[@Polonolo99]

Thanks so much for this. I also commented on your Instagram heel slides video. My PT is pushing incredibly hard on my straight knee and I'm only 10 days post op. Have my first Dr. appt tomorrow and will ask him about how my PT appts. hurt. Thanks so much.

[@debbielee133]

😊❤OMG Today is Thursday evening 9:30pm. Since Monday around 8am…. I’ve been contacting my health care professionals (in vain) wanting to understand this I.e. Is the intense and unbearable level of pain truly necessary???? Thank you for this sharing of your philosophy. I think I intuitively knew it wasn’t helpful. The extension Was the worst striving toward totally straight line on extension.

[@debbielee133]

Addendum: I’m just 4 weeks out from my left TKR

[@beyoncecole8103]

My Total Knee Replacement was on September 22, 2023. When I lie on my back at PT I can only slide back at 105. It is now November 19, 2023

[@dr.samanthasmith]

I would try doing the stretches in sitting instead of laying. I bet you’ll be able to stretch better and farther

[@marytesta3003]

Good advise. ?@Dr.Smith:Do you do any massage or soft tissue? I'm 9 weeks out and I just do the same exercises(strengthening) over and over. I'm bored. And I'm not progressing. I'm 67. Stairs aren't a problem. I walk my dog most days for 20-30 min., I take water exercise classes 3-4xweek, and still my flexion is about 115. Extention is about +5 on both knees before and after surgery. BTW, I went back to work as a massage therapist at 4 weeks. I worked for and adore my PT but the 1st weeks I had another PT and she did minimal hands-on. I am feeling really stressed out. I'm actually worse now than 4 weeks ago as far as pain and tightness. I keep doing and doing stretches, and it's painful. I actually took tramadol last night and tonight. I waited years too long to have the tkr. Work, my husband had cancer, then covid and lost my mom. My quality of life and function are so much better. Very much better. I want to just stop PT and get a massage therapist to do some mfr. I do cupping and soft tissue myself. My incision is lovely. I'm torn about what to do. I feel like I should keep doing what I'm doing and enjoy life instead of stressing over numbers. Surgery was 9-6-2023. Am I expecting to much?

[@Moira-lr5bp]

My physiotherapist did the same to the point I thought I was going to pass out ,TKR October, op. was a bit of a disaster, after operation when bending to test the bend my kneecap broke told osteoporosis caused that didn't know I had it so instead of a three day stay was in for a month with a brace on 24 hours a day for 8 weeks. The physiotherapist came to house once a week , told by surgeon to take things really slowly ,brace was set at 60 but she tried pushing it to try to get me to the 60 I was getting 54/ 55 ,no idea what its at just now as physio stopped after the brace came off was told to concentrate on two exercises bending and straightening its really stiff and still swollen but think it might be up to a 80 / 90% bend .Because I wasn't able to bend it much before the op. physiotherapist said I may not get full bend I'm not expecting great things im 82 see surgeon in a fortnight who wants me to have my opposite hip replaced which is 38 years old not sure what to do about that. Im a prisoner in my own home can't get into cars only patient transport when going for appointments .

[@phyllismcdonough6251]

Hi Dr Smith, why is it all around, right below my knee have stiffness? I thought it had subsided but feel it this morning. It’s not as bad as it was but it’s there. I’m 6-1/2 weeks po with 130 ROM. Thank you.

[@dr.samanthasmith]

Because the quad is weak. You’ll want to continue with a progressive strengthening program to help with the stiffness. I have one on my website. www.succeedcourses.com/Exercise-class

[@totlinegrant3418]

I'm 5 months I walk very well but my knee is still stiff especially the back

[@dr.samanthasmith]

You probably need to continuing stretching and strengthening the hamstrings. If you need an exercise routine, I have one in my website! succeedcourses.com/Exercise-class

[@KarenJames-l1p]

I never see the same therapist on my visits they just refer to notes same routine everytime I'm a little over 4wks TKR

[@jeffkelly5972]

tore my quads in October and had an operation in November. I go to PT and they bend my knee till I scream in pain. They said I got to 70 but the surgeon said I was only around 30 and I will need a MUA. I am worried about the pain being as bad as when they push my leg and I scream. I have even tried to take oxicodone while at PT. and it still hurts real bad. My knee is stiff and hard but I am now out of the brace and using a cane. I also got blood clots in my lungs 2 days after the operation and am on blood thinners. I am worried about the MUA and what the pain will be like.

[@dr.samanthasmith]

Totally understandable to be nervous about the MUA. you’ve been through a lot. Most people see a 20-30 degree improvement after the MUA. The first few weeks your knee will be swollen and sore. With proper PT it should improve. I do have a Knee Bending Course. It’s for knee replacement patients but it would work in this situation too. Check it out: www.succeedcourses.com/Knee-bending-course

[@jeffkelly5972]

@@dr.samanthasmith I am having second thoughts about a MUA I don't want to go through weeks of pain and then more pain in PT. I am trying to push it at home it just gets so hard and tight. I do feel like it helps though.

[@GloriaRodriguez-u9c]

Good morning Samantha they do that to me very painful my therapist puts 2 heavy weights he has me laying on my back putting my feet against the way bringing my knee half way down I trying pushing it more down it's very irritating my range of motion was 90 last week then it went to 85 I do everything I can to bend it my knee is swollen I elevate it ice I say to my what is wrong..

[@dr.samanthasmith]

I would highly recommend my Knee Bending Course to help! Https://www.succeedcourses.com/Knee-bending-course

[@i_am_born_again]

Yeah why do PT’s push it?

[@dr.samanthasmith]

There are some PTs that don’t want to disappoint the surgeon so they push it. Others just have learned from a previous mentor that did it that way. Overall, it’s a lack of education, in my opinion.

[@jeffw3776]

Well…The first two PT visits were hell. The third I told him go much slower and not too far. He did and I progressed perfectly to 130/ 0 ext. he was great off PT at 8 weeks . Now playing pickleball. Maybe the first two tough sessions are ok

[@jeffw3776]

I know you’re not a fan of pushing. But to be honest. It worked for me. The PT said to just relax as much as you can. The knee will not explode and the ROM is not a problem. It’s a very personal experience. My PT has 10 years and many experiences with TKR