Chancy

Jtmav,
I also have noticed the 2 schools of thought on how to rehab from TKR. It seems to me in the US, at least everyone I've talked to, that "No pain no gain" seems to be prevalent here. In others countries, UK for one, they lean towards "push until discomfort but not pain" and so not worry about muscle rebuild early on, just ROM. I am 4 weeks past a revision of a TJR done last November and have gone to 2 different PT clinics. Both clinics and all the staff are off the "No pain no gain" school. I am not sure it is important to rebuild muscle aggressively while regarding trauma.
Tailwinds,
Charlie

Jtmav

It makes sense to me that you can’t rebuild muscle before the surgical trauma, soft tissue has healed. The problem is they scare you into thinking if you don’t get good ROM within 6 weeks you’re not going to get it. I have made some progress and I rode the stationary bike for 15 mins this morning. I will be a month from surgery tomorrow and my ROM has been around 100. I haven’t had serious pain after a PT session, plenty during, but come home just feeling tired and elevate and ice my knee for a bit. I’m going to continue with my present PT and hope by 6 weeks the pain during the forceful bend will have calmed down.
thanks for your input

Chancy

Yes, the first clinic I went to definitely tried to scare me with the necessity for quick and somewhat aggressive muscle rebuilding while manipulating your knee as well early on. The second clinic didn't try to scare me yet the therapy is very similar, just done a little better, I believe.
I went to PT for 11 weeks post TKR and now 4 weeks post Revision. The pain experienced during the manipulation (forceful bending) in the first 11 weeks did not reduce any from week 1 thru week 11. The knee just bends a little more, my pain was still a 9, and up to a 10 before they would quit manipulating. Now that I am 4 weeks post my revision, my experience is similar, except the therapist (at a different clinic) has a different approach/method of manipulating that makes it a little more tolerable. I hope your pain lessens with time but mine didn't. Hopefully some other folks will chime in, there have been lots of knee replacements on the 50+ forum.
Tailwinds,
Charlie

Jtmav

I discovered a website dealing with all types of joint replacements where the overwhelming opinion is contrary to what you and I are experiencing. https://bonesmart.org/forum/view/kne...covery-area.9/
There’s a lot there which has just added to my confusion about all of this. If you take a look I’d be curious as to your take on some of it. Appreciate your insight

Chancy

Yes Jtmav. The BoneSmart forum was what I was referring to and most of the members seem to be from the UK, Canada, etc with a few from the US.
Tailwinds,
Charlie

Chancy

Jtmav,

Sorry I didn't fully answer you post. I read Bonesmart posts quite a bit following my initial TKR in Nov. 3, 2023. It had me confused as well. The main reason I kept reading it was the pain from PT was getting to the point where I was starting to dread going. I would love to bump into a clinic or therapist who had Bonesmart's philosophy and sit done and have a discussion with them, but I don't know of anyone like that where I live. With that said I did notice that Bonesmart members, on average, take longer to achieve ROM goals, some as long as 1 year or more! But they do seem to achieve them. Also most of the Bonesmart members don't seem to be quite as active as I think most 50+ forum folks are, thus willing to wait longer for results. Since I don't have the option of the"Bonesmart" way locally, I decided to get onboard and follow my doctor advice and use his recommended therapist (and quit reading Bonesmart). Despite my new therapist being a "No pain No gain" guy, I like him. His philosophy is a little different and when he manipulates my knee it definitely hurts (up to a 9 or 10) but is a bit more tolerable than the last clinic I went to. He stops and throws in some massaging in between multiple bends. I don't know if the massaging helps the muscles or knee but it gives me a mental break during the manipulation session.
I hope this answers your questions and helps in some small way.
Tailwinds,
Charlie

Jtmav

Thanks, I think we are of the same view. I have PT tomorrow and not looking forward to it. I have a follow up Monday with my Surgeons team and will ask their view on PT. I’m fairly sure it will be a more traditional one. Going to gut it out and see how things progress. I appreciate you taking the time to share your experience. Be well and good luck on your recovery.

rob214

I'm finishing up on post op week 8. bending is 117 and straight is -1. still needs work and I'm trying hard. I've ridden a couple of times and the range of motion is good for pedaling. can't put much pressure to the pedals yet but I'm happy for the outside therapy. still have pain and especially when moving sideways. I guess tendons and ligaments need more time to heal. not back at work yet as I'm a welder / fabricator and it's pretty physical. it hurts and becomes uncomfortable after a few minutes of standing in place. not bad if I keep moving. I can now walk a mile and a half which I couldn't come close to that pre op.

Jtmav

I’m a month out today and have a PT session later this morning. I’m around 100-105. Did 15 mins on the stationary bike yesterday but I did get a bit of swelling after. My PT is forcing bend, which is pretty painful but I guess necessary. Meeting with my surgeon on Monday for X-rays and will see what he says about my recovery so far. Good luck with your recovery.

rob214

hi guys, I started riding again. a few short rides then a 55 mile ride Saturday and a 46 mile today, the knee is great it's the rest of me that sucks right now. it's going to take some time to get the old bod in shape but the knee is rocking. no pain. can''t wait to get the other one done.

Jtmav

Thanks for the update, I am scheduled for my second TKR tomorrow exactly 3 months from my first. Been able to ride the stationary bike but that’s it so far. I am concerned about how the rehab will work with the second so close but my surgeon and PT said I should be good to go. The first one is still stiff and my ROM is good not great, although it wasn’t very good before surgery. Well at least I am encouraged by your success and am happy you’re back in the saddle.

rob214

ROM is a daily chore, I get stiff just standing for a few minutes and have to work on it hard. the nest thing is when you get the freedom of pain and the okay from the doc to do as you please. then you can get to working out real hard and the results come faster.