Lower Extremity & Knee Injuries/Conditions - Expectations in PT

Expectations in PT - knee replacement

Printed From: CyberPT - Your Online Physical Therapy Resource
Category: Patient Forum
Forum Name: Lower Extremity & Knee Injuries/Conditions
Forum Description: Patients can post questions and experiences about lower extremity & knee injuries/conditions.
URL: http://www.cyberpt.com/ptforum/forum_posts.asp?TID=483
Printed Date: Dec 12 2024 at 11:51am
Software Version: Web Wiz Forums 11.03 - http://www.webwizforums.com

Topic: Expectations in PT - knee replacement

Posted By: HyperZen
Subject: Expectations in PT - knee replacement
Date Posted: Sep 05 2009 at 8:15am

I am 42 years old and had a total left knee replacement 3 weeks ago (was in a car accident when I was 16 that caused the joint to degenerate over time.) I started outpatient PT this week, and I am struggling to understand the expectations for my rehab. My therapist is just out of school and I am one of her first patients; she's not very good at consistent communication, often gives me mixed signals and seems to be more concerned with my doing well to make her look good rather than my well-being. I have two questions:

1. My strength is getting better every day, but my flexibility is coming along VERY slowly. I am still swelling quite a bit after just about any activity and am only getting about an 85 degree bend with my heel slides right now. My therapist keeps saying we need to really push on that and get it to 120 by the time I go to see my doctor (in 2 weeks) but I feel as though the swelling impedes my flexibility significantly. I'm happy to push myself, and I do - often to the point of tears. But it would be very helpful to understand what is "normal" at this stage in my recovery (if there is such a thing, since I know all bodies are different) and if I should worry about my lack of progress. (When will the swelling subside???)

2. I am a communicator and a relationship coach by nature. I would like to give my therapist some constructive feedback about her approach and her energy (I can tell she's nervous and trying to look competent, but it comes across as aggressive), but I don't want to cross the line and I also don't want to embarrass her in front of her colleagues. Suggestions? I think she knows her stuff, but she needs to focus, stay with the patient she is working with (she flits around a lot and yells at me from across the room while working with someone else) and use more empathy even as she is pushing for the best results.

Thanks for any and all feedback.

Replies:

Posted By: Ask a PT
Date Posted: Sep 08 2009 at 2:04pm

Hello HyperZen,
In response to your questions:
1) Swelling or edema is quite normal after a knee replacement. The swelling is a contributing factor for why patients may have a difficult time with achieving ROM. Progress will vary from patient to patient. Patients can expect to achieve 0-110 degrees + of AROM from 3- 8 weeks post op. You can click on this link to give you a general idea of progression after surgery: http://www.cyberpt.com/documents/UHSTKA-Shapiro.pdf - http://www.cyberpt.com/documents/UHSTKA-Shapiro.pdf As the swelling subsides, patient usually achieve increase ROM
2) I think good communication with your therapist is essential for you to succeed. As a professional, I think she will understand and appreciate your feedback. Perhaps having a discussion with her in private and letting her know what you are thinking might be the best approach.
Best of luck with your recovery!

Posted By: HyperZen
Date Posted: Sep 08 2009 at 3:50pm

Thank you! That is very helpful! I asked for clarity today from my therapist and we had a good conversation so I understand things more, and she understands I need more communication from her about what is expected and what may be impeding my progress. She also got a more seasoned therapist involved who really pushed me hard. It was NOT fun and I am not looking forward to tomorrow, and yet I am because I made some good progress today.

Posted By: Ask a PT
Date Posted: Sep 11 2009 at 12:18pm

You are welcome

I am glad you were able to work things out with your PT. Hang in there and keep working hard! You will get there!

Posted By: HyperZen
Date Posted: Sep 11 2009 at 12:25pm

Do you happen to know anything about Mayfascial Release? Would it benefit me?

Posted By: Ask a PT
Date Posted: Sep 14 2009 at 3:29pm

Myofascial release could be beneficial if your PT finds that you have tissue restriction. I typically will focus more on scar tissue mobilization in the beginning and than myofascial release later on down the road if I find that my patient has the fascia restrictions.