bend it till i scream..please help!

[frog]

hello,

       i am wondering what to do. i am seeing results from my therapy sessions, ive gone from what they say is a 15 on my rom to a 62. in 3 sessions when  they measure the bend of my knee . BUT  i am in bad pain when i am doing therapy, i do my exercises daily like im supposed to .they are getting easier! heres the concern...... my therapist has me bend my knee while im lying on a table, just until it starts to hurt. then she pushes my foot back toward my bum. she stops when i scream and cry.  then she holds my foot there and has someone else measure the bend... last therapy session she forced it back to what she said was an 81, i cried , shouted, and threw-up on myself    the pain was un real. this hurt more than the first initial injury !!!!! i had to wait about 45 min before i felt ok to go home ,,, i know thats not normal!  i have a very hard time walking the next day its sore to the touch. we had a talk and i told her that i didnt believe this was beneficial to my knee!!!!!!!! and she said this has to be done ,it has to be forced in order for me to gain full rom again. and also she said my insurance would only approve 12 therapy sessions   what does that have to do with any thing sounds like she just wants to get paid. but any way should i look else where for therapy ? or is she right. and im just being a baby  what would you do if this was you help!!!!!!

[Heather M.]

What would I do?

I'd fire that therapist so fast she'd have skid marks.

Regaining ROM is important, and the work is tough and makes you sore.  But it shouldn't make you scream and throw up.  Your PT can actually cause more harm than good if she's not careful--people on this board have had their patellar or quad tendons torn during vigorous, indiscriminate bending exercises as you are describing.

The problem is that you have a lot of scar tissue in your knee, and it is physically preventing your knee from bending.  Depending on what injury/surgery you had, and how far out you are from that, it could be that the scar tissue is actually stronger than some other structures in your knee.  Or even worse...by cranking on and tormenting the knee, the PT is causing more irritation and swelling, and basically starting up a vicious circle.

I'm not a doctor or  PT, but I've been fighting scar tissue for 3+ years.  This is not the way to work on it--trust me.  Your PT seems to think that she'll come in and do this Rambo style PT and magically get back your flexion.  But the scar tissue formed for a reason--your knee was traumatized in some way, usually.  And this forced bending is further trauma to an already inflamed knee.  It can be counter-productive in that it can cause more heat, inflammation, swelling, and so much pain that your quad muscles may shut down.  Then you will be in a world of hurt.

I went through exactly what you are describing, and to be honest it left me worse off than ever.  I spent five weeks doing PT as you described it--my big, strapping, six foot tall PT would start our sessions by having me lie face down on the table and putting a trashcan near my head so I could throw up if necessary.  My surgeon was unfortunately all in favor of this aggressive, painful method.   But after five procedures in 10 months, I ended up much worse than pre-surgery, and finally sought out a surgeon who was a specialist in dealing with excessive scar tissue (a condition called arthrofibrosis).  I had surgery with him to remove the scar tissue for a fourth time, and he never, ever allowed any PT to crank on my knee during PT.  We actually weren't allowed to do any exercise that caused sharp pain, or irritation, or rebound swelling.  Because that can prolong and worsen the inflammatory cascade going on inside the knee as the body tries to heal itself...and inflammation is the mother of scar tissue.  So my new OS believed that forced ROM could actually end up creating MORE scar tissue in the long run, and this is exactly what happened in my knee.

Please read through this section and the one below it--soft tissue healing problems.  Read all about scar tissue, flexion issues, extension problems (inability to straighten the leg), and go through the NUMEROUS posts which deal with whether it is a good idea to allow the PT to crank, yank, and traumatize the knee.  The consensus among surgeons who deal with a lot of serious arthrofibrosis cases is that IT IS NOT HELPFUL, AND ACTUALLY CAN DO A SIGNIFICANT AMOUNT OF DAMAGE.

Heather

PS you will find ideas on how to improve your ROM on your own, or with a PT in a sensible manner.  You will also see posts by patients who have been seriously injured by non-judicious use of force.  There is actually a procedure (and old fashioned one) that some surgeons do for people in your situation called a manipulation under anesthesia...well, you're getting it without the anesthesia!!  This is wrong.  Don't let anyone treat you this way....

[stgiles16]

I had a lovely British Pt try that one on me in the hospital. I kept asking her to slow down (I was 24 hrs post op and thought my stitches would pop). She refused. She was forcing it while I sat on the bed so I just used my arms and yanked my leg out of her grasp. Talk about angry,,,,,, she was hot. I am not a wonderful patient person (sorry if anyone thinks I am,,,, I am not) I am stubborn and opinionated. LOL I then proceeded to bend my knee on my own. If  they say they want a certain number of degrees, I will work my hardest to go beyond that (she didnt bother to listen or let me take a breath for the pain). She never touched me again and I pity the next poor soul that she gets her hands on. I managed to excede the drs expectations on my own with good hard work. I dont understand how some therapists think they are doing you a favor by hurting you SO BADLY. Some pain is normal,. but crying and being sick on oneself is not normal.

Heather is right, find another therapist and there  are exercises that you can do at home (with the ok from your OS and pt)

good luck
missy

[PattiAnn237]

Im sorry to hear that you are having such a tough time, and you are definity NOT being a baby.  Its one thing to do a stretch that causes a little pain and makes you a bit uncomfortable, but shes going WAY to far.  My PT used to make me do an exercise that really hurt and one day I said I really don't think I can do this anymore, and she never made me do it again.  PTs are supposed to work with you, not for you.  They may know whats best, but if you are happy with the way your recovery is going, she really shouldn't push it.

You can in fact do that exact stretch completley on your own, get a long strap, like a dog leash or something, lay on your stomach loop it around your foot, hold it in your hands and pull gently.  It is true that PTs will stretch you better than you stretch yourself, but in yourcase I think youd be better to look for a new PT and in the mean time do it on your own!

Good luck, and take care, ~Patti

[frog]

Thank you very much!

                    I just had a feeling this was not right . I dont believe that I should have trouble walking afterwards.That was the red flag for me. I believe that I will have 2 words for her on monday, YOUR FIRED!!! Thanks again, if I didnt have replies from knowledgeable people who have gone through this before ,I would have still gone to her , thinking it was "No pain no gain". I will be shopping for a new PT ! Can anyone recomend one in the SW Lower Michigan area?                  frog

[Janet]

I have had two wonderful PTs in the Detroit area. Probably too far for you, though. I'll send you their names privately.

I did have a PT at the beginning who would "help" me bend my knee. My original injury was a quad tendon rupture, and I had been immobilized for almost three months post-op. I started PT 3 weeks post-op with directions for gentle ROM work. It hurt like h*ll, but she never pushed more than I could handle and always backed off if I said to.

Two doctors and three PTs later, I had the best PTs after my last surgery. My current OS does not want the PT to use pressure for ROM. It is up to the patient to work on their PT on their own, unless it gets to the point where the patient needs help. I eventually asked them to gently bend for me because it was just too tight and I couldn't do it myself. He went very slowly and gently, never measuring or trying to reach a specific goal. The whole philosophy was not to force the knee to do more than it could really do at any point. That doesn't mean PT wasn't painful, but it stopped way, way short of nausea or screaming. You're right to fire your PT!

Janet

[frog]

Thank you Janet!!

I live in south haven. Yes thats a little far for me to drive, but if I cant find a good , competent PT , whose not into inflicting pain . I will call one of those you recomended. I  have some friends that live around  there.  Im glad that you found a PT that is good to you      I dont know how to send a message privately . Im not to knowledgeable when it comes to this computer stuff. Or this knee stuff either, but I think Ill have a lot of time to figure it out . My knee was imobilized for about a month, and Im 2 weeks after orthoscopic surgery to clean up the mess that the dislocation and the fall caused. I am terribly stiff, yes it does hurt to regain lost rom ,I expected that but I didnt expect to have to change my shirt. . well im done with that type of PT, Thanks for the reply . Happy Holidays .                              frog  
                                                 ( a.k.a.  susan)

[imnotpunk]

Sounds like me.

Please find another PT if possible. I went through the same thing as you, however, my therapist did NOT stop when I pleaded for her to do so. She would only push further. Thanks to her I suffered a ruptured patellar tendon and a lifetime of knee problems. I should have found a new PT a long time ago, but I truly thought all PTs were like her. Not until I logged onto this site did I realize what she did to me was wrong. She was literally torturing me.

I would hate for you to go through what I went through, and am unfortunately STILL going through. My knee may not be salvageable at this point, but yours still is. Please, I am begging you to seriously consider finding a new therapist.

Patricia

[brattkids2]

frog,

That is horrible that you had a PT that did that to you. My current PT said she couldnt believe that somebody would do that to you. Forced pushing for ROM should NEVER be done. It should always be gentle and never to the point of extreme pain.

Im glad you are going to find someone else. I dont think your OS would like to hear that they are pushing you like that either.

I too live in Michigan just ouside of Lansing.

Best of luck to you on getting a new PT.

Paulette

[brattkids2]

p.s. I only get a limited amout of PT visits from my insurance too.  (You wouldnt happen to have BCN too do you. I am really getting frustrated with them.) And PT never rushed me. She always gave me guidance on what I could do at home and if I needed extra help she always said to call her for some advice. NEVER ever said we have to do this because you only have 12 visits.

Paulette

[MHB]

Frog,

I cast a vigorous vote with the rest here. Don't know what your injury/surgery was, don't know if your knee was immobilized or not, but regardless, your experience I hope will not be repeated.

After five weeks of immobilization, this knee's "bending mechanism" faced at least 3 obstacles - 1) the quad muscles had weakened, 2) scar tissue had developed, and 3) all the bending muscles, front and back, had shortened while they just sat there, not doing anything.

After the five weeks, had permission to bend again and started therapy thereafter. The PT was very helpful, and we made a contract. I would perform prescribed exercises conscientiously at PT and at home. As long as progress was reasonably steady, the PT kept hands off.

The arrangement worked rather well -- in two weeks, ROM went from about 45 to 140 -- nothing particularly special about the regimen either. I think the frequency (5 times daily for those two weeks) of the at home ROM exercises helped a lot. At first, used mostly heel slides to let gravity do all the work. One useful little thing I remember was gently massaging around the knee area while gravity was working -- sort of a distraction from the discomfort of it maybe.

Another thing that helped as much as the bending exercises themselves was stretching the ITB, hams, hip adductors/abductors, psoas, all that stuff that works together to bend/straighten the knee -- as frequently as I did the bending exercises. Lengthening those muscles naturally facilitated the bending.

But ya know, the idea of someone grabbing onto my recovering leg/knee and yanking it back scares me to pieces! You are very brave, dear person. Please don't let anyone do that again. Your knee, your perceptions, you know where it all is at any given moment, and gravity really does work without any yanking at all. As you progress at your own speed, you yourself will be able to intuit the different methods you need when you need them -- and lots of choices here too.

Best wishes for a full and comfortable recovery of course.

MHB -- charter member of the Hands Off method

[Janet]

Susan:

To read your private messages, look at the top of the screen. It will tell you if you have private messages. If you, simply click on the blue words to get the link.

To send a private message, click on the user's name in any post. That will take you to their info screen. Scroll down near the botton and you will see a line in blue that says something like "send this user a private message." Simply click on those blue words and it will take you to screen where you can send a message.

Janet

[frog]

I am learning new things every day here, and am grateful to all. All the info Ive gotten helped me to realize this treatment was not right.


Patricia,                                                                                     My therapist sounds like the one you had. I am sorry to hear about the damage she caused, How can they get away with this? I thought PT is supposed to help not injure. I was like you ,I thought  PT was supposed to be like this too... I knew this was going to hurt , but this is ridiculous! Like you said , torture. But thanks to all of the fine, caring ,people like your self on this site.  Or I too would still be going to her thinking this was normal. Yes I am going to find a new PT .  I realize now that I have to. For myself and my knee. Thanks again and I will keep you posted on the hunt for the new PT and how that is going! I hope all is well as it can be with you.




Paulette,

            Yes my PT really did that to me , I thought it was supposed to be that way,  But now I know better. She told me that we will push harder every time that I go. My first time going Icould only bend to a 15 on my own. Then on my 2nd visit she forsed it back to a 62. I was woozy then but I was seeing results, yay, this is working I told myself. Then I went this last time and I had enough , 81 she said, we will try for more next time . No we wont ! I will ,but not that way.  I believe  she is a new PT she dosent act as if shes comfortable yet, She spent alot of time asking the other pTs what to try next ,and to tell me what exercises to do at home, I just have that impression of her.     Yes I  do have BCN,  by the way, wonderful arent they?  I get very frustrated with them too. sometimes dealing with them is like pulling hens teeth. impossible. When I go talk to a new PT I will make sure that they understand what GENTLE   means!!!! thanks alot!!!!


MHB,

      Thank you for the advice! I am glad that you found a PT that is good to you. Yes my right knee was immobilized for about a month , and  I really can tell  the difference in the muscles . from my good leg to my bad. Their getting stronger. I do my exercises every day , its a very slow process, but I feel pressured because of the 12 visits that my insurancs will approve ... Even if I find a new PT it will be the same # of visits. Im afraid what will happen if I dont have full ROM by then , what next ? But I need to forget about that for now and concentrate on getting my ROM back GENTLY....Yes I do massage the areas that hurt and it helps. Below the kneecap is the worst. I told my PT that it felt like my knee was going to break or dislocate again when she forced it like that, and she said dont worry it wont , It just will feel that way, Like I  said I think she is probably new just out of school, it seems to me.Thats no excuse though. Iam truly grateful that I found this site. I was told about the heel slides and i am going to do them and see. thanks again!!!!!!!!!!!!!   frog  

[Heather M.]

Susan,

I'm so relieved to hear that you won't go back to that person.  Here's what you might also consider doing:  talking to the PT's supervisor or boss and telling them that you won't be going back to the clinic.  Then tell them why.  Tell them that the PT cranked on your knee until you threw up.  Tell them that she could have torn your patellar or quad tendon--be aware enough of the various anatomical structures so that you can circumvent any medical explanation they give you, like "you have to gain ROM back rapidly so we have to do aggressive work."  If they tell you something like that, give them a couple of articles on arthrofibrosis...highlighting/underlining the sections that say vigorous ROM work can actually make things worse.  Be very firm and indicate that you will not go back to the clinic because of the negligent manner in which you were treated; if that PT had no experience with arthrofibrosis patients, she has NO BUSINESS working on your knee.  Period.

And finally, I strongly recommend that you visit your surgeon and tell him what happened.  Be sure to tell the PA or nurse or secretary the name of your former PT and PT clinic, so that your doctor's staff won't send anyone there again.

Your instincts saved you a world of hurt, so listen to them!  Don't worry about having only 12 PT sessions.  You might want to try getting a good series of home PT exercises (non-weight-bearing ones!!) that you can do multiple times each day to work on your ROM.  Then you can go back once a week or once every ten days to a good, competent PT for objective evaluation.  That way, you can spread out your PT over 12 weeks or so, which will ensure that you get supervision and oversight for a longer period of time.  I frankly think it would be better for your to do the stuff on your own--that way, you go at your pace and you won't hurt yourself!  Every single exercise that I've done to restore ROM could be done easily at home with the exception of patellar mobilizations--these have to be done by someone else.  That's because when you lean forward to grasp your own kneecap and gently move it around, your hamstrings tighten, and this locks your kneecap down.  So it's better to have someone else do the mobes--perhaps you can bring a friend or family member to PT and have the therapist show him/her how to do the patellar mobilizations?  And to show you how best to do them on yourself?  It's better to do them on yourself than not to do them at all, so be sure that at least you are instructed on how to properly do the mobilizations.

Please be sure to visit the soft tissue healing problems section, as you will find postings (going back several years!) with detailed lists and descriptions of exercises that you can do for yourself, that will get your leg bending on a slow and steady schedule.  You were immobilized, and then your knee was traumatized.  Tissue that has been treated this way shrinks and contracts--so you have to GENTLY encourage it to lengthen and stretch again.  This is done by sneaking up on the knee, bending it just to the point that it starts to hurt and then easing off a notch and HOLDING the stretch for very long periods of time--up to 2-3 minutes.  Then sloooooooowly straightening again, resting, then begin the flexion again.

Top 6 exercises to look up for increasing ROM (both flexion and full extension or the ability to straighten the leg) include:

1)  Wall slides - done lying down in front of a wall or on a bed near the headboard.  Put socked feet (to help slide) on wall, then slowly lower the foot of the bad leg down the wall.  SLOWLY.  Use the good foot behind the ankle of the bad leg to support it.  Relax all the muscles in the bad leg and let gravity do the work of bending.  Any competent PT can show you this simple, very effective exercise.

2)  Patellar mobilizations - look this up as a keyword with quotes around the phrase to get detailed info on how to do them.  These are key.

3) GENTLE use of a stationary bike with no resistance at all.  None.  Upright bikes are better so you can control the motion.  Put the foot of the bad leg on the pedals, then use the good leg to slowly pedal forward.  Do it very, very slowly--likely you won't be able to go around all the way.  This is okay.  Go as far as you can, just to the point where the bad knee starts to hurt, ease the pressure a tiny bit, then hold the stretch by applying light pressure on the pedals with the good leg.  It's like equilibrium--the good leg is pushing very gently to move the pedal, but it is being held in place by the lack of motion of the bad knee.  This is just what you want.  Hold for a minute or so, then use the good foot to propel the pedal slowly backwards.  The bad leg will just come along for the ride.  Then when you reach the point where you can't go any further without pain, hold that stretch.  Continue rocking forward and backward as much as the knee can take without sharp pain.  Sore is okay, pain is not.  Then, one day you will go clean around--likely backward--without even meaning to.  You will rock out while seated on the bike seat in a triumphant, happy knee dance jig that we all have done, smiling like a fool and saying "I went around!" repeatedly.  People will look at you like you are insane.  Smile at them and laugh with the sheer joy that you are getting better!!

Cont'd

[Heather M.]

4) (This one may need to wait until you are reliably doing 60-70 degrees of flexion.)  Sit on a counter or high stool with the edge of the counter/stool right at the crease in the back of your knee, and both butt cheeks firmly planted--no lifting of either side!  This will ensure that any flexion comes from your knee, and not your hip.  Support the foot of the bad leg with the foot of the good one, and slowly relax your muscles in the bad leg.  Then start to relax the muscles in the good leg--the pull of gravity will make the leg bend in something like a 90 degree angle.  When you hit a painful point, support the bad leg with the foot of the good one.  Then let your legs just dangle.  Go 10 minutes, if you can.  If not, start in 30 second increments.  Your goal is to just let the pull of gravity gradually align your bad leg into a perfect 90 degree angle.  This is a huge milestone--it may take you some time to get there.  But you will.

5) For extension, start with seated quad sets.  Read the last page of my post to Jennifer123 in the soft tissue healing problems section for details on the hyper-extension aspect of quad sets that will help you the most.  It's here:  http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=softtissue;action=display;num=1072423595;start=330#330  The key is to protect the knee joint by doing a quad set and pressing the back of the knee into a rolled up washcloth, then holding both of these isometric motions while slowly raising your heel off the ground.  I know it sounds complicated, but it's not--read through this quote.  When in doubt, seek out the exercise photos/drawings on this page or on the web.  Or find a good PT to show you!

6) Foot on rolled towel, graduating to foot on coffee table.  Sit on floor with legs extended in front of you, heels on the ground, feet flexed (so your toes point up at the ceiling--don't let the feet flop to the sides like mine try to do, hold the leg so kneecaps and toes point straight up to the ceiling.  Start with a rolled up washcloth and put it under the heel of the bad leg (not the achilles tendon part, the actual heel itself).  This should force your leg to be super straight--at about 0 degrees of extension, as it is called.  Then, when you can comfortably hold this pose for 2 or more minutes, graduate to a slightly larger roll of towel (maybe a dish towel or hand towel, so the roll is a bigger diameter).  This should force your knee into hyper-extension--going beyond straight.  Most people hyper-extend a few degrees at least.  You will be measured by how much your bad leg can hyper-extend compared to your good one, so you will want to put the heel of your good leg on the towel and relax the leg muscles, gently pushing the back of the good knee into the carpet/bed/couch.  See how much hyper-extension your good leg has, and how much by comparison your bad leg is missing.  The goal is to match them up.  Once you have comfortably mastered washcloths and hand towels, try a bath towel.  When you can do that, sit on the edge of the couch and push the coffee table far enough away so that you can only set your heel on it.  Then sit with the heel of the bad leg on it, your bum on the edge of the couch (so you don't have support on the back of the bad thigh), and let the bad leg stretch between couch and coffee table. Gravity will pull the leg straighter and straighter.  When you are ready to bend the leg again after it has been straight, I always have to use my hands and hold the knee joint to support it, or tense my quads like I'm doing a quad set before I try to bend again.  Otherwise, my kneecap feels like it's going to pop off the leg--I get a big, crunchy snapping noise because I have a lot of damage to the back of my kneecap.  Hopefully you won't.

But it is possible that this last extension exercise will feel like torture.  You may need to take some pain medication before doing it--but it's critical to get your extension back.  Please clear this exercise with your new PT before trying it--it might be better for you to wait a bit before starting it.  You will know when you try to do it.  This exercise can cause some sharp pain--it's highly localized, in that the pain should be in one specific location.  So your PT may want you to try it periodically and see if it starts getting easier.

Note:  Some people skip the coffee table and practice lying face down on the bed, with the edge of the mattress just above their knees.  Letting the legs dangle in this position will force them into hyper-extension as well; I don't like this version as I can't really control the degree of hyper-extension and find it painful.  Others love it.  You will have to find what works for you.

Anyway, I just wanted to show you that these are all very effective exercises that you can do at home.  You don't need to be in PT every day, or even three times a week to do them.  I did these all at home about 7+ times per day.  I tried to do them every 90-120 minutes (you can see that knee rehab is a full-time job when you have ROM problems).  I didn't need a PT standing over me to do them, and I didn't need any special equipment.  However, it's a good idea to still see the PT regularly so he/she can measure your progress, adjust certain exercises, or even add new ones as you progress.

Heather