How to handle pain during PT?

[ponygirl]

Anyone have any advice for how to get through the pain during therapy?

I am 6 1/2 weeks out from a lateral meniscus transplant/ACI surgery. I have been non weight bearing, but can start putting weight on the leg May 4th, and see the surgeon again May 14th - and he wants me off crutches. Haha yeah right.

But that's not the point  ... The past 3 weeks I haven't gotten past 95 degrees flexion. Well, today the PT got me to *almost* 110 .. HOWEVER - I was yelping, "ow"-ing, and was brought to tears today. The last 2 weeks it's been like this every visit (2x week). Everything else is fairly easy or at least bearable. But having him flex my knee is SO painful.

I work on flexing my knee at home religiously. I ice it. I take 2 percocet before PT. Still have so much pain everyone in the office is staring at me yelping. And I'm not a wuss.

Any tips? I've had 6 surgeries on this knee, and never EVER had PT be this awful. Even when I had a ligament tightened and it was slowly stretched over weeks.. I was not having this much pain.

Surgeon has threatened a MUA if I'm not at full ROM by 3 months post op (about 5 weeks from now).. PT says I don't want to do that, BUT today I was pretty sure I'd rather have them knock me out, crank my knee, and deal with the pain after.

Sorry for rambling - I just have never experienced this level of pain with PT. Getting very frustrated and embarrassed for being a "wuss" during each session

[knee2no]

I am sorry you are encountering this but my past experience with PT was that "discomfort" is OK but serious pain is not.  The problem with this is we all feel "pain" differently!

[LindaM]

Sorry to hear you're in so much pain in PT.  Before your knee gets cranked on I expect you have done some warm-up exercise, but you might ask the PT if they could put a heat pack on it to loosen things before starting to flex you.  I find that heat makes it easier.  You could try it first at home before you work on it your self, then ice like crazy afterwards.

This last surgery my PT had me do something different to get the flexion all the way.  He had me put my foot on the second stair and do a gentle lunge forward, hold, then continue pushing into the stretch.  I had complete control of the stretch that way and could move it farther than just with slides. I would do it 3-4 times a few times a day.  I did it at home as my regular stretch after that and got back full ROM really quickly.  You have to work it into some pain to get anywhere, but a little at a time was a lot easier.  Since I don't have stairs at home, I did it on an armchair so I had the stability of the arms to support my weight and didn't overdo.

Good luck and good healing.

Linda

[ponygirl]

Thanks guys --
The PT has put heat on my knee before working on ROM, it doesn't seem to help. Perhaps I should figure out a way to get heat on it before I go to my appointment and see if that helps.

Today he had me stretch it - on my stomach, with a strap around my right ankle, then I held the strap over my left shoulder and pulled. I got it to 100 without crying. It didn't feel GREAT, but was tolerable.

LindaM- I have done a stretch like that in the past, but I am still non weightbearing on this leg, so that's not an option quite yet.

I accept a good amount of discomfort, and I truly have a high pain tolerance. 7 knee surgeries and I've never yelped like this. And I've had a PT really work on my IT band to where I'm whimpering a bit, but that was bearable.

I guess the weird part was the PT even explained about not pushing into pain.. so it freaked me out that I was in that much pain while he was bending my knee.

We'll see what next week brings

[captainruss]

pony,

Your PT should NOT push you into pain if they are telling you NOT to push into pain.  The only painful PT I have had was for scar tissue (AF) where a MUA would not increase my flexion, so I spent 2 hours or more in PT every day with the therapist trying to bend my leg with any/all force they could bring to bear.  I have a high tolerance and I screamed my fool head off for the entire 2 hours.  Each day they would tear the scar tissue and each night it would grow back.

That is not healthy and did not work for me.

Something that may help is a Lidocane patches or plasters.  You can put these right on your knee.  I am also using Flector Patches on the knee.  Ice is mandatory after every workout and I actually put an ice pack on driving to PT.

If you want, you can Google the "Intractable Pain Patients Guide" by Dr. Forest off of the Internet.  It tells you about all forms of Pain Management.  You cannot be in pain and heal.  Pain is your enemy and must be controlled.

Is this the same PT you have been to for your other 6 surgeries?  If so, you stated it was never like this before?  If they are different, you might want to change.  The three OS I had did not have a clue about AF so they were uninformed about treatment.  I am told now that my PT was wrong and harmful not only to my healing but to my manhood!! 

Let us know how you are doing.

Russ

[The KNEEguru]

Hi
Out of interest, here is the Stone Clinic's rehab protocol for meniscal transplant, but it is just for information as your situation is more complex; having had ACI as well.

http://www.stoneclinic.com/Meniscus-Transplantation-Rehabilitation

I am not sure that changing physios is the answer - but a word with the surgeon might be wise as you are at a fairly critical phase in your rehab.

KNEEguru

[The KNEEguru]

Hi again

Keep in mind that the risks of arthrofibrosis do increase as the number of surgeries increase and that increased scar tissue may be one of the reasons why this surgery is harder for you than earlier surgeries - ie the cumulative effect of surgical interventions.

I assume that your meniscal transplant sutures have been removed?

KNEEguru

[captainruss]

Ponygirl,

The wise and all knowing moderator has great advice for you.  A competent OS is the best remedy for anything that is wrong.

An educated patient is the second best remedy for what is hurting you.

I have had eight TKR's.  I did not set out to have eight TKR's, but after the first one my OS diagnosed me as being infected.  After two failed MUA's, he decided to removed the TKR, clean out the joint, replace the TKR, and then treat with antibiotics.  He was incorrect there and I did not know it.  The current procedure is to remove the TKR, put in an antibiotic spacer, and then six weeks after strong antibiotics, put the TKR back in.  He did neither because when he started to take out my original TKR, the tissue samples came back negative for infection.

I know this does not relate to you (TKR) but the AF does.  I had five (5) knee surgeries when I was 17.  After my sixth surgery, I ended up with the complication AF (arthrofibrosis).  No doctor in Florida is aware of it and to this day, all three (3) of my OS and all three (3) of my infectious disease doctors claim I am infected.  The following study by Dr. Noyes was given to me by the moderator.  If you get a chance, read it.  Take a copy with you to any OS you see.  If they do not take it seriously, RUN!  You may never get AF.  But if you do, it can be treated if caught early.  If NOT caught early, it will be a lifelong friend.

http://www.kneeguru.co.uk/KNEEnotes/node/633

I learned about it too late.  All six of my doctors are keeping to their story thinking I will never make a complaint about them.  The sad part is I am now forced to seek treatment and the complication has set in.

Be educated.  Read everything the moderator gives you and DON'T be afraid to respectfully question your OS.  If you feel uncomfortable, you need to get another opinion.  If you ask them what the chances are you might get the complication AF and they look at you with a blank look, be very careful.  If they tell you they are watching for the early signs, make sure what they tell you is the same as what Dr. Noyes recommends.

I would also get an x-ray and make sure you get simple anti-inflammatories every time you have any kind of surgery.  This will monitor for the outbreak and be preventative for HO.

Good Luck

Russ

[ponygirl]

Thanks so much for all the information, I will be reading through those links this weekend.

To answer some questions..

Literally between my posting this question and yesterday, I have been able to get to 110 degrees on my own, fairly comfortably. Now I do feel some tightness/stretch, but no pain. When I was in so much pain with the PT bending my knee, I don't think he was forcing it, but it did rattle me that it was that painful. And even when I would hit the painful spot, all movement up to that point has been smooth and painless.
I have not seen this PT before - he was recommended by the surgeon's office. I have seen a number of PTs in the past, some that was a joke. The PT I saw for my last 2 surgeries (the right knee meniscectomy and my left knee LR/medial plication) I really really liked, but she had not dealt with ACI patients before, and I felt she may be a little too aggressive for this.
Re; sutures, my large incision was internal sutures, but at about 3 weeks I had the portal stitches removed, and they removed the sutures that were poking out of my knee.

After my next PT appointment, depending on how it goes, I may call my OS. On Monday he was not super concerned with my ROM, but like I said, he did mention a possibility of MUA at the 3 month mark if I cant get there on my own.

I get to start weight bearing in exactly a week, so we'll see how thing go when I throw that into the mix.

russ- my friend's father had a similar story with his TKA, he had both done at once, and developed an infection in one. They removed the replacement, cleared the infection (which took months if I remember correctly) and then did the TKA again. I am sorry you went through that, but glad you are on the other side!

Thanks again and I will read up and check back in after my next appointment!

[captainruss]

Pony,

I don't wish to scare you or have you be concerned about your father, but I am not on the other side.  I have had eight ( TKR's and NONE of mine were infected.  I did not become enlightened about AF prior to going through all the procedures, but I must say don't be worried about it, I enjoyed each and everyone of them and would do it again (probably will do it again) if I could get a doctor to treat me at this point.

Russ

[ponygirl]

Oh whoops! Sorry I wasn't reading for comprehension - my apologies! I have the AF article bookmarked and am planning on reading it - it's a scary thought but I definitely want to educate myself!

Thanks!

[ponygirl]

I have a happy update!

Today, on my own, I was able to get my knee to just over 120 degrees of flexion! PT pushed and made me whimper a bit before that, but not as much or as bad as I was feeling a week ago.

So it seems my post wasn't necessary... Though I do appreciate the responses and will keep it all in mind!

Thank you!

[LindaM]

Congratulations!

It sounds like you are well on your way to getting back your full ROM.  Your post was necessary, don't think it was a waste of time.  When you began you needed to hear that things would be all right, and now they are.  In the future you will be the one encouraging someone else as they struggle through things.

Way to go

Linda