I have been in physical therapy all my life. And I have treated a lot of knee patients particularly over the last few years. In the physical therapy world it is not uncommon for the P.T. abbreviation, which is supposed to stand for Physical Therapy, to also be referred to as Pain and Torture. Unfortunately this is a very common reference for those who have gone through a total knee replacement. But is the “no pain no gain” approach really the best? I explore the possibility of no rehab pain more gain in this article.
There are a couple very important things to consider during this difficult recovery. While range of motion is the immediate focus, there are some barriers to achieving this goal. While there are several reasons that range of motion can be limited, I would like to discuss the variables that can be directly affected by your therapy sessions.
The Vicious Cycle of Knee Surgery Recovery
The inflammation and the muscle guarding response that our own bodies possess can be influenced by the type of treatment interventions that you receive after your surgery. So let’s review how our body responds to injury. Inflammation is an automatic immune response. The acute phase is commonly recognized by pain, swelling, heat, and redness. This acute phase also includes lesser known symptoms and loss of function. But what if we keep reinjuring the same area and remain in this acute phase? For instance with repeated forceful painful stretches. How is this promoting healing? Most acute symptoms can be controlled through medications and modalities. But what about the function we want desperately to return to our knee?
Protective Muscle Guarding
The other issue to consider is the muscle guarding response. This is an involuntary protective response to pain and injury. This is our brain’s approach to protecting and preventing any further injury or pain to our body. Most people at some point in their lives will experience this phenomenon. Those who undergo a total knee replacement know this all too well. So let’s get back to our therapy session and how this relates. Back to our aggressive and forceful stretches that sometimes are performed in the therapy sessions to maximize range of motion readings. I can’t think of a reason not to muscle guard at this point.
Your therapist might be a complete stranger who is now going to bend your knee as far as it will go or push down on your knee until straight. Some will push until you beg for mercy which ever happens first. Does this sound familiar to anyone?
As a PTA I know we all have the patient’s best interest at heart, but an aggressive approach can easily have negative consequences.
After ACL repair the biggest obstacle to recovery was a seemingly endless cycle of rehab, pain, swelling and then more P.T. Click below to learn how Luis turned to ‘no rehab pain more gain’ and got better..
No Rehab Pain More Gain?
So we can see that maybe the treatment approach in some circumstances may not be the most conducive to healing or achieving maximal results. This does not mean that therapy should be avoided in any way. But perhaps a discussion about the techniques and open communications between you and your therapist should be established and maintained. I am sure that in some circumstances very aggressive therapy practices have their place. It is also important to consult your physician with any questions or concerns. They cannot help and guide you if they do not know what is happening during this very important initial recovery period.
Please know that knee replacement recovery, patella fracture recovery, ACL repair recovery will not be pain free. But excruciating pain should not be commonplace either. I believe a no rehab pain more gain approach can deliver better results and shorten the acute phase of recovery. At the end of the day, perhaps we should give P.T. another acronym such as Persistent but Tolerable.
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery including ‘no rehab pain more gain’.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here. Executive Editor: PJ Ewing (firstname.lastname@example.org)