If you have knee pain, your doctor may refer you to physical therapy. There your physical therapist will use various treatments and exercises to help decrease your pain and improve your overall functional mobility.
If your knee pain is caused by knee osteoarthritis, you may be having difficulty bending and straightening your knee, and your knee may feel swollen from time to time. This stiffness and swelling may prevent you from walking normally.
Believe it or not, physical therapy does not help everyone with knee pain. Sometimes the loss of range of motion (ROM) and weakness are too great, and the pain and swelling cannot be controlled. Your physical therapist should refer you back to your doctor if this is the case. Many times, your doctor may then refer you to an orthopedic surgeon who will determine if a total knee replacement (TKR) surgery is necessary to help decrease your knee pain and improve your overall mobility.
If you do have a TKR, chances are you will likely require physical therapy and rehabilitation following the surgery. You can expect to be involved in physical therapy soon after your surgery, and you may require therapy for a few months following your total knee surgery.
Your TKR surgery will likely take place in a hospital or surgical center. Many times, acute post-operative physical therapy after a TKR starts the day after your surgery. If your surgery takes place early in the morning, a physical therapist may even visit you at your bedside on the same day as your surgery.
Some things that your physical therapist may help you with in the hospital include:
- Using your assistive device, like a walker or crutches
- Exercises to help improve your range of motion
- Strengthening exercises
- Using your continuous passive motion machine
- Learning to walk (gait training)
- Stair climbing
- Pain and swelling control
Be sure to speak with your doctor to understand exactly what to expect from physical therapy in the hospital after your total knee surgery.
Sub-Acute Rehabilitation after TKR
Many times after a TKR, you may be discharged from the hospital and can go straight home. Occasionally, you may require more extensive physical therapy and nursing care after your surgery. You may not be ready to go home after discharge from the hospital because of lack of family support, difficulty with mobility, or other problems that require more intensive care than you would receive at home.
If this is the case, your doctor may admit you to a sub-acute rehabilitation facility after your total knee replacement. There, your physical therapist will work closely with other members of a rehabilitation team to help you improve your functional mobility so that you can ultimately return home. The members of your rehabilitation team may include:
- Physical therapists
- Occupational therapists
- Social workers
- Speech therapists
Physical therapy in the sub-acute rehabilitation hospital will focus on your functional mobility like walking and stair climbing. Working on bed mobility and sit-to-stand transfers may also be a component of your rehabilitation program. Exercises to continue to improve your ROM and strength may also be included. The main goal of physical therapy in the rehabilitation hospital is to improve your safe functional mobility so that you can quickly return home after your TKR surgery.
Home Physical Therapy after TKR
Once you have returned home after your TKR surgery, you may still be limited in your functional mobility and may have a difficult time leaving your house to attend physical therapy. In this case, you may receive physical therapy services in your home.
Home care physical therapy will focus on continuing to improve your strength and ROM and on improving your overall functional mobility. Your physical therapist may also offer treatments at your home to help control your pain and swelling in your knee.
Once your mobility has improved enough for you to safely leave your home, your doctor may refer you to outpatient physical therapy to continue your TKR rehabilitation. Your doctor may request that you attend physical therapy at a specific clinic, or you can find a physical therapy clinic close to your home.
The main focus of outpatient physical therapy is to maximize your strength, ROM, and functional mobility. Therapeutic modalities may be used to help improve your muscular strength, control pain, or decrease swelling. Your physical therapist may also work on improve your overall endurance level by having your ride a stationary bike as a part of your rehabilitation program. Your surgical incision may be tight, and your physical therapist may perform specific scar mobilizations to help improve the mobility of the scar tissue in the front of your knee.
In general, you can expect to be back to normal in about 2-3 months following your total knee surgery. Everyone is different, so be sure to work closely with your doctor and physical therapist to understand what to expect.
Total knee replacement surgery can help you decrease your knee pain from osteoarthritis. Working hard in physical therapy can help you maximize your mobility after the surgery to help you quickly and safely return to normal activity and function.
Source: Hertling, Darlene, and R. Kessler. Management of common musculoskeletal disorders:physical therapy perinciples and methods. 4. Baltimore: Lippincott Williams and Wilkins, 2005