Twice this summer parts of my body were cut open, bone was sawed and soft tissue pulled apart to make room for titanium and plastic parts that were hammered and cemented into place, then soft tissue was reassembled, and wounds stitched and glued shut. The only evidence are thin scars that bisect each knee, which will fade in time to slight silvery lines. In our world of increasingly high tech medicine, this is still a brutal and physical surgery, both precise and crude. 

One knee is 13 weeks old and the other is 7 weeks old. At a recent doctor’s visit, the surgeon said I looked “fantastic.” I do errands, tend to easy household tasks, cook meals, meet friends for lunch, walk with a normal gait most of the time. In spite of lingering stiffness and soreness, my knees bend and straighten with increasing fluidity. I still use a cane for longer walks but will probably let that go soon. I need to rebuild strength in my leg muscles, regain stamina and good balance but that will come. 

I take part in an online forum where I exchange updates and rants, commiserations and celebrations with other joint replacement travellers. Our journeys do not proceed in a straight line; instead, they are tangled like a piece of yarn left too long in the knitting bag—up, down, and sideways—days of feeling strong, energetic alternate with days of immense fatigue; pain free knees give way to soreness and swelling; plateaus yield to progress then setbacks and another plateau. Inevitably, emotions follow a similarly tangled trajectory with gratitude and optimism often giving way to tears and frustration. This has been especially true for me after the second surgery as my spirit whines like a tired toddler, “Are we there yet??? Why is this taking so long???”

I recently listened to a friend describe a hike she’d taken earlier in the day—I could imagine the pull on leg muscles, the expansion of lungs, the scent of moist woodsy air, the accelerated heart beat, the sense of achievement. “Just think,” she said, “soon you’ll be hiking too.” I hope so but it feels like a misty dream right now when I measure my walks in feet rather than miles, minutes rather than hours. But I tell myself that despite the slowness of recovery, the end result, if healing continues to go well, are functional joints to replace ones that were no longer reliable–and that’s a wonderful thing. 

“Just a little more. Push it further. Go on. A little more…” This is the refrain from the physical therapist as I work on bending my knee. One more degree of bend, and another, and another as I work toward a magical goal of 120 degrees.

“You’ll need to work hard at PT,” were the words spoken by just about everyone I told about my pending knee replacement operation. And the expectation is that this will hurt. In the hospital I was offered extra pain meds before PT. When I told the in-home PT that pushing for more flexion was making my pain spike into the 7 to 8 range on that 10 point scale where 10 = intolerable pain, her response was “Good, that’s what should be happening.” Say what??? Her goal is severe pain???

The day after surgery I was strapped into a passive motion machine for an hour which repeatedly bent my newly operated knee to 60 degrees then to 90 degrees, flex and straighten, flex and straighten, over and over. That same day I was wheeled down to the therapy room and put through my paces—ankle pumps, quad sets, and bending. “We want you at 110 degrees of bend before you leave tomorrow,” the therapist said. “And you’re going to lock me up and make me stay if I don’t achieve that?” I thought.

“No pain, no gain.” The warrior’s approach to recovery. This is a very American approach. Push through pain to achieve your goals.

I take part in an international online forum for people who have had knee and hip replacements and from reading other participants’ posts, I’ve discovered a different perspective on recovery.

Yes, keeping the new knee joint moving is essential for a good recovery. But this can be done gently. In the first weeks of recovery, the focus can be on letting traumatized soft tissue heal and moving just enough to keep things from freezing up—bend to the point of pain and slightly beyond then stop.

This seems like such a sensible approach but when I mentioned it to the PT she looked horrified. “You’ll never get flexibility back unless you push hard!” she said.

I’m in my fifth week of recovery. On the days that the PT is here to measure me I push a bit—it’s hard to resist those cries of “just a little more”—but on other days, I follow the gentle approach. I spend a lot of time with my leg elevated and an ice pack on. I stroll around the house and take short walks outside. Every time I get up I spend a few minutes gently bending my leg but never to the point of extreme pain. And with this approach, right on schedule, I reached that magic goal of 120 degrees of bend.

Seems like there’s a life lesson in all of this. I’m reminded of my forays into floor waxing. My house has oak floors and when I first moved in they needed to be waxed regularly (I’ve since had them refinished). I rented a power floor buffer and had to learn just the right amount of pressure to apply to control the machine—too much pressure and it took off across the room at warp speed, dragging me behind and gouging the floor.

Sometimes less is more. Sometimes the motto should be “No pain, more gain.” The trick is knowing when to push through and when to back off and let healing happen.