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Pain after MUA

Discussion in 'Knee Replacement Recovery Area' started by lkbart, Sep 4, 2011.

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  1. lkbart

    lkbart New Member

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    Hi there. This is my first post. I had a TKR on my left knee July 18, 2011 & a MUA on September 1, 2011, because I couldn't bend more than 55-60. My extension was okay (0-2). I could tell right away after the MUA that I had more flex - before the MUA I had a very tight feeling all around my knee; that was gone as soon as I woke up. Pain-wise, I was only taking Tylenol & naproxen before the MUA & really didn't have much pain around my knee unless I tried to bend. I could bear full weight with no pain but was still using one crutch because of my lack of flexion.

    Since the MUA, my knee feels fine - no pain at all, just a bit of tightness across my kneecap when bending (nothing like the tightness all around my knee from before, what I have now is what I would expect). I was pleasantly surprised that I didn't have any bruising after the MUA, as I bruise quite easily, but I have more swelling above my knee than before & my quad is KILLING ME!! I understand that there was possibly some muscle tearing during the MUA, but the inside of my quad is soooo painful - mainly when I bend or try to walk, but any kind of movement makes it hurt. I worried about a blood clot, but the quad has never felt hot so I kinda ruled that out. How long should I expect this pain to last? I'm 4 days out from the MUA & I didn't expect to be in this much pain still. ~ Lillian
     
  2. Jamie

    Jamie Administrator

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    Hi, Lillian...welcome to BoneSmart. I'm glad you joined us.

    You can expect to have pain and/or swelling after an MUA for some time. Your surgeon forced your knee to bend during the procedure and likely broke up extensive scar tissue. However......there should NOT have been any tearing of muscles! Where did you get that idea?

    Are you able to stand on your knee okay without pain? What are you taking for pain management and how often? If you are hurting this bad, you probably need to be on something stronger than Tylenol and naproxen....a prescription pain medication.

    Also be sure you are icing and elevating your leg frequently. You need to rest following this procedure for a few days, so if you haven't been doing that, it could be why your muscles are complaining. They were manhandled pretty good!
     
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    • lkbart

      lkbart New Member

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      Thanks Jamie. I am on Percocet & it does help some. I have been regularly icing, either with a rice bag or with my polar pack; I elevate it most of the time. I also do some stretching & massage in the hot tub 2 times a day.

      The reason I said tearing of muscles is because of the location & type of pain I have, & they may not be torn, but they have definitely been "abused". The pain starts about 3" above my knee & continues to about 4" below my pelvis & encompasses the inside (medial) quadrant of my quad muscle area. It hurts any time I try to use my quad and also hurts to a heavy touch (like my kitty just jumped on my lap & about sent me through the roof!). I had no pain in that area before the MUA.

      As far as standing, yes, I can stand with no pain, but if I try to move my leg with my quad muscle, well, lots of pain, so I've gone back to 2 crutches for now. I guess I didn't expect my quad to be where I was hurting after the MUA & also hoped it would quit hurting so much sooner.
       
    • Jamie

      Jamie Administrator

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      Well, we're all different with these procedures so it's pretty difficult to predict how anyone will do in the days following. Be sure you are taking the maximum dose of the Percoset on the schedule prescribed on the label.....like if it says "1-2 pills every -6 hours" take 2 pills every 4 hours for a while. You have an angry muscle in there and it needs some time.

      You are doing the right thing by going back to crutches to protect it for a bit. The heat and stretches should help too as long as you don't find yourself swelling after time in the hot tub.

      These things happen. It will get better. Rejoice in your new ROM and be patient!!!
       
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      • lkbart

        lkbart New Member

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        Thanks again Jamie - it's hard to be patient after struggling for the first 6 weeks with that terrible tightness & such little ROM; now that my knee feels so much better & I can bend, it's just frustrating that my quad muscle isn't cooperating with me, and I don't want to lose the ROM that I gained with the MUA because my quad hurts!
         
      • Jamie

        Jamie Administrator

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        You won't lose the ROM. Just continue to do whatever gentle stretches you can do for a few days until the muscle pain improves.
         
      • kneesrus

        kneesrus Sr Bonesmartie

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        For my own interest, what is your flexion now?
        David
         
      • lkbart

        lkbart New Member

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        It's around 90. I heard they flexed it to 110 in the manipulation.
         
      • Josephine

        Josephine NURSE DIRECTOR, BONESMART Administrator

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        It's often difficult to describe what actually happens during an MUA. In fact, because the adhesions are between the bodies of the various muscles, there is 'tearing' but between the muscles. I think that's probably what Lillian meant.

        And you are lucky to have had so little pain. Many MUAs are extremely painful and continue to be so for a couple of weeks or more. Something we tend not to dwell on in here too much (for obvious reasons)! :wink1:
         
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        • tarheel

          tarheel Member

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          I am 2 weeks out from my MUA and my quads had a good deal of soreness. The pain is mostly gone now. I was attributing it to the PT because it started after the first PT session, and I have been doing my stretches and strengthening exercises ever since. Anyway, the quads seem to have improved and I hope yours do as well!
           
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          • paige

            paige New Member

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            Does anybody know the statistics regarding the need for,and the success of, MUA after TKR? I am a little over 4 weeks (4 Aug) out from my TKR and I am not where the pros (doc & PT) would like me to be. Come to that, I would like to be further along in the process!

            My extension isn't too bad but I have to start over each morning to get it nearly straight. My flexion,with much force, was 86 last Friday. My PT says that in all her years of practice she has never seen anyone get good results with MUA. Could she be trying to scare me into working harder? She worked me so hard Friday that it has taken 48 hrs for the heat and excessive swelling to go away.

            Any ideas?

            paige
             
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            • Jamie

              Jamie Administrator

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              Ahhhh....thanks, Jo! That makes sense.
               
            • lkbart

              lkbart New Member

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              Hi Paige - Hopefully someone else can chime in with some stats.

              Honestly, I did kinda feel like my PT was trying to scare me into working harder when he first mentioned a manipulation! But for me, it didn't seem to matter how hard I worked; I got about 55-60 flexion about 3-4 weeks out and couldn't improve it past that, even with therapeutic massage & hot tub therapy 2 times a day in addition to the PT exercises. So I researched the manipulation & knew it would probably be painful, but since I wasn't improving my ROM, something had to change. After my research, I discussed the MUA with my PT & then we mainly worked on my extension, because he said that an MUA would not be as likely to improve my extension, but that it could help the flexion.

              One of the things the massage therapist did & strongly encouraged me to do on my own was to rub on & around the scar (since it is fully healed over) to help break up scar tissue. I do think this self massage has helped me to improve my ROM some.
               
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              • Jamie

                Jamie Administrator

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                I have an idea, Paige.....your PT doesn't understand what an MUA is.....many, many ARE successful when scar tissue is the problem with ROM. In your case, I'm betting the problem is your therapist. Insist that she STOP working you so hard. If it takes 48 hours to recover from a therapy session, it's not being done right. All that pushing merely inflames and irritates sensitive internal tissues that have been through a lot with the surgery. Then you get swelling (even it you don't see it externally, it's there inside your rather compact knee compartment). The swelling prohibits you from realizing the ROM that is there.

                Four weeks is too soon to be worrying about an MUA. Focus on GENTLE stretches and other exercises that work the muscles just enough to feel mild discomfort....certainly NO PAIN. Remember, that YOU are in charge and this therapist works for you.
                 
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                • karmigirl

                  karmigirl Post-Grad

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                  Paige,

                  "Remember, that YOU are in charge and this therapist works for you."

                  After all that's why we pay them, and I don't need to pay anyone to cause me more pain, I can do it for free myself.
                   
                • Jamie

                  Jamie Administrator

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                  Rose....:hysterical:...."for free", huh! That made me laugh.
                   
                • kneesrus

                  kneesrus Sr Bonesmartie

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                  Hi Paige. Here is a study that compared early MUA, defined less than 90 days versus late MUA greater 90 days. There really needs to be more studies in this area. The one thing I found interesting was the comment on aggressive early PT could lead to early poor motion. The late MUA did have better stats because the procedure wasn't dealing with swelling, inflammation and primary healling.
                  “The early postoperative period after TKA is characterized by extensive inflammation from
                  surgery and exercises directed at breaking adhesions. Aggressive physiotherapy may perpetuate persistent swelling in some patients. After 6 months, most patients have dramatically reduced knee swelling and warmth. Manipulation under anesthesia performed in this milieu of reduced inflammation may achieve gains in motion that may not be obtained with protracted physical
                  therapy. For patients with limited flexion 6 to 12 months after TKA, a late MUA may provide a safe and effective opportunity to improve knee motion and function. For some patients, even a modest increase in knee flexion could make an activity such as descending stairs possible.
                  Flexion contractures were not significantly improved”
                  "There was no clear indication for recommendation of MUA in our series, but early MUA (b3 months postoperatively) was performed on knees averaging to 68°of flexion and late MUA on knees with maximal flexion averaging to 81°".

                  Namba,R MD,* Inacio, M,[FONT=AdvTT7e6f044d.B]Early and Late Manipulation Improve Flexion After[/FONT]
                  [FONT=AdvTT7e6f044d.B]Total Knee Arthroplasty,[/FONT]The Journal of Arthroplasty Vol. 22 No. 6 Suppl. 2 2007

                  Their stats did indicate improvement in range of motion in both groups.
                  David
                   
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                  • Jamie

                    Jamie Administrator

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                    Great information, David! Thanks! Do you have an actual link to the study?
                     
                  • kneesrus

                    kneesrus Sr Bonesmartie

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                  • Josephine

                    Josephine NURSE DIRECTOR, BONESMART Administrator

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                    A great report! I shall read and precis for the Library! :thumb:
                     
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