MUA DebP's recovery thread<^

I agree with Jockette. Way too soon to have this done. In my PT group, I’ve met some who went through it and are now trying to catch up with those who are recently recovering from surgery. They are no better. Apparently research shows that over time, MUA make little difference. I wouldn’t go there for a bet!


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I've been in your shoes except I had a hard stop at 85 degrees. Hated going through all of that, the limited ROM, the PT efforts (painful!), the MUA. It was all so troubling, especially after watching friend after friend rave about their TKR. We have an informative article here on the procedure: MUA

I found that my PT, after MUA, was like a race horse at the track, taking an aggressive approach, and I wonder what would've happened if they had taken a gentle approach, maybe I would've been able to gain flexion and avoid the arthroscopic lysis of lesions. In any case, I was all done with them after the lysis and through my own gentle efforts gained good flexion.
 
Why do others seem to get so much range of motion like up to 110 degrees very soon after surgery. I know I should not compare myself to others. I have been at 95 comfortably for almost the whole 10 weeks. Will let you know how it goes. Thanks so much for all that read and opine on my thread. Sure do enjoy reading the other threads.
 
I’m at 9 weeks and delighted to have reached 75. With the swelling until now I’ve never got to even 90 - was around the 60’s all along. I’m waiting and trusting that time will be the answer.


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It's as everyone says: no 2 knees are the same, even 2 on the same person. Reading your posts, you seem to have been doing a lot. Maybe fluid has built up inside even if the knee doesn't look very swollen, in which case it won't bend as easily. Perhaps ease off on activities and see if that helps?
 
I wonder the same thing. I did have quite a bit of scar tissue the first time and dreaded it happening again. Started off this time slow on ROM but it gained slowly with gentle efforts.
 
Had the Manipulation under anesthesia on the 27th. So glad I was unconscious for it. He did inject some marcaine into the knee afterwards. I was able to bend the knee much better right after the procedure. Have been able to maintain 117 degrees since. Was at 95 degrees before. I feel much better about returning to work in a couple of weeks after I have seen the doc. Hopefully he will release me. I was so elated for my abilities that came after being able to bend better. I can get out of my car without scooting the seat back like before. I did stairs at the hospital with fair ease. I can walk without a limp and don't need a cane at all. I am glad that I had it done. Now I am working to maintain the ROM that I now have. Pain is there but without the tightness pre MUA I am so much happier with the surgery. I
 
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Great stuff!

Be aware that MUA does stress your soft tissue. You should take things very easily and remember the motto, no pain, more gain!
 
Glad that the MUA seems to have worked for you.
What sort of anesthesia do they use for the manipulation?
 
I had the MUA on the 27th of March. He injected Exparel into the knee right after per my request. This is a long acting anesthetic like lidocaine or marcaine. Pain was minimal for several days. I was amazed at the difference in flexion. 95 degrees to 117 degrees.

PT is more intensive, 3 times a week to maintain the range of motion. For a couple of weeks I have had some discomfort. On the 12th I went to PT and on the 13th (Saturday) I had much more pain when getting out of bed than usual. Taking 1 gram of Tylenol a couple of times a day.

I went on the 15th (Monday) and now I am awake at 0345 with worry that if I continue with PT for the next couple of weeks as per plan of care it will impede the healing and prevent me from returning to work as a staff nurse in about 10 days.

My original TKR was on January 7th of 2019. Monday the 15th with PT I worked hard same as the 13th. I had better flexion and less stiffness when I left but getting out of bed on Tuesday was painful again. Been icing and elevating the leg and trying to rest the leg. Still obviously limping

I am going to let my therapist know that I will do the minimal exercise, bicycle for 5 mins which i have come to love and maybe bridges which are easy as well as clam shells. She has me do weight bearing exercises to strengthen the quads and the ham strings. And I have been pushing myself as I have gained strength. I think I will refuse the weight bearing exercises for the session later today to see how I feel when I wake up on Thursday (tomorrow). Guess I should take more pain medication now so hopefully I can get to sleep.

I like this forum as I can solidify my thoughts. It has been an answer to prayer as I ponder, then read about others challenges and successes. Just writing this has helped me to organize my thoughts and come up with a plan that will allow me to be participant in my healing process. My therapist told me that the MUA was like restarting the healing process for the TKR. I am just discouraged that I seem to having a setback.

I had general anesthesia although the doc said I watched him do the manipulation. I have no memory of this. My first memory was waking up in PACU and being thrilled at the ROM that I had compared to pre MUA. The Exparel was very helpful too with pain for several days.
 
My therapist told me that the MUA was like restarting the healing process for the TKR. I am just discouraged that I seem to having a setback.
Your therapist is correct. MUA is very forceful and re-upsets your healing soft tissue.
I am going to let my therapist know that I will do the minimal exercise, bicycle for 5 mins which i have come to love and maybe bridges which are easy as well as clam shells. She has me do weight bearing exercises to strengthen the quads and the ham strings. And I have been pushing myself as I have gained strength.
@Josephine does not recommend bridges or clamshells. Gently riding the bike at no resistance for 5 minutes is fine.

Most people have such a set back after MUA.

Also keep in mind it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 
I had general anesthesia although the doc said I watched him do the manipulation. I have no memory of this.
I should sincerely hope not!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
1. It is 0 to 1 when at rest, when getting out of bed an 8, normal walking at work, 2 at start of shift, 6 to 8 when I go home.

2. Tylenol 1000 mg every 6 hours especially at work. Sometimes I sneak in 2 Naproxen before work but because of my gastric sleeve (4 years post-op) it is actually contraindicated.

3. swelling: slight

4. I think maybe 110 for flexion and 1 for extension.

5. Icing several times a day and several times while on my 12 hour shift.

6. elevating?

7. are you doing any exercises at home?
bending and extensions maybe once a day, 10 each.
Walking at work, 2 to 3 miles and in my life, but trying to rest at home to facilitate healing.
Stopped PT 2 weeks ago.


Josephine, thank you so much for your input and support. Going back to work has been rough. I see my doctor in a couple of weeks. I think the MUA did set me back but I think it was necessary and I am glad I did it. I am just fearful the level that I am at is how it is going to stay with all the pain that I now have. I have a couple of more years till retirement but I am fearful that I will need to retire at age 64 (now) rather than 66.
 
@DebP Wow! You have my respect as one tough lady! I can't imagine 12 hour shifts so soon after an MUA. From everything I've read on this site an MUA puts you back pretty close to day 1 of recovery. I went back to an office job after 6 weeks and quickly had to go back to every other day working from home, an 8 hour day was completely draining. Hope things improve for you.
 
Have been back to work for 3 weeks. I hurt when I get off and need to sleep to go back.

My shifts are variable, 3 12's in a week, sometimes 1 every other day or 2 in a row then a couple of days off. I find that 2 days in a row and I have a lot of leg spasms when trying to get to sleep.

When I get out of bed after sleeping it feels like arthritis, stand up, pain about 8/10 and over time when walking the pain goes from an 8 to about a 2 or 3. Take Tylenol before during and after work. Is it normal to have arthritis like pain in the knee joint being almost 5 months out? I know working as a floor nurse exacerbates the swelling and pain. I try to ice the knee at work while sitting to chart.

Also I started getting the pain about 2 weeks after my knee manipulation was done. Was back to work 4 weeks after the manipulation but my pain and discomfort is not improving. Had left TKR done Jan 7th 2019. My mindset is that the knee needs to figure out how to adjust to the work load and the pain will diminish over time.

3 weeks in and I am thinking that I will have to retire if this does not improve. It is 4 am and I can't sleep, not due to knee pain so much. Ice the knee a couple of times a day when at home and think in terms of resting the knee. Just emoting since I am not able to sleep.
 
Your knee is not quite halfway healed and you’re asking more of it than it is ready for.

The knee is in charge of this recovery. You can’t tell it what to do and have it adjust to your expectations. As you have found, it just doesn’t work that way.

It would be sad to have to retire before you want to. Is there any way you could reduce the amount of standing when you do work? Probably not, but it might help. I would request not working 2 days in a row so your knee can recover between work days. I’m sure you are a valued staff member and it seems they should be willing to help you out with a better schedule.

When you are home, try to rest and elevate as much as you can to help your knee recover from those tough work days.

My heart goes out to all of you who have to go back to work with a knee not finished healing. :console2:
 

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