Hinged Joint Double PKR and MCL replacement a year later

[Jockette]

My experience has been that when the body is toxic it is out of balance and that affects all kinds of things, including thyroid and adrenals and can signal the immune system that it needs to do things it doesn't need to.

That’s very interesting. And so many medical professionals have such conflicting opinions, I find it hard to know which ones to believe. I’m glad you found someone to believe and trust.

 

[Layla]

It can be difficult to find the perfect balance between rest and activity. At least you're listening to your body and taking those rest days when needed.

I am sorry to hear of the autoimmune condition you developed following your PKR surgery. I love that you're taking a holistic approach to this. I am a firm believer that the body has a remarkable capacity for healing, often beyond our comprehension. Detoxing, good nutrition, exercise, reducing stress and getting adequate sleep all help in healing. Surgery is a major stressor / trauma to the body, causes injury and inflammation which stimulates our immune system to promote healing, and I've read that in rare cases the heightened immune activity can become imbalanced, leading the body to mistakenly attack it own tissue.

This is an interesting topic and I will be following your progress, so it is appreciated that you're sharing your recovery story here, Rosadogrose. Thanks for your update....wishing you perfect healing and all the best!
@Rosadogrose

 

[EalingGran]

Both of them said that the very obvious atrophy of my muscles in my right leg is causing the pain because I don't have the infrastructure to keep the leg straight without a lot of thought and effort - remembering to straighten on each step. It doesn't happen naturally as it does with the other leg

If you can manage to get up and down from the floor OK- have a look at my pilates teacher's free classes on YouTube.
Google Katja pilates and they come up.
Her side lying glute strengthening one with no squats is pretty knee friendly and good for strengthening muscles.
I have a weak overstretched MCL from years of being increasingly valgus.
General leg strengthening is good but you especially need the vastus medialis ( medial quad) to keep the MCL pulled as tight as it will go. This muscle only really engages in the last 10 degrees of extension. There is a specific exercise - lying on your back with pillows supporting the underside of the knee and then straightening and elevating the leg. Turn the foot out and gently lower the leg back down.
With particularly complex muscle issues it is worth trying to find a really good physio or pilates teacher who can teach you the exercises that your body needs.
Unfortunately there seem to be a lot of post surgery rehab programmes which are very stereotyped and too keen to push to pain or beyond.

 

[Rosadogrose]

Such helpful responses. Thank you. Layla, your message feels to me like a gift of days off - my tendency is to try too hard.

EalingGran, just the impetus I need to find better physio. I hear there's a physio in town who specialises in knee recovery and I think I'll take your email with me. I will look at Katja pilates. I watched and subscribed to David Middaugh's El Paso knee recovery programme. You probably know he feels there is too much emphasis on the quads and that a lot of knee problems come from a quad/glut imbalance. So I've been working on my gluts for over a year - I don't think my right gluts believed there was anything at all for them to do most of my life. If I can engage the gluts before I step, the pain is much less. I wonder what you think about this idea of the muscle imbalance causing knee problems?

I also have valgus knees, but this last operation did improve the alignment quite a bit. How interesting about the vests medialis - I will keep that well in mind and see if I can feel it the last 10%.

The exercise you describe - I call them leg lifts - is one I do several repetitions of a day. Even the surgeons are keen on this one. But no one has mentioned turning the foot out before lowering, so I'll add that in.

Thank you!

 

[Jamie]

The exercise EalingGran described is not actually a leg lift even though it is similar. The added movement of turning your foot makes the big difference. When you are doing rehab exercises, even very small movements like this can engage completely different muscles in the body. So be sure you’re doing the exercise just as she describes for maximum benefit.

 

[Rosadogrose]

Thank you, Jamie. I was taught to flex the ankle first in order to straighten the leg, raise and count to 10, then lower. I've now added in the shift of foot inwards going down and can feel the change in muscles. I hope this is right and will strengthen support of MCL.

 

[Jamie]

What you were taught IS a leg lift and it’s a common exercise after surgery. What EalingGran gave you works different muscles just by the small shift of your foot at the proper time. It’s not a “leg lift” even though you are lifting your leg, but I don’t know what the proper name is for it.

 

[EalingGran]

I don't know if this exercise has a particular name. I was taught it by my pilates teacher Katja as a way to get the vastus medialis to fire. The foot turning is outwards/ eversion with the toes turning out and heel slightly inwards.
It's quite a complex exercise as you need the right amount of support under the knee to get the leg fully straight before slightly lifting, foot turning and lowering.
When done correctly you can feel the medial quad working. A good physio should be able to help you target the exact muscles you need to progress.

 

[Jamie]

I agree that this is a time you need the assistance of a good physical therapist until you learn how to do exercises targeting specific muscles. It’s pretty easy to do them incorrectly if you aren’t taught exactly the right way.

 

[Rosadogrose]

Thank you both. I am seeing the NHS physio next week, and will describe this exercise to him and the firing of the medial quad. I have been given a repertoire which has gradually expanded but I may see a physio privately who specialises in knees.

I've also used Bowen therapy a lot and while it couldn't fix my overstretched MCL it did help to keep my. body in better balance. Does anyone have thoughts or experience with Bowen? I'm thinking of going back to this practitioner, especially to help alignment and protect agains the autoimmune disease. It's a matter of allocating funds.

Many thanks and good wishes.

 

[Layla]

Hi Rosadogrose,
Following is a search of Bowen Technique for you to check out if interested - HERE

An abbreviated definition of this therapy for those reading and unfamiliar -
Bowen technique, also known as Bowen therapy, is a gentle form of bodywork that involves subtle rolling movements over muscles, tendons, and connective tissues to promote pain relief and relaxation. It aims to stimulate the body's autonomic nervous system to encourage self-healing and address underlying issues rather than just symptoms

Good Luck with Physio next week!
@Rosadogrose

 

[Rosadogrose]

Thanks for those references to the Bowen Technique, Layla. It is very gentle and was the only thing I could find that healed my severe sciatica - previously I'd tried a chiropractor and acupuncture as well as the more standard approaches. Three Bowen treatments and I was cured and thankfully, it hasn't come back.

As one post says, it's used for all sorts of things, including emotional well-being. I can see that my hips are misaligned, which will of course affect my walking and cause pain, so I'll see my practitioner to right that. Also, I believe it helps the immune system not to overreact.

Another tool I'd used in the year before my first op and after it and I found helpful but should have been more disciplined in using is the idea of muscle imbalance. This particular theory is that many people with knee arthritis have a muscle imbalance and the quads are much stronger than the glutes. This was certainly true of me. Dr. David Mddaugh who runs a knee clinic in El Paso has a whole host of - I found - very helpful videos on YouTube.

I found that when I began to build my glutes (and they are far from built yet) and really focussed on using them as the main muscles for walking, I had much less pain. But I forgot about all that this time round, in my eagerness to do what the physios were telling me, and caused myself more pain by increasing the imbalance using all the quad exercises.
I'd be really interested if anyone has had contact with this approach or clinic.

All good wishes,
Mary

 

[mendogal]

There are a few factors potentially throwing us off affecting our knees.

Glutes, leg abductors, or hamstrings not firing effectively or becoming weak can contribute.

Foot that over pronate ("flat feet"), tight Achilles tendons, tight calf muscles can contribute to imbalance of weight distribution, causing the knees to rotate in and creating uneven wear and tear of cartilage and tendons.

A good PT or body work therapist (or podiatrist in the case of foot and ankle issues) can use eyes and hands to help identify and correct these.

 

[Rosadogrose]

Thank you, Mendogal. Flat feet and poor alignment were my major issues, I think, causing me to over-rotate inward with valgus knees. Also I stood on one foot a lot, contributing to the very weak glute on the knee which is struggling. And in my job I kneeled a lot and didn't take care of my knees while doing it.

I see that you've had ligament issues and am wondering how you're faring with repairs on those? And how you are with your knees, if you don't mind my asking. And your shoulder? I also have some rotator cuff issues on my right arm, though the exercises I've been given seem to help.

Very best wishes

 

[Layla]

Let's tag @mendogal to make sure she catches your questions to her.
Good to read the rotator cuff exercises seem to be helping. I hope you continue to notice improvement.
A great week to you, Rosadogrose!
@Rosadogrose

 

[mendogal]

Hi @Rosadogrose
1) ligaments: totally unrelated to yours. I blew out my R ACL in a martial arts injury that was 100% my error. Women athletes are more prone to ACL injuries than male athletes. There were many theories put forth but engaging quads rather than hamstrings was shown after extensive research to be the primary correctable gender-based difference. I may have been at increased risk due to hyperpronation turning my knee inward and due to somewhat lax joints. Neither of which I was aware of at the time. My ACL repair was successful in terms of the ligament, but the medial meniscus damage led to early onset traumatic arthritis.

2) I'm very happy with my TKRs. I can walk over 3 miles nonstop - they LOVE walking - can squat, can kneel although I keep the knee bend at closer to 90 degrees than I used to. The R has some scar tissue affecting the lateral quads/ITB that creates aching if I sit too long. The pluses far outweigh that!

3) my shoulder is fine. There was no rotator cuff problem. Definitely keep up the exercises! It's very easy to develop a frozen shoulder through not gently doing those range of motion movements. My current hand PT is thrilled that I did arm and shoulder ROM while my wrist and hand were in a cast as she's seen people develop frozen shoulder from inadvertently immobilizing their shoulders for no reason!

My R TKR thread is in my signature. I will add my current hand thread to it.

 

[Rosadogrose]

Thank you, Mendogal, for all that information. I'm very glad to hear that both your TKRs are serving you so well.
I hope your healing from your hand and wrist surgery is continuing to go as you hope. You sound to be a very determined and resourceful person - inspirational!

I'm continuing my glute-focussed rehab as guided by Dr. David Middaugh of the El Paso knee clinic. I've had more than five physios now and it's his approach which has helped me. He is careful not to introduce exercises until you're managing any pain and offers a range of strategies for doing that. I've used many of his YouTube videos but have also bought his healing from knee arthritis package and his one to do with a failed knee replacement. Swam again today, using kicking downward exercise and walking through the pool interwoven with gentle lap swimming. I think I see a bit of progress this week - I'm stronger, a little more agile, and less daunted by the prospect of moving. I just wish the MCL wasn't as loose as it is - but at least I have one now.

Many thanks to you both for your support.

 

[mendogal]

It sounds like you have found the resources you need and are taking a sane, safe approach to your individual rehab needs

 

[EalingGran]

And your shoulder? I also have some rotator cuff issues on my right arm, though the exercises I've been given seem to help.

I had a shoulder problem a few years ago and it was starting to stiffen up.
The best exercise I was taught was this.
To stand back from the wall and put the palm of one hand on the wall, bending at the waist so you form a 90 degree angle.
Then just loosely let the other arm hang and gently swing/ circle. This stopped me developing a full blown frozen shoulder.
I am still careful with certain exercises on that shoulder. I probably do have some arthritis there but have never had it scanned.

 

[Rosadogrose]

Thank you for this, EalingGran. I have tried it now and will add it to my RC repertoire. Very much appreciated. I also have to be careful what I do with my shoulder.