BoneSmart® Hip / Knee Replacement Forum
Knee Replacement & Hip Replacement
Patient Advocacy & Online Community
  1. Your support makes a difference...BoneSmartie Member

    Industry changes have drastically reduced orthopedic partner contributions, which for 13+ years supported the operation and development of BoneSmart.org.

    Our patient-focused articles and world-class joint replacement community forum have helped millions of people. Your gift today provides the important funds necessary to keep this valuable resource online.


    Donate Now
    Dismiss Notice

[MUA] Festina lente -Hastening slowly

Discussion in 'Knee Replacement Recovery Area' started by Spex10, Dec 3, 2016.

Thread Status:
Not open for further replies.
  1. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    Now almost 6 weeks post op but my knee is as stiff as ever. Probably about 70 max. My knee is swollen. I rest and elevate etc. Physio sessions seem to make it worse. She sits and forces my knee back and its awful.
    However, on the plus side, I get about well, can manage most household tasks, go shopping, sleep OK (in bursts adding up to about 7hrs) and hardly have to take any pain meds. I'm due to see the surgeon on Thursday and am scared that he'll say I need a MUA. I really don't want that. My question is -will my ROM improve without it?
     
    • Useful Useful x 1
    Tags:
  2. Celle

    Celle Forum Advisor

    Member Since:
    Nov 19, 2011
    Age:
    75
    Messages:
    20,183
    Gender:
    Female
    Country:
    New Zealand New Zealand
    Hello @Spex10
    :welome:
    I'm sorry you have a worry about your ROM.

    I'm going to suggest something that will probably surprise you. What you have been doing until now hasn't worked for your knee, so you have nothing to lose by trying something different. Stop going to Physio (PT) and stop letting that therapist force your knee. That is what is preventing your knee from bending, by keeping it constantly irritated, inflamed and swollen.
    This is your knee and you have the absolute right to say what will happen to it:
    Saying no to therapy - am I allowed to?

    Your poor knee has had major surgery which caused a lot of trauma. It needs time and gentle treatment, so that it can recover properly. Your knee has had as much trauma as it would have if it was broken. You wouldn't allow anyone to treat a broken leg the way your therapist has been treating your leg, would you?

    You're right. Your knee can't bend right now because of the swelling. It's a bit like a hose pipe that is stiff because it's full of water. Get rid of the water (swelling) and your knee, like the hose pipe, will be able to bend much more easily.
    So, instead of concentrating on PT, give your knee a rest and concentrate on decreasing the swelling. Once that goes down, your knee will begin to bend, all by itself, without any exercises or forcing.

    This is the approach to recovery that BoneSmart recommends - and it has worked so well for many people
    - rest, elevate, ice and take your pain meds by the clock
    - if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you.
    - if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

    - if you won't die if it's not done, don't do it
    - never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
    - be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!
    BoneSmart philosophy for sensible post op therapy

    I'm going to give you the rest of the recovery reading list. Do read all the articles. Most of them are short and they are all informative.
    Tale particular note of the ones I have put into bold print.

    Next is a FAQ (Frequently Asked Questions) thread.

    And here are some very crucial articles
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?
    Energy drain for TKRs

    Myth busting: no pain, no gain
    Activity progression for TKRs

    Heel slides and how to do them

    Extension: how to estimate it and ways to improve it

    Elevation is the key
    Ice to control pain and swelling

    Healing: how long does it take?
    Chart representation of TKR recovery
    Myth busting: the "window of opportunity" in TKR

    Myth busting: on getting addicted to pain meds

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    It will take at least 3 weeks for your knee to settle down after the abuse it has received, but it will start to bend again and I really don't think you will need a MUA. Don't be frightened if your surgeons says he wants to do one. Just as you can refuse to have harmful physiotherapy, you can also refuse to have an MUA. All you need to do is tell your surgeon that you are not ready to consider it yet and you would like to put it off for a while longer. There's no time limit on having an MUA, so you could always have one later, if it proves necessary - but I doubt that it will. MUA: the ineffectiveness of early MUA (JBJS)

    So that we can see it at the bottom of every post you make, and thus advise you appropriately, please will you create a Signature, in which you put your knee surgery and its date in full? Write the name of the month, so there’s no confusion.
    Hover over your username, top right of the page, and select Signature from the drop-down box. Enter your surgery details and then save. This article also explains how to do it:
    How to create a signature
    If you can’t do it, please let us know, so that we can do it for you. Thank you. :flwrysmile:
     
  3. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    Thanks Celle. I tried to post my date of operation (27th October 2016) but kept being told that I 'do not have privilege to post'.
     
  4. Celle

    Celle Forum Advisor

    Member Since:
    Nov 19, 2011
    Age:
    75
    Messages:
    20,183
    Gender:
    Female
    Country:
    New Zealand New Zealand
    That's OK. We'll get it done for you. Which leg is it?
     
  5. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    I'm so sorry Celle. I'm an idiot! Its my Right knee. Thank you very much.
     
  6. Roy Gardiner

    Roy Gardiner Forum Advisor

    Member Since:
    Jul 23, 2011
    Age:
    65
    Messages:
    4,972
    Gender:
    Male
    Location:
    Essex and London
    Country:
    United Kingdom United Kingdom
    effect and cause, right there
    Stop going, she is hurting you and worsening your recovery.
    Yes. Follow the mantras, especially the ones about not doing anything that hurts or causes swelling, as Celle has said.
     
    • Agree Agree x 3
  7. Want2hike

    Want2hike Member

    Member Since:
    Oct 28, 2016
    Messages:
    226
    Gender:
    Female
    Location:
    Arizona
    Country:
    United States United States
    @Spex10,
    I had my bilateral 10 days before your surgery and my 6 week checkup last week. Both of my knees still have swelling, which limits ROM. Like you, I get around fine and can do most tasks.

    ROM in my left knee is about 90 and right knee is 75-80. My surgeon did not even mention MUA; because of the amount of swelling, my knees don't really have room to bend any more. He prescribed Celebrex as an anti inflammatory. The swelling is slowly going down (the right went down enough to be able to drive!) and I've been gaining 1-2 degrees each day.

    While it is frustrating, the swelling really does control your ROM, so you need to work on reducing the swelling and your PT forcing your knee won't help that.
     
  8. KarriB

    KarriB Forum Advisor

    Member Since:
    Apr 20, 2015
    Age:
    60
    Messages:
    9,757
    Gender:
    Female
    Location:
    Pittsburgh, PA
    Country:
    United States United States
    Stop going to PT. Aggressive PT is hurting your new knee. Don't let anyone push, pull or put their weight on your knee. It's swollen and sore due to your physio. Start icing and elevating like mad and keep it up until you see an improvement. Your ROM can improve, but not by someone pushing on it. The articles Celle left can help with pain, ROM and extension. :ice:
     
  9. little red canoe

    little red canoe Graduate

    Member Since:
    Oct 23, 2016
    Age:
    70
    Messages:
    526
    Gender:
    Female
    Location:
    Maine
    Country:
    United States United States
    Your OS can say anything. But its your body not the OS'. You can decline his advice. Yes you are allowed to resist the threat of an MUA.

    You have the right to refuse PT too. Give PT a break for a month and see how your knee comes around. If at that time you want to resume PT there are more PT's out there ( some that will obey your wishes and not assault you). But I bet you won't want to!

    Some exercise of course is good.. Its called getting around. No one wants you to be a couch potato all the time.. But do ice elevate and rest as much as you can.. That is your new job.
     
    • Like Like x 1
  10. cait1981

    cait1981 Member

    Member Since:
    Nov 19, 2016
    Age:
    59
    Messages:
    121
    Gender:
    Female
    Location:
    NSW
    Country:
    Australia Australia
    Hi Spex10 - I also had TKR on 27th October - my left knee. My flexion hadn't changed much since leaving hospital until this last week when Im noticing slight improvement. I stopped PT after 2 weeks and the swelling is slowly reducing with ice, elevation and gentle exercising - this week my extension is at 0 with slight improvement in flexion which is a little over 95 which makes me happy as it was at 90 to 95 since surgery - I think 6 weeks is still early days but I see my OS on 14th December and it will be interesting to see what he thinks. I think you should rest up and I suspect as the swelling reduces your ROM will improve as it is starting to for me.
    Cait
    LTKR
    27th October 2016

    Sent from my SM-G930F using Tapatalk
     
    • Like Like x 1
  11. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    Thanks all. I'll keep on keeping on and will try to be tougher with the PT at this weeks appt. Seeing the surgeon on Thursday. I feel better armed to face him thanks to all your useful info.
     
  12. zzevi

    zzevi Graduate

    Member Since:
    Jul 24, 2016
    Age:
    55
    Messages:
    573
    Gender:
    Female
    Location:
    Wisconsin
    Country:
    United States United States
    The threat of MUA makes recovery stressful with that hanging over your head. I am a prime example of doing household activities and lots of movement, going to P/T and not gaining a lot in the line of ROM. I was a slow learner, really thought my moving and doing I would end up better, not worse. But the truth to it all is we can do to much and actually hinder improving our ROM. I allowed P/T to push to gain ROM, and I was swollen so I was defeating the purpose, but of course they are not going to tell you that. They kind of place all the lack of gaining ROM on you not doing your part on your end.
    From what I've read you do need to cut back your activity level and if you go to p/t you can't allow them to push you, in fact you may even want to stop p/t.
    So much good advice on this site and I was reluctant to listen and apply it at first. I wasn't till I was some what stalled out with my ROM and had enough talk from p/t about MUA that I said (even tho I wanted a better ROM than I had and still probably have,) I wasn't interested in starting over and with a MUA that is what your kind of doing with out going back in and being opened up.
    Cut back, give yourself some time and see how things go, you should see improvements, if not you still have time to have a MUA if needed.
    Icing, Elevation and pain medication to help with the swelling should all be your friend at this point. (elevate high also toes above nose. ) Where your at is some of the hardest weeks, as you get stir crazy and want to things to be back to normal and it will be months before that is possible, you will see improvements all the way along, but it's still a long road ahead for you yet at this point. I'll be watching your progress. zzevi
     
    • Like Like x 2
    • Friendly Friendly x 1
  13. little red canoe

    little red canoe Graduate

    Member Since:
    Oct 23, 2016
    Age:
    70
    Messages:
    526
    Gender:
    Female
    Location:
    Maine
    Country:
    United States United States
    My ROM improved greatly since "firing" my PT.. I quit going cause it cost me money each time and the exercises were the same as I could do at home or in the gym( not because of PT brutality).. My family resisted that decision because they thought I would sloth at home. And I did sloth.. ROM changed from 110 ish to the same as the other knee.. about 130 in two weeks. Swelling almost all gone.

    The other factor might be that weeks 4-6 were kind of a plateau.. Nothing got better. Nothing got worse. It could be just the nature of the healing process.
     
    • Like Like x 1
    • Agree Agree x 1
  14. BBCG

    BBCG Senior

    Member Since:
    Aug 6, 2016
    Age:
    66
    Messages:
    327
    Gender:
    Female
    Location:
    Eugene Oregon
    Country:
    United States United States
    Spex10, I am a complete example of how the mantras here are right! Like you I was worried about being told I'd need an MUA too. My ROM and swelling was slow to progress and my OS was not happy at my 6 week checkup. If you go read my tale, you'll pick up my stress and anxiety at that time, too! At 6 weeks I think my ROM was maybe 70, too. But, soon I read more and found that this is normal if you're overdoing it, like you and I both are/were...

    But, now, at 4 months, I'm doing very well: can almost keep up with my 5 year-old granddaughter (who is a monkey bar queen, she says!), kept up with the OS' PA at my last visit, following her quickly down the carpeted hallway (way ahead of my husband), can carry 20-40# bags of birdseed out to customers' cars, even helped lift an 80# bench top the other day, etc.

    I did not need to stop PT but did say no more pushing on my leg to get it to bend! Set rules, it's your knee, your recovery; and your leg had surgery, it is not a sports injury like so many folks PTs work with have to recover from. I followed the mantras here, except did have to go back to work way sooner than ideal since I hadn't known to not expect to do so!

    Your new baby knee deserves being treated gently until it starts to relax and stop swelling. Just doing normal stuff works great, and may even be too much at first, as it was for me.

    But, the advice here to me was very valuable and helped me set realistic boundaries on people who like to push patients and for us, it's inappropriate. Hang in there! I'll follow your thread, too, and highly recommend following the mantras here and changing how you're letting the PT folks abuse your new baby knee! You can do this, but only with gentleness at first!
     
    • Like Like x 2
    • Agree Agree x 2
  15. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    I should say that my poor knee was swollen before the op. It was so painful that I was willing to have the op although I knew I'd be in for a hard time at first. At least, with any luck things should improve in time. I'm not in pain and I can do lots of the physio exercises just not the ones involving bending. My leg is lovely and straight! Glass half full eh?!
     
    • Like Like x 1
  16. KarriB

    KarriB Forum Advisor

    Member Since:
    Apr 20, 2015
    Age:
    60
    Messages:
    9,757
    Gender:
    Female
    Location:
    Pittsburgh, PA
    Country:
    United States United States
    Yes, everyone had swollen knees before surgery. Just today I was looking at my left natural knee that needs replaced and comparing it with my RTKR. My left is swollen even above my knee.

    Due to an infection four weeks after TKR surgery I was in an imbolizer for a month. No bending for a new TKR for a month! I was panicked! But my OS would always answer my panic with, "the knee will bend when we tell it to bend". So because of the imbolizer I did very little walking and lots of elevating. The OS wanted me to rest my soft tissue which he felt was very compromised. After a month of very little activity I could actually see the outline of both knees! Friends and family commented on how thin my legs looked! And when it was time to bend my knee it bent because there was no swelling holding it back.
     
    • Like Like x 4
  17. Celle

    Celle Forum Advisor

    Member Since:
    Nov 19, 2011
    Age:
    75
    Messages:
    20,183
    Gender:
    Female
    Country:
    New Zealand New Zealand
    My point was that you need to stop doing all the exercises for a month and concentrate on resting, icing and elevating your leg.
    Just the ordinary walking around during your everyday life is enough exercise for you knee right now.

    One thing that many people don't understand is that it's not the exercising that gives you back the ROM - it's time. Time for your wound to heal, and time for the swelling to go down. The ROM is already there inside your knee, just waiting to show itself once your knee has recovered enough from the surgery and once the swelling has decreased.

    I did no PT at all after my last TKR and only minimal PT for the previous one. Both my knees are strong and reliable. They straighten fully and bend to over 125 degrees. I can do anything I want to with them.

    I'm going to ask @Josephine , our Nurse Director to advise you. She will probably ask you a lot of questions about your activity. Do try to answer them as fully as possible, so that she can advise you appropriately.
     
    • Like Like x 1
  18. Majella

    Majella Member

    Member Since:
    May 3, 2016
    Age:
    64
    Messages:
    206
    Gender:
    Female
    Location:
    University of Iowa
    Country:
    United States United States
    Good luck with your OS appt. Hopefully with less PT your knee swelling goes down and ROM improves.
    It will take time so please be patient :console2:
     
    • Like Like x 1
  19. Spex10

    Spex10 Graduate
    Thread Starter

    Member Since:
    Dec 3, 2016
    Messages:
    616
    Gender:
    Female
    Country:
    United Kingdom United Kingdom
    I don't do that much in the way of exercise. Since I found this website I've really held back. I just do some leg lifts as I sit with my feet up, try to step up onto a pile of books and try some very shallow squats /standing knee bends. I gave up on heel slides as I just can't do them :-(
    Otherwise its just everyday walking about the flat and twice weekly supermarket shopping. Pushing the trolley really helps.
     
  20. KarriB

    KarriB Forum Advisor

    Member Since:
    Apr 20, 2015
    Age:
    60
    Messages:
    9,757
    Gender:
    Female
    Location:
    Pittsburgh, PA
    Country:
    United States United States
Thread Status:
Not open for further replies.

Share This Page

If this forum is helpful to you, please consider a donation!

Support BoneSmart with a Tax Deductible Donation

Loading...
Sponsors
Close X