Nana moon 27
alpha
Same here, I learned the hard way xxx thank goodness for sound advice on here xxx this forum has so helped me xxx
TKR I can’t believe I’m still dealing with this darn Knee^
- Thread starter Danlovesmary
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Danlovesmary
junior member
Hello BoneSmart!
I have one more PT session on Friday and then go to OS a few days after that. He will decide then if he wants to do an MUA. I know it's ultimately my decision if I let him do it, so I wanted to ask some questions here so I am as well informed as I can be.
I like my OS, but I don't know him and he doesn't know me....our appointments last 5 min at most and I have only seen him a small handful of times.
I was at 18 on extension when I restarted PT 5-6 wks ago. Yesterday I was at 2. So that's good, right??
Unfortunately, my bend is not getting past 90 on a bad day and maybe 100 on a really good day. Yesterday it was 90. It just won't bend. And as awesome, talented, and gentle my PT is, my knee stays pretty warm most of the time, slightly swollen, and hurts MOST of the time.
By the time I see the OS I will be about five and a half months post TKR.
Any input? Does it sound like I need an MUA? A couple of weeks ago my PT was pretty certain that wasn't going to be required. He's been pretty non-committal, though, the last couple of times I've seen him. We are going to talk after my session on Friday and he will tell me his recommendation for the OS, and I will hand carry his report and latest measurements to the OS next week.
Anyone have any thoughts? What is the best way for me to get this post read by Josephine? Or any other super experienced BoneSmartie?
Thanks so much!
Mary
I have one more PT session on Friday and then go to OS a few days after that. He will decide then if he wants to do an MUA. I know it's ultimately my decision if I let him do it, so I wanted to ask some questions here so I am as well informed as I can be.
I like my OS, but I don't know him and he doesn't know me....our appointments last 5 min at most and I have only seen him a small handful of times.
I was at 18 on extension when I restarted PT 5-6 wks ago. Yesterday I was at 2. So that's good, right??
Unfortunately, my bend is not getting past 90 on a bad day and maybe 100 on a really good day. Yesterday it was 90. It just won't bend. And as awesome, talented, and gentle my PT is, my knee stays pretty warm most of the time, slightly swollen, and hurts MOST of the time.
By the time I see the OS I will be about five and a half months post TKR.
Any input? Does it sound like I need an MUA? A couple of weeks ago my PT was pretty certain that wasn't going to be required. He's been pretty non-committal, though, the last couple of times I've seen him. We are going to talk after my session on Friday and he will tell me his recommendation for the OS, and I will hand carry his report and latest measurements to the OS next week.
Anyone have any thoughts? What is the best way for me to get this post read by Josephine? Or any other super experienced BoneSmartie?
Thanks so much!
Mary
Hi Mary,
It's good to hear from you again.
You tag Josephine just the same way as you tag other people, by putting @ before their name.
I'll do it for you this time.
@Josephine - please can you look at Mary's post, above, and give her the advice she needs?
It's good to hear from you again.
You tag Josephine just the same way as you tag other people, by putting @ before their name.
I'll do it for you this time.
@Josephine - please can you look at Mary's post, above, and give her the advice she needs?
@Danlovesmary, I started p/t 5 weeks ago and my extension was 20 and it is now 6. I'm really struggling with it. You have a tough decision to make and I will keep you in my prayers that whatever decision you make, it will be the right one. Good luck!
Personally, I do not think TKR patients should let their PT's opinions weigh too heavily in these decisions. My PT was certain I'd gain ROM if I "worked hard." He talked me out of MUA. But I was not gaining one single degree, and it turned out he didn't have a good grasp of arthrofibrosis.
You do not have what's called a "hard stop," which would be a clear indicator for MUA. Scar tissue literally tethers muscles, thereby limiting their ability to stretch, which doesn't change day to day.
Let me ask you this: have you tried cutting out all PT except for slow, gentle stretches? I say this because, for some of us, getting ROM requires a balance between keeping the tissues calm via minimal PT and challenging the muscles to get back their ability to stretch. This is how I did it (once scar tissue was addressed): I'd bend my knee twice a day, 10 sets. Each effort was quite slow and the stretch held 60 seconds minimum, without incurring discomfort beyond 3 on the 1-10 pain scale. Alternatively, you can do 2-3 such stretches each hour throughout the day. These stretches should be followed by a good icing. It's almost a muscle retraining program.
This was my answer to PT (which I quit). PT seems to think we have to do a variety of exercises, and when bend is the problem, most of what they do doesn't help bend at all and only inflames the tissues thus making them less likely to stretch and contract normally. If you were to try 2 weeks of this no-PT and home-stretching only (again, never painful) routine and you haven't gained any ROM, then go for the MUA. It's essentially a 30 second procedure. The two-week program I'm recommending will help quiet down inflammation and make you more likely to have an effective MUA if it turns out that's what you need.
It took me nearly a month after my last procedure (arthroscopic removal of scar tissue) to get past 90, which I considered a critical marker of improvement. You are already able to get past 90, even to 100. It's possible that your knee is what I think of as rebellious -- responds to PT by stalling. By the way you have accomplished a lot by improving your extension. Extension issues can be more difficult to solve then bending issues.
OP
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Danlovesmary
junior member
Thanks, @Celle ! I had brain fade on how to tag! It's been awhile since I've popped in here.
@maryo52, great input...thank you so much! I think you might be right, the more PT I have done, the less ROM I am able to achieve. I actually had reached 108 one day....and then rapidly went backward.
At home I have one of those big, inflated exercise balls. I sit on it and roll slowly forward, doing gentle bends, holding it for about 30-60 seconds, 10 times. Is that sort of what you're talking about?
@maryo52, great input...thank you so much! I think you might be right, the more PT I have done, the less ROM I am able to achieve. I actually had reached 108 one day....and then rapidly went backward.
At home I have one of those big, inflated exercise balls. I sit on it and roll slowly forward, doing gentle bends, holding it for about 30-60 seconds, 10 times. Is that sort of what you're talking about?
That's exactly what I did (exercise ball). I'd do it watching TV because that way I did not get too goal -oriented. How about doing only that and no PT for a while? It's hard to let go of goals and expectations.
OP
OP
Danlovesmary
junior member
@maryo52, do you think two weeks can make a difference? Gosh, that would be SO cool! I will go to my last PT session this Friday, so he can measure and write his report. He is very respectful of the OS and he really only offers his opinion about the MUA when I push him for his opinion.
I have myself freaked out about having that done, if I need it. Did you have one? Is that what you were referring to when you said it's a 30 second procedure? I have read - on other places on the Internet - that's its super painful after, and the therapy is CRUCIAL and painful afterward.
I have myself freaked out about having that done, if I need it. Did you have one? Is that what you were referring to when you said it's a 30 second procedure? I have read - on other places on the Internet - that's its super painful after, and the therapy is CRUCIAL and painful afterward.
tashia
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Is there a way you can get a new PT? Thats all I have to say but stay ahead of that pain. Please rest, ice, and pain medication. I also took medication for stomach. Its ok and its ok to cry also. This is ruff and you will make it like the rest of us. Take care. Tashia
Uh-uh. No.
(Don't go to those other places on the internet.) If you have a MUA, REST is crucial, not therapy. Only gentle exercises should be done. In effect, a MUA causes some degree of re- injury, which means you need to do all the things you did initially - rest, ice, elevation and pain medication. As initially after a knee replacement, too much exercise, too soon, can just irritate those soft tissues and will slow down your recovery.
Jozilla
supremo
@Danlovesmary Celle and Maryo52 have given you great advice and are very knowledgable. I cannot give you advice on MUA but I think you have improved tremendously. You will also continue to improve for awhile to come. You have nothing to lose by taking a couple weeks off from PT. I only did PT 8 sessions after my tkr and my recovery was great. I believe for this surgery the less you do the better. I instead concentrated on simple home exercises. It is funny but my OS does not even push for PT - if I never went he would have been ok with that as I just improved on my own. Glad Jo was tagged as her advice is always so good and invaluable. Good luck!
My ortho described the MUA this way (his approach): Once the patient is under anesthesia, he grabs hold of the lower leg with both hands just below the knee and slow pushes the lower leg toward the torso, thus bending the leg. That upper handhold ensures that not too much force is used. It is really only a minute or two. They measure the ROM and it's all done. Afterward you feel as if your quad was strained. Not a big deal, really, but then I suppose it differs from ortho to ortho. You'll have to ask your ortho to describe it factually. Some times (often!) we forget to ask for details, and it's the unknown that eats away at us.
You should see some difference in two weeks if this approach helps, a month would be a better trial. But do it only if this makes sense to you. As I said, it cannot hurt, you'll lose nothing, and it might be just the ticket - OR - confirm the need for MUA.
You should see some difference in two weeks if this approach helps, a month would be a better trial. But do it only if this makes sense to you. As I said, it cannot hurt, you'll lose nothing, and it might be just the ticket - OR - confirm the need for MUA.
There really is no rush to have an MUA. So please don't feel like you must do it now or never. You seem to be making acceptable progress. I like the idea of taking some time off from exercise/activity to see if your bend will stabilize at one of the higher numbers. Right now it seems to be kind of jumping around and that does tend to indicate that and restrictions you have are due to soft tissue swelling. Your extension at 1 or 2 is just fine.
I say take things easy for a bit and give your knee a bit more time.
I say take things easy for a bit and give your knee a bit more time.
OP
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Danlovesmary
junior member
Thanks, everyone! @Celle - I know!! What was I thinking?? Browsing around the Internet for stories about MUA's is like going to a Haunted House at Halloween time! There's someone around every corner waiting to jump out and scare me! I know exactly where to go for calm, experienced, rational, and caring information. And here I am!
Thanks, @Jamie, it's reassuring to hear that my progress is actually not that bad.
I am probably at a point in recovery, emotionally, where it's been a long, tough few months and it's easy to get discouraged. You know what I mean? I'm IMAGINING everyone around me is SO over this whole thing, even though I rarely mention it. But I do limp at the end of a long day, and there are places I don't want to sit because I will have trouble getting back up....so.....anyway...
Enough doubt...I have a game plan, thank you everyone! I will do this new, recommended routine for a month. I will tell my OS, if he wants to do the MUA, that I want to reevaluate in a month.
Thanks, @Jamie, it's reassuring to hear that my progress is actually not that bad.
I am probably at a point in recovery, emotionally, where it's been a long, tough few months and it's easy to get discouraged. You know what I mean? I'm IMAGINING everyone around me is SO over this whole thing, even though I rarely mention it. But I do limp at the end of a long day, and there are places I don't want to sit because I will have trouble getting back up....so.....anyway...
Enough doubt...I have a game plan, thank you everyone! I will do this new, recommended routine for a month. I will tell my OS, if he wants to do the MUA, that I want to reevaluate in a month.
Nana moon 27
alpha
Hi @Danlovesmary you are not in your own with a slow recovery. I'm still not driving or even back at work, as I'm still on Morphine for the pain. I got stuck in a garden chair a few days back and my eldest daughter and 86 year old father in law had to get me to my feet, how embarrassing. My knee just would cooperate. The chair was a couple of inches too low and my knee didn't like it xxx I have to sit in a certain height chair or stack cushions up!
I'm seeing the OS on Tuesday lunchtime. I'll pop in and let you know how that goes xxx
Take care love Nana moon 27 xxxx
I'm seeing the OS on Tuesday lunchtime. I'll pop in and let you know how that goes xxx
Take care love Nana moon 27 xxxx
OP
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Danlovesmary
junior member
@Nana moon 27, I'm sorry - for your sake - to hear that your recovery hasn't been quick and trouble-free. It does help me, however, to hear that I am not unusual, or "a slacker"...and that recoveries are indeed very individual.
I am lucky, in that I am back to driving. I do have to recline the driver-side seat all the way back so I can get in and out. I put it back in the upright position after I'm in, and I can drive easily. I just cannot bend my knee enough to get in and out. I have been working on quad strength, to help me get up from chairs more easily, but it's still a challenge!
You and I have OS appt on same day! I look forward to hearing how your's went!
I am lucky, in that I am back to driving. I do have to recline the driver-side seat all the way back so I can get in and out. I put it back in the upright position after I'm in, and I can drive easily. I just cannot bend my knee enough to get in and out. I have been working on quad strength, to help me get up from chairs more easily, but it's still a challenge!
You and I have OS appt on same day! I look forward to hearing how your's went!
OP
OP
Danlovesmary
junior member
My last PT today before seeing OS on Tues. I am at 2 and 100, and that 100 was not easy.
I'm praying it is enough improvement to take MUA off the table. It's almost 1:30 am and I'm pretty antsy...knee inflamed - hot and stiff and swollen. Sure wish I could sleep.
Good night BoneSmart.
Mary
5, February, 2014
I'm praying it is enough improvement to take MUA off the table. It's almost 1:30 am and I'm pretty antsy...knee inflamed - hot and stiff and swollen. Sure wish I could sleep.
Good night BoneSmart.
Mary
5, February, 2014
bottomshollow
Former BoneSmart staff member
Here's our Library article on MUA---it's not as bad as folks think: MUA (Manipulation under Anaesthetic) and Adhesions
Take care and keep us posted. We care.
Jozilla
supremo
@Danlovesmary I think you are doing fine. Those numbers are not bad and you continue to improve. I look forward to seeing what your OS says. Ice as much as you can - we are all different and you will get there!
