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MUA Manipulation and stiff knee after TKR

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Suzie, loved hearing your story. It reminds me of some of the same things that I had to deal with over a year ago when I had my right knee replaced. I was pushed by my PT and the knee just kept swelling. I went back to work way too early (at six weeks) and am finding that work really doesn't leave me the time I need to exercise as much as my knee would like. Icing and elevation way beyond the time you "think" you ought to be doing it, and for longer stretches of time than American docs typically tell us to, have both made a huge difference for me. This site is amazing and relentlessly encouraging. I mean that in the most positive way. The only way you'll stop getting encouragement is if you hide and stop posting on the site. Such generous people moderate and post on this site. Good luck to you. I think you're on the right path now.
 
Hi juniper,
Thank you for your comments. It's nice to read your knee story too. Now that you are a year out from surgery it is an encouraging story. I noted that you must be sick today I hope you get better soon.

I just can't understand why the medical professionals still want to push the knee when it still is swollen! I went to my PT today and she seemed to want to push the knee past it being uncomfortable to being painful. I did tell her that my knee felt stiff today before we started.
A note to myself that next time she does that I will have to tell her to stop. My knee was in so much pain and in turmoil after that session.

Luckily I was seeing my body ecology lady a few hours after that. She was curious as to what had been done to the knee as she could tell that things weren't right. After an hour of her therapy she was able to reduce the pain and stiffness that the PT session seem to bring on.

I love this site. It's so nice to have the message to ice, rest and elevate. And not having to worry too much about getting more ROM as time and patience will get that. The encouragement and information from the people here has enabled me to lick my wounds after doing battle again with the medical professionals.
Thanks again Suzie
 
[Bonesmart.org] Manipulation and stiff knee after TKR
Suziepi, please do not let your PT cause you pain. Remember you are the customer. You (or your insurance) are paying the bill. The PT is working for you not the other way around. Remind her that she is not working with a "weak" knee but a "damaged" knee, and that you are there to have your knee rehabbed not trained for the Olympics. And do keep in mind that PTs are just folks like you and me doing their job----they are not any more special or important than you are.

Note that above poster talks about movement---if the PT is causing pain then movement is going to be restricted.

Take care and keep us posted. We care. [Bonesmart.org] Manipulation and stiff knee after TKR
 
Thanks Bottomshollow,
Yes PT are just folks like you and me. I think what happened is that last week during the PT we got 87 ROM which was a big achievement seeing a few weeks before I was at 75. This week it was down to 82. She was attempting to get back the missing ROM by massage and stretching in the session. She just went a little too far.
My knee had decided it wasn't going to be party to that. It was telling me it was tired before the session. Next time I will be prepared and I will let her know that my knee needs a break and doesn't want to be stretched into pain. I am sure she would listen to me and her intentions are good.
Thanks again and have a great day
Suzie
 
Suziepi, one thing I have had to learn is the importance of balance. After I first went on Bonesmart, I sometimes did so much resting and icing that I wasn't being faithful about exercising. And pushing your knee to discomfort is very different from pushing it to pain. I have my husband push to get a bit more bend and he pushes it to exactly where I can feel the discomfort, no further. Massage has been amazing for me. I'm stunned that I trust someone to really massage both of my knees. One had a reconstruction when I was fifteen, and it still is sensitive. So keep searching for the things that will make a difference for you. Balance and patience. This experience has made me much more aware of both.
 
Thanks juniper
Yes it is so true about the balance between doing nice things for the knee ( like massages, icing and resting ) and then couching the knee by pushing it to discomfort. It is a long journey in applying this principle to get the knee to be able to have a decent ROM for normal living.

After 4 months my ROM is at 82. My knee doesn't allow me to do normal daily activities properly like climbing stairs, getting into cars and walking. I am concerned when my current Physio says it will take months for me to get to a ROM of 100 and that might be all I will get.

My OS and GP also don't seem to be of much help. I feel the OS has given up on me as I'm just one of his failures. He is not recommending another MUA or suggesting alternative courses of action.
You are correct I do need to keep on finding other courses of action. I am thinking its time to rattle some cages, and get second opinions. Another patient of my OS that had a TKR the same day as me has done this last week. She also felt she was getting no where because of the lack of action. She had a ROM of 100 and pain in the back of the knee. She sought a 2nd opinion and immediately was given the solution to have a MUA.
Thank you again
Suzie
 
Suzie, I am sorry your ROM is so stuck. I can imagine that stairs must be difficult. Do you do any pool therapy? I found that stretching in the whirlpool and swimming really improved my ROM. A second opinion sounds like a good plan, but in the meantime the pool might give you some help. I still stretch in the whirlpool and I am noticing that both of my legs have better flexion than before the surgery, and I am not someone who has ever had a lot of flexibility.
 
Thanks ElanorG
Yes a whirl pool sounds great. I go to a Hydrotherapy pool 3 times a week and stretch. It certainly gives me lots of relief. Maybe doing that more often and might get me somewhere.
It was my daughters wedding a couple of days ago. She wanted to get married in Thailand. So here we all are. It's been good to take my mind off this silly knee. While I am here I get into the pool or sea every day.

Have a nice day
Suzie
 
Wow Thailand, that is so cool! Yes, it is good to get your mind off of your knee sometimes. Have a wonderful time! Enjoy the sea.
 
Hi all
I had great time in Thailand. It was so nice to be able to relax and get my mind of things and to be there for my daughters wedding.

My knee is still worrying me as I still haven't got to 90 ROM. I know though I will just have to be patient. I have seen my GP and Physio after coming back and they are recommending that I keep up with the exercises and stretching as I am almost getting 90. I'm still on pain medication and I still wake up in pain at night. I am looking forward to the time when I will get a full nights sleep.

I am still off work as I want to concentrate on getting this knee to work. It does take time to do the exercises, go to hydrotherapy, see doctors and the Physio. I don't want to sit at a desk all day as I think it would slow my progress even further. My bosses are coming to visit me today. I am not sure what for, maybe they are concerned that I am taking too much time off. Oh well what is, is.
Suzie
 
Suzie, I was in your shoes two years ago. After my manipulation I got to over 90 but then everything went into reverse and the ROM went backwards: 90, 85, 80, 75, . . . . You don't seem to be having that experience but it does seem things are slow for you.

I just wanted to touch base and let you know there is another recourse, which is having the scar tissue arthroscopically removed. That's when things started to turn around for me. I had slid backwards despite PT to 70 degrees when the surgeon got me in ASAP. It confirmed what I'd been experiencing. I actually had a 1/4" band tethering my quad to bone that created the "hard stop" of ROM.

I will also mention that if you took a few days and did no PT you would find the pain would be all but gone. ROM efforts, no matter how gentle, take their toll.

It took me two months after my arthroscopic procedure to get past 90, and now I'm 120-130.
 
Hi maryo52,
Thank you for your reply. Its nice to find people that seem to have similar issues. I'm not sure why my rom is so low and slow to get anywhere. I am trying everything. My Physio thinks I am just a good healer and I'm slower than normal to recover. The GP thinks I can break the scar tissue by swinging the leg on a table and do this often during the day. I will do this for 2 weeks and see how I go. If it hasn't improved the GP said he would look into it more. Like get a second opinion.
It is great that you have found a solution to you knee problems and getting between 120 - 130 is great.I am sure for me it will get resolved. I just got to find that solution some how. Patience and perseverance I guess.
Yes I do find when I am not exercising and stretching that I am not in pain so much. Sometimes I give myself a break and rest a bit. That feels good. I'm not sure if resting is good for me but sometimes I just have to do it.
Suzie
 
I don't know about you, but I had arthrofibrosis for sure, which my OS explained can happen on one knee and not the other. They just can't see it coming until it happens. Studies have found a growth factor that's gone into overdrive. Another way of thinking about it is that the body is "shoring" up the weak area -- as you said, good healing. But keep the arthroscopic procedure in mind. It should be an option to you, and it would be good for you to know an ortho who would be willing to do that. Maybe your own. My ortho says the word "arthrofibrosis" causes doctors at conferences to run in the other direction. It's a bugaboo that's not well understood and there seems to be no remedies around the corner. Another resources on here for this issue is skigirl.
 
Suzi our surgery dates and mua dates are very close. I didn't think that my rom would ever get better. I got 105 right after the mua (the os got 120) and then for weeks that's all I got and that was with pushing. I finally got to 110 2 weeks ago and this week 112. My knee felt like just a big solid hunk before the mua but afterwards I could tell that it "wanted" to move, it is just taking it's own sweet time. My extension is not so good and I started wearing a dynasplint on Monday. I started with 2 hours and am up to 4 hours now. Will increase to 8 hours this weekend. Hang in there, hopefully your knee will decide that it wants to start bending soon.
 
Thanks maryo52 And covergirl59,
Yes I will hang in there and work on my knee as much as I can. I have a deal with my GP that if my rom hasn't improved in two weeks after doing his suggested exercise. Then he would help me further. It has improved in two months from 65 to 85 ROM so I should be happy with that. I need more to make daily living activities viable. Such as climbing stairs, getting in and out of cars and walking.
I will look into arthrofibrosis too.
Suzie
 
Greetings,
I'm another slow recoverer. Here I am at 7.5 months and I've been stuck for almost 3.5 months at about (-5, 105) it sort of depends on who does the measuring. PT's have said 112, but if it is measured before they work it over, it's 105, which my OS said, explained why I still can't go downstairs normally yet. My functional range is 105.

My OS wanted my MUA done by 8 weeks. He said the research showed the best results at that point. My leg ballooned after surgery. Then it ballooned again after the MUA. My OS got 130 after the MUA, and I did bend better afterwards. Before I had 70, after I had 85. My extension got worse though. Suddenly a month later I had a very painful day/evening, but the next day I had gained 15 degrees overnight. OS measured one day, PT the next. I also have aggressive scar tissue issues.

By the way, I find taking a benadryl at night helps me sleep through the night better. If I've had a rough PT session, I will still wake up in the night, though.
 
Hi hhilltop,
I feel for you as another slow recoverer. Yes i do wonder who is ever correct about the ROM measurement. Physio's seem to want to have shown that they can get more ROM with their work. But as soon as you leave them your back to what is was before their session.

I wish I Had known that the recovery may take a long time. The surgeon didn't mention this at the time before the TKR or MUA. But I suppose I could have done more research about it. I am just glad that this forum exists. As often I feel discouraged.

To me it looks like I just have to preserver with the exercise and stretching. If it takes 2 years then so be it. Although I will still research for things that will help to get more normal.
Suzie
 
You have the right approach. However, if you need the arthroscopic recourse, it's not something that will work at a later, I'm afraid.

When I see my ortho, he refers to two other patients of his with arthrofibrosis whose ROMs are below 90 and they could never get further . . . which makes me feel very lucky. I still believe that the PT I did which I designed was key, but I would never have gained even one degree without the arthrolysis.

Re: ROM measurements. They're kind of like other measurements that obtain a number but which we actually can guesstimate pretty well. I actually refused to be measured except on three occasions. My ortho measures by eyeball, and I did too.
 
So Maryo52, how did you decide you needed the arthrolysis? Actually if you were stuck around 90, it was probably easier to decide. I'm stuck on the cusp as my OS's intern said. I almost have what I need to do stairs, but I've been stuck at this cusp. I can go upstairs, on a good day without a handrail, but it hurts. Much more often I sort of haul myself up. Going down I'm usually one at a time. I did do 4 - 6" stairs without the handrail this week, but most stairs are 8". So how long do I hold out for getting there on my own and then regret the wait if I really need arthrolysis? Are there things I should or shouldn't do to help me get there? Guess I should probably post this on my own thread, too. Is this the norm?
 
That is a very good question. Mine was a clearcut case. I think the giveaway is the "hard stop." In other words, no matter what you do, you never get beyond a certain measurement. It's like a wall. That would suggest that there might be the kind of band I had, which is common in arthrofibrosis. However, if through gentle PT -- and I stress "gentle" -- you get a degree a week, then that suggests that things are moving forward.

The 2nd PT I went to (after firing the 1st) actually talked me out of my MUA, but then I soon re-scheduled. And they were not in favor of any other interventions because, they said, if I worked "hard" I'd get there eventually. Once I had the arthroscopic procedure it was clear that no amount of PT or even an MUA would've broken that 1/4" band of scar tissue I had. So the beauty of arthroscopy is they can see in there. I was very grateful that my OS referred to MUA when I failed to gain ROM, as in "If your bend doesn't improve, then manipulation would be our next step"; and when I had my MUA he mentioned that if the problem continued they would go in there and clean it out. So I was always informed of the next step should the current effort fail.
 
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