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TKR Pressured by pt and doctor to have manipulation

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My ortho navigated me appropriately through my ordeal with adhesions. The MUA was the first step. I actually cancelled MUA when it was first scheduled because PT convinced me that if I "worked hard" I could get ROM without MUA. All it took was another session in PT (painful, frustrating) to realize that I had a hard stop at 85 and I needed that MUA . . . plus, mentally, being stuck was really really hard to deal with. The pain wasn't really that bad. I think the confusion and uncertainty were the worst!!!! My MUA had brief results -- he got 115 "on the table," I was 97 at PT that week. The next week I was 90. And so it went. In fact, I would say the MUA, for me, stimulated more production of adhesions. By the time I had the arthroscopic lysis my ortho was beginning to panic. By then I'd regressed to 70.

If you need MUA, better to wait until the tissues have calmed down. I think most orthos are comfortable doing them as late as 4 months post TKR. There seems to be no standard protocols so each ortho goes by whatever they personally believe rather than evidence based medicine.
 
Thanks Mary for your response. I will be showing all this soon to my husband.
 
Question, if I choose to not have manipulation, and I am rom at 80 or 85 right now at 7 weeks, can I ever reach 100 or more rom down the road? If I keep icing, stretching, etc. will my rom increase slowly as I heal or will I encounter adhesions that are stopping me now also keep me from getting more in the future? Does this make sense?
 
If your problem is swelling and inflammation, which is likely so early in the game, MUA will not help you. What will help you is icing & elevation and minimizing activities and PT (per the BS articles). Only diligence to this approach and time will tell.

If your problem is adhesions, the above measures will not increase your ROM significantly and you can opt for manipulation.

Adhesions proliferate in the setting of inflammation. So no matter what's holding you back, addressing inflammation will serve you well.

No course of action comes with guarantees. All I can say, personally, is that most of those who come on this forum with ROM issues either get acceptable (at least 0/110) ROM via the gentle approach. A few get there after a manipulation. There are a very few who require further intervention (like me).

This is a process. It's really crazy making.The weeks of uncertainty I lived through was one of the toughest things I've encountered in life. At 61 we have collected a lot of wisdom, and then we go through TKR and feel like some stupid uncertain insecure 21 year old again!
 
You are so right about that feeling of uncertainty. I'm just glad I have a God that can direct my footsteps. Thanks again for all your help. It is very appreciated.
 
sbovard.....I completely agree with everything Mary has told you. I hope you take her advice to heart and allow yourself some time to get the swelling and inflammation under control.

Quite frankly, we've even had members on BoneSmart who had manipulations after a year or more, so I'm just not buying that "limited time" argument you're hearing. At any rate, it should NEVER be your therapist who demands a medical procedure or tries to pressure you to consider one. I'd like to know where and when he received his medical training that allows him to leap to that conclusion!!! Next time that comes up if you're in therapy, tell him to knock it off and you'll discuss that with your doctor.
 
Has anyone used the graston technique before?
 
I read up on it but wasn't able to find someone to do it.
 
I met with a new pt that does this method but she said it was for muscular tightness not for bad range of motion. She also told me I neededmanipulation. My rom today dropped to 75. I am thinking of doing water therapy. I really do not want manip since I grow scar tissue and adhesions very easily. Been icing and elevating.
 
If you are correct in the aggressiveness of your scar tissue (I was the same), then probably your best remedy is going to be a combo arthroscopic removal of scar with a gentle MUA. Another forum member is about to have one. Inflammation is the growth medium for scar tissue so best to get it all settled down in whatever way you can. Afterward all I did was very gentle stretching only along with CPM afterward in order to keep inflammation at a minimum.
 
Your knee just may need more time to heal and the swelling to go down. I was a delayed ROM person and then it started picking up :). Do not let anyone force you into a MUA until you are ready for it. I did the water therapy and found it very helpful! Let us know how things are going. All I can say is ICE and ELEVATE and don't over tax your knee. You are still in the early stages.
 
sbovard, I could not get past 70 ROM up to almost four months, which is when I had my MUA. I am thankful for that procedure. Personally, I found it to be a doddle if you compare it to actual TKR. It certainly helped me. Am currently 105, but still hopeful on improvement.

I am no expert by any means, but to me seven weeks IS too early for an MUA. Please give it a few more weeks. It sounds like you are a bit impatient. For some of us, not everything comes when we want it to. For others, they have an uneventful fast recovery - they are lucky. But each and every one of us is different.

This is in general a procedure with fairly slow recovery and we all need to be patient patients.
 
I struggled with ROM getting stuck. I was 92 at 8 weeks, 105 at 3 months and stuck there for months. Every few months I'd jump a few more and stop again. It started to get tiresome. At 10 months I think I was around 115. I saw my surgeon at 15 months and he measured 118. Its only in this past month at 20 months post op that I've got 125. I measure it with an app on my android phone. My surgeon told me it probably isn't that accurate but is good to show me that it is increasing.
 
Thanks everyone. I am 9 weeks and around 85 to 90 rom. Still very stiff. Thanks for the encouragement.
 
sbovard, I had removal of scar tissue (an Open Lysis of Adhesions) at two years out. My surgeon stressed with me that if you exercise or push on an inflamed and hot knee, you contribute to the development of scar tissue. I did almost nothing for eight weeks---just gentle stretches and then began to do more.

It sounds like you have had aggressive pt and aggressive massage therapy. I also understand the confusion that results from conflicting opinions. To me, if you try two weeks of decreased activity, propping your leg up with three pillows Elevating your leg to control swelling and pain and gentle stretching, you will increase your options. You can easily have a MUA at 10 weeks with no problem. And, you can take two weeks off from pt without changing your life too.

Water therapy is wonderful---I used it myself. I used to get into the pool and put on a floatation belt. I would then "run" in the water. I would stretch my knee in the shallow end and let my legs "hang down" in the deep end. I always felt better when I left the water. It was relaxing and I could begin to feel the improvement in my rom.

If, at the end of two weeks with no pt and no aggressive massage you are still at 85, then you can make another decision. I had graftson treatment as well from a Chiropractor. I would not do it now as it is also aggressive.

One of the ski instructors in our ski school has had a lot of problems with adhesions. there are six of us with fake knees. She is the only one who has struggled with rom. She has had two manipultaions, grafton massage, two arthroscopic removals of scar tissue---an open removal of scar tissue and at the end, she has a rom of 105.

Mary has a similar rom but she has not undergone all of those procedures. At some point, you have to take some time to assess your own situation. Two weeks of bed rest and no pt, no massage. If there is no change at all, then you can look at Mua. But . . . if you do gain rom by the more conservative treatment that is also a lesson for you. At this time you really have nothing to loose from a conservative approach. After the two weeks are up, you can go to the pt and have him measure you again. If there is a change, then perhaps THEY will also learn something!!
 
NatureLoverCD
Hi, here's the link to the app I use. You need to sit on the ground and bring you ankle towards you bum for it to work for knees. It works for other joints as well.

broken link removed: https://play.google.com/store/apps/details?id=ROM.goniometry
 
Had my last pt today. Im at 90 rom. Still choosing not to manipulate. Will begin in pool next week to begin my own gentler stretching. Leg is stronger but still limping. Im at 10 weeks post op.
 
I sympathize with your distress and confusion. Since my OS and PT always talked about how I had to "push myself", making me feel like I was not doing enough, not feeling enough pain, etc. My ROM inched up very slowly, but too,slowly for them...so I heard more about pushing harder, tolerating more pain. The worst time was when I reached a plateau. No mater how hard I pushed, no matter how I tried to tolerate more pain...no improvement in ROM, none. Then, I missed a week of PT due to a work conference. When I returned to PT, my ROM has increased by several degrees. Huh? Did some miracle happen?! Then, I found this forum...and realized that my ROM was better because I had a week of NOT pushing, of NOT absorbing more pain. I also learned that I was not elevating my legs correctly...after more than 4 months post-TKR!

My PT was a sweet guy. His heart was in the right place. But his head was not. To be honest, I have surges of anger about how much time I wasted, about how much unnecessary pain I endured...all because I trusted my "hired professionals", instead of trusting what my body was trying to tell me. Had my head been in the right place, I think I might have made better use of my PT. I might have been able to help him help me. Lesson learned.
 
The pool is a great idea. I wish more people had the strength and belief in themselves to say "not now" to the "professionals." You're at 90 now. On Aug. 16 you were 75 (a set back at that time). So that looks an awful lot like decent progress. I was one of the ones who clearly needed MUA. I had not one degree of progress, and I tried everything, including the pool.
 
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